Jocko Podcast 392: Life, Death, Darkness, and Light. "OUTLIVE" with Dr. Peter Attia

this is Jocko podcast number 392 with Carrie Helton and me Jocko willink good evening Carrie good evening the truth is we died together once before we died together once before so says the character Thomas Shelby in the series peaky blinders he's speaking of himself and his brothers who had served as Brutus soldiers in World War one he and his brothers Arthur and John as well as three of their friends Danny whizbang Jeremiah and Freddie Thorne we're in the field and they were caught off from the British retreat as the British left the battle they couldn't get away they had no bullets left they were simply waiting for the Prussian Cavalry to finish them off and while they waited they decided they should sing the old hymn In The Bleak mid-winter then they waited to die but in the end they were spared for whatever reason fate or Providence or chance or destiny the enemy never came and so they lived and Thomas Shelby says at the end of this story that we all agreed everything after that was extra bonus and that attitude that perspective permeates in the way that the Shelby Brothers lived and the way many veterans live after War this is something that war can do to a person if you've accepted death then the rest is all extra it's all a bonus and so how do you live what do you do are you taking risks Reckless risks are you taking advantage of every second that you have are you living to honor the ones who didn't make it home or are you guilt-ridden that you did make it home are you trying to remember or are you trying to forget are you trying to leave a mark or just trying to leave I've seen some of my friends do some of those things or all of those things I've done some of those things that's War my friend Peter attia told me a story once and I've probably morphed it in my mind over the years but it was something like this he was an ER doctor at the time of this story and there was a teenage girl who was brought in by her mother and this teenage girl had broken up with her boyfriend or experienced some other kind of adolescent drama and she tried to kill herself by taking an overdose of Tylenol and sometime it passed and the young girl realized that this wasn't that smart and she didn't want to die and so she apparently told her mother and her mother had brought the girl to the hospital where the girl's mother politely told Peter the ER doctor what had happened and I can hear the conversation in my head you know the kind of casual home my daughter she broke up with her boyfriend and you know she took a bunch of pills and and I think she probably just expected Peter to pump her stomach or give her the antidote or give her an IV or give her an injection of something or perform whatever simple routine medical procedure that would resolve the issue and then the girl and the mother could carry on Happily with their lives Having learned from this little innocent naive Mistake by this young girl when Peter asked some questions and did some math in his head and realized based on how long it had been since she had interest ingested the drug and how much she had actually taken as he ran that math in his head he feared it would be too late because with Tylenol there's a certain point of absorption in the blood where too much has been absorbed and the liver is poisoned and the liver fails and the body breaks down and you die and there is no procedure and so Peter quickly ran the necessary tests and his fears were confirmed but it was too late there was nothing he or anybody else could do she was going to die I've thought about that story a lot from the girl's perspective from the mother's perspective from Peter's perspective and I think about that story and how it relates to my own experiences with death which because of the war those experiences have been too often and too close and I wonder sometimes do we realize the value of life when we have it doesn't encounter with death bring fear or does it bring comfort and what do we do and how do we act when we realize it's all going to end because it is all going to end for everybody There Is No Escape no one gets out of here alive days months minutes or years we don't know how much time is left but the clock is ticking like Thomas Shelby and his brothers we are all caught off from the retreat we will run out of ammunition and we will be waiting for time to come and finish us off In The Bleak mid-winter now strangely or I don't know maybe not so Strangely I thought about all of this as I was reading Peter's new book the book is called outlive a much more positive title than the subject matter I just addressed but it's a book that should be required reading for everyone and really it is it at least touches upon or borders upon being a textbook a textbook where Peter does his best to teach us what he's learned about health and about happiness and about disease and diets and drugs and about life and about death and Peter's been on this podcast before I think it was 2016. episode number 56 and it is a privilege to have my friend Peter back here again to discuss well to discuss all these things so Peter thanks for coming thanks for coming by thank you for having me back In The Bleak Midwinter how close am I on that story um one small detail off one large detail off and the large detail is a good one to be off on so I wasn't the ER resident I was the surgical resident so I wouldn't have been the first person they encountered but the good news is she was one of the lucky ones in that while her liver did fail we managed to get a liver transplant for her in time oh she lived she lived oh that wrecks my whole story it actually makes my story a happy ending it does but it's but it's the same point because I was the first person that she saw when she woke up so most people in that situation die because the liver unlike other organs in the body you don't have a way outside the body to support it we call that extra corporeal support So if you take a drug that destroys your kidneys you could be put on dialysis for a period of time years in fact until you've got a transplanted kidney even the heart is true in that way if you took something that was so toxic to the heart you could be put on a ventricular assist device or something like that until a heart transplant came along the liver we have no option for that so you've got got in the case of this girl if I recall you probably have about a 20 a 36 hour window to get her a liver and that's not big odds so there's a decent chance that you just die she was one of the really lucky ones so she got a liver and I you know I just remember taking care of her when she's you know in the ICU and you know I think it's a very I mean again she was very young right so she was probably late teens early 20s probably an unbelievable feeling of Shame um and you know I'm sure you read these accounts of the few people who have survived jumping off the Golden Gate Bridge yeah and they all say the same thing right I mean there's only a handful of them that have survived and that two things they all say are they can't believe how long it takes to hit the water it's technically about a three second fall but they describe it as taking like minutes and two they again it's an all it's a small n but they all say the second they jump they can't believe how much it puts in perspective whatever it was that made them jump sketchy that's uh that's crazy I was looking at statistics on the Coronado Bay Bridge and I think I I want to say like 10 people have survived is that too big of a number how many people did you say survived uh San Francisco it's on the order of of 10 or so and and I'm trying to think like the Golden Gate Bridge probably averages two a month yeah it's a similar number it's a similar number it gets shut down all the time because people are jumpers are up there um all right so you wrote this book we're going to get into it a little bit and you've also done a bunch of podcasts about the book the book you did the audiobook of the book I'm gonna try not to read too much of the book but you know me I probably will read more than I should um it starts off with this going to the book the intro of the book once again the book is called out live the science and art of longevity and it's a lot more than just that in the dream I'm trying to catch falling eggs I'm standing on a sidewalk in a big dirty City that looks like a lot like Baltimore holding a padded basket and looking up every few seconds I spot an egg whizzing down from me from above and I run to try and catch it in the basket they're coming at me fast and I'm doing my best to catch them running all over the place with my basket outstretched like an outfielder's glove but I can't catch them all some of them many of them smack the ground splattering yellow yolk all over my shoes and medical scrubs I'm desperate for this to stop where the X coming from there must be a guy up there on the top of the building or on a balcony just casually tossing them over the rail but I can't see him and I'm bit so busy I barely even have time to think about him I'm just running around trying to catch as many eggs as possible and I'm failing miserably emotion Wells up in my body as I realize that no matter how hard I try I'll never be able to catch all the eggs I feel overwhelmed and helpless that's the opening of the book this is a very similar like military dudes like me we have a dream where the enemy's coming and we're running out of ammo it's kind of like the Tommy Shelby thing like we're running out of ammo and then you run out and you're looking for other magazines and the enemy's closing on you and you know what's gonna happen and you that's when you wake up drenched in sweat and you're all happy you don't really call him and just in bed we're all good but this was the this is how you viewed what medicine was doing what you call in the book medicine 2.0 which is here's a problem right here let's fix it right now and not try and figure out where it's coming from that's the impact that this dream had on you is to to to make you think of medicine in a different way yeah although not at the time right it's only in retrospect that I put two and two together at the time um yeah it just seemed like it's amazing to me that it wasn't obvious what that dream was about at the time because it's so obvious in retrospect oh so you what you thought it was about at the time was you needed to get better with the basket and be able to move quicker and be able to catch more just some stress just stress like it was just some dream about internalizing stress how often do you remember your dreams now oh you know it's funny if I'm really deliberate about thinking about it first thing in the morning I would say probably more than half the time are your dreams good or your dreams bad very rarely do I wake up and think that they're significant um about oh I don't know maybe a little less than half the time that I do remember a dream I can at least say I bet that's me ruminating on this fear or this concern um but there I would say that the valence of my dreams tends to be negative it's rare that I wake up and think oh I wish I was still sleeping having that dream it's usually I'm glad that's over that could be some kind of a bias though because if you're having a bad bad dream seem to wake you up more then good dreams I bet we just like happy good dreams you keep sleeping I can always tell when I've had like a a bad dream because I wake up just drenched in sweat and it's nasty and my wife is like you are as disgusting and I'm like yeah I'm sorry but it's always like you're running for ammo you're doing something you're trying to catch someone like something's going on like that it's weird that you physically sweat even when you're not moving yeah for sure I mean it's still there's still huge sympathetic uh you know uh nervous system is is activated I mean it's uh it wouldn't know the difference right yeah I guess well mine doesn't that's for damn sure all right I'm gonna fast forward a little bit and go read another chunk of the book I'll never forget the first patient whom I ever saw die it was early in my second year of medical school and I was spending a Saturday evening volunteering at the hospital which is something the local school or the school encouraged us to do but we were only supposed to observe because by that point we knew just enough to be dangerous at some point a woman in her mid-30s came into the ER complaining of shortness of breath she was from East Palo Alto a pocket of poverty in that very wealthy Town while the nurses snapped a set of EKG leads on her and fitted an oxygen mask over her mouth and nose I sat by her side trying to distract her with small talk what's your name do you have kids how long have you been feeling this way all of a sudden her fight her face tightened with fear and she began gasping for breath then her eyes rolled back and she lost consciousness within seconds the nurses and doctors flooded into the ER Bay and began running a code on her snaking a breathing tube down her Airway and injecting her full of potent drugs and a last-ditch effort at resuscitation meanwhile one of the residents began doing chest compressions on her prone body every couple of minutes everyone would step back as the attending physician slapped the defibrillation paddles on her chest and her body would twitch with immense jolt of electricity everything was precisely choreographed they knew the drill I shrank into a corner trying to stay out of the way but the resident doing CPR caught my eye and said hey man can you come over here and relieve me just pump with the same force and Rhythm I as I am now okay so I began doing compressions for the first time in my life on someone who is not a mannequin but nothing worked she died right there on the table as I was still pounding on her chest just a few minutes earlier I've been asking about her family a nurse pulled the sheet up over her face and everyone scattered as quickly as they had arrived this was not a rare occurrence for anyone else in the room but I was freaked out horrified what the hell had just happened do they give you any heads up at all are they talking to you about this any of this from a psychological perspective when you are going through doctor School certainly not when I was there I I don't know what it's like today but [Music] you know it would only go from bad to worse right I mean I went to medical school at Stanford where that's often how you saw somebody die but it you know in residency I was at Hopkins which was more of a war zone so there what I saw his death was penetrating trauma for the most part in car accidents as well but but I would say the majority of the people that died well um you know right in my hands would have been trauma victims um and you certainly saw people die post surgical procedures you know somebody dies after cancer surgery or heart surgery um but they usually didn't die right while you were watching them the the ones who die when you're standing there pumping on their chest and trying to do something heroic or usually trauma victims and that was just very that was a very common occurrence and no I don't think that was ever um yeah there was just there was no there was no sense of how do you process this um and I I don't know that I did a great job of it I mean I probably internalized it more than was healthy um I I I feel like um yeah there were many times when I after right after that person would die I would do something like I picked their I take their wallet and look through it and like find a picture of them or something like that and it's it you know I mean I'm sure your audience can handle it but like I remember the first time I saw somebody literally whose brains had been blown out we use those terms very Loosely right but but you know what that's like I mean when you see a person with an entry wound yay big and an exit wound on the other side of their head yay big and their brains are on the gurney that's not what they looked like 10 minutes earlier an hour earlier that's not what they look like in their driver's license photo and um yeah I just think I think that is something that we would be better prepared to or we would have been better off if we'd had some sense of how do you compartmentalize that yeah I can tell you that I don't think the military does a good job of that kind of stuff at least it didn't when I was in we didn't talk about it it's in fact it's interesting we even talk about like hate if someone dies what do we do what's our replacement plan for that individual like where are we are we gonna get another guy I was like oh no that won't happen well it was so far from our heads of thinking it could happen that we didn't even have some kind of a replacement plan you know you talk about World War II they had replacement plans and Vietnam had replacement plans oh here's what you're going to get for Replacements we have another platoon full of stragglers that they're going to come in on the you know the fourth wave and they'll fill in whoever's whatever spots are empty we didn't have that so that means you're not even thinking about it so now you're not thinking about it it's like okay what what goes on what goes on what how do people how are people supposed to handle it so it's interesting that even in medical school where you are 100 going to see people die you're not giving any sort of prep for that now listen it's also like oh you're going to be inundated with that and we've been doing it for however many years 100 200 300 years there's been people going to medical school and people figured out so we're good yeah I mean I think that I think the disadvantage of that approach in medical school is that it produces a level of callousness that I think all of us experience to some extent which is you tend to retreat from from Death now when it's acute death you don't have a choice you don't have time to retreat I mean when that patient comes in who's been in a horrible car accident or he's been shot or stabbed you're going to be there and do your job and they're going to die and that's that but you do tend to retreat from their family and and you know you have an enormous obligation I think to the family of someone who dies under your watch um and in trauma it is especially difficult to wrap your head around this because by definition the last time that family member saw them they were a hundred percent normal like their kid left the house today totally fine and got T-boned in a car accident and now they're dead who who should be the one to talk to them I I think that the physician has to be there now it's it's true that hospitals have social workers and have people that can come in to help with that but but I think that the doctor needs to be there um and and we don't we didn't certainly get any training uh in that and I think a lot of doctors don't want to be there for that because they don't feel equipped I was on my first deployment to Iraq and I'm not going to go into the details of what happened but essentially we had ended up recovering a body of an American Soldier and we put this this individual you know he's in a body bag he's in the back of our vehicle in in the back of a Humvee and one of my friends was in in the back seat I'm in the front seat and um it was yeah it was we're driving and the the the body the bag started to leak and my friend who is in the back seat like he's all of a sudden there's the blood is kind of going on to his boots it's running down a seat or whatever and he's yelling at me you know he's yelling at me and yelling you know can pull over we [ __ ] you know he's he's he's he's I he's mad he's irate and we can't like pull over he can't just like stop him on the middle of a convoy or we could but like well now what additional risk are we incurring and he's yelling and this guy's a dear friend of mine but it it was one of those things where I'm thinking this is going to leave a deep mark on and this was we this was a soldier that we didn't know this was a soldier that we went out and and helped recover and so we didn't know this this soldier at all and yet my friend is in the back seat he's got his this guy's blood is leaking into the the way a Humvee set up it's sort of like you're in a in a I guess a way to describe it would be you know the lunch school lunch trays that you have that have like a little village yeah so you have like the division for your seats and there's a place where your feet go and it's all one big molded thing and so that is what kind of tracked blood into my friend's feet and I could hear in his voice he was just um you know yelling at me like [ __ ] stop hey boy can't be smokeless and he I'm like hey bro we're gonna be okay we can't stop right here come on man we can't stop and uh yeah again that was he probably hadn't thought about that at this juncture in his career in the military and be and you know what I did when we got back nothing I didn't pull him aside I didn't say hey bro or UK I didn't do any of that we just like hey what's our next mission you know so it's another case where sure and you know what he did got ready for the next mission you know what I mean that's what he did but it it it functions but as you mentioned it's it's definitely not the optimum way to go about dealing with this kind of thing in life um listen this book is big and 410 pages of actual book and then I think it's got a little more after that um obviously I'm not gonna read the whole thing and you you read that I've listened to the sample the audiobook you read it you did an outstanding job and I think you realized how hard it is to read books that's the hardest thing I've ever done it's a challenge for sure but get the book get the audiobook listen you've done a bunch of podcasts you you've been on rogans you've been on um huberman's you've been on Peterson's like you've been you've done a bunch of podcasts around the book and they're and there's a lot there's oh you guys Deep dive into a bunch of different stuff um so I'm feeling like I'm getting a little I'm going to be getting a little bit tangential in this with what I'm going to be talking about or what I want to what may what the book makes me think about that's outside of the normal stuff you say in this second book I think about health span and its deterioration in terms of three categories or vectors the first Vector of deterioration is cognitive decline our processing speed slows down we can't solve complex problems with the quickness and ease that we once did our memory begins to fade our executive function is less reliable our personality changes and if it goes on for long enough even our setting itself is lost fortunately most people don't progress all the way to Frank dementia but many people experience some decline in their cognitive capacity as they age our objective is to minimize this the second Vector of deterioration is the decline and eventual loss of the function of our physical body this may precede or follow cognitive decline there is no predetermined order but as we grow older Frailty stalks us we lose muscle mass and strength along with density stamina stability and balance until it becomes almost impossible to carry a bag of groceries into the house chronic pain prevents us from doing things that we once did with ease at the same time inexorable progression of disease might leave us gasping for breath when we walk to the end of the driveway to fetch the newspaper or we could be living a relatively active and healthy life until we fall or suffer some unexpected injury that tips us into a downward spiral from which we may never recover my patients rarely expect this decline to affect them and when I read that we had a guy on the podcast a guy named Dean Ladd who's in the United States Marine Corps in World War II and he had done I forget which island can he did multiple Island assaults with the Marine Corps in the Pacific and he was on I think it might have been his second but he had already done one or two Island assaults in the Pacific and so he's going into Tarawa and as he's going into Tarawa I was asking him I said hey we're you know were you scared and he was like no because in his mind he's this is what he said on the podcast he's like in my he said I none of this stuff could happen to me like it was going to happen to the other guys I'm sure the other guys must have been scared because because maybe they thought they were going to get shot maybe they thought they thought they were going to get blown up but I wasn't scared because that wasn't going to happen to me and he ended up actually getting gut shot 800 meters off the beach and only by the disobeying orders of two other marines that dragged him back to a boat and threw him on did he live but what do you think that is what do you think it is in human beings myself included a hundred percent I by the way believe that if I'm on a commercial aircraft and it blows up in the sky I'm gonna survive so what what is that and and how does that how do you have to try and convince people that they are actually part of this well the first question is the hard one uh and also the one for which I I just don't think I have an answer um I mean there's probably some evolutionary reasons for it um I think there are I think it stems from a broader problem so I don't know if you've read Oliver berkman's book 4 000 weeks no uh it's it's a fantastic book uh and I I've had him on the podcast as well although by the time this one comes out it might not yet be out because I just interviewed him recently um but he talks about sort of one of the most important issues with respect to the human condition is our inability to to cope with finitude like we simply can't accept the finite nature of our lives and that's why he really uses this 4 000 weeks thing it's a very jarring thing um I I keep a calendar in my office on the wall with one block for each week so it's got 52 blocks per row and it's got 88 rows you know assuming I'm going to live to 88 which of course there's zero guarantee I will and every Sunday I color in a block so you know I'm into like the 51st row of coloring in those blocks those rows are looking lean boy well there's no denying I'm more than halfway done and my kids every day they come and they look at this thing and even they're starting to figure out like Daddy's more than halfway through life and um so I think there's something important about putting that in front of our face now I have an advantage that I think the average person doesn't which is I've spent a lot more time observing the end of life um this this thing I call the marginal decade so the marginal decade is just defined as the last decade of your life which by definition Nobody Knows the day they enter it like nobody knows that any including people who die of natural causes they don't know the actual day they are standing 10 years away from the end of their life but most people know when they're in it you know most people have a sense of I've got less than 10 years to go as as someone I once spoke with about described it to me he goes I'm on my last roll of toilet paper and I'm going to be very careful about how I use each Square no more gratuitous toilet paper using around here every minute counts and of course if we could apply that principle at the beginning you know that that's a different situation so so I suspect that that this is such a painful concept for us that we just simply irrationally block it out and say that's not going to be me like you know and also it's so it it you know it occurs over a relatively long period of time that you think well all right look I'm in my 50s today and I mean I'm I can do anything there's nothing I can do it's not like I'm going to wake up one day and not be able to do all of these things so when we ask our patients um to go through this exercise which is a part of the marginal decade exercise which is Define we Define your centenarian decathlon so we give them a list of like 50 activities some of these are activities of daily living like do you want to be able to carry a piece of luggage up an escalator that's broken so 30 pound luggage carried up two flights of stairs functionally some of these are you know very recreational specific like do you want to be able to go and Hike you know this many miles at this speed over this type of terrain um and we show people this list of 50 and we're like pick the 10 that matter most to you the ambition that people come up with is remarkable oh I'm going to be heli skiing in my marginal decade and they're very serious about this they're very serious about this because they can heli ski in their 40s which is what I'm asking them to do this and in their mind there's no reason they shouldn't be heli skiing 50 years from now um and I don't want to tell them they're not I just want to show them that the amount of strength eccentric strength concentric strength cardiorespiratory Fitness like I do we March through the measurable metrics the amount of things you need to do that are here if you want to do this when you're 85 and we know the rates at which these things decline this is where you need to be at 45 in terms of those metrics and you're only here you're well below that so you're still above the threshold to do them but nowhere near above the threshold given the inevitability decline in other words you're telling me that you want your glider to be able to fly another two miles but you're only 500 yards in the air if you want to go another two miles you need to be a mile up the deterioration is inevitable the decline is inevitable decline is inevitable we have some control over the pace of it we do so so in other words the first derivative is absolutely negative once you reach a certain age but you have a lot of say in the magnitude of that derivative so you got this this chapter in here is called uh the centarians and you look at a bunch of people that are over a century old which is pretty awesome which is pretty awesome to be oh how old are you I'm a century old that's pretty awesome and you got a bunch of different examples in there and of course you cite a bunch of examples where the people are drinking whiskey and smoking cigars and you go through all of that when I was reading this you know I've written some books and the the fiction books I've written which are one adult fiction book when and a bunch of kids fiction books story needs an arc right you kind of have a story arc and sometimes I look at a lifespan of 80 years or whatever you said 88 years 70 years like pretty good story arc you can fit a good solid story arc in there how long is long enough in terms of lifespan yeah well I mean look there's a lot of cliches and ways to look at this right it's not about the the length of life it's about the quality of life it's it's it's not the number of years it's the Life In Those Years um look I think there are extreme examples that we would all agree are not ideal okay so I think we would all agree that if you take someone who has the greatest quality life they're the greatest person they they're living life to the fullest and yet they die prematurely at 50 they're struck down by an accident or by a cancer diagnosis that they didn't live long enough right they should have lived longer I think we would all agree on that I think similarly we would agree that a person who lives a long life from an Actuarial perspective you know someone that lives into their 90s right remember the median uh life expectancy today in the United States for a male is probably hovering around 80 or just slightly below so you take somebody who outlives that by 15 years but you know since they were in their 70s they've been in a stage a stage of such fragility that they haven't really been able to enjoy anything or they've been physically totally fine but cognitively they're in such a state of decline or both mind and body are fine but they're miserable sons of [ __ ] and they have no meaningful relationships and contribute nothing to the world well maybe that's too long you know so so so I just I don't I just don't think we know the answer to that question I think I think it's a it's a complex integration of of of lifespan and health span and that's why I think this health span concept is so important and it's something that for understandable reasons because it's not as objective um especially on the emotional side uh is is largely ignored by the medical community right the medical definition of Health span is freedom from disability and disease that's a that's a that's a broad definition and in my view not a helpful definition because are you as free from disability and disease as you were when you were 20 I mean you are but if push comes to shove the Jocko of today couldn't physically do what the Jocko of you know 30 plus years ago could do yeah you don't have the recovery capacity right now you have other things you have more wisdom right I would bet that you're emotionally more competent uh so so Health span has to include these more nuanced ideas it can't be just about disability and disease I have two comments on this number one my my mom I think it was last year my mom was talking to me I was talking on the phone and she said something along the lines of like you know it's been a hard you know my mom's my mom and dad are getting in their 80s late 70s 80s and so their friends were all late 70s 80s and my mom was saying you know it's been really hard for three months four months whatever um because this person died this person died this person died and I said hey Mom I have gone to like so many funerals of guys that were 27 32 41. 29 and all your friends lived a full happy life I mean I I get it it's sad but be thankful that's part one uh the other thing I want to say which is on a lighter note I have a friend who had sleep apnea and so we had the big machine and he was in an unhappy marriage and he would rip the machine off at night because he's a very aggressive hostile you know form seal friend of mine and he would rip the machine off at night and his wife one time was trying to put it back on him in the 90s batting our hands away and they woke up in the morning and and she said you know you need to let me put my machine on you know put your machine on you need to keep that on and he says if I if it if I take it off just leave it off and she says what do you want me you'd want me just to leave it off that's what you want me to do you want me to do anything and he goes no just let me die [Laughter] just let me die so that's the other end of the spectrum I guess if you're in an unhappy marriage that can be a that can be a real bummer you know the other thing uh Have You Ever Seen The Show by the way I want to go back I want to go back to the first point you made because I really I've been thinking a lot about that lately just to take it back to Oliver bergman's book that's one of the framings that he talks a lot about and it's this idea that okay we're really struggling with this idea that we're only here for 4 000 weeks like we as a species because we have that because of the sentient nature of our Consciousness like we can really process that in a way that an animal can't right so they're not tormented by their by their finitude we are and he said look you know if you think about it through the lens of cosmic insignificance one none of us matter right so let's just let's accept that none of us matter but another framing is the probability of any of us being here is infinitesimal it can't even be calculated it is so small like on the day you were created like the probability that that that that was the day that your parents had sex and that one sperm and that one egg managed to meet to create you because if it was a different sperm and or a different egg it would be your brother it wouldn't be you right so the probability of your existence is so remote we can't put a number on it it's functionally zero and he said you know look you think about this another way to imagine this is how grateful are you to have any number of weeks and again I still would argue that just the way we're wired I think sometimes it's too short right I don't think that the 29 year old at the funeral no matter how much they accomplish in their 29 years you're still mourning on some level but you know if you make it to 80 and you die it is sad and I I just saw somebody I sort of know reasonably well die at 83 and he was one of those guys you never thought could die so it was a little just it sort of it was it was just upsetting in a way that it would be more so than just anybody dying um but you know how amazing is it that any of us might get four thousand weeks stoked yeah uh have you ever seen the show True Detective okay I watched the first one did you watch the first one is it like a Netflix series or something I don't know what's on HBO HBO series The it's done two three I think they've got three outputs three out the first one's words like three seasons yeah three seasons the first one is really really good especially the the first the early episodes anyways cops Mayhem going on but there's a character in there called rust Cole who's it's just an unbelievable unbelievable character amazing character uh just a really smart cynical guy who's going through life and and at this one point he's being investigated for crimes there's a whole plot but he's being investigated he's sitting down interviewing there's there's cops that are interviewing him and he goes on this speech speech which you can go watch on YouTube but basically what he's saying is he's talking about looking at DBS dead bodies he's talking about looking at DBS for 14 hours and he's going through pictures and he and he's saying look it doesn't matter if you're looking at pictures or if you're looking at real or if you see them just before they die or just after they die you'll see that in that last moment they realized they they're okay because they realize that everything that they've loved and everything they've hated and everything that they've lived and everything that they've worried about and everything they've been sad about everything they've been happy about I think he says it's just a dream that they had in their own head and they can just let it all go just let it all go what do you think about that hmm foreign I don't know I don't know if everyone goes through that I don't know if everybody experiences that right and again it might depend on the time scale right it might if if that's a statement about the milliseconds prior to expiration maybe there is something to that and right we also just really don't understand death I mean it really is a vexing problem like we don't understand the neurochemical process of death we don't you know when you you know I'm sure you've heard like all of these people that have near-death experiences come back and basically say the exact same thing it's kind of hard to believe they're just making this up or something right like there's clearly something really profound that's occurring neurochemically in that in in those final moments um you know presumably for the people who aren't like decapitated or something like that whether it's in instantaneous surprise death um but what I find interesting is that you know like there are some people who I hear talk about it so look we're all dying we're all terminally dying so we're all we all have a terminal disease but there are some people for whom that terminal disease is so apparent so I'm sure you've heard Sam Harris talk about The Hourglass uh have you heard about this this is I I find this to be a very powerful way to think about life and death so um all of our lives are represented by an hourglass so when you're born um there's you know all the sand is in the top none is in the bottom and then immediately the sand just starts flowing but The Hourglass is opaque at the top so you never actually know how much sand remains in The Hourglass so we watch the accumulation of sand in the bottom with Clarity that's the years we're living but we have no idea how much time remains now some people you know let's say someone gets a cancer diagnosis and it's a very bad cancer diagnosis so it's you know you have pancreatic cancer and it's it's spread to your liver this is as close to a certain diagnosis as possible you know you've got six to nine months to live what that means is now there's all that opacity starts to become transparent in the upper bulb and you see that there's actually very little sand there and as those days get closer and closer to the end it becomes more and more clear and I would say that there are very different reactions that people have to that um and maybe I spend a disproportionate amount of time thinking about that and wondering you know what's my reaction going to be because I've seen many people in that in that final stage of sand and I've seen very different reactions um but I would imagine that yes virtually everybody if they're being honest with themselves realizes that many of us certainly I would be the heavyweight champion of this probably spend time worrying about things that don't justify worry um I have a really I had a really weird kind of horrible comparison to this I was thinking of people that quit people that quit whether they're quitting you know in Seal training whether they're quitting like you're training with them and you see them just quit and you can see sure there's there's a there's a moment of they end up with the the shame and the man you know should I stuck through it but there's also like a Split Second where they rationalize with themselves and they say I don't have to do this anymore that's what I think of when I when I think of that like someone getting their life is upon them and it's the weight and you can't keep it together anymore I'm good I hope I don't feel on my deathbed like a quitter I really hope I don't that would uh send me um I know I just wouldn't appreciate that I don't think at all right um I'm gonna fast forward again the book is 410 pages long get it get it there's so much good so much incredible information in here um it's it's to me it's like a textbook as well right it's a textbook because it is so filled with with knowledge and and information that look there's a bunch of great stories in it but it's a textbook to teach you this stuff and a reference back to unless you're a medical doctor you're not going to read this thing one time and be like or like you know it's cool for me because I've been listening to you and known you for a long time so I've I've heard you talk about these things a lot so I get to read them and now oh that's that's the definition I've been missed so get the book um going a little bit here autophagy represents the catabolic side of metal and again I'm fast forward this is a totally different section autophagy represents the catabolic side of metabolism when the cell stops producing new proteins and instead begins to break down old proteins and other cellular structures into their amino acid components using the scavenged materials to build new ones it's a form of cellular recycling cleaning out the accumulated junk in the cell and repurposing it for or disposing of it instead of going to Home Depot to buy more lumber and drywall screws the cellular contractor scavages through the debris from the house he just tore down for spare material that he can reuse either to build and repair the cell or burn to produce energy autophagy's essential life if it shuts down completely the organism dies imagine if you stopped taking out the garbage or recycling your house would soon become uninhabitable except instead of trash bags trash bags this cellular cleanup is carried out by specialized organelles called lysosomes right lysosomes which package up the old proteins with other detrious including pathogens and grind them down via enzymes for reuse in addition the lysosomes also break up and Destroy things called Aggregates which are clumps of damaged proteins that accumulate over time protein aggregates have been implicated in such diseases as Parkinson's and Alzheimer's so to getting rid of them is a good thing impaired autophagy has also been linked to alzheimer's disease related pathology Parkinson's disease and other neurodegenerative disorders mice who lack one specific autophagy genes succumb to neuro degeneration within two or three months by cleansing our cells of damaged proteins and other cellular junk autophagy allows cells to run more cleanly and efficiently and helps them and helps make them more resistant to stress as but as we get older autophagy declines impaired autophagy is thought to be an important driver of numerous aging related phenotypes and ailments such as neurodegeneration and Osteo osteoarthritis so this is how how long have people known about autophagy this is something look I went to high school in the freaking 80s right but I remember some stuff from biology I don't remember a damn thing about autophagy well I mean I think we'll put it this way the Nobel Prize for the genetic elucidation of how autophagy Works was awarded relatively recently so long after you and I were in high school okay um so in that sense it's a little more recent of an understanding um it's you know the million dollar question because you can't read what you just read and not ask okay how do I make sure this is happening what do I need to do to make sure I'm in the right balance and of course there is a balance very few things in biology are just a straight line or a monotonic increasing or decreasing function they're usually used or inverted use not always and we'll talk about some exceptions potentially Fitness as an example of one where there's no you or inverted you it's just a straight up the more fit you are the longer you live on average period hire your VO2 max longer your lifespan but with autophagy there's a Goldilocks principle you want to have the right amount and the the most important things that are required to signal to autophagy are generally reduction of nutrient in one form or another now the two obvious ways to do that one is obvious I guess one is less obvious the most obvious way to do that is fasting right so when you are fasting after some point in time and most people are surprised to learn we don't know how long that is in humans so we we know in mice very well how long a mouse needs to fast before it you know has a sufficient amount of autophagy going on but the metabolism of mouse is so much faster than ours that we can't extrapolate so um you know in humans we could probably say that a day is not long enough five days is probably long enough no idea where the balance is um but what's interesting is at the cellular level exercise is a really important tool for autophagy because at the cellular level when you are exercising the cell is actually experiencing enough of an energy deficit that it triggers this process so this is why exercise and fasting would probably be the two most important tools we have outside of pharmacology there's one drug that may also you know be used for this purpose but again it's a little too soon to say at least in humans and so that that's where we want to point people what up that's another thing and I think I'm gonna get to this later but you know you talked about the chances of us being here is so small this freaking system that we're rolling around in is a damn miracle I mean you think about this stuff going on inside your body something you've never thought about before that we'd even know was going on until pretty recently it's it's insane what our body is doing all the time to to to be here to be sitting here surviving living yeah my kids right now you know my boys they're young of course and you know them well um they're going through that very predictable stage that uh five six seven eight-year-olds go through which is total obsession with dinosaurs and sharks so pretty much all we're doing is watching everything there is to watch on YouTube about dinosaurs and sharks and my the oldest of them the who's eight like he knows every fact about these things do you know that if a Spinosaurus lost its spine he would still be able to survive because I was like I don't even know what a spine is like I knew what a T-Rex was and a Triceratops like I just didn't I don't have any recollection of this he knows all of them and you know it if you think about it like how many millions yeah so let's just say like 30 million years ago you had these things roaming the Earth with their little tiny P brains and to think that like we're here today like this is unbelievable and we I love talking about Evolution and natural selection with them like I really enjoy talking about it yesterday my my son was debating with me and he might be right I think he's wrong but he was trying to convince me that the great white shark is has evolved from the Megalodon and the Megalodon did not really go extinct and I'm like I don't think that's true buddy I think the Megalodon is extinct and maybe the great white you know you just but but these things are kind of unbelievable and even at the simplest level I still can't believe it works like just at the level of a great white shark or you know never mind something that's as sophisticated as we are yeah when when you got all this act like it was just sitting here thinking about your kids right and I was thinking about Jiu Jitsu the other day Jiu Jitsu is evolving it's so much faster right now than it did 30 years ago and it's because more people are participating but it's more because the information is just readily accessible so you can go on YouTube and you can learn all this stuff and I heard an interview I think it was I think Lex Friedman was interviewing um uh the chess player the greatest chess player Gary Casper yes he was interviewing Casper off and he he asked Casper off if he could meet if he could beat Magnus Carlson and kasperoff said no but what was interesting there's two things that he said number one he said because I thought you could beat him of course because you've been playing longer and you're like the guy he said I can't think as fast as I used to so there's the greatest chess player in the world and he's saying no I can't do what I used to do which is crazy because there's no physical thing we this was such it was like one of the first times I ever accepted the fact that the cognitive decline is a real thing that was number one number two he said he he he said Magnus he has all my moves and he's had all my moves and so he didn't have to create any of my moves he just got them and so now he's creating he's building on what's already there so when we advance in medicine let's say are we advancing at a faster rate now than we did 50 years ago because everyone's just the information's all there I mean now we've got AI that can pull up all this old information you could do studies is it are we getting better are we getting faster yeah in some ways I mean the the concept of course that you're describing is the most important concept of our Evolution right and I think one fun way to think about this actually life was over a couple weeks ago when we were having dinner and and sitting around you know our job was making sure that none of the food got burnt on the grill so while we were sitting there this I posed this thought experiment to him which was which I'll pose to you now so you you know what you know it's 2023 this is everything you know I'm going to put you in a time machine and send you back 2 000 years now make it let's make it five thousand years here we're gonna send you back five thousand years how much can you bend the Arc of civilization with the knowledge you have now five thousand years ago yeah well that depends if I don't just get it you know die let's assume I put you back in the appropriate part of you know the five thousand years ago I'd have to put you in Egypt to be in the center of civilization right so I'm going to put you back in Egypt I'm going to color your skin the right color I'm going to make you look like you're Egyptian right so you're not gonna have the knowledge that I have you have the knowledge you have now but let's be clear you don't have any more than the knowledge you have now right so you know what 2023 looks like and you're in 3000 BC can you bend the Ark of the universe in some areas where let's talk about it well I can tell you straight up like because I'm sitting here thinking if they want I would probably provide little to no value in medicine now look there's one area you could I could I could say collect cleanliness right exactly sanitation is the only thing I can think of where if you put me back in time I could make a difference now that assumes people listen because remember and I write a whole chapter not a I write a whole section about semelvice he came up with this idea first and they put him in an insane asylum where he died so you also have to assume people would listen but outside of that man yeah I got nothing to offer yeah you could imagine you standing there you'd sound like a prophet we're gonna have these things they're going to be called iPhones and you're gonna and they're gonna have this thing called the internet like what I mean the point is Connecticut Yankee and King Arthur's Court you remember that book no yeah it's like this guy goes back from Connecticut Yankee he goes to King Arts Court one of the things he does he he knows when the uh the eclipse is gonna happen and so he's like I'm gonna blot out the Sun and oh my gosh but uh okay sorry continue yeah so so my point is like all of the the modern nature of the world we have today is all predicated on knowledge transfer it's codification and transfer of knowledge and until that happened like we were in the dark ages for hundreds of thousands of years and then the reason I think we're you know technology is increasing exponentially is due to to that it's and these have fed off each other right so the the more we can codify knowledge presumably starting with the printing press the more we could get to the point where we could generate knowledge that could do all these other things so to answer your question um I think it's non-linear I think there are some spikes so I'll give you an example um you know most things that people think about and most people understand Moore's Law which is kind of like the PA you know it's about an 18-month doubling uh or halving depending on how you look at it uh you know semiconductors you know so sort of Chip size and incapacity well there's actually been one thing in medicine that has taken a step function faster than Moore's law in its genetic sequencing so when the first human genome was sequenced in about the year 2000 the cost of sequencing went down at a Moore's law rate until about 2006 and then it just went boom just dropped to nothing and now it's continuing at Moore's law rate but from a way lower Baseline and that big drop was uh High throughput sequencing next-gen High throughput sequencing so like that's one example where there's been a step function change in recent years in the past you know 15 years that has made at least genetic sequencing you know completely transformational but you know what it hasn't translated to a huge impact in health so it's been a big scientific breakthrough that hasn't really translated to a huge impact in health um I think there are other areas where I think we are starting to see areas where I'm optimistic so in cancer Therapeutics I think it's been largely pretty unsuccessful for you know 75 years and then in the last 10 years there's been a pretty big Improvement in harnessing the immune system now we're still in totally nascent days but I would say and this is probably a conservative estimate eight percent of people who would have died even 25 years ago are living today with metastatic cancer and and we made zero progress from 1950 to 2000 on metastatic solid organ cancer and and so now we've you know so we're moving we're moving yeah that's good um your initial question about what I would do it five thousand years ago and I was like well there's one area like I know jiu jitsu and you don't need anything for that because like look I know about weapons but I couldn't I don't know how to make the metal to make a weapon right I know there's I know you can take like bat guano and make freaking gunpowder somehow right but I wouldn't be able to pull it off but I know Jitsu I'd be I could I could jack some people up I'd put together an army we'd take over the world I can say that well what kind of weapons were they using 5000 years ago what did the Egyptian armies use my guess is Spears yeah sure on the trebuchet yeah I don't know if I yeah I could show the trebuchet like we could we could start if they didn't have I guess if they didn't have bow and arrow yet we could get the bow and arrow Out start using that crossbow yeah crossbow but again like figure I'd have to go through the procedure concept here is that military advancement would be the most important thing that we could bring to us as civilization well that's the most important thing I could bring I think you would be a much better person to send back in time I would make things much worse it would be much smarter to send Peter Tia back not Jocko we just end up in some weird war like freaking dystopian time right now but but but you know so let's say you sent me back right and let's say by some miracle I could convince people to wash their hands that would have an enormous impact but you know what I couldn't do I couldn't build a microscope yeah I was going to say you could build you I mean could you build a scalpel it wouldn't be as much value they would probably already have it it's the anesthetic I wouldn't be able to build ether I wouldn't be able to make ether and that was the big breakthrough and by the way that didn't happen until the late 19th century can you believe they used to cut people surgically until just 140 years ago without 150 years ago you would undergo surgery like White Knuckle in it yeah damn they were hard back then huh the people just pass out or you think they just got through it um so it's totally it's really interesting when you go back and read about surgical what was prized in a surgeon pre-anesthesia versus post pre-anesthesia the only thing that mattered was how fast you were damn like literally it didn't matter how accurate it was like can you operate fast they used to operate in front of crowds yeah that was actually not that was you would even see operating theaters that exist probably in up until the 1940s or 50s who's going uh usually students and other people there to observe but it's not just like it's not Friday night yeah yeah yeah no it's like the medical students okay that makes sense do they still do that right uh I mean not in a formal theater okay you know but you but you're probably watching videos yeah look when I was in when I was in medical school I I I'd have vhs's of procedures that I would watch so that I you know I didn't I didn't want to go in and try to like assist on my first one without having watched it a bunch yeah that's crazy there was a guy in ramadi Army Captain Awesome guy and he would sit back like go out on Ops and he would run a camera the whole time a video camera from his Humvee and then he'd go back and just sit there and watch and he'd be like oh yeah he would know that little what that door looked like what that courtyard looked like that's squared away you know that's why why would you not do that freaking awesome all right I'm gonna fast forward a little bit in the 1950s a surgeon in Topeka Kansas named Samuel Zellman was operating on a patient whom he knew personally because the man was an aide in the hospital where he worked he'd known for a fact the man did not drink any alcohol so he was surprised to find out that his liver was packed with fat just like one of my patients decades later this man did in fact drink a lot a lot of Coca-Cola Zellman knew that he consumed a staggering quantity of soda as many as 20 bottles or more in a single day these were the older smaller Coke bottles not the Super Size we have now but still Zellman estimated that his patient was taking an extra 1600 calories per day on top of his already ample meals among his colleagues zelman noted he was distinguished for his appetite his curiosity peaked zelman recruited 19 other obese but non-alcoholic subjects for a clinical study he tested their blood and urine and conducted a liver biopsies on them a serious procedure performed with a serious needle all the subjects bore some sign or signs of impaired liver function in a way that eerily in a way eerily similar to the well-known stages of liver damage seen in Alcoholics this syndrome was often noted but little understood it was typically attributed to alcoholism or hepatitis when it began to be seen in teenagers in the 1970s and 80s worried doctors warned of a hidden epidemic of teenage binge drinking but alcohol was not to blame in 1980 a team at the Mayo Clinic dubbed this hit hero unnamed disease unnamed disease non-alcoholic Stadium hepatitis am I saying that right hepatitis the Idaho hepatitis or Nash since then it is blossomed into a global plague more than one in four people on this planet have some degree of Nash or its precursor known as non-alcoholic fatty liver disease how disturbing is that yeah the hidden epidemic they thought initially that kids were just binge drinking and that's why they had this fatty liver but it was just because our freaking diet was heinous yeah in fact I think I opened this chapter talking about um a patient that I you know this is when I was an intern and I was assisting on a procedure this was a patient who had colon cancer he was there to get the right part of his hemicolon removed and you know we and my job was to pre-op him so that meant I had to go and ask him all the mundane questions among them is how much do you drink and that's relevant from an anesthesia perspective right so you've got to know if somebody's a big drinker he claimed to not drink at all so fine so we get into the OR and again my job is to pretty much just retract and suction that's it I'm a lowly intern at this point and uh we we open them up and like the biggest fat liver just pops out of this guy and the attending surgeon is upset at me thinking clearly I didn't even do the one thing I was supposed to do which was figure out if this guy was a drinker um and of course it turned out he wasn't and you know none of us really thought much about it at the time and but you know this was more than 20 years ago and we now realized today that the nafldi and Nash are the leading indication for liver transplant in the United States and this chapter is called the crisis of abundance because this is just too much Coca-Cola too much freaking crap which is crazy right like that's where we're at that's what's going on yeah I mean let's let's start with the Positive spin going back to our evolutionary discussion well okay I like it all right so you talked a minute ago about how amazing it is that we're here and I assumed you were mostly referring to humans um it's obviously true of all species but but it is true like we are we're in a league of Our Own but what puts us in the league of our own is it our strength no even your strength right no is it our speed no I mean it's it's one thing that catapulted us out of the swamp and passed every other species pre or current and that is our brains our brain is the defining feature of our species and we pay a price if you will to have a brain like ours and it's a metabolic price so your brain takes up two percent of your body weight and yet it consumes 25 of your metabolic rate 25 of the calories you eat go to feed that two percent of your body weight so how could we possibly get where we are without evolving a very elaborate system to make sure you never run out of energy and that's what we had to do right and so and if you by the way if you look at primates today right these would be our nearest evolutionary relatives they don't have this capacity right when you over feed primates they get more muscular when you overfeed humans we get fatter and again in light of all we're going to talk about that's not a good thing but from an evolutionary perspective it's important because muscle is a lousy source of energy fat is not fat is a wonderful source of energy so basically we were the we were like the only electric car to show up with a huge battery everybody else basically had an electric car with a mini battery and that meant they couldn't drive very far we were the only ones that could drive all over the place so if you think about it up until a couple hundred years ago those you know tens of thousands of years of evolution served us really really well we were incredibly active food was incredibly scarce we didn't have natural we didn't have unnatural light and we didn't really have chronic stress we only had acute stress so you've got acute but no chronic stress no you know unnatural light scarce food and you're active as hell and by active as hell I don't mean we were like running marathons a day but like but you're we're more Gathering you're moving around yeah and we conserved energy like it's a bit of a myth to say that humans were like constantly hoofing it we looked for every reason to not move an inch because of the scarcity problem right like you never wanted to wait but you put all those things together and we were in perfect energy balance and then you know a hundred years ago or so all that started to change when we we tried to solve a problem so the problem was hey we don't want to be in farms anymore like we want to do other things we we want to set up a society where people can do things other than be in charge of growing their own food so we're going to centralize that we have to be able to scale that problem so we have to be able to grow food at huge scale we have to be able to preserve food to be able to ship it and distribute it we should really make it taste good as well you know start to get into the hedonic side of this um and you basically arrive at this thing called the standard American diet and it you know none of those things I mentioned that were part of the optimization State involved make it not harmful like that was neither a goal nor a thing to be avoided it was just it wasn't considered it was how do you make it cheap how do you make it abundant how do you make it non-perishable and how do you make it taste good those were basically the criteria and so what we have today is the standard American diet and so when you take our genes and superimpose them on the standard American diet it's the crisis of overabundance and for most of us that requires being deliberate because if we just let our brains run rampant I mean for most of us we end up in an unhealthy State yeah because part of our part of the evolution that we made was to want to eat all this stuff that tastes good and that's just you have to fight against that absolutely I mean if you think about it like you know it's not an accident that we like sweet things I mean that was a very important characteristic to have right I mean we depending on which which ancestral tribe you look at I mean some of them got up to 20 25 of their calories from berries and honey I mean we were we really wanted to know what what sweet was that was a very important trait in fact I mean I I think I write about it very briefly I you know one of these things I'm sure you can relate to this Jocko is you're writing a book you sometimes forget the first version versus the published version because it's been hacked down so like the first version of this book was 200 000 words what people are reading here is a hundred and twenty thousand words which is still to your point a very long book but the 200 000 word book that was A Treatise and I think some of this got I think there's a much longer section I wrote about the evolution of an enzyme called uricase and um how basically there was a period of time in which we we also couldn't get very fat um by we I mean Apes that became us right so these Apes basically left Africa went to Europe Ice Age comes and they're only the subset of the Apes that developed a mutation to preferentially store fat out of fructose survived because they could eat enough fructose in this fall to fatten up for the lean times during the winter and the ones who couldn't develop that mutation died off the surviving ones came back to Africa they basically became the precursor to us as humans so again very valuable set of mutations up until you know the last 0.001 of our time on this planet that's an amazing system this freaking flesh bot we're running around in isn't it really it's nuts speaking of that I'm gonna fast forward here scientists have been exploring the medical Mysteries of the human heart for almost as long as poets have been probing its metaphorical depth s it is a wondrous organ a tireless muscle that pumps blood around the body every moment of Our Lives it pounds hard when we're exercising slows down when we sleep even micro adjusts its rate between beats a hugely important phenomenon called heart rate variability and when it stops we stop our vascular network is equally miraculous a web of veins arteries and capillaries that if stretched out and laid end to end would wrap around the earth more than twice about 60 000 miles if you're keeping score so that's each individual human so I have that yep are these like microscopic that's why yeah so so if you think about it like coming out of your heart is one huge artery called the aorta and then it immediately um splits so it comes it has three things that hop off it okay so they're major arteries but if you trace the like the the major arteries they become smaller and smaller arterioles that become capillaries that become venules that become veins tiny veins that become bigger veins and bigger veins that become the two major veins that flow back into the heart so what it's saying is yeah you take all of those things because once you're at the capillary level you have a whole bunch of these things in parallel it's not just a Serial process so it's take all of that out and yeah it's insane each blood vessel is by the way yeah not not to just harp on this idea this is one of those things that I don't think gets enough attention in terms of like how that even works like we like the best and brightest Engineers Material Science Engineers on this planet can't come close to making materials that can do this because if you think about it how does something that small stay patent it shouldn't like we we can't even figure out a way to make an artificial coronary artery like if someone needs a coronary artery bypassed we can only use their native blood vessel from somewhere else and that's a an artery that's like a millimeter and a half wide in diameter it's even visible to the eye we still can't come close to making something that small let alone the microscopic stuff uh it going on same path through each individual blood vessel is a Marvel of Material Science and Engineering capable of expanding and expanding and Contracting dozens of times per minute allowing vital substances to pass through its membranes and accommodating huge swings in fluid pressure with minimal fatigue no material created by man can even come close to matching this if one vessel is injured others regrow to take its place ensuring continuous blood flow throughout the body then it's interesting uh my route here was F1 engineering is F1 car engineering is like a miracle and but compared to the human hand the human heart to the human brain like it's just not even it's nothing it's a joke yeah it's pretty amazing how our bodies manage to work so my other note here was what is what is it that we do we know what we don't know what is the spark that makes life because we can't create an amoeba right now can we do we know what we're missing do we can we can we identify what it is that we don't know well I mean I I should clarify this um there there are some ways to create synthetic life um at the at a very like an algae or something like that there is some type of synthetic biology that can be done um so we can take no algae we can take the material that is in algae no I shouldn't I shouldn't say that here's what we can't do let's so going with algae which is really simple right so what makes algae special or makes plants special for that matter is photosynthesis um we can't in a black box make photosynthesis in other words we can't in a black box make something that takes carbon dioxide and Light and fixes carbon atoms and spits out oxygen and water like we can't do that um you know it depends okay so so your question is a bit difficult to answer because we can you could argue we can take an egg and a sperm and merge those together using in vitro fertilization and we can grow that out yeah I get that um but we're starting with the perfect genetic material at the outset like we're starting with a perfect egg and a perfect sperm and we inject them and both those things are alive right when you say they're alive I don't know I mean I guess this that's a bit of a semantic question right what I mean how do we Define alive uh it's not bad meaning if you take an egg and you put it out in the you know on the shelf and hit it with a hammer and put it in the sun it's not going to work anymore right that's right yeah same thing with a sperm yeah so there's something there's some attribute that they have that I believe we would call life it's alive yeah there's there's yeah I mean I guess you could say it's cellular respiration would probably be the definition or the the line I think I think cellular respiration would be this cellular definition of life so which me which is metabolic right so it's a metabolic definition of life and we can't create that no do we know what it is that we're what we're missing do we understand that is a chemical thing well I mean what we understand why it's happening we don't like we can't make a mitochondria yeah that's what's so freaking crazy right yeah we can't make the engine that drives cellular respiration someone working on that I mean we're not even working on that what we're working on is how do we minimize the damage to our mitochondria right because if you think about aging there are Hallmarks to aging I list all nine of them in the book right and I think one of the most important or significant Hallmarks of Aging is mitochondrial dysfunction so as we age our mitochondria become less and less functional so while as interesting it would as it would be to see if we could make mitochondria I would settle for can we figure out how to stop or decline stop the decline of and or reverse the decline of mitochondrial dysfunction and the good news is we we have some interventions that do exercise does right like exercise clearly blunts that effect and if you take a person with type 2 diabetes which would be kind of the Hallmark state of mitochondrial dysfunction and you get that person exercising like crazy and their diabetes goes away like you've improved the state of their mitochondria absolutely full stop so we have functional tests that are usually exercise based to determine mitochondrial Health um but shy of that like it's not like we've got a drug that we can give somebody to to Tinker with that system or to take an 80 year old and give them 20 year old mitochondria just not happening oh yeah we got a long ways to go don't we I think very long and in a way that's kind of what like you know there's there's an entire topic I don't touch on in this book and it's a very deliberate decision right and and and it's it's basically the entire topic of the Sci-Fi of anti-aging right like so so in some ways I'm sure there are some people who will read my book and come across and and come to the end of the book and do like where's all the cool [ __ ] Oh you mean like uh cryo yeah or just like like where you freeze yourself yeah or like where's all the you know cellular engineering stuff and where's all the you know the highfalutin really cool ideas that are you know we're going to become immortal and um and the reason I don't write about that stuff is um one I think enough other people are but but more than that I think that I'm trying to write the operating manual for what you can do today and if nothing else even if any of those other things come to be viable In Our Lifetime and I don't think they will this would still be your hedge right this is the what you can do today like why does exercise matter why would exercise add a decade to your life and more importantly even if it didn't even if you know I often said this I think I even make the point in the book even if you told me exercise was going to shorten My Life by a year it would still be worth it based on the dramatic expansion and quality of life and if you're I think most people if they really think about it they don't care as much about length of life outside of those extreme states nobody wants to die at 50. no matter how good their life is um but if you say to somebody do you care if you live to 78 versus 88 if you told them that the 88 was going to be 15 years of poor quality and the 78 was going to be six months of poor quality I'm not sure I know anybody who wouldn't take the 78. so um as it bringing it back to the mitochondria like we might not know for a very long time how to rebuild those things um but we sure as hell know how much exercise will give you better mitochondria more of them and better ones speaking of high school science I was taking my high school science class and I remember it was in I think it was in chemistry and like we finally got this something where my teacher was like we don't know why this happens and it was the first time in my Scholastic career and I was like well you know I was sitting there doodling or doing something he said we don't actually know why this happens and I was like wait a second what he's like we don't know it should have been the thing that sparked me to enter physics and become a scientist what is that I was like damn that's messed up you know Chief knucklehead to try and think oh I could go try and figure that out uh interesting fast forward kids are great for that right I mean the the amount of stuff that like you know because kids are they just don't care they'll just ask questions and they'll keep asking and they'll keep asking and they'll keep asking you a question were you where you've gotten to I don't know yet oh you have tons tons oh yeah all the time yeah my especially the boys right because they're at that age where they're my daughter now just doesn't ask me too many questions she knows that you don't know anything but but the boys love asking like you know all those kinds of questions yeah that's good all right um fast forward a little bit Richard Nixon declared a national War again I'm skipping through like massive chunks of this book go get the book I don't think I'm doing a good job of skipping Parts I think I'm skipping too much but anyways that's what we're doing Richard Nixon declared a national war on cancer in 1971. initially the Hope was that cancer would be cured within the next five years in time for the bicentennial you want to talk about some presidential promises gone wrong good job yet it remains doubly undefeated in 1976 and still by the time I finished medical school in 2001 and today for all intents and purposes despite well over a hundred billion spent on Research via the National Cancer Institute plus many billions more from Private Industry and public Charities despite all the pink ribbons and yellow bracelets and literally millions of published papers on the pub Med database cancer is the second leading cause of death in the United States right behind heart disease together these two conditions account for almost one in every two American deaths the difference is that we understand the Genesis and progression of heart disease fairly well and we have some effective tools tools with which to prevent and treat it as a result mortality rates from cardiovascular disease have dropped by two-thirds since the middle of the 20th century but cancer still kills Americans at almost exactly the same rate it did 50 years ago so cancer horrible that being said I read one time that nurse they surveyed nurses how would you want to die and the nurses chose cancer the and and I guess it was what they said was you have time you can say goodbye you can set things up correctly that's what they thought um I had a friend die of cancer pancreatic cancer how old 48 something like that uh very very fit triathlete type guy and and I remember I didn't I Googled it it was it was early internet so this was probably it was not really good but it was like 2000 and let's say 2010 2011 2012 something around that and one of my other friends called and said hey we just got you know he has cancer he's got this kind of cancer pancreatic cancer I Google it pancreatic cancer cancer survival rate after two years zero percent something that maybe a survival rate after five if it spread yeah zero percent well overall it's like less than five percent for everybody yeah uh it's the most lethal cancer along with a certain type of brain cancer he died four months later I mean it was he must have not known about it until late which I know you get into in the book but uh yeah it was awful what it did to this incredibly healthy guy in a very short period of time which is what surprised me when these nurses said I think cancer would be the best way but I guess you have that time to make things right I'm really I don't know why you're telling that story really reminds me of um another one of these memories I have from residency so um I was doing a rotation in the ER so as a surgical resident you will do typically one month a year as the surgical lead of the ER so you're in the ER taking care of everything that walks in but they're they're driving to you the surgical cases and um so that means you know anything that needs to be stitched up sewn up drained pus this that and the other thing put a chest tube in you're kind of doing all those things so I'm in the I'm in the surgical wing of the of the ER at Hopkins and uh this young girl comes in and um God she was she was she was probably 21. um she's her mom brought her in and she was just complaining of back pain and it had been like pretty significant but it sounds like you've been going on for weeks um and she finally you know they just came to the ER which again is kind of an unusual place to go for back pain you normally would go and see your doctor or go and get a referral to PT or something like that and um you know I examined her and she's really in a lot of pain and and I remember there's a handful of things you just sort of remember and I remember like just beautiful beautiful um completely healthy looking 21 year old but there was no question that as I pressed on her spine like it was really quite tender um and so I suspected maybe she had a fracture like it's possible she didn't report any trauma um and who knows like I just assumed look either she's got some fracture there because there's some tenderness or you know more likely maybe she's you know really had some serious disc disease and um so you know for a fracture the test you want to do is a CT scan not an MRI at the time it was too it would take too long to get the MRI so I figured look let's do the CT scan um if nothing else we don't see a fracture we would probably just admit her for pain and then you know she would get you know she'd go to the you know Orthopedic floor or something they would do an MRI and figure out okay so anyway to make a monster story do the CT scan she's got metastatic pancreatic cancer and it's spread to her bone and that's why she's in so much pain and I mean it's it's again it's just one of those moments where like I can't believe this is happening and how do I go and tell this girl and her mom and her mom looks like she's you know 45 like her mom's a a young woman and um and at that point she's going to be admitted to not a surgical floor because this is not a surgical case when the cancer has spread she's going to be admitted to a medical service to a medical oncology service um and you know they're gonna they're gonna palliate her at this point they're probably they might give her some ineffective chemo but it's mostly palliation um and I just um you know I just remember not wanting to let her go like I just had this sense of like God I wish I wish I could admit her to a surgical service which of course was made no sense at all right [Music] um but you know pancreatic cancer is awful I mean it is awful it's you know it's it's it's one of those cancers that gives cancer a bad name um and it's interesting that there's a subset of pancreatic cancer that is curable so most of them um are what are called exocrine pancreatic cancer so the adenocarcinoma of the pancreas um so the pancreas is made up just broadly speaking five percent of the pancreas is endocrine that's the part that secretes insulin and glucagon and these peptides and then 95 of it is exocrine it secretes the digestive juices that's where the majority of cancers arise and those are the cancers that are essentially uniformly fatal but every once in a while someone will get a pancreatic cancer of the endocrine system like a glucagonoma or an insulinoma believe it or not those cancers are almost always survivable provided you don't let them Fester forever do you know who died of a pancreatic endocrine tumor unnecessarily no Steve Jobs how'd that happen so he was diagnosed with um a tumor and for reasons I don't I was never involved in his care of course I didn't I never knew the guy but based on everything I've read he just decided he was going to beat this treatment he was going to beat his cancer with juice and stuff like that so he went way too long without getting treatment and by the time he did get treatment the cancer had spread to his liver it was a bit too late they treated him but ultimately he needed a liver transplantation which is a very unusual procedure you would do you normally would never do a liver transplant for cancer that has spread to the liver but you could do it for this type of cancer but even then it was too little too late and he ultimately died as a result so um it's sort of one of the great ironies right which is you have this person who you know had such a remarkable impact on the world gets diagnosed with the cancer but gets really lucky in that he gets diagnosed with a cancer that is survivable but you know for reasons of his own just felt that he could sort of beat this without traditional treatment but you know the people I've spoken to and I do know people who were involved in his care and they've all said that had he undergone the standard treatment for that immediately uh you know he'd probably still be alive is this is this just crazy ego I don't know I mean I again having never met the guy knowing nothing about him you know literally only having read a bunch of his biographies you know his biographers would certainly speculate um and and they have um but I don't understand yeah and at a certain point your doctors are telling you and then you're you know I'm sure he went and got a second opinion and a third opinion and they're all like hey bro you need to get this taken care of and he's like no I'm good pass me the carrot juice yeah damn that's insane I did not know that um fast forward a little bit important to bring this up the final and perhaps most important tool in our anti-cancer Arsenal is early aggressive screening this remains a controversial topic but the evidence is overwhelming that catching cancer early is almost always net beneficial unfortunately the same problem I encountered in residency applies today too many cancers are detected too late and after they've after they've grown and spread very few treatments work against these Advanced cancers in most cases outside of the few cancers that respond to immunotherapies the best we can hope for is delay is to delay death slightly the 10-year survival rate for patients with metastatic cancers virtually the same now as it was 50 years ago zero we do we need to do more than hope for novel therapies when cancers are detected early in stage one survival rates Skyrocket this is partly because of simple math the early stage cancers compromise fewer total cancerous cells or sorry comprise fewer total cancerous cells with fewer mutations and thus are more vulnerable to treatment with drugs that we do have including some immunotherapies I would go so far as to argue that early detection is our best hope for radically reducing cancer mortality where does the resistance come from I think it comes from an overly simplistic view so let's take a step back right you alluded to kind of medicine 2.0 earlier and we you know I the one of the first chapters in the book is kind of devoted to explaining the difference between medicine 2.0 and 3.0 and by the way it's the underlying that's the underlying theme of the book is that medicine 2.0 is hey we treat what hits us medicine 3.0 is or sorry medicine 2.0 is we catch the eggs that are dropping from this from the building medicine 3.0 as we go and find out who's dropping these eggs and we get them to stop so it's it's prevention interdiction early interdiction early detection that's what medicine 3.0 is yeah so as you go deeper and deeper into that you realize that one of the Hallmarks of medicine 2.0 is an appropriate Reliance on randomized control trials so again um if you take a step back and go into the medicine 1.0 days which was basically all of human history up until the late 19th century um we were just making stuff up like every everything was just sort of made up everything was a story right I mean I mean if you go back and really think about it like that's how we made sense of the world around us we are storytelling creatures and we had to make sense of the Sun the moon the stars Darkness bad things happening every you know how why is Johnny sick it must be the bad humors must be the bad air um clear it's getting darker than light clearly these things are revolving around us right so you can't fault us for doing this but once the scientific method was really developed this happens in the sort of middle of the 17th century um you fast forward a couple hundred years and we now start coming up with this idea of doing experiments and this becomes very very important in fact it becomes the Cornerstone of medicine 2.0 and these experiments which everyone has heard of called randomized controlled experiments have um an area where they work really well but they have blind spots so they work really well when the interventions are simple and when the outcomes are going to occur relatively quickly so a good example of a randomized control trial is you know does giving kids you know this vaccine for measles prevent measles and you you know even that's too complicated let's take something simpler like does using this antibiotic when you have an ear infection reduce the risk of perforated eardrums and long-term complications you would take a bunch of kids and you would randomize some of them to the antibiotic and some of them to a placebo and you would follow them and you would very quickly see that there's a difference and because they've been randomized you've eliminated the bias this is the magic of randomization it takes out bias we otherwise can't eliminate bias fully um randomized control trials don't work very well in nutrition because the intervention is way too complicated it's very difficult to tell a group of people to go and do something nutrition wise and have them be perfectly compliant for five years and come back and compare it to another group of people we can talk about some examples of where that's work but nevertheless it's challenging there's that time course so even with the best of intentions the randomized controlled experiment has a problem which is it's only giving you average information so you put n people into the system they're all different you you run an intervention and you get an average outcome that's valuable information at the population level it's not very valuable information at the individual level any individual that went into the computation of that average could be quite distinct there's quite a variance to that so bringing this back to cancer screening the real issue with cancer screening is the the technologies that are typically debated all have strengths and weaknesses all have limitations all have blind spots and if you look at this in a very simple way and you factor in dollars you might make the case that you know the only way it's Justified to catch a cancer is if it saves money in the long run and that's kind of true in a way but it's based on a couple of problems that I'm not really here to write about so I'm only here to write about the individual I'm not here to write about the policy and the reason being is I think the policy side is broken so we have artificial costs associated with health care in the United States so none of the dollars that we talk about in the U.S are real dollars it's just funny money they're made up numbers and it's gotten a lot worse in the past 12 years so 12 years the US government made a deal with the devil and the deal was you promote um the Affordable Care Act we will never negotiate with you on price again to the drug companies so we just pay much more for that furthermore we have this two-tiered system of for-profit not-for-profit in health care so all of a sudden unlike everybody else we have a for-profit health care System which just drives up cost remarkably so you know that's a whole separate discussion which I'm not interested in at the moment I'm actually asking the question what should you do what should your wife do to maximize their odds of not getting cancer or if you get cancer beating it so in that situation we have to stack screening modalities so let's take breast cancer as one example and then we'll take prostate as another example and use those two because they're those are the second and third leading causes of cancer death so it's lung uh breast and prostate colon pancreatic those are the top five those five cancers are responsible for more than 50 percent of cancer deaths in the United States so the standard you know thinking on breast cancer historically has been mammography and a mammogram is a decent test but it's not a great test because no single test is a great test a mammogram has like a roughly 90 sensitivity and 85 percent specificity so sensitivity means How likely is it to see cancer if cancer is present so the answer is about 90 percent the 85 percent specificity means How likely is it to say no cancer is there if indeed no cancer is there 85 that might sound okay it doesn't sound okay to me at all bro honestly yeah it doesn't because when you start to factor in the relatively low prevalence of cancer which might be one in ten your positive predicted value and your negative predictive value are horrible so this is how mammography got a bad rap and this is why some people say well you know mammography is like yeah you should do it but you know we don't need to do it that often or you know you've got all these reasons for not doing it or and and what I would say is yeah mammography is really good at some types of cancer it's good in women typically post menopause because postmenopause their breast tissue is much less glandular so it's easier for the X-ray to see it's also better when cancers have some degree of calcification in them but it's not good for glandular glandular breast tissue it's not Crea if great if the cancer doesn't have any calcification in it so instead of just thinking about mammography we should be thinking about how do you combine mammography with either ultrasound or MRI which are far more sensitive now again A lot of people are just going to say who's going to pay for that well I'd argue that's where we should be spending money we shouldn't be spending money on drugs that we're going to put people on when they have metastatic cancer for cycle after cycle after cycle after cycle it's much better to spend the money right now when you treat something that's very small similarly for prostate cancer I mean the PSA test has basically become persona non grata so basically the the thinking today is there is no official recommendation on prostate cancer screening despite the fact that it's the second leading cause of cancer death in men there is no actual recommendation on screening and the reason is people say the PSA test is neither sensitive nor specific enough and that's true it's and in particular around the specificity it has very low specificity but that's if you take it in isolation in other words if you say look we're only going to care we're only going to trigger you know an awareness if a guy's PSA is over four and if you do that you're going to be doing a lot of unnecessary biopsies you're also going to miss quite a few prostate cancers and I just think of that as like I don't know paint by numbers right like yeah paint by numbers sucks like if you want to be a real artist you can't have lines that you color in with numbers like you have to go beyond that and to do that for example you should be looking at the velocity of PSA so not just looking at so if you check a guy's PSA every year you should be not just looking at the number but what's the rate of change if that is over 0.45 per year that's even if the absolute numbers are low that's a reason to be concerned secondly you should be looking at PSA density so not just looking at the PSA but dividing the PSA by the size of the prostate so you're looking at how much PSA is coming out per unit size of prostate and the bigger that number the higher the concern and if you have any man that's high risk and there are lots of different things that easily would tell you somebody's high risk you should be doing other tests such as a 4K test and if any of those other things trigger you would do a prostate MRI and if you do all of these things you could say oh well gosh the cost is a little bit higher yeah but it's a fraction of the cost and the morbidity that comes with missing that and waiting until that cancer has spread to the Bone because against one once prostate cancer is spread to the bones it there's no going back there is no effective treatment it's a terminal condition so all of these things come down to just understanding the basics of the following observation which is every Cancer that gets treated at an early stage when compared to the same cancer being traded at a late stage even when they use the exact same drugs has a dramatically different survival profile and we don't need very very fancy drugs to treat these early stage cancers so do does the the hospitals just run the numbers and think well we got a hundred patients if we give them all all this screening that's going to cost more than what it's going to cost to give it's not the hospitals it's the payer so um you know it's it's a really complicated system our system is and um you know it's funny we were talking about this before the podcast started that I'll never write another book again and that's largely true because there's only two conditions on which I would ever write a book again one is I'd have to have enough time to do it and that's not going to happen for like a decade and two there would have to be a topic I'd be willing to go deep enough into to spend five years doing it one of the few topics that would at least trigger that is this topic right which is and I don't know if I could ever do it right like I just I don't know if I could in just five years wrap my head around this if I totally immersed myself but how would you structurally fix our system and um one element of that problem is the you have the wrong people owning the risk right like we should actually own the risk for our lives we would make better decisions you want someone with skin in the game owning the risk hospitals should not be profiting off disease care like there's all these things that are totally broken but it's it's it's the payer that's making the calculation that's saying look I mean we you know we don't want to do these things because it pays primarily the insurance companies or the employer so it depends on the size so with it usually for a company more than 50 people the employer is the insurance company so you know if you're if you're you know if you're General Motors you are insuring your employees you do it through someone that's like looks like an insurance company you do it through Etna or Blue Cross or whatever but but you're the one that's footing the bill and you're the one that's you're the actuary basically so but they're doing what I said which is they got a hundred people or whatever that number is and they run the numbers and say look it'll cost this much money for all this different screening or we just roll the dice and usually the dice come up that we'll lose a couple people or they just look at lousy studies right like there was a study that got so much attention last year by all of The anti-screening Advocates and it was a study done in the New England Journal of Medicine so again very prestigious Journal it might have been Jama but I think it was in England Journal medicine and it was a study done in Europe and it was testing the hypothesis which is hey what's the efficacy of colonoscopy for colon cancer screening now I mean I don't know how many pages in this book I devote to the reasons why colonoscopy is one of the most important tool we have because of those five top cancers that kill colon cancer is the only one that we could completely prevent meaning it's the only one that we can definitively look at and stop in its tracks yeah you say that so every every colon cancer starts as a polyp that's right and you can see the polyps and you can get rid of them that's right this is like just the facts yep so here's this opportunity this is a this is a cancer you could basically eliminate that's right you could eliminate that I can't say that for breast completely or prostate or lung or pancreatic those are more complicated cancers obviously not smoking would get rid of 85 percent of lung cancer so you know that's a given but 15 percent of lung cancers are coming in non-smokers and if you took all the smokers out of lung cancer and just looked at the non-smokers and never smokers lung cancer would still be the seventh leading cause of cancer death that's how devastating it is so back to this question so so this study um and I believe it was done in the Scandinavian country but I'm blanking on exactly which one if if in fact it was in Scandinavia it was a 10-year study that if you read the headline you would come away thinking yeah it's not worth doing colonoscopy because the headline was in the group that was randomized to get a colonoscopy versus the group that was randomized not to the reduction in colon cancer was only oh I'm gonna sort of it's it I've written about this briefly but I'm going to butcher it it was small it was like a couple of percent and so the argument put forth by The anti-screening Advocate would be all those colonoscopies the cost of doing those wasn't worth saving a couple of percent of people from getting colon cancer but again here's where you have to be a good consumer of science you cannot just rely on the headline you have to look finer okay so the first thing is the study was very poorly done the study tested taking a group of people and telling them to do nothing and telling a group of people and recommending they get a colonoscopy in the next 10 years now I don't remember the number but it was less than 40 percent of the people who were told to get a colonoscopy actually did get one colonoscopy in that 10-year window of time so to me a more interesting study if you're really trying so in other words all that study told us that if you tell people to get a colonoscopy in 10 years and it might have been less it might have been like it might have been 25 of the people actually did it one in ten years yeah you're not going to make that much of a difference because because in the book you say it should be it's not once every 10 years and this this thing can progress what do you recommend in the book every two three years there's no definitive answer to this because no one can do the full math on how long it truly takes for a polyp to develop but in our practice we're typically looking about every three years for modest risk normal risk individuals higher risk individuals so someone who gets a colonoscopy and you find a Cecil polyp which is a higher risk polyp or someone who gets colonoscopy and they didn't have a complete bowel prep so you the endoscopist couldn't visualize the complete colon we're going to repeat that in a year um but let's just say all things go well all systems are go you go and have a colonoscopy they pull off a couple of pedunculated polyps that turn out to be nothing yeah we'd recommend two to three year repeat as aggressive as that sounds but again in this experiment they did 10 years recommend you get it and then they actually use this as a reason to not get colonoscopies that's insane how does it how does somebody publish something like that well again you know it's people would look at that and say I mean it was a big randomized controlled trial but again there's a big confusion I mean I think even in the medical establishment there's a very big confusion between what is efficacy which tests how well something works if done perfectly versus Effectiveness how well something works based on how you're told to do it both of those things are important they're not the same you have to know which one you're testing okay so there's cancer damn uh and I'm thinking as I as I am going through this and as we're doing this podcast I realized like I would I would have been much better off to have laid out kind of the way you lay the book out and I didn't do that so I apologize because you hit these topics you know and the next one that you get to is Alzheimer's you say this Alzheimer's disease is perhaps the most difficult most attract intractable of the horsemen diseases and you talk that's what that's another main theme of the book tell us the horsemen disease is the four horsemen yeah these are the the main four diseases that that are the result of chronic death the chronic diseases so cardiovascular disease cancer neurodegenerative disease and dementia and then the fourth one is kind of the foundational one which is all of those metabolic diseases like non-alcoid fatty liver disease and type 2 diabetes yep so you hit these and at this point in the book you're talking about the the most intractable of the horsemen diseases we have a much more limited understanding of how and why it begins and how to slow or prevent it than we do atherosclerosis how do I say that freaking word atherosclerosis yeah that unlike with cancer we currently have no way to treat it once symptoms begin and unlike type 2 diabetes and metabolic dysfunction it does not appear to be readily reversible although the jury is still out on that this is why almost without exception my patients fear dementia more than any other consequence of Aging including death they would rather die from cancer or heart disease than lose their minds their very selves I had I watched a close friend of mine actually a couple close friends of mine their father um got Alzheimer's and it was way more rapid than I envisioned and he was a very active very physically healthy individual and this came on very quickly and it was horrible he was angry he was confused he was violent uh this is horrifying and and another important lesson that was passed on to all I passed this on to everyone is they didn't try and get him into a home until he was too far gone mentally where it could not be explained to him what was happening he didn't accept it you know you can go and if you can make that transition while you're more mentally aware of what's going on and you make the decision and now you are in a home but like good family is trying to do you know we don't want to take you we don't put you in there you know you stay out here and he didn't want to go in right and by the time they got him in he got kicked out got kicked out of the home like he was too too violent um it was all it was absolutely awful the only blessing in all this is that he did die he he died relatively quickly after it got really bad um the the weird thing about this is like you you say we we lose our minds in their very selves who are we like who are you who am I what makes me me and if I behave a certain way what am I not me anymore yeah it's an interesting question and again it's a human question right it's um I don't I don't think we can I don't think we can think about this through the lens of any other animal um you know uh a meditator would say we are not our thoughts right I mean I think that that would be that would be one of the tenets of of mindfulness-based meditation is learning to create distance between our thoughts um but you know on some level we are right I mean I think on some level we are um we are we are our Consciousness we are our thoughts um I think those two I don't I don't think those two are mutually exclusive I guess is what I'm saying I think we I think we can I think it's very valuable to be detached from our thoughts and it's very important to understand that they are things that pass through our minds and that that that but but at the same time you know there are certain things about me that would cease to make me me if they didn't exist I had a woman on this podcast a friend of mine her name is Sarah Wilkinson her husband was a seal um Elite seal great reputation and she they got married when you know when he I think they got married actually before he was in Seal training and then she spent spent her his career with him and he he killed himself while he was on active duty um and what she said was the guy she married was not the guy that killed himself like he was a different person and look what was it it was PTSD it was explosive breaching like all those things that the brain gets exposed to and that's why I've been I've been thinking a lot about that idea lately is you know what makes you you and at what point are you not you anymore and I guess there's a lot of second and third or effects that go into that you know do you say hey if I no longer remember these things and I'm not me anymore then put me in a home let me you know put me on put me out out to pasture the uh the Alzheimer's disease the way it's described in the book when it's like uh it sounds like spider webs kind of in the brain is that what it is that's what it appears to be yeah I mean it's it's the word Dental you like dip that's the word you use there's a word Dental to describe what the brain looks like well there's um I was thinking of floss that's the only thing you know there are these proteins that get folded um and and amyloid is this is the Protein that's most associated with uh with Alzheimer's disease and if if this amyloid protein gets misfolded uh inside the inside the neurons it's uh it's an inflammatory process and then you get these other types of neuro uh fibrillary Tangles uh called Tau and they're kind of these structural Tangles around the neurons so so there's very much a physical process that's actually happening in the cells that are destroying the cells and um one of the challenges is that we don't have a direct way to measure those um in an early stage now as of right now we do have some pretty interesting advances where there are certain blood tests that can look for things that correlate very well with those findings both the amyloid and the Tau so we are just now starting to do this type of stuff where we can use a blood test or if you're willing to be a little bit more aggressive you could use a lumbar puncture so do a spinal tap on somebody and look at the cerebral spinal fluid we don't do that in clinical practice but they do that in research studies and you can identify beta amyloid and Tau in people who are still normal um and we can use that and you might say well what's the value in that I think can you do anything with that yeah I think the value in that is we can we can start to reverse that and we are seeing that uh now again this is still too early to tell because it hasn't been you know studied in a large rigorous fashion so anecdotally all I can tell you is we do see that making positive changes and there's you know we can list what those changes are can take people who are pre-clinical so either they don't have any signs of cognitive impairment or they only have mild signs called MCI of cognitive impairment and we can pull those people back what I don't think we can do is take people in Frank dementia and make a difference well speaking of what we can do about these things and and I'll I'll give myself a little reprieve here in saying that this next part of the book that you write part three of the book is the basically what we can do about it part of the book and uh you go through a section talking about thinking tactically versus thinking strategically which is a great thing to put in a book especially for my military perspective strategically obviously the big picture of what we're trying to accomplish overall in tactically how do we actually make these things happen and you say this in medicine 3.0 which I think we've described now and I apologize for not describing that more clearly out of the gate this is this is us trying to prevent things from happening medicine 3.0 we have five tactical domains that we can address in order to alter someone's Health the first is exercise which I consider to be the far most potent dominant in sorry potent domain in terms of its impact on both lifespan and health span of course exercise is not just one thing so I break it down into components of aerobic efficiency maximum aerobic output VO2 max strength and stability all of which we'll discuss in more detail next is diet or nutrition or as I prefer to call it nutritional biochemistry the third domain is sleep which has gone unappreciated by medicine 2.0 until relatively recently the fourth domain encompasses a set of tools and techniques to manage and improve emotional health our fifth and final domain consists of various drugs supplements and hormones that doctors learn about in medical school and Beyond I lump these into one bucket called exogenous molecules meaning molecules we ingest from outside the body and the beautiful thing about those is we can control all those different things we have some level of control over which is awesome uh chapter 11. exercise the most powerful longevity drug I never want to fight in the ring I always won in preparation Muhammad Ali uh this gives good background here several years ago my friend John Griffin pinged me with a question about how he should be exercising should he be doing more cardio or more weights what did I think I'm really confused by all the contradictory stuff I'm seeing out there he wrote behind his seemingly simple question I heard a plea for help John is a smart guy with an incisive mind and yet he was even he was frustrated by all the conflicting advice from experts touting this or that workout as the sure path to perfect health he couldn't figure out what he needed to be doing in the gym or why this is before I had gotten back into full-time practice of medicine at the time I was immersed in the world of nutrition research which if anything is more confounding than exercise science Rife with contradictory findings and passionately held dogmas backed by flimsy data are eggs bad bad or good what about coffee it was driving me nuts too I remember those days uh I started typing out a reply and kept on writing by the time I hit send I had written close to 2 000 words way more than he asked for the poor guy just wanted to click answer not a memo I didn't stop there either I either I later expanded that email to a 10 000 word manifesto on longevity which eventually grew into the book you're holding in your hands clearly something about John's question triggered me it's not that I was a passionate devotee of strength or training over endurance or vice versa I'd done plenty of both I was reacting to the binary nature of his question in case you haven't figured it out by now I'm not fond of the way we reduce these complex nuanced vitally important questions down to simple either ORS cardio or weights low carb or plant-based olive oil or beef tallow I don't know must we really make take sides the problem and we shall see this again in the nutrition chapters is that we have this need to turn everything into a kind of religious War over which is the one true church some extra experts insist that strength training is superior to cardio while an equal number assert the opposite the debate is as endless as it is pointless sacrificing science on the altar of advocacy the problem is that we are looking at these hugely important domains of life exercise but also nutrition through far too narrow a lens it's not about which side of the gym you prefer it's so much more essential than that more than any other tactical domain we discussed in this book exercise has the greatest power to determine how you will live out the rest of your life there are reams of data supporting the notion that even a fairly minimal amount of exercise can lengthen your life by several years it delays the onset of chronic diseases pretty much across the board but it also amazingly of is amazingly effective at extending and improving Health span not only does it reverse a physical decline which I suppose is somewhat obvious but it can slow or Reserve or reverse cognitive decline as well so if you adopt only one new set of habits based on reading this book it must be in the realm of exercise if you currently exercise you will likely want to rethinker and modify your program and if exercise is not part of your life at the moment you are not alone 70 percent of the U.S population is like you now is the time to change that right now even a little bit of daily activity is much better than nothing going from zero weekly exercise to just 90 minutes per week can reduce your risk from dying from all causes by 14 it's very hard to find a drug that can do that thus my answer to questions like the one my friend John Griffin asked me is yes and yes yes you should be doing more cardio and yes you should be lifting more weights yes I was so stoked when I was reading this part of a book because I finally felt like I was doing something good because I work out very religiously and uh that that was awesome so I should have had you read that chapter oh what do you think yeah yeah like don't you think a guest reading how did we not think of that that would have been cool yeah that would have been cool guest reading by Jocko yeah I could have thrown in this little chapter here um I would have to get somebody to help me you know put the phonetic pronunciation for some of the words uh what I was thinking so so that was weird 77 of people that don't exercise I am so if you were to ask me that question I would have said it was probably going to be at least 15 or 20 percent of people in America that don't exercise like that's how that's how much I mean obviously I own a gym I do jiu-jitsu I do CrossFit like everything that I'm doing I'm around people that work out and people that come up and talk to me all over the world they all work out so 70 percent that's crazy uh what with your patience is there anything that stops your patients from exercising when you get that patient that's like you give them the program and three months later he's like well you know next month I'm really gonna start for real because he hasn't done anything yet what's the what holds him back yeah I think there are probably a number of things so there's probably a subset of people who genuinely don't enjoy it um and I try to be sympathetic to that because I acknowledge that I genuinely do enjoy it now what's not clear to me is do I enjoy it because I just started it at such a young age and it's always been a part of my life and I've done it enough to appreciate the short-term and long-term benefits of it um you know one of the things I try to explain to people is that all of these things that we're talking about but let's use exercise because I think it's the most important have an advantage over of them that saving for retirement does not so it's not like rocket science that you would tell somebody when they get out of college and start their first job like you gotta you gotta put some money away right you got to save money for for when you're you know gonna retire and um that you know there's value in that and we understand that um but we should also acknowledge that when you ask somebody to do that there's no short-term gain that comes from that so if you're making a thousand bucks a week and you want to set aside 150 bucks a week there's lots of long-term gain to that but let's be clear you get nothing in the short term for doing that you're just a hundred and fifty dollars lighter every week it's 150 bucks you could be spending on anything and you are not but almost everybody would agree that there's value in doing this with exercise I can point them to all the long-term data and I I can make a more compelling case for this than I can for anything else again I can't restate this enough right like is it better to be fit than to not smoke yes is it better to be fit than to not be obese not have diabetes not have high blood pressure nothing compares to Extreme Fitness in terms of lifespan with with respect to all cause mortality and health span I can give them all of that that's like saying you can save that 150 a week and I'm going to give you the greatest rate of return I have an investment vehicle that's going to give you the greatest rate of return such that that 150 a week is going to be 10 million dollars in 40 years that would require a great rate of return but but I can say that guess what you also get something in the short term yeah you do like you get something every single day that you do it and that's why I mean by exercises this really potent drug and we can't replicate it because it's not just one molecule it's doing so much every single time you pound it right you're getting an endorphin raise you're getting an immediate response to your vascular system it's changing your energy levels it's allowing you to do things here and now that make you better there's a psychological component when you do something that is difficult in the gym or on the track or in the pool or wherever you choose to get your exercise and you develop a sense of fortitude again I'm saying any of these things to your audience is dumb right it's sort of like what's the expression it's like telling singing to the choir yeah singing to the choir saying something about the pope right so so I don't need to go through all of that but but if someone's never done it and they've never experienced the short-term benefits the inertia can be really hard so so again I think this is an argument for I think why we want kids to be active I think it's very important that kids are active because I think this is a very important lifelong skill and so again I you know I'm sure you've been asked these questions like if you could you know change one thing in the in the in the in the world today what would it be with respect to you know your particular issue and I think for me the one thing I would probably change is Institute a much more rigorous process of fiscal education and exercise um from from basically the time kids are born so it's just take all those movements that kids do perfectly which they do they're all perfect when they're born and just never let that go away and everything should be built around movement everything education should be built around movement isn't that crazy gone in complete opposite direction like they don't they have schools with no PE now and and when they do have PE it's like nothing uh no it's funny you're saying this stuff I don't need to tell your audiences but you actually when I wrote discipline equals freedom field manual I sent you speaking of chapters I sent you the chapter on physical fitness and I was like hey I got and on diet I was like hey man here's what I'm here's what I'm putting out how am I doing and you're like freaking good to go because which meant I basically had already been listening to you for a while so so uh that's cool but oh I wasn't gonna say oh I was gonna say this I this reminded me you talk about like putting money in the bank physically I remember when I was gonna join the Navy and I was like damn you know this is like 20 years a long time but I remember thinking to me as a 17 year old hey when I when I joined I'm gonna be in such good physical shape that when I get out I'll still be like good to go and I was right like it teaches you a lot about physical fitness and it becomes a physical culture of life is there anything so if you get one of these clients of yours one of your patients by the way you have a practice where you help people with longevity again I'm skipping all kinds of stuff today uh when you have someone that doesn't want to exercise have you found anything that helps them and I have to preemptively say this people ask me all the time like well how does someone get through SEAL training and some people say like you know you uh you've got to have something like really meaningful the fact of the matter is there's guys that like have an a girlfriend that dumped them in high school I'm gonna show her I'm gonna be a seal and they make it there's someone else that you know told his dad that I'm gonna do this and that's enough there's like it and there's someone else that's like oh they told me I couldn't do it at the recruiting station so I'm gonna do it just to prove them wrong there's and there's some people like oh I want to serve my country I want these people have an infinite number of reasons that they just make it through this program and it doesn't really matter it doesn't really matter which one you have some people you'll I I see people on like uh online will comment like you'll never make it through if you don't have the why or if you and I'm like bro you don't know this dude just like wants to prove his older brother wrong and he makes it like that stuff happens have you figured out a way to coerce that out of people so they understand the value that they'll get if they freaking exercise 90 minutes a week yeah it's a combination of things and it's different for everybody but I definitely do a little bit of carrot and a little bit of stick so the stick is usually showing them what the end looks like without it It's Going Straight Scared Straight well it's it's marginal decade reality right it's like okay so let's let's talk about the inevitability of decline well I don't know what you told Leif Babin but I called him today and he was like he's like breathing hard and I'm like oh what's going on he's like you know finish up a workout I was like oh I'm getting ready to record with Peter attia right now and he goes yeah that's why I'm here right now we're talking about that marginal decade man I'm I got my I'm not on the path right now which is funny you know I've been he's been hanging out with me for freaking 17 years but it wasn't until he looked at his marginal decade from you where he's like I better get my ass in the gym so there you go good job yeah and look part of it is we're all victims of what works for us and for me that's a very motivating thing like it's really motivating for me to think about that last decade I'm now old enough that some of the things that used to motivate me don't vanity motivates me less okay I'm gonna be honest like the first time I step a foot in the gym it was for a totally different set of reasons than the reason I lift weights today you wanted them guns yeah you didn't you didn't want it you didn't want to be you didn't want to be the scrawny kid anymore right you wanted to show everybody how strong you were how tough you were and that and and sort of none of that stuff means to me today what it did then so now I I have a different point of view but but I will say this look that's the stick part the carrot part is uh and this is this has come with with you know more years doing this is realizing that I just want someone to get a win because once they get a win they're going to get addicted to the win so when I start with that patient who's doing nothing I don't I hate when they say Peter what do you do because I'm like wrong question like for me to tell you what I do is just going to make you feel worse and make you feel like this is not you know achievable it's not achievable so let's forget that who cares what I do I've been doing this since I was a fetus basically what what do we want you to do and I will say something like hey if we can get you working out three hours a week well actually I take a step back and I go how many hours are you willing to give me of your time and they might say 90 minutes and they might say three hours and they might say five hours whatever it is but let's just say they say three hours I say great and I point them to the date and I say look with a three hour if you gave me three hours of your time and I could do whatever I wanted with you during that period of time and I promise we're not going to hurt you right we're gonna we're gonna take this incrementally you know this is how much we're going to extend your life potentially and we're talking about years and this is the difference in quality of life so I get them to buy into that okay then I say all right here's the formula half of that time we're going to do cardio half of that time we're going to do strength training and what does the cardio look like I show them what it's going to look like and it's not crushing we're just not there to crush anybody they don't have any aerobic base at this point so all I want them doing is really easy peasy stuff and it's just about habit building as much as it is about the stuff and it's like hey like this is a great time for you to listen to podcasts listen to audiobooks listen to music whatever it is in the weight room we're not I don't care what you do if you're someone who wants to go to a gym and work out on a bunch of machines because they don't look intimidating that's great but if you want to do something a little more complicated let's just get you carrying things can you you know and again it's a bit more nuanced because I want to make sure they can do it safely and all these other things but it's like what a step UPS on a box look like what does carrying look like so they might have this idea that they're walking into a CrossFit gym and they're going to be doing cleans and they're going to be squatting and deadlifting it's like no no you're not gonna be doing any of that stuff anytime soon um and and and I think if people give you three to six months of that I'm still waiting for someone who at the end of that period of time says I don't feel better and if they as long as as long as you get there your your home run then you're good yeah uh the chapter goes I mean the chapters all kinds of good detail in there zone two VO2 max strength training grip strength concentric and eccentric loading and you cover all kinds of stuff in there with in in clear language that helps people understand what they need to do so go get the book the next section here is the gospel of stability chapter 13. re-learning how to move to prevent injury this is like a journey that you had to go on and what does it mean to you when you when you want to explain to people what is what do you mean by the gospel of stability you know I mean this is a I think it's one of the most complicated chapters in the book and it was definitely the hardest one to write from a technical standpoint because I think stability is something people kind of understand but it doesn't really have a great definition I mean I Define it in there in the the you know the best ways I can but I think the easiest way to think about it is you know a stable body is a body that transmits Force to the outside world without dissipation of force and energy leak and it's one to which force can be applied without internal collapse and dissipation of energy or injury so um you know just an example thinking about that right like you know if if you're walking up a flight of stairs and or you're carrying something heavy up a hill and your knees hurt or you're walking down a hill and your knees hurt that's that's an energy dissipation right and and you can you can really go through what's the path of force from the point of contact which virtually every time we're making contact with the outside world it's our hands and our feet that are doing the contact and how is that force moving from your hand or from your feet into the center of your body because that's that's where it's always going right so you're you know your feet are transmitting Force through your ankles your knees your hips into your pelvis Etc and you know stability really comes down to you know creating an exoskeleton um that allows that force to be transmitted safely so the injuries that we have many of which are chronic but even the acute ones are usually acute on chronic weaknesses so you know when somebody tears their ACL that wouldn't necessarily have happened you know if you took 10 people and exposed them to that same Force at that same moment maybe seven of them would have torn their ACL three of them wouldn't have um and and a lot of that can be attributed to different types of strength so stability in the knee for example lateral strength in the knee um stability within the back explains a lot of why people have you know as I did lower back injuries and why um you know failure to generate sufficient intra-abdominal pressure can lead to energy leak so to me this concept of stability goes so hand in hand with strength because a big part of Health span is not just being strong and having you know good cardio respiratory Fitness it's also being free of injury it's being relatively pain-free um and I think that a very important part of this journey for me personally has been learning how to manage the sins of my youth from an injury perspective I I I often get asked about like you know this kind of stuff especially with Jiu Jitsu people they're like oh you know you what what injuries have you had and I'm like um I'm pretty good to go you know I'm pretty good to go and I think the reason that I'm pretty good to go again knock on wood a thousand times is because I I work out and I work out religiously so I think that when you you know you put your foot down you put your arm down and you get injured because that's what happens we have a friend that just towards ACL like just taking a step literally like he's doing Jiu Jitsu but he wasn't getting heel hooked he wasn't no nothing Dynamic he was taking a step he's actually taking a step backwards felt a tweak falls down on the mat like holding his knee torn ACL from nothing scary but I feel like working out lifting squatting doing pull-ups doing dips I feel like those things I feel like I feel like I have pretty good stability I I at this juncture I need to work on my flexibility again I I worked on my flexibility several years ago and I got flexible and I felt good about it and then I I'm the worst I'm the worst which like give me an example of something that is is sub-optimal for you my shoulders are really really inflexible right now they're really inflexible night and I've lost a lot of mobility in them and I've just started getting it back started proactively doing the stretches that I did for I just I just shoulder that hurt me one time this was probably 15 years ago maybe even longer than that yeah it's probably 15 or 20 years ago I had a shoulder that was constantly hurting constantly hurting constantly hurting and finally I did like religious stretching and the pain went away and the mobility increased and it felt great so I'm gonna go through that protocol again and get it back but those are the kind of things where I know and another thing you know I had to uh you know burst siren from sorenex no anyways I had was oh builds gyms built my gym but we were having a conversation and it's really easy to have an exercise that you for whatever reason can't do for whatever period of time for instance a pull-up right you could say oh I hurt my shoulder can't do a pull-up it's very easy to never do a pull-up again in your life and that's not good so what I told him is like I don't even whatever I try and keep the exercises that I've been able to do before and continually try and maintain them and if for some reason like I I got a I got an arm injury by Dean Lister my friend my coach he's showing a jiu jitsu move he's never hurt me while we're training in 20 something years he was showing a move and like really hurt my arm and so for six or seven months I couldn't do an overhead squat because I just could not ex you know you gotta kind of lock out your arms under overhead score I could not do it and when I finally could extend my arms again I could I just didn't have the strength anymore and I could see I was like oh that's what happens to people what happens to people is they go oh I guess that's gone and I said to myself I will not submit to this I will give me the PVC pipe where let's start again let's go and slowly started building that strength back so I think that's what happens and I know we've got a section in here about or maybe we already covered the section but you talk about the fact that you you see people get derailed matter of fact one one of the stories you telling here is one of your friends moms she was healthy doing well she fell broke hip FEMA or something and then all sudden you can't work in the garden you can't walk around anymore and everything falls apart that's why here's you want great here's some great piece of advice I don't know if you have this in here this is from me because I get asked this question all the time I hurt my arm I hurt my back I hurt my whatever I'm sick what should I do and this is such a good answer I'm going to give it to you do what you can you do what you can you look you used to be able to do 20 pull-ups and now you can only do a negative and only on one arm right now because your shoulders hurt and your other arm cool do what you can oh you can't run anymore because you got your knees tweaked cool but you can go on the hand bike cool do what you can and then try and get back try and try and aggressively go back not too aggressively but go back and and retake those exercises retail I was I was uh building a house and while I was building a house I was living in another house my house that I was living in had a garage where I put my garage gym with whatever seven foot ceilings I couldn't do muscle ups in those and I didn't think much about it it wasn't like I was injured or anything I just oh you know and it took 18 months to build the house so for 18 months I would wasn't really doing muscle ups didn't really think about it again you know you just couldn't couldn't go up that high so it just wasn't doing didn't think about it I was really excited I got back to my new house had my I have I have 20 foot ceilings in my garage now so like I can do Muslims rope climbs everything but I did that first muscle up workout and I was like oh oh you got weak in this pajama look I did dips the whole time I did pulse all time but I got weak and then I just had to rebuild that that's a good thing is if you've had to rebuild before from an injury you realize that you can rebuild you had the shoulder surgery yeah so I had um I tore my labrum probably for the first time in boxing anytime you once you dislocate or sublux your shoulder you're gonna damage that labrum and so I had multiple subluxations in my in my teenage years and then swimming you know as an extreme distance swimmer that that sort of made things worse so by about 2012. it was it was sufficiently bad that I knew surgery you know I knew I was going to need surgery but I met you know some really good folks who rehabbed me to the point where I was doing awesome so in 2020 when we came to Austin um I you know met this awesome well actually I'd met him many years before but he happened to be in Austin he was an orthopedic surgeon that split his time between New York and Austin named Alton Baron and I went to see Alton having a little shoulder pain and he said well let's do another MRI it's been you know eight years since your last one and it's like yeah it's horrible like dude you're you don't have a labrum it's just it's all hanging off there and more importantly that explains your symptoms right the MRI by itself doesn't actually tell you the whole story it's let me examine you and see where your pain is and um he's like yeah I mean luckily you do so much other stuff like your rotator cuff is in amazing shape it's so strong but your rotator cuff is stabilizing your shoulder um and not your labor your labrum is what should be holding that in place so I said so do I do you think I need surgery now he goes no I wouldn't I wouldn't do it until you can't take it anymore like let's see how far you can milk this and I was like great and then finally in one day in 2022 January 2022 I was I was uh driving my car at the racetrack and there was just something about the way I was getting in and out of the car that day that just finally tipped it over the edge and to make a long story short we were like yep okay now it's time to do the surgery so we did the surgery in March of 22. and I actually put a video up on Instagram of him examining me under anesthesia on the table because that's the only time he could ever fully demonstrate how loose the shoulder was because I had to be under general anesthesia for the rotator cuff to relax and it's one of the most gruesome videos you'll ever see it's like I'm sitting up intubated oh I remember this yeah yeah yeah yeah and he's just gone and I mean it's like he demonstrates like if there was any doubt that you needed this surgery we just erased that doubt so I have the surgery and um it's so funny to hear you talk about you know what you just said because these are all my fears right it's like you know grip strength is such an important part of my existence like so much of what I do is predicated on being able to carry things being able to hang being able to do pull-ups you know the dead hang is one of my favorite tests it's a it's not a regular part of my training but it's a test set twice a month I will do a dead hang for time and there's something we do with our patients and you know my goal was to get to five minutes you know five minutes is generally considered the gold standard like if you can dead hang for five minutes you're you're really special I'd never got there but I was at like four four minutes and 36 seconds or something how big of a bar um probably like a oh oh you know I do it on a 45 like a regular like okay yeah um so I put that up on the pull-up bar can it rotate while it's there it doesn't okay yeah it's it's sort of locked in cool cool um my wife by the way first time she ever did a dead hang went 308. damn like that's ridiculous for anybody but for a woman that's really strong um so I knew that post-surgery like it was going to be and again not this is not true for every shoulder surgery but because of the because of the nature of mine I knew it was going to be six months before I could deadlift and it was gonna be six months before I could carry anything very heavy so I knew how much my grip strength was going to decline so I did as much as I could around it right so it's funny the day after surgery I was in the gym in a sling doing leg extensions and leg curls and within three days I was even able to do this other machine where you strap a belt to your waist and you do like you know sort of like deadlifts but without holding the bar so it's um but I'll tell you what here we are today 15 months post surgery I still can't get the four and a half minutes like and I'm working at it but that's like I tell this story to say when you lose it it can take a while to get it back and why this matters is the most important rule of working out is don't injure yourself doing it because once you get to a certain age anytime on the sidelines is going to just make it harder and harder to get back so you know you alluded to the broken hip story right I mean these statistics are so important to understand for two reasons one is so let's just State the stats once you're 65 and up if you fall and break your hip or femur depending on the study there's a 15 to 30 percent chance you're dead in a year the one-year mortality of a broken hip or Femur for those age 65 and up is 15 to 30 percent what's equally tragic in my mind is of the 70 to 85 percent of people who don't actually die half of them will have a full level reduction in Mobility meaning if they were able to walk easily before they will require a cane for the rest of their lives if they were walking with a cane before they will go to a walker if they were in a walker before they will go to a wheelchair that's called a full reduction in functionality what if someone's a freaking stud and there's 72 years old and they break their femur doing jiu jitsu they're more likely to survive than someone who's not right because I mean again there's a lot of acute things that can go wrong you know you can have a fat embolism you can have a you know a pulmonary embolism there's a lot of stuff that can go wrong in the perioperative phase but a big part of why those people die if they don't die immediately it's the inactivity it's you know once you reach a certain age it can take six months to 12 months to put on the amount of muscle you'd lose from 10 days of inactivity think about that for a second right like 10 days of inactivity is not a lot for someone who gets injured if that's like you oh you went on vacation and decided oh you know what I'm just gonna relax and you didn't work out well it's funny you say that I mean this is one of the things we talk about a lot with our patients is we've got a lot of patients and at the end of the year they're not making gains and what we're realizing is you know you're in Ibiza for a month like you undid all the work you did now again you're not killing it for those 11 months but you're doing good enough for 11 months but you just undid it in a month what is that what is that when you're 23. um I don't know but it wouldn't be as dramatic it seemed like when I was 23 goodness nothing matter yeah it was just it was just like nothing mattered just do whatever you're still it's gonna Crush yeah yeah but but you know the experiments that are done are done in you know 60 65 year olds and as you get older you become more anabolically resistant that meaning literally it is harder to experience anabolic function you require more protein to make the same amount of muscle um you good more steak let's go so you can continue how much denial there is over here on my side of the table like I'm like hey the guy I was talking about earlier that won't happen to me that's me all day long that's my attitude it's freaking jacked up or it's really cool I don't know what do you think Carrie I think it's good to go more steak more milk more Jujitsu just keep it rolling now uh so you again the chapter and go ahead oh no I was gonna ask you tell me tell me a little bit about um I mean Jiu Jitsu fascinates me I don't do it I've never done it my boys both do it they love it I'm so happy to see them doing it um it seems especially the younger ones still you know you just have a hard time getting his attention sometimes but um but the older one who's eight like it really is the thing he loves um I can really see him doing this uh as as his thing he loves it in a way that he didn't love any other thing he tried yes um and so you know like do kids get injured doing this I mean like what are the what are the what are the things that a parent needs to understand as their kid is doing Jiu Jitsu kid's gonna get internet Jiu Jitsu same likelihood soccer basketball uh whatever else what are the main injuries are they head injuries are they shoulder injuries knee injuries knees shoulders elbows just sort of like they're playing basketball um so it's more resilient because it just freak bounce back so much quicker kids honestly my kids didn't get hurt during Jiu Jitsu like they were doing Jiu Jitsu seven days a week from the ages of zero no from the ages of five to like for the girls five to twelve and for my son five until current time and they never had any kind of serious injury my daughter that did gymnastics got injuries from gymnastics my daughter that did ballet got way worse injuries ballet is crazy um so I don't think there's like huge for kids I think it's great and what about the opposite end of the spectrum like what are the oldest people you have coming into the gym 60 yep but no one in their 70s and 80s there's people that there's people that compete at 70 they have a master's division at 70 and up uh it's definitely you know depends on the person um you can do it I mean Elio Gracie the the founder of Gracie Jiu Jitsu he was doing Jiu Jitsu and rolling until you know he was in his 80s 90s still doing it so you can do it I think it can be a lifelong sport I think it'd be a lifelong sport as much as as much as tennis or golf or you know people play pick up basketball I mean it just depends on what you do with yourself and if you let those little movements slip away and you don't say to yourself hey I'm gonna get that movement back you know if you don't do that it's going to go if you don't if you don't use it you're gonna lose it that's that's an accurate statement so I the other thing that's great about Jiu Jitsu is you know they're going to get cardiovascular work they're going to get strength training they're gonna get flexibility all from one big thing so that's kind of nice too not to mention they'll never get they'll never get beat up at least not in school by someone their own age right can there be a 16 year old when they're 12 yeah but generally speaking 16 year olds don't beat up 12 year olds like generally speaking they might bully them they might push them around but you usually have peer or near peer bullying situations and so so they're not going to get bullied which is amazing they're going to be able to protect other people and what's interesting they generally speaking will not become bullies because they understand what physical confrontation does to people and they don't like it and they recognize that it's not a way to get power over people so it's beneficial across the board across the board freaking awesome do you have an occasional like catastrophic injury in Jiu Jitsu yep competition yup with kids competition they generally hopefully have referees that will stop the match if you know a kid gets in an arm lock and he's not tapping because little kids they won't tap they want to win so bad they won't tap and so a good ref will stop the match you win you know the other kid wins sorry you you shouldn't have gotten caught in that position I always coached and refer like that hey I don't care if you weren't going to tap you were caught in that position you lose but but they also are pretty safe the way they do it in terms of they don't allow certain submission holds at certain ages because you don't have the maturity to tap out there's moves in Jiu Jitsu there's a move called the heel hook which is putting torsion on the ankle but what it ends up doing is it's very strange it's very different than other submission holds because it doesn't hurt until it until it injures you so you can see a lot of people they don't want to tap they don't want to tap they don't want to tap boom and you don't want to tap do they know they're in the heel hook they know they're in the heel hook generally so they're just thinking I can get out of this I can get out I can get out can you get out of it you can yes you can you can get out of some heel Hooks and that's what they're trying to do and I always we know we as instructors instructors in general always saying Hey listen this doesn't hurt on arm lock it hurts before you're injured a a a choke you just go to sleep um a straight knee lock it hurts before you're injured but the heel hook I mean you tell me you're the doctor like you don't have nerves inside your knee by your ACL that's telling you there's pressure there right that's just there and what would the purpose of being they're being nervous I don't guess there wouldn't be any so in in the heel hook manipulates the the knee but it's the the pressures coming from the heel and the foot right so with like any straight arm lock or anything like that the pressure is directly on the joint that you're manipulating yeah this one's like you know the the next one in the chain that's actually getting the the pressure and the Damage yeah there was just uh my kids just sent me a video of someone getting heel hooked and luckily for the person that didn't tap you could see that it broke their tip FIP it just broke the bones which is great because then you're fine you know you get four weeks later it's stronger than it was you know that acl's lifelong you're dealing with yeah so yes Jiu Jitsu safe and beautiful for your children the most important thing you can give children even more important than love uh you got a whole chapter about that stuff stability you go into nutrition here and you kick it off with you say potato I say nutritional biochemistry which is classic then you got a a quote from Feynman in here religion is a culture of Faith science is a culture of doubt very important to understand and you tell a story in here I'm not going to read it but it's the same story that I freaking had with my wife who used to be like you're not allowed to talk about nutrition with my friends like and this was in the I guess it was in the 2000s where I was pretty fired up about nutrition and of course my wife's friends would would go crazy at the table with me you know oh you're giving your kids poison that's cool that was how I'd open up the conversation um and then you say this uh actually you say I am no longer a dogmatic advocate of any particular way of eating such as a ketogenic diet or any form of fasting it took me a long time to figure this out but the fundamental assumption underlying the diet Wars and most nutrition research that there is one perfect diet that works best for every single person is absolutely incorrect more than anything I owe this lesson to my patients whose struggles have taught me a humility about nutrition that I never could have learned from Reading scientific papers alone so that's what you figured out people are different and again Perfection can often be the enemy of good um and and so we we want to be careful that we don't um lose sight of what is known and what is speculated and what's a first order term versus a fifth order term and I think what's abundantly clear are the first order terms give me an example don't be overnourished and don't be undernourished consume sufficient enough protein to support the anabolic activity of muscle uh derive sufficient micronutrients from your food vitamins minerals things like that avoid toxins in food that's about it so good advice I I had a friend here at this gym and he was got pretty chunky we might go so far as to say he got fat he was overnourished he was overnourished and then you know six months later he's back to his kind of fighting weight and I said Ralph you don't even cut some serious weight huh I said yeah yeah I did I said would you like what'd you do he said I stopped eating like an [ __ ] and I was like everybody that's that's probably a great diet stop eating like an [ __ ] because we all know what that means and you don't have to read a freaking book or be a scientist to know what eating like an [ __ ] donut [ __ ] right if we could go down the list like how much spaghetti can you possibly eat I can eat it all if I'm an [ __ ] to myself um yeah it's I found it very helpful that you are explaining to people and then you go you go into you know you talk about everything in this chapter um and and you hit the dietary I mean that's kind of the irony of this I wrote two chapters on nutrition it's a 17 chapter book exercise gets three chapters that's insane nutrition gets two everything else gets one and um you know there was a part of me that wanted to do a very glib chapter on nutrition which would have been a paragraph basically just stating the kind of stuff we're talking about don't eat like an [ __ ] yeah it's like look be an energy ballast get enough protein avoid the toxins get the right but but of course I go into the detail right which is you have to be able to answer three questions about yourself or anybody else if you're in the business of trying to treat this and and again it's really easy to get the answers to these three questions are you over nourished or undernourished are you adequately muscled or under muscled are you metabolically healthy or not when you know the answer to that question then it's just a matter of understanding do you need to increase intake decrease intake maintain intake go up or down on protein and what do you need to do with exercise sleep and all the other things that factor into that vis-a-vis metabolic health for most people the answer is you need to eat less you need more protein so you need less total calories you need more protein calories and that's what brings it full circle to strategy versus tactics right so there are basically three strategies to reduce energy intake dietary restriction calorie restriction time restriction so once you identify your strategy then you can get into all the tactics and the tactics is where the religion happens people get crazy it's unbelievable you were kind of crazy yeah bro you were doing I went out to dinner with you in New York it was like you me Tim like just a a bunch of dudes and we were out having a good time I still remember the restaurant yeah I was freaking delicious but you wouldn't know I would not because you sat there with an empty plate in front of you because you were in the middle of a fortnight five days into a seven day pass or something yeah oh that was awesome I that you really missed out that night though that steak I got was amazing I've been back since my place you tripled down uh so look again I I just have a note here that says get the book because this is a textbook this is going to help you do an assessment it's going to help you answer those questions and then guide you in in a direction of which of these strategies and tactics you can utilize to sort your nutrition out um the next section is the Awakening your favorite section yeah and you know what I figured this was gonna happen so I broke out my book discipline equals freedom field manual and here's what it says sleep is a necessity humans need sleep failure to get enough sleep has serious side effects lack of sleep can cause negative hormonal changes interfere with the metabolizing of glucose increase blood pressure and suppress the immune system less sleep also means less human growth hormone in your body which means less muscle mass and weaker bones mentally the brain is impacted as the ability to pay attention and concentrate begins to diminish and problem solving and basic reasoning become less acute furthermore over an extended period there are psychological effects like paranoia and even hallucinations so that's me you're on it you got it that's me I wrote that now because you know like I don't know people think uh I wake up early I've always waked up early I've always woken up early and um people think I don't believe in sleep or that you need sleep and I'm I'm not like that I actually understand that people need sleep and the and quite frankly other people need more sleep than I do that's just the way it is I'm not bragging it's been like that my whole life I have I don't need a lot of sleep and that's the way it is but I've never told anyone like hey you need to sleep less I've never told anybody that let me confirm I don't think I've ever told anybody that I've never told anybody hey you need to sleep less um and you go into some pretty great detail in this book about sleep and it actually you know I'll just read the section old man blood uh scary as it can be in some situations this short-term harm done by a knight or three of poor sleep pales in comparison to the damage that we do to ourselves if this situation continues Kirk parsley who's been on this podcast observed this when he was a physician to the seals he was also a seal outwardly these men appeared to be prime physical specimens finally honed in the rigorous training but when parsley analyzed their blood test he was shocked many of these young guys had the hormone levels and inflammatory markers of men several decades older than them old man blood parsley called it because their training exercises and missions often begin at odd hours of the night and required them to stay awake for 24 hours or more at a stretch they were chronically sleep deprived their natural sleep wake Cycles utterly disrupted when Kirk told me the story I experienced a jolt of recognition too I I too had had old man blood during my not thin Peter phase this earlier part of the book where you were uh not you were in good shape swimming freaking to Catalina Island but you're also a metabolic disaster and not looking as lean as you should according to your wife who said you should try to be a little what'd you say a little less not thin with elevated insulin high triglycerides and a testosterone level in the bottom five percent of men in the United States I'd always attributed my poor health and hormone imbalance to the point of my at that point to my lousy diet and diet alone but I had also spent at least a decade in a state of severe sleep deprivation in residency and afterward belatedly I realized that not sleeping had actually caught up to me as well it was probably even evident in my face Studies have found that people who sleep less chronically tend to have older looking flabbier skin than people their same age who sleep more now I recognize that sleep diet and risk of long-term diseases are all intimately connected to each other knowing what I do now I would bet that a few months of perfect sleep could have fixed 80 percent of my problems back then even on a crappy diet sleep and I remember you know just to make sure people understand why I make such a bold statement there because I was exercising 28 hours a week yeah in other words I look back at that and say how is it that with so much exercise I was still you know in the state I was in and I think that there are extreme cases with extreme sleep deprivation where you know because the old saying the old adages can you out exercise a bad diet and the traditional thinking is no the truth of it is you could if you can exercise enough like when I was growing up I could clearly out exercise a bad diet because I had the world's worst diet and I was probably six percent body fat and fit as a fit like I mean I look like a specimen and you also had freaking like high testosterone of course so there's clearly a scenario when you can but the difference is like it I couldn't exercise that much today if my life depended on it you know I mean I asked this question of a couple of our mutual friends right who were former seals who live in Austin now and one night we were having dinner this is probably like a year or two ago and I was like okay I get from having talked to enough of you guys that like getting through buds is mostly here like you know I get that well you guys are no more mentally you guys are probably at least as mentally strong today as you were then could you get through buds today and every one of them said no and the reason is they said we don't physically recover the way we used to like we couldn't do that volume of suffering today in our late 40s and early 50s and so that's why I just think the strategy of I'm gonna out exercise my bad diet like that strategy will not work Beyond a certain age and that age is pretty young sleep introduces another wrinkle to that which is really bad sleep and really bad diet there's no there's no out exercising that at any point either yeah I think when uh when it comes to females going through SEAL training I think one of the things that's going to be very problematic is the ability to recover quickly enough because they just don't have like the testosterone I don't think they have the hormones to to recover because you are getting a beat down you are getting annihilated and it's hard six months right six months yeah and what I think would happen is I think that what would happen was if you took an extremely fit person which I had a actually was life life and I were having a discussion this discussion as a matter of fact and tia Claire to me who's a CrossFit Champion I mean just an incredible specimen of a woman just badass and I was saying I said you know I mean you take someone like tear I mean I said she got she can deadlift more than me and he's like no she can't I was like bro she's she's like a professional athlete of course you can blah blah and um and uh and he's like no there's no way and I'm like I bet she can he's like I bet she can't we looked it up and her deadlift I think it was you know 405 you know which is a little freaking outstanding for a girl but for a man that's pretty normal right right it's pretty normal but so so but it's still like so she's in the she's in the ballpark right she's in the ballpark but if you um I think what would happen with a female in Seal training is that like they give you the weekends to recover but you're barely recovered on Monday morning barely and then you you go another week and you have to recover again and again and again and I think what would happen is someone is buds the worst of it as far as as far as the physical uh demand and the the recovery or lack thereof it's not it's not well it's not because you'll go overseas and you'll be in some situation where you'll be getting crappy nutrition and even worse sleep or just as bad sleep and you'll be nervous and like it's gonna be worse it's going to be worse uh so that's what I think would happen is I think I think they would need recovery time and they just wouldn't have they wouldn't be able to keep up over they probably they'd probably be in the top 20 on the runs and swims in the first week they'd be in the top 40 in the runs and swims in the second week they'd be in the bottom 50 in the third and fourth week and then and then they just would continue to go down and what was the at the at the worst of your training I assume hell week was the biggest sleep deprivation you've ever experienced in a in a training not not in real life yeah it is and is hell week 30 years ago the same as hell week today in terms of sleep deprivation damn close okay yeah yeah yep it's it's for yes it's the same it's the same they'll sleep they sleep a couple hours and usually why they put you to sleep is to get people to quit because on you know you've been awake for Sunday and then Monday and then Tuesday and then they'll come and say like Hey listen we just got in trouble with the commanding officer and he says we've been too hard on you guys and he's now told us that you guys need to you guys are going to get six hours of sleep and you have to get dry so go put on dry clothes and you guys will see you in six hours and then you're like oh of course you put on dry clothes and you crawl into bed and then 20 minutes later or an hour later or 40 minutes later they're in there with Bourne sending you right back the surf's on a bunch of people like I'm out dude I'm not getting back into this game so and they do that a couple times they do that or something like that so that's why they let you sleep they let you sleep so that you have to wake up and go back into hell so that's a transitional period that something how much use is there of stimulants uh what kind of stimulants modafinil uh you know Ritalin things like that none do they check guys for that or like I mean in your day and age those things weren't popular but today those are very popular drugs that any high school kid could get a hold of do you have any idea if they're they drug test the [ __ ] out of these kids they do so you're getting drug tested during Halloween I don't know if they drug test them during hell week but certainly after how weak and prior to hell week you're you're getting drug tested a lot um how much do you eat during hell week as much as you want you eat it well yeah you eat a ton you eat a ton that's that so you're not limited on nutrition nope you're you're basically and then um um coffee you can have coffee I don't know I did I didn't drink coffee I still don't drink coffee and I don't know if you could drink coffee I don't think you can I don't think you can drink coffee during a week but I don't know by the way there must be a real difference between if you get your if you're doing your hell week in January versus August there's a big difference is the dropout rate significantly higher in January it's higher it's higher for sure I mean it's you know the deal to San Diego it can be 37 degrees yeah you know it could be 37 degrees the interesting thing is what is it in the winter hell weeks the the cold so you'll get more quitters in summer hell weeks they'll get more chafing and more swelling and more disease but more people will make it because cold is it what month did you do it spring I think May late May and here's the other thing like when you're when it's winter time they check the water temperature they put you in that water until someone's getting hypothermia oh so you'll spend less time in the water from January so that means in the winter time you're running more you're doing more and some for depending on who you are because some people you know that did cross country they don't care if they run they'll run all day some people that did water polo they'd rather swim there's some people when you go to a pool Evolution it's it's a rest for them I was very comfortable with my water any of the pool not the swims but not tying pool comp well I failed pool comp but uh life-saving those kind of things drown proofing I was they were like a break for me some people were absolutely horrified of those things uh some people you know you take a kid that ran cross country in college he's doing a Four Mile time run there's no doubt that he's going to pass and he's going to be fine a guy that swam in college or played water pool he's going to pass those swims really easily so people depending on what your strengths are you'll have some time where it's you'll get a little reprieve um but they'll find your weakness too because no one is good well just about no one is good at everything and even and you will get some studs you'll get some freaking guys that are complete and utter studs and occasionally make them sometimes they quit sometimes they quit because they lost something for the first time you know they never lost a race before and that's too much for them they never failed pool comp like I did you know I failed all kinds of stuff in my life so I felt pool compost like cool what I need to do to fix it um but the sleep deprivation thing you know some people have bad hallucinations and stuff and I didn't really have I had like one hallucination you know as we were paddling our boat and I looked across the ocean I found I saw a traffic light and I was like and I knew it I was like well there's we're in the ocean so there's no traffic light I'm just hallucinating and it wasn't that big of a deal I recovered from Hell Week pretty quickly and like I said I've always been I'm I'm very functional without sleep as well very functional like when I hear uh Matt Walker and he'll say you know if you've had less than five hours of sleep you cannot you're basically it's equivalent of four beers or it's equivalent of whatever that is just not true with me and it's not true with many of my friends too it's not true with many of my friends or at least a decent amount of my friends I I just went out to I I was I did an event in Las Vegas got on a red eye slept two hours on the red eye arrived at my next gig and was speaking and interacting and answering questions for eight hours like literally no Factor literally no factor and and so I don't know I think there's some a little bit of exaggeration or something with that or I don't know am I wrong I mean I don't know exactly what the stats are I kind of forget but it's um I don't think it's four beers I think it's is it four hours is equal to a blood alcohol of 0.08 maybe that sounds about right yeah baby yeah there's no doubt there has to be there has to be personality what you get some alcohol be I'm a different man you want to see some changes bro and it could be no sleep lack of sleep it's gonna be gets to get me on the sauce get me on the fire water and I'll you'll meet a different Jocko all day when did you stop drinking basically when I retired yeah so that was in 2010 and I didn't like yeah there wasn't like yeah just all of a sudden I wasn't hanging around with a bunch of my friends anymore and I I just stopped and I looked up and I was like well no point in doing that anymore I mean and I well at the World Cup I had a I had a Guinness you know I I don't I don't like the taste of alcohol anymore at all I don't have any desire for it and man I've seen it just destroy so many people that I just can't I can't get on board I can't give money to that industry I just can't do it I'm I'm I'm I'm becoming more and more anti-alcohol every you know every moment of my life now and and look I I've been kind of giving the caveat that you know I had a lot of fun and bonded with the guys and I've started to just like kind of kind of think about that too and think well how much fun would I been having if I wasn't drinking what if I wasn't doing that what would I have been doing what did I miss out on so I'm even starting to revoke that caveat a little bit as I get older and and you know the culture was very strong for alcohol in the whole military and it was even stronger in the SEAL Teams and you're a frog man that's what we're doing and I was like cool that's what we're doing I'm here I'm here to be a frog man let's go that's what we're doing I'm in and I'm gonna do it hard so watch this but thankfully I you know I always also you know some people have the they say oh I have an addictive personality and it's almost like a humble brag um like I have an addictive personality I think you actually do have an addictive personality to some things yeah I don't think I have it like I'm like okay cool I don't yeah I I can stop doing something maybe jiu jitsu's a little bit but but you know I go I go times where I can't train and I don't freak out about it so I don't think I have an addictive personality and it scares me when I think about people that do have that it's scares me to think about what it must be like to want to drink alcohol or do whatever thing so badly that you can't control it that's that's very scary to me I think I have a little bit of I think I have a little bit of I like to be in control of what's happening and which is weird because when it comes to leadership I don't have that at all I don't need to be in control and everyone that works for me will tell you like oh yeah Draco is like he's crazy he'll let me do whatever I want because I had somebody say something to me about that about me wanting you you want to control stuff I'm like actually I don't care I talk to anyone that's ever worked for me unless they were an idiot and I had to micromanage them which is a very small category of people but most people they work for me they're like doing whatever they want and I'm giving them free reign and backing them up and supporting them but for my personal life I don't like to uh feel like I'm going to lose control or feel like I can't control something that's happening so that's what scares me about the oh it doesn't scare me but the the Psychedelic you know voyages that people are going on because and the way I explained it to some of my friends that have been on these voyages and it's been very helpful for them and I've said like well I feel like I'm driving down the road at 80 miles an hour in my vehicle I don't think I need to stop pull over to the side take apart my engine put it back together again and like hope I got it right it doesn't seem like a worthwhile risk to me and I don't feel like I have you know that I don't feel bad or feel good I'm happy so um there there's my my thoughts but sleep back to sleep uh the the other thing is you can only the short sleepers the genetic short sleepers which I don't know if I'm one I don't I don't really think I am because it sounds like it's so rare that it could be impossible that I could be one I used to think it was genetic because one of my kids is like the same way doesn't need to sleep one of my kids my oldest daughter doesn't need to sleep my middle daughter go pull her out of bed you know my wife pulled her out of bed my son somewhere in the middle my youngest daughter pulled her out of bed so I thought okay well that makes sense different jeans um but then when I hear how rare it is that you're actually really a short sleeper I'm like well then it can't be me but I can survive for sure on a pretty small amount of sleep without really much inhibition and I don't think that's cool in fact I want I want to sleep more I want to like let's go uh but to your point which you explain in great detail in the book there are all kinds of negative impacts to not sleeping enough and you've got a section in here about okay get the book go get the book um but you know don't drink alcohol don't eat anything less than three hours before bedtime abstain from electronics for at least one hour before bed avoid doing anything anxiety producing or stimulating such as greeting work email or God help you checking social media uh for the folks that have access to a sauna or a hot tub go getting that before bed room should be cool ideally in the mid 60s I hate to sound like one of those people that I I guess I am now but I have a Asana and I have a bed cooler thing and that bed cooler thing is legit yeah it's amazing it's freaking legit it and when I had it's cold and so like I don't really have like the crazy sweat nightmares anymore I guess they're more in Arctic environments but it works out good uh give yourself enough time to sleep you call it sleep or scientists call it sleep opportunity fix your wake up time don't deviate it from it even on the weekends this is where I feel really lucky because my boys especially the middle one he's like I mean this kid is on a clock he cannot sleep past 6 a.m yep so we don't sleep past six a.m you don't doesn't matter if it's a holiday doesn't matter if it's a weekday it doesn't matter if it's a weekend it's we're always up at six and uh there's something good about that right you you don't get into what's called social jet lag which is when people try to you know shortchange their sleep during the week and then make up for it on the weekends it doesn't work that way yeah or you do the opposite this is what I've always advise people oh it's Friday night so I'm gonna go out a little later I'll sleep in okay so now you wake up at eight and now it comes to 10 o'clock at night you're not tired that's right because you had more sleep so you stay up until midnight and now you next week until 10 and now you can't go to sleep until one o'clock in the morning and now you're for you're getting up early on Monday and it sucks so so there you go um get your sleep everybody from me get your sleep definitely from the doctor here get your sleep chapter 17. work in progress the high price of ignoring emotional health health and this was the surprise chapter on Tuesday July 11 2017 at 5 45 pm to be exact I had received a call from Jill my wife she was in an ambulance with our infant son Arrington on the way to the hospital for some reason he had suddenly stopped breathing and Fallen unconscious his eyes were completely rolled back in their sockets and he was lifeless and blue with no heartbeat only the quick reaction of our Nanny had saved him she rushed him to Jill who is a nurse her Instinct took over she immediately put him on the floor and began performing CPR rhythmically but carefully pressing her fingers on his tiny sternum as the nanny frantically dialed 9-1-1 he was barely a month old by the time the firefighters stormed at the house about five minutes later Arrington was breathing again and his skin was turning from Blue back to Pink as oxygen returned to his body the firemen were stunned we never see these kids come back they told Jill to this day we still don't know how or why it happened but this is likely what occurs when baby dies when babies die suddenly in their sleep they choke for a moment on their own saliva or some other insult occurs and they ver and they're very immature nervous systems fail to restart their breathing when Joe called me from the ambulance I was in New York in a taxi on 45th Street on 54th Street on my way to dinner after she finished telling me what the story I just said without a shred of emotion okay call me when you get to the hospital so I can talk to the doctors in the ICU she got off the phone pretty quickly and of course it's obvious why she was upset our son had nearly died and the right thing for me to say the only thing to say was that I was getting the next flight home Jill stayed in the hospital with Aaron alone for four days she pleaded with me to come home I called in Daily to talk to the doctors and discuss each day's test results but I stayed in New York with my important work Aaron's Cardiac Arrest happened on a Tuesday but I did not come back home to San Diego until Friday of the following week 10 days later even today just thinking about what happened I feel nauseous about my behavior I can't believe I did that to my family I can't believe what a blind selfish checked out husband and father I was and I know I may may never fully forgive myself for it as long as I live I must have been giving off very troubled Vibe during this period because around then my close friend Paul Conte a medical school classmate who is now a brilliant and very intuitive psychiatrist began urging me to go to this place in Kentucky I looked it up and it seemed to be a place for addicts this doesn't make sense I told him I'm not an addict he explained to me over several months of gentle discussion that addiction can take many forms not merely to drugs or alcohol often he continued it's an outgrowth of some trauma that has happened in a person's past Paul is an expert in trauma and he saw that I displayed all the behavioral signs anger Detachment obsessiveness a need to achieve that was fueled by insecurity I don't know what it was that happened but you just have to trust me on this he said he was relentless I agreed to go to Kentucky but I was still looking for any excuse to get out of it in early November a woman from the bridge which is the rehab place in Kentucky called to do my intake interview it was a long tedious conversation and my patience finally expired when she asked have you ever been subject to any kind of abuse I got so angry I yelled [ __ ] you and hung up the phone after this call I decided to cancel my planned stay what was wrong with these people asking such idiotic questions that Thanksgiving weekend was still a blur it's the only Thanksgiving in our life together when we didn't go to dinner with friends or family or host one ourselves we just stayed home alone on Sunday night Jill begged me to go to again to go to Kentucky I just can't go off the grid for that long I said my patients need me and you need me to help with the kids this was total [ __ ] and we both knew it she replied Point Blank you're of no help to me in fact you're hurting me and your kids very badly confronted with the brutal truth I knew I had to go so you go out to this place in Kentucky um you get out there you are you know trying to keep a low profile I thought it was funny that you had called out that you wanted a private room you know because you're so important and no you're going to get a roommate I'm going to fast forward a little bit after four or five days I could no longer remain silent which is what you had done for your first several days they're not telling anybody anything they'd set aside almost an entire day when we were all supposed to tell our life stories from the beginning we had an hour each and we were supposed to prepare so I was finally telling my life story for the first time to this group of perfect strangers not even Jill had heard the whole thing but I was telling it in a way that was very matter-of-fact this happened when I was five this happened when I was seven and so on some of it was sexual some of it was physical but it was not all bad I explained these events terrible as they were had led me to take up boxing and martial arts at the age of 13 I got to punch bags people and that channeled my anger I learned how to protect myself but I also gained discipline and focus qualities that proved invaluable when around the age of 19 I pivoted from pugilism to mathematics terrible as it was my past was also what set me on the path to becoming a doctor I continued growing somewhat defensive throughout College I volunteered at a shelter for sexually abused teenagers and I became close to many of them over four years including one young woman who had been abused by her father when she attempted suicide one of my one of many attempts I went to the to visit her in the hospital I was a senior by then and I had already applied to the top PHD programs in aerospace engineering but I wasn't really sure it was my calling spending so much time in the hospital with her helped lead to the Epiphany that I was meant to care for people not solve equations so you see I concluded parts of my past may have been bad but in a way they also ended up setting me on a course towards a better life some of the kids I grew up with and boxed with meanwhile were getting arrested for armed robbery and getting girls pregnant in high school and all kinds of other stuff that could have easily been me so in a way I said my abuse may have actually saved my life I don't really even need to be here right then one of our therapists Julie Vincent cut me off there are many rules at the bridge and one of the most important ones was no minimizing you're not allowed to minimize anything that someone else is saying and you're especially not allowed to minimize your own experiences but she didn't flag me for that instead she asked a simple question you were five years old when this happened first to you right that's right I replied and your son Reese is almost five years old right now right I nodded so you're saying it's okay that this happened to you and you were his age but would you be okay with people doing that to Reese now another rule at the bridges you're not supposed to hand anyone Kleenex when they're crying they're supposed to get up and fetch it themselves now it was my turn to stand up and walk over the clean Xbox it all came pouring out of me and finally I was able to embrace why I was there and begin the hard work of unpacking the last 40 years of my life foreign when you're going to this place and you show up there you know they say like uh uh someone that's going to Seal training when you when you go there you know if you're gonna quit or not like deep inside you actually know do you think you knew what was going to happen when you went to this place no no I mean I was just I was just I was just so angry you know I don't think you know I wasn't really there on my choice you know I mean if I didn't go I was leaving the house right and never coming back so I think I just you know I just had so much anger that I I wasn't thinking about anything other than just trying to get through the day and this place is wonderfully awful right I mean they deprive you of everything they don't you know you don't you don't have a phone they take your books away there's I mean I I think I mentioned there the only thing they let me indulge in was exercise you know I could get up at 4 30 and they had this janky little Universal machine somewhere in the basement that like you know I could go down and use and run in the woods like that was it right so so aside from that you're stripped of every defense mechanism you have um but no I had no idea what I was in store for now I've felt like talking about combat which I've done I mean basically because I have a podcast and I I you know I I've said that when my friends have died I've often been the guy that's giving the eulogy and matter of fact I have a sop now if someone I know dies I'm immediately writing because I don't know if when you get the call or not but I'm Gonna Be Ready um and I found that to be very I think that's very helpful and so is this the first time would you were able to like Express these things that you had gone through growing up yeah it's it's it's more than that though right I think stating them as facts is not really the issue it's understanding it's it's stop it's not justifying them anymore right so I think again there it wasn't like I didn't know this had happened it wasn't like I blocked this out it was that you know bad things happen to everybody and we come up with adaptations this is a normal healthy important thing if we don't adapt to bad things we're hosed right like that's the end of our species so the only issue is how many of those adaptations are positive how many of those adaptations are negative and what I don't think I ever appreciated was that all of the attributes of my personality um that were positive and negative were actually quite linked and they all kind of stemmed from A coping strategy around these issues of my childhood and I think the first sort of thing that I had to kind of realize in that moment was that the you know in this this place in the the bridge they use a model right where you have kind of um you know you're born as a as a young healthy child and then you you suffer some sort of insult and they they talk about this thing as the trauma tree right so the trauma tree has branches and Roots so the branches are the things you see they're they're above the ground right so the branches are addiction codependency you know all the things that we think of as you know habituated survival strategies the roots are the things beneath the surface that's the trauma so that can be abuse neglect and measurement witnessing tragic events would be traumatic and the thing to figure out is how do we go from sort of the young healthy child into an Adaptive child into a maladaptive adult and like what does that transition look like and what adaptations are serving you well and which ones aren't and I think that was really you know a big part of the takeaway right which was many of those adaptations have served me incredibly well um but some of them haven't some of them have been very destructive and you know we were talking earlier about alcohol well I feel very fortunate but like you I mean I can't I can't actually relate to somebody who drinks alcohol through addiction um so there's very different chemistry in people's brains there are some people for whom ethanol triggers a pleasure Center in them the way I can't relate to so you know drugs alcohol gambling these things have never resonated with me those aren't my addictions it just so happens that my addictions are very socially acceptable I mean work is a very socially acceptable addiction perfectionism is a very socially acceptable addiction um anger can be tolerated uh provided you can sort of keep it in check which I mostly could um but again you know as as the the story you read at the outset displays I mean it can get to a point where you're so detached um and you're so addicted to you know work and you know your own sort of narcissistic beliefs um that you know the destruction is just enormous around you know to those who are closest to you again it's not it's not visible to the outside world but it's it's absolutely visible to the people closest to you so you go here um you get you get I would say from from what you write in the book it's sort of get it's moves you in the right direction it does yeah I leave early I only stay for 14 days and most people believed I needed to be there for six weeks um but I begged to go and they they relent fast forward a little bit here um we're into covet times 2020. as March bled into April it became clear there was no end in sight one day in late April 2020 I was on a Routine Morning Call with my practice manager when I couldn't take it anymore and started venting I've lost control I told her I can't keep my patients stories straight anymore was it patient X or patient y who just last week told me about his daughter's struggle at school was a patient a or patient B whom I needed to reach out to that evening about an issue she was having she tried to soothe me saying I was doing the best I could under the circumstances and that our patients were grateful but the more she talked the angrier I got and just like that I spun into a radical self-destructive episode one like I've never experienced before or since even remembering it now is terrifying I threw a table across our living room I tore my t-shirt to pieces I screamed in Rage in pain my wife begged me to leave the house for fear I would harm her or the kids I thought about driving myself into a bridge abutment or some other structure fast enough that I'd be killed I was convinced that I was broken defective when they autopsied my brain they would discover just how screwed up I was I was beyond fixing nothing could make it right I ended up holed up in a motel on the phone with Paul Esther and Terry they insisted that I needed to go back to a place like the bridge now true to form I stubbornly disagreed claiming that I could fix this with just a little more time and support if only I could get home and get some rest after pleading with them for 48 hours I finally relented in the middle of the night I drove myself to Phoenix Arizona to be admitted into a place called psychological counseling services or PCS Terry had been telling me about PCS for nearly a year he said it was a place that worked miracles healing wounds that seemed Beyond permanent I asked how he could be so sure he said I just needed to trust him so you head out there fast forward a little bit on my second day I was assigned to write a list of 47 affirmations representing one positive statement about myself for each year of my life I made it to about five or six before I got completely stuck for days and days I couldn't come up with anything good to say about myself my perfectionism and my shame did not permit me to believe anything nice about myself I just couldn't do it finally on the 19th day a blistering hot Wednesday morning it happened one of my therapist Marcus was pushing deeper and deeper into a story I told him earlier about how it stopped wanting to celebrate my birthdays when I was about seven in fact I revealed I would keep my birthday a secret until well into my twenties his question made it clear that this was not something a healthy child would do and it likely masked something more deeply wrong he just kept digging and would not let it go that recognition pushed me into an emotional free fall it had been two and a half years in the making but I finally was able to let go and accept the truth about my past and how it shaped me without any excuses or rationalizations all that I had become good and bad was in response to what I experienced it wasn't simply the Big T traumas either we uncovered many many more little T traumas hidden in the cracks that it affected me even more profoundly I hadn't been protected I hadn't felt safe my trust had been broken by people who were close to me I felt abandoned all of that had manifested itself as my own self-loathing as an adult I had become My Own Worst Enemy and I hadn't deserved any of it this was the key insight that little sweet boy did not deserve any of it and he was still with me once I had accepted all of this it was easy to write out the 47 affirmations so when you're going through this with these people with these therapists was it was what what happened so what's going on like I literally don't know what this looks like like explain it to me if I never seen a boxing match before what is going on with these therapists I know we get it you get into the dialectical behavior therapy DBT what does this look like well PCS is set up as um about 80 percent individual therapy about 20 group therapy you're doing therapy from seven in the morning till seven at night every day 30 minutes for lunch basically seven days a week most people go there for one week I was there for three so I was there for 21 straight days um which man I went through I went with three different groups so I I basically did the same thing effectively but with three different groups of people but I had the same individual therapist so we were kind of going deeper and deeper and deeper and again um you know I didn't want to stay for three weeks but I also knew from the last time like I'm gonna surrender a little bit on this one and I'm gonna I'm gonna stay as long as they tell me I need to stay this time um and so at the end of that second week I really thought I was there um and then my friend Paul called me the night before I was supposed to leave and said we think you need another week and I was like I can't do another week of this like I just can't do any more of this and you know he just said like you gotta trust me and I did and it and it made sense because of what happened in that last week like that you know there's the uh and I there's a quote in there about um you know the stone cutter hitting the stone right and it's like on that 101st you know hit the stone breaks and it looks like well he did nothing for the first hundred no the first hundred were just as essential to that one so even though I think kind of everything really came together for me on that 19th day it goes back to two and a half years earlier in Kentucky and all the work that had happened in that two and a half year period of time but it it really it just it really came together on that one one that moment and and through you know Marcus's real probing and um and it was more into the little T stuff truthfully right it wasn't into the big obvious stuff at this point what's a little t look like yeah I mean it's it's you know it's it's um in my case I think it was more around um not not having a dad around probably was was the most formative thing that I had just never assumed mattered I just didn't think that that meant anything um and I I think I finally came to accept the fact that you can't use a totally rational brain of a 40 year old to try to explain what a two-year-old a three-year-old a four-year-old five-year-old experience they don't process things that way um and I think once I came to understand that I just stopped making any excuses you know I think there was always still some lingering excuses and they were really standing in the way of um doing this this kind of work that needed to be done so would an excuse be well I get mad but this is the way I was treated well as a kid so that's just the way I am is that the type of excuse we're talking about um no I mean no so so an excuse I mean yes that could be but that would so it would more be um hey you know I might not have had this kind of attention as a kid but it doesn't matter because you know I wasn't getting beat to a pulp every single day like there was always sort of a way like it wasn't that bad it was you know um or another excuse could be um so that that's an excuse towards what's happening to you another excuse could be like you know I have a horrible temper but like I don't hit my wife or my kids so therefore it has no effect on them right like yeah they see me like screaming at a driver um or pulling a guy out of his car and almost killing him but I mean like I'm not hurting them uh and not realizing of course how you know illogical that is I guess it's because kovid was going on but like I remember exactly when this was happening because you and I were talking all the time like um yeah and and it's weird for me because like seem normal and you you told me like I can't remember you told me before or after you you you went I don't remember if you told me hey I'm going somewhere or if you told me after I just got back from somewhere but I remember you indicating that you had gone and you said something along the lines of like hey I'm not addicted to anything but I need to get some [ __ ] sorted out type thing that's the thing and I was like okay cool um but I the reason I'm saying that is because from just to just to your point that from the outside I didn't have any like look that I think like for Peter gets pretty pissed when he you know misses a shot or whatever sure but you know whatever I didn't think that was uh any kind of like deep issue you know um so from my perspective again to be aware of your friends and pay more attention so that you can help out is a good thing to do and obviously in the veteran world we need to do that but clearly it's not just veterans that go through trauma Big T trauma Little T trauma whatever and might need some freaking support sometimes and who knows like you know like to talk a little bit about you know if you see someone that's doing this kind of stuff like losing their temper or they're they're doing things that you think that's a little weird that seems a little strange like just to be like dude what's going on are you good I don't know I feel like a bad friend you know to not maybe just be a little bit more um proactive yeah I mean I I don't know I mean look I think you know Paul Conte was able to see that because he's literally one of the smartest psychiatrists on the face of the Earth like I I just don't know that a normal smart a normal otherwise smart person could could sort of put those patterns together so I I you know I just feel lucky that that you know and again Paul I remember him saying this he's like you just live your life like a trauma victim and I was like what the hell are you talking about I'm not a trauma victim and he goes I okay but I'm just I'm just telling you like you walk like a duck you quack like a duck it's possible you're a duck um and that's a functional alcoholic but you're a functional trauma because you're freaking highly functional I mean damn you know like you're just kicking ass across the in in so many different aspects of life for extended period of time you know like hard to see how often were you around uh quite a lot right because Paul and I shared an office in New York um so I probably saw Paul more than any friend you know during like a five-year period of okay you know 2015 to 2020 and but but again he knew me in med school like he's he's known me forever he he understands um yeah he just understood the the perfectionism the rage the the constant need to prove myself um and again I think it's I'm I'm not here to suggest that like striving isn't good or any other things like that that's not that's not the point here right the point is at what point do these things become maladaptive right and there you could take someone else who's working just as hard as me who's you know just as committed to excellent work but it's not coming from this place of insecurity it's coming from a place of love and it could be a totally different experience and it's not destroying their life I mean the point here is it was destroying my life that's the point that's another thing that matters is uh and that's why again this chapter is not written as like you need to do this it's it's not a you need to do this it's this is a story that I hope lets you examine yourself um because there is no question in my life that I was like there was just a a trail of body bags around me if you wouldn't have gone gotten this help or you you're getting divorced your wife wasn't going to see you anymore she was going to get custody of the kids you were gonna get pissed off you were going to stop working so much like everything is going to fall apart that's the trajectory we were on I mean I don't think I would be alive today because because shame is really the problem here right shame is the shame is the thing that that kind of uh underpins all of this stuff right and that's so EV every time you make a mistake at least in my case every time I would make a mistake I would hammer myself harder for it right like so for example let's go back to when I come home from that trip 11 days or 10 days after my son is almost dead do you think I'm acting better or worse as a result of that like the logical person would say oh my God you must have been bending over backwards to be a better husband after you were such a dick but that's the logical person no no the reality of it is you feel the shame for how you've behaved so you come home and you act worse again shame is an awful thing how do you act worse like what do you do yeah just more aloof more distant more of a dick more Gruff less helpful probably went back on the road three four five days later are you in your mind thinking well I'm just like such a beast of a human that I just this stuff doesn't phase me and I'm just carrying on I don't you know it's funny I wish I knew I wish I could go back and find out what lies that guy was telling himself prob probably your job is to provide like your job is to be the financial provider not to do not provide any emotional support so this you you explain this story um you know obviously like I said get the book but what is a beautiful thing is it says this uh one section it says if you take nothing else from my story take this if I can change you can change and you know this is you're talking about this specific kind of emotional side of it but it's really all aspects of health and of life and that idea right there if I can change you can change and by the way you have health issues earlier in the book you have uh metabolic issues earlier in the book you have opioid do you talk about opioid in this book I don't know if you do no no but you talked about the last time you're online podcast like you have been through really bad spots in just about every aspect or potential way a person can be in bad spots and yet you've figured out that you can change this one's the hardest this was the only one I really thought couldn't be changed um I always had confidence the others could change I always felt like I could bend the Ark in anything else this was the only one where I was like this is truly unchangeable um I've I've never had a stronger belief in my life stronger than the belief in gravity that I could not change this this set of traits in myself that these these were hard wired into my motherboard at Birth when's the last time you lost your temper well never in a destructive way since 2020. now I I won't like let me be completely clear three days ago is the first time in three years I got mad at another driver and honked at them and yelled at them was this in traffic or is this on the race course no no it was just we just it was a I was at the airport in San Diego and I went to get the car and I'm driving back to get pick up my family in a bus cut me off and I was like all right so I pull out of the way and then I go to go around them the other way and then the bus like almost smashed me into a wall so I pull out and I'm like I mean I just got super pissed in that moment and um you know I'm hot I'm like literally laid on my horn for 30 seconds right like how do you not see a vehicle you literally almost put me into the wall um and that's the first time I've had like road rage in three years and what was your debrief to yourself after that um I went through kind of like okay what what made what what else was what West was really bothering you that day because you've been cut off a thousand times in the last three years and you've never cared so what is it about that day and secondly did you figure that out um yes I think this is the this time really was almost really resulted in an accident like it's a if there's an asymmetry when a bus is almost cutting you off um also this sounds dumb and I don't know if this justifies any of it but in my mind it's like this was an airport bus at the airport like you should know your way around the airport you shouldn't be weaving in and out of lanes with concrete on either side like there was sort of an expectation um but regardless it was on my mind like for a couple days I was really like examining this and here's another thing I've learned like you have to forgive yourself like I'm not I'm not here to sound perfect but I'm here to say that I'm not going to let one mistake spiral into 20. so the you know I say this to my patients all the time don't beat yourself up if you miss your workout for a day but just don't miss it two days in a row just get back in the gym the next day don't worry about it if you eat if you if you go on vacation and eat like crap come back and start eating well don't let a mistake spiral into Infinite mistakes and so in many ways it comes back to this idea of Shame right it's really tempting for me to just berate myself in shame because of my misbehavior but instead it was like you know what that's like not a proud moment for me like I'm not proud of the fact that I laid on the horn and yelled at someone who by the way doesn't hear me but it doesn't matter the point is like I'm not proud of how I acted and I'm gonna do better next time but just by doing that I can do better next time right that didn't it didn't real and I'll tell you what I was most proud of is about 30 seconds after that I picked up my family and I was totally fine whereas like three years ago that would have ruined the day I would my wife would have got in the car I'd have been like you wouldn't [ __ ] believe what just happened this [ __ ] idiot I'm gonna go find them but instead like to this day my wife might hear this podcast but she would otherwise have no idea what just took place so it's just like we're done with that so you know it's a little bit of a setback but there's a victory I know that you posted a video the other day after you dry fired my bow and you're like hey I click on it you start off with something like this is progress I was like oh no and then and I was thinking the same thing I was like oh and then you explain it you're like hey you know what I it was really dumb and I just feel shouldn't do it and you know what it's okay yeah I mean like I had I dry fired a bow in April of 2021 it was last time I drive fired a bow and I mean and I that was after going through all of this and I did okay but I had to go jump into an ice bath like that was the own and I still screamed I was so pissed when I broke it um but prior to that when I drive fired a bow like 2019 I smashed the bow after like so you know people listening might not understand what happens when you drive fire a boat you've already broken the string the cams and the limbs well then I just broke the boat I was like I just I'm gonna destroy this bow everything is gone um so yeah like I I think that's like literally the thing if you were to say like what are the three things you're most proud of in the last 12 months I literally would put that on on those the top three driver on their boats try firing a boat and within three minutes first of all not yelling not screaming not throwing anything and within three minutes being okay it's so crazy that you're a freaking grown ass man that's a doctor uh this look at your life incredible and you do that kind of [ __ ] it's like oh you did that kind of [ __ ] it's like it's kind of crazy right isn't that kind of crazy yes it's so hard to like picture that I have a friend named JP Danelle do you know JP is I know you do remember my friend JV Dale who's in the SEAL Teams with me he was um very young when he worked for me and like I see he he's you know had a bad temper and at one point I was like hey man losing your temper is a weakness and we broke it down you know like later because we look at our dads right and you're like oh when when my dad loses his temper it's like a force it's like a thing it's like no one no all of a sudden economy turns into like a weird Superman character because now everyone cows to cows down to his behavior and everyone gets out of the way and it's just like so you see that you go I'm gonna get that superpower and that was what JP grew up with like oh you know that's a power and I was like hey man when when you lose your temper it's a weakness and that impacted him because he never saw it that way and and I I don't even remember when I figured that out I don't really remember when I figured that out but it was I was in the seal themes and I you know probably saw some idiot officer freaking lose their temper and start yelling and screaming and everyone little platoon going what an idiot and I remember thinking I will never do that you will never see me lose control of my emotions that's that's a bad thing and then just never let that happen again that's that's like uh I think Echo Charles has a similar story where Echo Charles realized at some point that losing your temper he read it in a book actually he read in a book that losing your temper was a sign of you know insecure that's what it was for him it was he he read in a book that losing your temper was a sign of insecurity and he's like I'm never going to lose my temper again and you know I haven't seen Echo loses temper once in a long time but that's just yeah it's just so weird to think about that and think about um how negatively that can impact you when you when you uh you see your kids lose their temper how do you how do you help them see the the uh the problems that it causes and I guess how old are they uh just turned six and we'll be nine at the end of the summer and Olivia's already what 14 14. so she's good to go um so yeah six years old they're kind of not quite there yet but nine it's like if you're losing your temper at nine we can start discussing how that's going to impact you so do you have any conversations like that what do you do when they lose their temper yeah I mean look it's um you know one of the great questions you can ask a kid when they're misbehaving in general after the fact is how how did that impact the outcome right as opposed to just saying don't do that right it's like okay you made a choice to act a certain way there were repercussions from how you acted how did it work out for you um and that that's one lesson I've taken away another lesson that I think every parent knows is the most important thing to do when a kid is losing it and this is not easy to do but it's important thing to do is to not lose it yourself I get asked uh like what you hey how do you discipline your kids what's your favorite way of discipline do you you know do you beat them do you make them do burpees do you whatever you know they've got a bunch of and and I got asked that a while ago and I was like I can tell you my favorite form of discipline with children my kids my favorite form of discipline was asking them questions because when you say exactly what you did like hey that make you feel better how's it how's that outcome how's that how'd that help you how's that make you look what do you think everyone's thinking of you right now that you laying on the floor crying when you're seven or you're storming off the field when you're 10 or whatever the case may be asking questions is powerful discipline disciplinary tool for children um like I said there's so much of this the you cover which we didn't even touch on we didn't cover the actual tools that you use that you got taught to to handle this to you have tools that you learned to utilize just like I could teach you how to shoot a bow you got taught what to do when your temper starts to flare up when you start feeling certain emotions and it's all in the book and it's so worthwhile to read that for yourself and for your family and for everybody around you that you can there's tools that you can utilize to come to overcome those things um but you know what I'm going to fast forward a bit and kind of close this thing out I mean we've been in here I think approaching four hours uh you write this as my recovery progressed I noticed my preoccupation with dying began to fade away and my quest for longevity no longer felt like a grim desperate task now the things I did every day felt welcome necessary I was enhancing my life and looking forward to the future my journey to outlive finally had Clarity purpose and meaning it brought me back to something my dear friend Rick Alias had told me Rick had been one of the 155 passengers on U.S Airways flight that emergency landed in the Hudson River in January of 2009 as the plane was coming down Rick and most of the other passengers were certain that they were going to die only the Pilot's skill and more than a little luck prevented disaster if the plane had been going down if the plane had been going a little faster it would have broken a power on impact and few miles per hour slower and the nose would have tipped forward and it would have sunk into the river a handful of tiny factors like that made the difference between everyone on that plane living and many or most or all of them dying that day changed Rick's outlook on longevity in a way that really resonates with me all that time I had been obsessed about longevity for the wrong reason I was not thinking about a long healthy life ahead instead I was mourning the past I was trapped by the pain that my past had caused and was continuing to cause I wanted to live longer I think only because deep down I knew I needed more Runway to try and make things right but I was only Looking Backward not forward I think people get old when they stop thinking about the future Rick told me if you want to find someone's true age listen to them if they talk about the past and they talk about all the things that happened and that they did they've gotten old if they think about their dreams their aspirations what they're still looking forward to they're young here's to staying young even as we grow older so uh that's the book that's some good advice from the doctor um and you give away advice all the time you're still doing that now that's what you're doing now what currently what are you doing tell us what you're doing where we can find you well my podcast the drive still comes out every week so that's you know continue to be a huge Joy we're about five years into that and I we we've come no closer to running out of topics to explore uh than we were five years ago so I see no end insight to that um and we have recently uh launched what we soft launched it it'll be kind of rolled out a little bit more this year a product called early which is sort of a digital um uh I don't know how to describe it other than kind of a master class of everything we do in the practice so this is something that took us two years to build um and it's it's it's it's truly the this is all you need to know to to do all this and it you know it's God it's probably 30 hours of Highly produced video plus tons of downloadable material and stuff like that so we had a very limited release of it in April where we put it out for four days just to our subscribers we're gonna have another release later the year and then probably open it up to the public in the beginning of 2024 because your practice we've mentioned your practice but your practice is helping people have better health Span in lifespan yeah but it's super small and it's effectively closed right I mean at this point it's it's sort of a friends and family but this is a way for a normal person to say all right I read this book because look what we covered today I barely dusted on anything that's in the book today like it's freaking 410 pages of dense awesome information we barely touched on any of it uh and once you get done with that book you're going to say to yourself I need more um so the podcast you have a subscription version of the podcast as well that's right so it's um one episode a month is dedicated to subscribers called an AMA and then um and then the show notes are for subscribers only so yeah we don't we don't have any ads on our podcast it's all forever you're on Twitter yeah Instagram more you're on Instagram the most yeah you're on you have a YouTube channel yep you have a Facebook they're all they're all Peter attia MD Peter at TMD he got it done he got it done I let only because somebody had Peter attia before I started oh yeah otherwise I wouldn't have thought to put the MD on there it seems a bit douchey but well luckily there was no other Jocko willings back when I got a hold of my stuff but um Ninjago willink MD definitely definitely not that's for sure Carrie sir you got echo's job right now you got any questions I got an echo question actually oh damn so you you talked a lot in the book about sleep and uh you know the the effect that has on our ability to perform and things like that I'm curious about uh your kind of opinion on Mouse taping do you have an opinion okay yeah it's it's really it's really important for people who are mouth breathers to to not be mouth breathers so when you're breathing through your mouth be it awake or at sleep I mean you basically want to reserve mouth breathing only for when there is no other option which should really only be when you're exercising strenuously and so if you're sleeping in your mouth breathing it is sending a message to your brain that your energy requirements are significant and you're in a more sympathetic state so your sympathetic nervous system ramps up your parasympathetic nervous system goes down your heart rate goes up your heart rate variability goes down so this is a physiological State you don't want to be in when you're trying to rest and recover so again once you address any structural issues that a person might have in their nose being able to put on mouth tape for people is an awesome tool to teach them how to nasally breathe right on and what are some of the benefits of nasal breathing I I know there are some I'm just not 100 sure what they are I mean everything actually starts I write a lot about sort of how so much starts with the breath right so your breathing strategy and there were basically two major breathing strategies your breathing strategy determines your center of mass your center of mass determines how you how you kind of exist with gravity in in the world right so are you hunched over are you sitting up too much um being in that high sympathetic low parasympathetic state by itself is counterproductive to your health so that's that's really why you want to be nasally breathing got it cool yeah JP Danelle and I both we've been geeking out about the mouth tape and we both do it now when we sleep and yeah it's it's been crazy beneficial for me I used to wake up with headaches a lot of times and because my mouth was like gaping open when I was sleeping I guess but uh it's it's been super helpful awesome yeah I'm glad you I'm glad you asked that question because that's the type of information that you can get from from your podcast from the drive podcast from the book from the newsletter that you sent out from everything so I'm glad you like legit like that's I'm glad you asked that because I spent all my time talking about death and hell and all this other stuff so that's what I did but that's not what you do for a living that's just the stuff I wanted to talk to you about you know as my bro uh Peter you got any closing thoughts no guys this is uh it's a privilege to sit down and be able to go deep into this stuff well uh thanks for joining us once again I can't believe it's been seven years or yeah something like seven years since you came on this last time um thanks for what you're doing too last time I was on I was just starting to write this book put it that way wow crazy uh thanks for what you're doing for so many people you give away so much information and everybody is should be so appreciative of that thanks for your friendship over the years man um it's been very meaningful to me uh but like your friend Rick said after his exposure to death on that seemingly doomed plane I like to think more about the things we will do in the future um the hunting the shooting the driving and the Mystery Mission the mystery Mission which I got for you which is going to be so freaking awesome I got Peter's wife asked his friends to send a video with some things some request some event that they were going to that we would do with Peter individually in the future sometime in the future in the next five years and I couldn't think of anything because what do you get what do you do with Peter T like I was like oh we go hunting oh we go shooting oh wait there's a bunch of stuff I was like yeah blah blah blah no offense to people that said that because it'll be awesome but I got struck with a bolt of lightning of something that I know he could never guess it's something that he's been preparing for his whole life but that he doesn't need to prepare for but that's something that he's never done before if you can imagine all that and so do you remember how you worded it in the video when I say uh so you gotta remember my wife this is she asked me what do you want for your birthday and I said this is what I want I don't want any presents I don't want to party I want I want an experience with each of my friends and um and so it's this two hour video right because you know every person's gonna talk for a few minutes and it's amazing and Jocko's is I will call you with a pack list and coordinates and a time to meet and by the way he prefaced this with a beautiful beautiful kind a lot of really you know and it the ask wasn't what do you have to say to Peter but a lot of people did that anyway it was very kind it meant a lot to me but after Jocko had one of the sweetest things to say it was this is the gift pack list coordinates time be there right it's going to be like it's going to probably be three three days total with maybe a day of travel on either side or half day of travel so it's gonna be awesome um but that's what I like to think about like your friend Rick advised I like to think about what we're going to do in the future we're going to do that we're gonna do rock marches we're gonna we're gonna do uh a lot of cool stuff in the future and I think as much as we can we will do our best to stay young and outlive thanks bro thank you and with that Peter attia has left the building and well freaking I legit I'm glad you asked that question at the end because that's the kind of knowledge that he is freaking packed with and go listen to the first podcast me the guy's life has been he's been an overachievers all whole life he just he is brilliant and he's been focusing on this stuff for decades and and he's willing just to give it away so and I didn't do the best job of like bringing forth that information that's what the whole book is filled with get the audiobook like do you really want to hear me sit here and and read the scientific parts of this book I I was like well I could do that or you can go get the audiobook and listen to the doctor himself read it that's what we did I'm glad you asked that question so people recognize how much information they can get uh from him from his podcast from this book outlive the science and art of longevity yeah you got an opportunity you got Peter T in the room man yeah something cooking on the brain yeah you've been taping that mouth Taping that mouth breather up yeah bro me and JP Danelle we've been geeking out about that man we we both use the same like brand of tape or whatever and uh it's been I think we're getting your hostage tape on that's what it is right yeah that's that's the one we've both been using and it works man uh not waking up all you know headaches and bro I'm glad because for so many years I've been running around telling people hey quit being a mouth breather right like what's your problem I didn't know there was some scientific Truth for it right but guess what the dog was right again man good mouth breathe inside it's there's they're glad you got that tape I was wanting to tell you to get that tape boy close that mouth boy oh there was a guy that was a mouth breather in the SEAL Teams but somehow is his nickname wasn't mouth breather it was fart sniffer because it kind of looked like he was cut out his mouth open like he was kind of like trying to sniff that fart yeah pretty rough nickname on my homeboy but you know yeah that's the way it goes sometimes it's crazy too I catch myself closing like literally I'll be breathing through my nose more throughout the day too and I'll just notice it like my my mouth closed I'm breathing through my nose I I don't know if that's you know a subconscious thing that's going on because I said Improvement bro I feel like that bad friend now that didn't tell his buddy he had a booger hanging out you know I should have been like hey bro your mouth breathing all right man step back and shut your door shut your mouth man shut your mouth shut off well your boy's on it we're getting that taken care of right right there you go Um well hey that's one of the many ways we can try and become healthier uh and live healthier live longer have a better health span a better lifespan all that stuff so that's what we're doing need to get the right fuel in your system by the way you might as well go get that Jocko fuel 100 get that Jocko fuel hitter uh what am I thinking about I'm thinking about Mulk because because that's one thing Peter was saying you gotta up that protein you gotta up the protein your muscles get that up that protein when it tastes good and it's what is that word satiating right it fills you up you crack that Mulk and get it done RTD style all right so RTD if you're not in the industry that means ready to drink you can get get some mocha just have it in your house you can drink 30 grams of protein like a boss two two minutes yes it's a bit tasty and you know what's crazy it's so it's filling you feel you feel good so get some of that and and look I'm still old school with the pow pow get the milk powder because if you're feeling like you want a little bit more you know like if you want a full-on meal yeah yeah go get yourself get some of the powder um joint Warfare super Krill krill oil vitamin D3 just we got it all for you time War Time Warner you want longevity bro you want eyesight yeah you get that talk it's a Time Warner get the time more time Wars the subscriptions for time war is crazy right now because when you so when you go to dockerfield.com you can you can get it and then if you like it you can subscribe to it so right now like once people go on time War they're just hitting that subscribe button just send that [ __ ] to me boy send it to me I was I was digging into the Jocko system the other day because I was tooling around on fuel you know I'm getting some stuff and yeah uh I was looking there's like the Jocko system in the ecosystem and I was like digging around George I was like oh okay got the full stack yeah uh there's go like in that system too so all all the cool things we just mentioned they're all like listed in order in that in that stack so easy access yeah time war is one of them I I told you this before like I will take time more until I die just the way that what you get out of it from a from a feeling good perspective to like the joint solo and the eyesight thing was crazy to me the eyesight thing was crazy my eyesight got legitimately better and like oh I must have been about a second I have to look at what what the Monster was because that's when I noticed it but it's crazy so anyways go to jocofuel.com get yourself some of that uh if you don't go to jockofuel.com you can go to Wawa you can hook it up at Wawa bottom right corner of that shelf they kind of we got we got to put the squeeze got put on us by the big imperialistic beverage companies you know who they are I don't need to name them there's you know who they are trust me but they went paid millions of dollars to try and subdue the rebels try and take out the rebels we're out there on what planet we're on Hoth or some tattooing tattooing right we're out there trying to be free trying to offer people something that's actually good for them they're trying to they're trying to take us out with the Death Star you can't deny performance Jamie Cochran said that when she was on the podcast the other day man and yeah uh that's what I think about are people clear shelves like you can't compete with that you know you can't buy that away from us that's the way it goes down man look if not vitamin shop GNC uh we're coming into a fees so all those military commissaries across the world be able to get your supply be able to get it Hannaford Dash stores in Maryland wake from ShopRite HEB HEBs represent all you've all my people down in Tejas just rolling in there and just getting after it thank you appreciate it you got a full Supply to HEB we're sending it as fast as we can Meyer up in the midwest Harris Teeter in there now Lifetime Fitness in their Shields rolled into Shields 300 000 square feet of just awesomeness go and check that out and they also have Jocko fuel they got everything you want including Jocko Fuel and and by the way we're in a bunch of little gyms small gyms Jiu Jitsu gyms CrossFit Gyms we're in there we're the we're the where the energy drink across fit so when you get done knocking out that Annie knocking out that work out of the day before you hit it you can get that energy drink after you hit it you can get that Mulk hit her get that protein in you if you're if you own one of those gems you want to sell Draco fuel go to J or email JF sales at jockofuel.com we can hook it up get that wholesale account that wholesale account rolling originusa.com uh we just we just launched workout gear hey it took a while I know trust me I know trust me I know but to re-establish a supply chain of American-made materials so that we could cut and sell it here in America took a little bit of extra time then to design it properly get the right materials it took some time but we got it now RTX Roll Train execute execute execute uh you can get that you can get hunt gear you can get Jiu Jitsu gear you can get free you know what hoodies bro are are hoodies American yes 100 right where if you're in America you wear a hoodie yes right you're just you have a hoodie you probably got two get yourself one more get yourself an American-made kilo hoodie get the kilo get the kilo hoodie the if you're if you're in the northern part of the states get the heavy uh but the kilo everywhere also you see you you never lived in the northern part of the states right because in the summertime in the fall you don't need you don't need that you the Heavies for the cold weather you need that kilo kilo hitter and look you live this is what we were talking I was just I don't know at a at a meeting with origin and Jocko Fuel and they're like well you know it's it's we're not going to be selling many kilos right now because it's the summer time and I was like bro what are you talking about what are you talking about in California you need to you need a kilo year back of the Jeep I've got two key like two kilos you know after 7 P.M you throw that little guy on you good but California but but east coast same thing you yeah I was in Maine when I was growing up in Maine the sun goes down guess what you need to put that kilo on that kilo is a go-to piece of equipment that should be with you at all times now listen I'm not gonna lie to you I have a blue kilo I have a black kilo blue Keel is what I work out in the morning black kilos kind of this wear around I have a cami I have that Raptor kilo so and look do I wear it when I'm out in the woods yeah do I wear it when I'm also rolling down down the streets hell yeah do you wear is it roll it into the podcast Studio every day yes yes yes I do sure and then I have we have a zip up one now too and I got one of those where I found out about cool about the full zip for travel if you're traveling you may want to have some variable warmth right so you uh it may not sound like much but you just unzip that bad boy and all of a sudden let that coolness in or a little chill a little chill coming through a little wind no problem zip it up we're good get that versatility with the kilo zip hoodie dude I just invented that right if you get hot unzip it I'm over here smart yeah freaking technology it's from giving Peter a tea a run for his money on Intel on his intelligence because I said if you get hot you can unzip your hoodie check it out originusa.com go get yourself an American-made hoodie and wear it with pride help your help the National Security in this country and help your children live in a stable Free Nation in the future that's what we're doing originusa.com there you go also got Jocko store jockostore.com you had one job one job blew it on a jungle story it would Echo here's that right there bro he's getting over man what'd you say what uh just give it a go let's give it a go here we go jockostore.com we got rash guards t-shirts trucker hats beanies hoodies um we got the shirt Locker subscription echo's putting out a shirt every month new design every month this is one of the earlier shirt Locker ones this is still one of my favorites though got the element D and we got layers in in every shirt this one's got the zero zero four thirty four at the bottom uh no big deal but great subscription new shirt layers layers getting deep in the layers layers it's like the first time Echo said that and I was like are you kidding me and now we say it now everyone says it it's so true people talking about them layers we gotta go back I don't know who said that first I might have said that first gotta watch the tape got to go back to the tape man we'll check it out yeah if you want to get some of those layers chocolate store.com subscribe to the podcast uh also subscribe to Jocko underground.com we got that going on and just in case all other forms of communication go down we'll be there on the Underground uh Jocko underground.com we got a YouTube channel subscribe to that origin USA YouTube channel Jocko fuel YouTube channel Echelon front YouTube we've got some YouTube channels you want some you want to get some watch some videos watch some good ones um psychological warfare on iTunes flipsidecanvas.com Dakota Meyer just making cool stuff for you to hang on your wall got some books outlive the science and art of longevity by Dr Peter attia just get that book it's a textbook for you on how to be a better human so there you go I've also written a bunch of books you know what they are final spin leadership strategy and tactics code Warrior or the code devaluations the protocols discipline because freedom field management I mentioned it today I had to quote it today because I knew Peter T was going to come at me he was going to come at me you gotta sleep you gotta sleep it's good for you take that mouth son take that mouth boy uh way the warrior one two three four and five everywhere I go those parents are thanking me because what their kids are doing so they're doing Jiu Jitsu they're doing pull-ups they're doing all the stuff that Peter T was talking about today he talked about how you would change the way children are raised his kids are Warrior Kids by the way forgot to mention that today but his kids are absolute Warrior Kids he posts the other day they're doing the warrior kid workout they're in the game bro get the kids you know that book Mikey and the dragons about face extreme ownership the dichotomy leadership it's all there Echelon front we have leadership consultancy we solve problems through leadership that's what we do go to echelonfront.com for details next big event let's say we get the council which is sold out we got we got a battlefield August 8th through the 10th at Little Bighorn I think there might be a couple tickets left so if you want to come and check that out come and check out we got a women's assembly run by Jamie Cochran our chief operating officer what'd she say you just quoted her um can't deny performance yeah yeah there you go well there you go you want to learn about that activity go to the women's assembly which I think it's called Women's Summit oh so it's it's the assembly now oh okay yeah so they they had a you know a little name change but the women's assembly uh it's a free uh live event that we host through the extreme ownership Academy got it and the Summit is an actual live event via Sim person yeah the assembly will be the the the in-person event in Phoenix okay it's September 14th and 16th Phoenix Arizona so go check that out if you want we also have online training extreme ownership Academy this is where you learn the Jiu Jitsu of Life 100 that's where you learn the Jujitsu of life and listen if you don't understand Jiu Jitsu let me explain it to you a person that weighs 150 pounds can beat a person that weighs 250 pounds that's what can happen with Jiu Jitsu if you want to learn Jiu Jitsu of life so you can out maneuver out think overcome problems lead go check out extreme ownership Academy extreme ownership.com how how much of how much of your um career would you say was relationships based like percentage-wise 99 99 right on 99 was relationship based I I I will have to think about this I never as a matter of fact I just got done saying this to a company I never had to say hey like do what I told you to do which is not relationship that's authoritarian-based that's rank based right never had to do that never had to do that very seldom and I can't think of any examples where my boss told me like hey shut up and do what I told you to do no because I had a good relationship with him they wanted to know my opinion they wanted to take lead from me we were influencing each other we were listening to each other up down and across the chain of command so you want to talk about how to get through life in a better way build good relationships so we actually teach because there's this is you can't if I asked you like right now hey hey Carrie build me a a 40-foot gaffed rig Schooner boat would you be able to do that negative no you don't know how no there's skills you would need yes sir it's the same thing with building relationships there's skills that you need there's things that you can do to build strong relationships and when you build a strong relationship you build a strong team when you build a strong team you get the results so that's what we're doing go to extreme ownership.com and learn how to build relationships learn how to make decisions learn how to get better and learn how to lead that's what we're doing also if you want to help service members active and retired you want to help their families you want to help gold star families check out Mark Lee's mom mommy she's got a charity organization if you want to donate or you want to get involved go to America's Mighty Warriors dot org she is doing all kinds of things to help our veterans and also don't forget about heroes and horses.org that right there is Micah Fink's organization we just got a report in from the field did you get that report from the field I did not okay I probably should have related to you uh currently Micah Fink he just actually had a wrestling match with a bear and he was about to submit it when out of nowhere flew a bald eagle and the bear got scared and ran away so we're still giving it to Micah undefeated 100 100 undefeated in the field he's out there getting after it no but seriously Michael Fink doing awesome stuff helping veterans First Responders find themselves out of the Wilderness it's an awesome program if you want to connect with us on the interwebs Peter attia is on Twitter on the gram on YouTube and Facebook all of them at Peter attia MD and for us Carrie Hilton is at Carrie underscore Helton didn't get that didn't get it huh still still haven't gotten that one resolved didn't get that Carrie Hill is there another Carrie Hilton out there somebody has that there is yeah and yep I hit him up trying to try and say hey man oh because he's not active negative yeah did he get it before like yeah yeah he's he's had it for a long time I I first hit him up a couple years back and was just like hey man like if uh you know maybe we can work something out throw you a hundo bro no interest zero interest in responding yeah get some computer out there I uh that's Carrie Carrie's at underscore Helton and I'm at Jocko willink just watch out for the algorithm and just just please and uh thanks to all the service men and women out there who are on the front lines of Defense around the world keeping us safe also thanks to our police law enforcement firefighters paramedics EMTs dispatchers correctional officers border patrol Secret Service all First Responders thank you for keeping us safe here at home and a special thank you right now in honor of Dr Peter attia thanks to all of you doctors nurses that's in honor of Peter's wife Jill and all the Health Care Professionals out there who support us in our darkest hours and to anybody else out there and everybody else out there just remember what Peter Tia said if he can change so can you so can you and that is so powerful it's so true look if you've been on the wrong path if you did some hits if you've been doing some things you shouldn't have been doing if you're not as healthy or productive as you should have been and maybe you haven't been the best mother or the best father or the best husband or best wife maybe you've been hyper emotional or not emotional enough and maybe you've been lazy and gluttonous and just generally freaking miserable you don't have to be you can't change overnight but you can change you can do it but in order to change who you are you have to change what you do how you live and that is something you do have full control over and there's no better time to start than now put down that donut pick up that kettlebell and get after it and until next time this is Carrie and Jocko out

Channel: Jocko Podcast

Views: 88,016

Keywords: jocko willink, podcast, discipline, defcor, fredom, leadership, extreme ownership, author, navy seal, usa, military, echelon front, dichotomy of leadership, jiu jitsu, bjj, mma, jocko, victory, echo charles, flixpoint

Id: EASh9I8EOF8

Length: 271min 40sec (16300 seconds)

Published: Thu Jun 29 2023