"USE THESE 4 Secrets To STAY HEALTHY Until 100+ YEARS OLD!" | Peter Attia & Lewis Howes

those people are saying i would love it if i could live a little bit longer and that's called lifespan living longer and extending life but i'm more interested in extending my health span which is the quality of my life and so to that end healthspan has three pieces right it's the i think you gotta have a dream the school of greatness yeah please welcome welcome back everyone to school of greatness podcast very excited about our guest his name is peter atiyah and he is a physician focusing on the applied science of longevity and many other topics that he covers in his podcast called the drive i'm super excited you're here but been wanted to have you on for a while and you are extremely highly respected in the community of nutrition learning about diabetes weight loss about extending life having a higher quality of life so i'm very grateful that you're here thanks for having me with us and we were talking offline for a second about what you think is the most interesting for people right now in terms of longevity in terms of extending life and extending the quality of life which i think is a hot topic right now that everyone wants to people are afraid to die and people don't want to be sick and you mentioned something interesting about the impact of emotional and mental health in terms of longevity so i'm curious we could start there about how important is mental health for our length of living and the quality of our life and what can we do to increase the quality of our mental health you know i think it's something that has been so ignored um typically by by medicine and i think part of it has to do with just the stigma that's associated with mental health and that can be depression uh in a formal sense where we have a diagnosis of depression or mania hypomania bipolar schizophrenia all these things that you know sort of get labeled by a diagnostic criteria but frankly i think it goes much broader than that it basically comes down to how well do we all cope with distress because life is stressful and whether it's really big stress like loss of job due to covid or loss of a spouse or divorce or just frankly the day in and day out kind of grind of life the the tools that we have to cope with that distress and maintain kind of a buffer uh within which we function really determines so much of the quality of our life and when people come to me as patients most of them are paradoxically not saying the the silly things you might expect which is i i want to live forever i'm in pursuit of immortality no i think most people are saying i would love it if i could live a little bit longer and that's called lifespan living longer and extending life but i'm more interested in extending my health span which is the quality of my life and so to that end health span has three pieces right it's the cognitive piece so how well does your brain work as you age and we could talk about what makes up what makes up cognition then there's the physical piece so you know basically what we think of as the exoskeleton right so your bone mineral density your muscle mass function uh ability to move freedom from pain all of those things and then of course this this third piece which we just talked about which is the emotional resilience and um the ability to maintain a tolerance around distress and and again those three things to my mind sort of form the boundaries of quality of life when any of those are lacking even in the absence of disease right you could have no no imminent death on your doorstep but if your cognition is sliding if your physical body is breaking down through injury or if you're just emotionally unwell it doesn't seem to matter that much it's not a high quality of life if one of the three is off and if all three are off you might be in a completely depressed state in physical pain you'll have some mental challenges and you're just like what's the point of even being here yeah you could even go further and say most people when they think of death think of what we call cardiopulmonary death or what i'm calling death certificate death so and so died of a heart attack so and so died from breast cancer so and so died from in a car accident and all of those things basically your heart and your lungs stop working and you're dead and that's the end of it but most people actually and i can't give you a stat because i think this is more sort of more of a heuristic but probably 80 percent of people have actually died one of the other deaths before they die a cardiopulmonary death so they've either died a cognitive death which is to say their minds have become so dull that they're really not able to be the people they wanted to be their body has broken down so much that the things that once gave them so much joy whether it even you know be the ability to play sports ski golf whatever it is that they love play with their grandkids they're deprived of those things or emotionally you know they've become despondent they've become depressed they've become secluded in a way that has basically robbed them of joy so so so you sort of reach one of these other types of death that precludes the cardiopulmonary death certificate death right and to me we want to minimize that gap right we would like it such that you know when you die it's really your first encounter with death of any form right i think when i talked to david sinclair about this he said the key is not to extend life and be in pain for 20 30 years of suffering he's like the ultimate way would be to live till 100 105 whatever it may be and then die quickly like have something suddenly fail and then don't try to extend that with a lot of pain and suffering for 20 years but die within the next couple weeks and actually be rapid is what he's mentioning is kind of like where you extend the quality of health span as long as you can and then you have a short window of pain suffering or whatever may happen until the body then shuts down he says that would be the ultimate way to live and die as opposed to and i agree with that yeah yeah i completely agree and unfortunately if we embrace that that is optimal and i've yet to meet a person who doesn't feel that way right like i've never met a person who says no no no i want to suffer as long as possible yeah baby keep me yeah so so if you accept what david me and four thousand other people would argue then you have to ask the question why is medicine practiced the way it's medicine the way it's practiced because let's think about medicine for a moment medicine says we don't do anything until there's a problem right so the entire system of the way a diagnosis works the way a diagnosis is attached to a set of symptoms the way it is treated the way it is billed for and the infrastructure of healthcare delivery is all around waiting until there is a problem treating that problem and basically you know doing better and better at treating chronic disease and i don't want to suggest that we have not done a good job of that right so if you go back in time 60 years your likelihood of dying from your first heart attack was well over 50 percent in other words you know somebody shows up with a heart attack and by the way for men two-thirds of those were going to occur before the age of 65. wow so you show up with your first heart attack you know at that time you probably had a 70 80 chance of dying on first presentation well today thanks to emergency medical care stents blood thinners all sorts of other things we have going you know lots of medications that's no longer the case i mean we can keep people alive for unbelievable periods of time we have things like dialysis we can do organ transplantation we can do so many things that do indeed extend life in a chronic sense and i'm not suggesting that we shouldn't do those things it's just that when most of us finish medical school we haven't got the foggiest clue on how you would tackle the problem the way say david explained it there's there's no system in place to say that because if you really believe in that system you have to figure out how to prevent disease not treat disease they're not the same thing yeah what would you say is the main cause of chronic disease for most people well that's a tough question because so you so you want to think of there are basically three categories of chronic diseases so we can break the big three down and i actually think of chronic disease in four but i'll explain why i'm talking about i sort of think of them as the four horsemen of death but it's sort of three pillars on a pedestal okay so the big three are in order atherosclerotic disease so that's vascular disease meaning like heart disease and stroke so those two are the heavyweight champions of death more people will die of those than anything else yeah and that's been true for 100 years and i don't suspect it's going to change that much wow okay but not too far behind it is cancer and then take a little step further and you reach neurodegenerative disease of which alzheimer's disease is far and away the most common and also the most rapidly increasing so again you have heart disease and stroke cancer and then neurodegenerative disease and we'll just talk about it through the lens of alzheimer's disease because that's the most common and those three effectively make up three quarters of deaths of people who don't smoke if you smoke we will change the ratios a little bit and add you know chronic lung disease and a few other things side note before you go on there is vaping considered smoking um i think it's a bit too soon to tell it hasn't been around long enough for us to know if it behaves just like smoking did so i think the precautionary principle needs to be in order there obviously vaping is not identical to smoking but you might be trading one known nasty thing for an unknown nasty thing right so so i think it's just and you have to remember how long it took before the evidence implicating smoking became dispositive i mean that really took about 60 years yeah so you know i i just personally it's not something i would think of as you know doing in abundance i gotcha so we got those big three diseases and then they rest on top of the fourth horseman which is kind of the answer to your question right so there's one disease which is not really thought of as a disease but i think of it as a continuum that is the foundation upon which all of those sit so it is the one thing that makes all three of those worse and in its most extreme state it's type 2 diabetes but but that's a continuum that starts at hyperinsulinemia so high levels of insulin insulin resistance non-alcoholic fatty liver disease type 2 diabetes so that's a spectrum that probably afflicts oh a half you know easily one half of all americans half americans have type 2 diabetes no are on that spectrum i've just described yeah the spectrum including so are starting with elevated levels of insulin daily and they're talking about like daily they have spikes of sugar spikes they would wake up with an insulin level that i would deem too high and then anytime they eat something their insulin is too high that's the first step and then that also turns into now what we call insulin resistance and that's sort of that sort of a harbinger of insulin resistance which means boy insulin resistance means your muscles don't do what they're supposed to do in the presence of glucose so when a person eats glucose which is basically any form of starchy carbohydrate so anything any carbohydrate that's not a vegetable potatoes rice and this could be good carbohydrates that we all would think are reasonable potatoes you know rice something like that and includes of course junk carbohydrates you know candy bars and stuff like that your body is supposed to really easily be able to take that glucose and park it inside the muscle and it's supposed to simultaneously tell your liver hey stop making so much glucose because the liver is constantly making glucose to keep your brain happy because your brain loves glucose and needs it and so when a person becomes insulin resistance both of those things start to break down they can't put the glucose from their bloodstream into their muscles and they can't tell their liver to stop making it so both of those things result in glucose going up and that is actually the definition of type 2 diabetes and then somewhere in there you also have this problem where you start accumulating fat in your liver and that's you know so so like i said about 50 of the population is somewhere within that spectrum with about 10 to 12 being at the far end in that they have frank type 2 diabetes how do you know if you have type 2 diabetes like i don't even know how do you probably know i'm feeling symptoms or is it you go to the doctor and they tell you would there be symptoms that you would recognize oh this is something that's happening i should take a look no it's much it's much more insidious than type 1 diabetes and it's unfortunate that type 1 and type 2 diabetes share the word diabetes in their description because they're quite different diseases so we'll put type 1 aside for a moment but type 2 diabetes is a very clear diagnosis but it's made by one number and i don't think it's actually a particularly great definition but the definition of type 2 diabetes is having a hemoglobin a1c which i'll explain in a second above 6.5 so we've reduced the diagnosis of this to one simple laboratory test that most people would get every year and what that number means is uh how much of your red blood cells are basically saturated with glucose and once you get to a point where 6.5 of your red blood cells have been saturated with glucose we would impute from that that you have an average blood glucose level above 140 milligrams per deciliter and we would acknowledge that above that threshold you have type 2 diabetes historically we diagnosed it by making people drink glucose and then timing um like looking at frequent you know sort of pre-defined time intervals how high their glucose got and we would make the diagnosis that way um and what happens when we have type 2 diabetes what actually happens to our bodies does this decrease our lifespan and the quality of our health span is it something that's manageable for a long time yeah it actually impairs everything so unregulated diabetes uh can be acutely fatal of course so um if glucose levels get too high and they're unregulated uh you know you could die from a you know hyperglycemic coma you could have you know organ failure things like that fortunately that is almost unheard of so acute death from diabetes type 2 type 1 is a different story from type 2 diabetes almost unheard of it's really the chronic death and the chronic damage of type 2 diabetes comes in two flavors or i should say has two axes there are two things that are driving it all three of those diseases by the way that i mentioned have diabetes as either their first or second greatest risk factor the heart disease cancer and right so for so for so i would say for heart disease um actually for heart disease it would probably be the third biggest risk factor behind smoking and high blood pressure for cancer it would be the second biggest risk factor after smoking and for alzheimer's disease it's a bit tricky because there's such a strong genetic component but you you might be able to make a case that once you normalize for genetics it would be a toss-up between diabetes and vascular disease which are themselves dependent as to the next biggest risk factor so again there's no disputing that diabetes is an unbelievable risk multiplier for alzheimer's disease for cancer and for heart disease and so now the question becomes well i mean you could also ask what else does it do so you know it also leads to blindness amputations impotence all sorts of things that might not shorten the length of your life but would definitely impair the quality of your life is there a way to reverse type 2 diabetes there is and that's kind of the great news um you know it we can get into the semantics around curing versus reversing but i actually like the term you used because it doesn't really force one to get into that semantics i would say you can absolutely put type 2 diabetes into remission um and i've done this many times myself with patients and there are many physicians who have done this but it also it starts by acknowledging you know what the disease is and it is a disease of carbohydrate intolerance there's no way around that so what does that mean essentially intolerance meaning you've abused the use of eating so much carbohydrates that the body can no longer i would even tone it down from there you know lewis no i would just i would just say look let's be unemotional about it and let's say a person with type 2 diabetes has in some combination created a metabolic environment where the carbohydrate intake is exceeding the capacity for glucose disposal the capacity to put glucose at work now i think there are four huge things that factor into that and the first job of the doctor is to figure out how to rank order them so you know what to work on okay okay so the most obvious one because you alluded to it and i think it is the most obvious is intake how much glucose are you eating so back when i was a marathon swimmer um i was swimming i averaged about 28 hours a week in the water so i'm i'm just like you're burning calories i'm your bird stop swimming yeah but i was pre-diabetic oh man now how do you make sense of the fact that a guy that's in the water four hours a day on average is pre-diabetic i mean it just shouldn't happen um and in in looking back at my life i think my i had limitations on two of the four things we're going to talk about but on the input side i had this incorrect belief that i needed to be drinking sports drinks all day sugar sugar sugar sugar sugar i'm drinking power aid and gatorade like it's my job gulping it yes like i don't get through a sprint swim practice without going through two liters of this crap and then i'm drinking you know i'm drinking probably a liter an hour in the ocean and stuff like that so you can have a problem on the input side you are simply consuming too much of this stuff you can have a problem on the output side which means you do not have enough muscle or you do not have efficient enough mitochondria within the muscle to take up that glucose that wasn't my problem i actually at the time was you know more muscular than i am now was obviously exercising far more than i am now but for many patients the lack of exercise is a really key issue when it comes to type 2 diabetes they're sedentary they're not moving and therefore their body is weak and it's it takes off they don't have a place to put the glucose you have to have a place to park it and there's only two places glucose can be stored liver and muscle and the liver is a very small supply so the more muscle you have the more places you have to store glucose so the glucose cannot be stored in fat it can but and you don't want that to happen so you can't get that acutely yes and you can't do that acutely so you that's not something that can happen in an hour so the only way you can acutely get rid of glucose is to put it into muscle or into the liver and so that's why someone with type 2 diabetes gets glucose spikes yes you're right they eventually put that into fat um but in the liver starting to break down quickly or yeah okay yeah okay okay so what what's the third thing the third thing um which is getting more attention now and i think this by the way was the second factor in my pre-diabetes is sleep disturbance so um you know most of my swimming uh my most my swimming career kind of took place during my residency and shortly after and obviously sleep deprivation was a big part of you know surgical training and right even when i finished my residency uh or i should say when i left my residency and went into you know working in consulting i still sort of took the surgical ethos with me which was i'll sleep when i'm dead yeah and i was like you know this is awesome like i love i loved working i love training i love i just didn't sleep was just such an aggravating thing to me i remember routinely i'd you know come home from work it would be 11 o'clock at night i'd be up at 4 30 for swim practice like that was life every day and what we now realize and this has been demonstrated so elegantly with some really clever painful research which is um if you take subjects normal subjects and just sleep deprive them for two weeks by to the tune of four hours a night so that's pretty extreme but only for two weeks so if i just took you know 20 guys like you and took them from eight hours a night to four hours a night for two weeks and then did these glucose tolerance tests i could reduce your glucose disposal by 50 i could basically within two weeks turn you into an almost diabetic just by sleep depriving you yeah so reduce the ability to assimilate it to take that glute yeah reduce the ability to clear glucose out of your circulation and if it's not cleared then it turns into fat or it's surrounding your organs and it's making you weak it leads to higher levels of insulin which i'll come back to in a moment you asked a minute ago how does this disease hurt you well it hurts you through to two vehicles it hurts you through the high insulin which causes one set of problems and then the high glucose which causes another set of problems so okay having having having horrible sleep you know and there are some people for whom this is you know unfortunately an occupational hazard right so you know people who work night shifts it's going to be much harder to sleep during the day you know people who had dumb jobs like me in residency where you just don't get to sleep so there are there are lots of people for whom this is an occupational hazard and then frankly there are you know there's the things that we're doing to ourselves too much time on electronics um you know we know that you know sitting there looking at your phone looking at social media until you go to bed is not good um alcohol has a horrible impact on sleep so you know not being thoughtful about the timing of alcohol even the timing of meals eating too late in the evening so lots of things we do impair both the duration and quality of our sleep before we get to number four i want to add to this what's the latest we should be eating before we sleep how many hours before i think this is somewhat empirical but it seems that about three hours is a pretty good gap you know so so i'm kind of an early to bed guy um so i like to be in bed but you know by nine and absolutely no later than ten and i'm kind of trying to be done by about six um which again is i can do that most nights um and if i you know maybe one night a week i'm going to be eating within an hour and a half of bed but but i i clearly see a difference in the parameters that i pay attention to like heart rate and heart rate variability and temperature overnight because those things all move in the wrong direction with a meal if you eat a healthy meal let's say an hour before bed i'm talking about greens and lean meat and healthy stuff or if you eat pizza an hour before bed are they both going to impact your ability to sleep better or is the quality of the food before you go to bed matter yeah that's a that's a really good question uh the short answer is yeah it does matter um so the probably the two things that would have the greatest determination um would be the simplicity or glycemic the simplicity of the carbohydrates or the glycemic load because that's going to impact the sort of glycemic roller coaster you go on at night and then probably the amount of protein because that has a greater contribution to what's called the thermogenic effect of food so the thermogenic effect is how much does your body temperature actually rise to digest the food our bodies want to be very cold at night so anything you do that opposes that leads to lousy sleep so what foods help you sleep better that keep you colder what are those foods whether it's an hour before or three hours before yeah i i honestly it's like almost anything you're gonna eat is gonna come with something that's gonna slightly raise your temperature so i just generally say try to not eat too much before bed um and i go out of my way to avoid the two things that i think are worse so i just say i wouldn't have huge protein before bed and i don't want to have anything that's going to raise my blood sugar before bed so you know i'd have an avocado before bed i'd have you know something that's like you know i just generally don't eat before bed the body really rewards you in terms of if you wait or if you don't eat right before bed is it going to sleep better sleep deeper be cooler and therefore healthy help you have more energy the next day if you don't eat before bed yeah and this is at least for me been most easy to exhibit and and i think many of my patients would agree uh during periods of fasting so fasting is kind of a funky state because you're you're altering so many other things in the physiology but one of the things that happens especially by about the second day of a water only fast is you really are seeing the impacts of what deep sleep can look like in a in a state that is totally absent food and it's it's very interesting because you're competing with two forces one that's keeping you awake and one that's helping you sleep a lot deeper the one that's keeping you awake is cortisol you have more of it you have more stress hormones when you're fasting because that's the thing from a prehistoric standpoint that would have been going on right fasting would trigger a signal that says go get more food right be alert be focused go get food like we don't want to die and so that's kind of keeping you awake but the flip side of that is the total absence of nutrient is allowing you to get into this amazing sleep and your body temperature is really going down because your body's turning down its metabolism so i actually find fasting sleep to be some of the most amazing physiology because i'm watching this plummeting temperature rising heart rate variability falling heart rate all of these really valuable things but a little bit of rising cortisol that can lead to shorter sleep times but i still feel quite you know rejuvenated by sleep wow okay um i want to stay on sleep for a second i know you got the fourth one which i want to close that loop but do we uh does that hurt us if we nap throughout the day or take a power nap for 20 to 40 minutes does that help our bodies recover more even if we're doing the seven or eight hours of sleep or does that not matter you know it depends i would say naps are not a bad idea provided they don't reduce your drive to sleep later so i just got back from like a a hunting trip last month where just based i mean first of all it was exhausting right you're sort of hiking 10 or 11 miles a day on vertical walls you know carrying a 50-pound pack it's it's all the stuff that is physiologically as taxing as it gets at altitude right so but there was no way you could go to bed like any earlier than 11 and you had to be up by 4 30. really well just because you know you have the most uh the the two times when you're gonna have the best opportunity to to go and stock the animal is in the evening and in the morning so that those are the times so you know there was no way i was gonna survive a week of that if i didn't carve out an hour and a half to two hours in the middle of day and the day to sleep and i'm normally not a napper but i made it a priority above anything else including practicing you know with my bow and arrow in the middle of the day which i would normally want to do nothing was a higher priority than getting that nap in during the day because i was deficient at night and getting that nap in the day didn't rob me of the ability to sleep at night you still were passing out right when you got in your pillow absolutely now let's say we talk about a person who is getting seven and a half or eight hours of quality sleep at night is there any downside to a 20-minute power nap i would say no but if going any longer than that i would be i would be mindful of it because you know sleep comes down to balancing basically three things uh the first is cortisol so the the stress hormone cortisol must decline in the evening for you to be able to sleep the second thing is you have to accumulate something called adenosine so adenosine is kind of like this metabolic breakdown product that is cor you know corresponds to how much work we do physical work cognitive work so more adenosine makes us more tired that's how caffeine works by the way caffeine blocks the adenosine receptor so it functionally makes you think you have less adenosine and napping reduces adenosine so you want to make sure you don't reduce it too much the third is melatonin by the way which has to go up so good sleep is when melatonin and adenosine go up and cortisol comes down so i guess to close that out i would say if you are sleeping so short during the middle of the day and this is what i was thinking about on my trip you want to try to replicate a full sleep cycle in your nap which is about 90 minutes so that's why i really said look i'm gonna set aside two hours to take a nap in the middle of the day to get to give me one full sleep cycle because i'm clearly being deprived of one during the night time and is there such a thing as too much sleep if you're getting 10 12 14 hours of sleep every day consistently is that does that affect the body in a negative way really an interesting question by the way and quite a controversial question in the sleep literature so um there is no question that hyper sleep has been associated with poor outcomes so you know there's a inverse you share sorry a u-shaped curve of mortality with sleep right so people who don't get much sleep have a higher mortality and it's really more of a j curve right so they kind of you know as you get more and more sleep the mortality comes down down down but then it does sort of uptick so you get these people who are sleeping a lot and they're actually having worse outcomes than the people that are in the seven and a half to nine range historically that has been explained uh by the fact that people who are sleeping a lot are usually sick and that's why they're sleeping a lot so we're not we're missing we got the arrow of causation wrong we're saying you know are they sick because they're sleeping too much or are they sleeping too much because they're sick right while i think that the majority of the hyper sleepers are hyper sleepers because they're because they are sick there is actually some emerging evidence to suggest that absent that there might be a downside and too much sleep um but again i think for most people most of us are on the other end of that spectrum which is we're constantly battling the need to get enough and that's either through you know our kids our work our stress our electronics yeah our food our alcohol you know all the above our travel and is there a negative if you're a kid and you're eating a lot of junk food you're not sleeping you're staying up late because you're whatever playing video games all night but you've got all this energy all day and you're active is there a negative for in your early ages teens early 20s through lacking sleep eating poorly or is there a way to recover in your 20s from the damage you've done in your before 20. yeah that's a good question um i mean certainly you can break it down into sort of the behavioral habit side and you can talk about it through the physiologic lens the good news is before the age of 20 or 30 we are pretty remarkably resilient i mean you're an athlete so you can relate how old are you now lewis you're 37 37. so you you might not have fully appreciate i'm 47 so i'm a full decade older than you and when i think about 17 to 27 to 37 to 47 i can really talk about those decades through the lens of resilience like at 17 you could shoot me and i think i'd still get up the next day like you just couldn't right you're superman yeah you're absolutely superman and i don't know i i feel like the first observation of not being superman for me kind of kicked in about 42 ish about five years ago was the first time i was like oh so this is what people talk about right like you can't just go out and crush it every minute of every day and i think that's just one lens which is through the lens of exercise but the same is true of physiology right like or i'll give you another example many of my patients have observed this i've observed this like i was never a big drinker in college but certainly there were enough occasions in med school or college where i'd go out and drink far more than anyone should and yet somehow the next day i could like get up at six in the morning and go and do whatever i need to do like i remember one night actually being out drinking until three in the morning i mean having so much to drink it was ridiculous and somehow getting up at six in that morning to do a hundred mile bike ride oh my gosh man probably probably still partially drunk and but but felt fine by about like two hours into the ride today if i had three glasses of wine like the headache i'm gonna have the next day is gonna last me till the middle of the day is that because your body was able to assimilate the glucose into the muscles and it used it for its to its advantage then and now it's like it's a very good question i really i mean i could i could sort of you know speculate on what it is but i i just think there's an over so there's this thing called homeostasis right which is one of the hallmarks of youth and it's one of the hallmarks of aging and you know it's it's the ability to or it's our lack of homeostasis we lose this ability to get the body back into the zone of optimal performance so everything about the human body is very particular for example take ph which is the amount of acidity in our body we're so highly regulated like our body really needs to be at a ph of 7.4 so 7 would kill you and 7.6 or 7.7 would kill you and this is a scale that goes from 0 to 14 to put that in perspective okay so tiny perturbations will kill you how good is our body at staying in that amazing temperature right you go much below about 94 you're dead you go much above about 104 you're dead how good are we at staying in that range oh i mean good i mean we generally stay within a 1.5 degree band so this homeostasis thing is amazing it gets weaker and weaker as we get older and so your ability to tolerate bad food bad sleep sedentary behavior more stress all those things it just gets weaker and weaker and weaker and i think it declines non-linearly so again what you experience as a decline between 30 and 40 it's bad 40 to 50 yeah that's worse 50 to 60 you can fall off a cliff is there a way to reverse this i don't think we know i think you can definitely slow the progression of it and i know you know what i would say you probably can reverse it right so just as you can clearly reverse diabetes diabetes is a glucose homeostasis problem and it's clearly reversible um you know so there are probably some variants of this that that are harder to reverse than others uh but but no i i think we can reverse this process uh but it gets it gets harder you know it gets harder as time goes on and it gets harder the further the further you are into you know sort of the physiologic trap what are you doing to reverse it now that you've been experiencing this kind of not maybe a cliff but a dip over the last five years for yourself how are you thinking about it well i sort of had a change of heart um five years ago so actually six years ago 2014 so i sort of hung up my bike which at that so at that point i'd switched from swimming to cycling as sort of my main sport um but i you know you know at that point a couple of things had happened so one i had become very familiar with a lot of emerging research on excessive cardiovascular training which again is a rich man's problem ultra marathons ultra biking ultra swimming hiking that's that's right that's right so again ver and it's the same sort of curve right where as exercise dose of exercise goes up mortality comes down but it has this little bit of a j where once you start to get into hyper amounts of exercise especially over the age of 40 you're actually driving an increase in mortality now really yes does that mean like running a marathon once a year or is it running a marathon every week yeah great great point running a marathon once a year probably not increasing your mortality at all um but you know running 40 50 miles a week probably is especially at that age now again this gets to your point about resilience someone in their 20s doing that doesn't seem to have any impact on mortality it really only seems to be an issue if you continue in fact i did an interview with a cardiologist james o'keefe on my podcast who is you know the world's expert on this and and um it was actually james's work six years ago because i heard him speak at a conference ten years ago we became friends i you know it's one of those things i'm sure you've experienced this where you hear something and you don't want it to be true so you basically come up with all the reasons you're gonna poke holes in it until you find the game you find the evidence the other way yeah yeah yeah and eventually it became very difficult to ignore that this hyper amount of exercise was counterproductive this so that's one piece of the the change six years ago it's probably bad that i just committed to doing the marathon next year yesterday that's all right though you'll be fine i just think don't do one a month yeah exactly um and then and then i think the second thing was i realized like it was sort of funny but i realized like my prime was so far behind me that i needed to think about like what what was what was i doing this in service of right like um and not that i needed anyone other than myself to do these things because i'm very self-motivated so i don't like but just as a joke one day i asked my wife i said hey do you know what my pr is for 20k like bike run or swim yeah bike on a 20k bike on the time trial and i was like this is my wife she hears me talk about this stuff all the time i have spreadsheets and models and data and i analyze my power data every single day and i'm trying to break the record for san diego like i'm really so switched on to this she'll probably get it within a minute she'll guess what my pr is within a minute she was off by 20 minutes meaning she wasn't even in the zip code so i was like huh that's funny like it's like literally the most important person in my life couldn't care less about this and what i realized was you know i need to start thinking about a different sport which is the sport of longevity so what does it mean to be a kick-ass hundred-year-old and so that was the beginning of a mental model for me that in the past two years has gained much more traction called the centenarian olympics so how do you train to kick ass at 100 should you get there and of course everywhere along the way so that now dominates my landscape of training which means i don't you know care about how fast i can you know ride a 40 kilometer time trial because that doesn't quite fit into what a centenarian needs to be able to do what is your mindset going into a 40 mile bike then or some type of experience is it more the joy of it so i don't i don't i don't train no my training is very specific but now it is fundamentally organized around four pillars um so the pillars being stability strength uh mitochondrial or aerobic efficiency and anaerobic performance and so each of those then has a super layer detail approach and i still ride my bike four hours a week so it's a fraction of what i used to do and it's now very much geared to a certain energy system and a type of training um what was the fourth one stability strength mitochondria mitochondrial efficiency or aerobic efficiency and then the fourth and final one is anaerobic performance so you focus on those four metrics now on a day-to-day basis yeah yeah those those four pillars sort of make up the training program which is then in service of something that i invite every patient to define for themselves which is because you will have a different you know set of variables for me potentially but you know my centenary olympics has you know 18 events in it you know like i want to be able to pull myself out of a pool that you know where there's a one foot gap between the water and the curb like lift myself up i want to be able to hop over a three foot fence i want to be able to walk three miles in an hour i want to be able to carry two 10 pound bags up four flights of stairs i want to be able to goblet squat 30 pounds because that's about the weight of a kid i want to be able to get up off the floor without using my hands so i could rattle off all of my 18 things and you would say peter those seem really easy and you'd be right as a 37 year old stud but the point is as a future a lot of them aren't easy most 60 year olds couldn't do this if their life depended on it and i have yet to meet but maybe one person in their 80s or 90s who can and so that's the aspiration is to get to that level in your 80s or 90s how do you work that backwards to inform your training in your 60s in your 50s and in your 40s and it's actually very hard and as i'm getting into you know i'm three years away from 40 what should someone in my age range be thinking about when they're you know i'm healthy i feel good you know maybe some aches and pains here and there when i'm training hard or something but for the most part i feel amazing what should i be thinking about moving forward so that i continue to feel amazing and have the ability to do these things so i don't i think it's never too late to at least become familiar with what these ideas mean and it doesn't mean that you have to go whole hog and devote yourself to this like i've obviously made a very conscious choice that i don't go to swim meets i don't go to bike races like i don't train for those things anymore and a big part of that is just time you know there are only 168 hours in a week and you know i have a very clear set of priorities and i'm willing to set aside 10 to 12 hours a week for exercise which by many people's standards is still quite a lot but probably by the standards that you exercise and certainly by the standards that i used to exercise i've never exercised so little in my life so i have to be very efficient with every one of those minutes and that means i'm laser focused on the four principles of that in your case i think it comes down to saying okay how much time do you want to avoid devote to the long game how much time do you want to devote to the short game another way to think about this would be investing if you're looking at an investment portfolio you might say how much do i want to put both time and money so the actual capital i set aside but also the amount of time i spend deliberating over it into my retirement account versus how much do i want to invest as a day trader for short-term gains um for you know money that i'm going to be using in the near term that's maybe even supplementing my income today you could have totally different strategies for that that's totally fine so i'm just in the category where i'm only thinking about long-term permanent capital and so um so that's the first question is you have to decide how do you want to do that and it might be that you say you know peter 37 i just want to focus on running a marathon i've always wanted to do an ironman so i'm going to go and do that and you know i want to climb mount everest and that's going to require like you might have a whole bunch of these bucket list things and truthfully i would say do them now because it's only going to get harder because you're not going to do it later yeah yeah i mean i don't think you're going to want to do it later so get those things out of the way yeah and then maybe when you turn 40 you say okay now it's time i'm going to really focus on my centenarian olympics when i have a better sense of what those events look like for me personally that's interesting is there a list somewhere of your 18 on your website that i can link up for people to check this out no it's um it's it's it's not we have we we have uh i think i have a subset of them for for for our patients in our you know documents that talk through this stuff but uh it'll be in my book i want to close the loop on these four things we talked about sleep for a while the first one was intake of glucose second thing was you don't have the efficient muscle to take in the glucose the third is sleep disturbance we talked about that for a while what was the fourth thing that we were gonna cover here stress yeah so cortisol is a really important hormone um without it you'd be dead um but too much of it can really wreak havoc um and a big part of what too much cortisol does is really drive that excess production of glucose out of the liver and so of these four i certainly have never seen a case where just stress alone resulted in diabetes and a person whose nutrition intake you know or you know their their their intake their exercise and their sleep were perfect but it it really is like having just a little bit of extra kindling on a fire it's a mole yeah it is it's a multiplier what are the three causes of stress well i mean i think there are many causes of stress right so so i think you've got kind of the the there's that you could divide it into sort of internal versus external right so i i i think of this in a way that says look it's really more about a person's response to externalities right response to the experience the event the that's right that happened that's right you can have three people that are exposed to the exact same externality that have three completely different responses to it so i think it's less productive to focus on the external piece and more productive to focus on the internal piece so this is where i think my favorite by far well so now i think there are three ways we can go about coping with this which because this kind of goes this is just the tip of the iceberg is the stress piece this really becomes now the sort of gateway into what is mental and emotional health all about yes and and and and now i think there are basically three you can see i'm a very pillared structured guy right so so now we go into basically three ways that we can approach dealing with this one of these is through psychotherapy which i'm a huge huge proponent of pharmacotherapy which i'm also a proponent of though i think it's vastly misunderstood and then behavioral therapy which i'm an overwhelming proponent of in particular a type of behavioral therapy called dialectical behavioral therapy or dbt yes dialectical behavioral therapy not to be confused with cognitive behavioral therapy or cbt which um is also popular uh but but i believe that dbt is more efficacious but that said i think different personalities respond different to different versions for what it's worth my personality responds so much better to dbt than cbt so therefore i found it to be much more helpful so these three things will help give us the tools to cope with stress yes gotcha and what i'm hearing you say is it's we a lot of people lack tools for these three main things cognitive physical and emotional resilience we're lacking the tools to then amplify them in our favor as opposed to against us and the more tools we can gain then we could hopefully take the actions to live healthier and longer yeah and it has to be proactive i mean i think that's the piece that's inherent in what you said is at some point you have to decide you're going to go on offense so you you can't just sit on defense and say i'm going to take it as it comes and what's going to happen is going to happen and and i just i think you you you have to take this view which says i'm going to be incredibly proactive and i might not be able to control everything you know i i i don't represent that you know there's some path where everybody's going to be able to make it to live to a hundred there are just some people whose genes don't don't don't command that uh and that's fine you know there are people out there who who have so many you know genetic things working against them that they'll be lucky to make it to 80. but but the point is with without making these proactive changes they might have lived only until 70 and to your earlier point they might have spent the last 20 of those years in an unbelievable state of misery so when you contrast you know living to 70 spending 20 years in misery versus living to 75 with maybe two years in misery it just doesn't even strike me as a trade-off the more i'm hearing you speak and the more i've done my own research i'm not a you know medical professional but i've interviewed a lot of incredibly smart people who study this it's for some reason it's all coming back to emotional and mental health because if we aren't able to have control or learn to navigate our emotion and the way we think then we're going to make bad decisions which will turn into bad results for our health and our life is this is this off that if we the root being mental and emotional health is potentially the thing that could cure and help us live longer but if we take care of everything else but that then we're always going to go back to these negative patterns that hurt us or is that all i don't think it's off i think i think they all have to be in place i mean i think the you know i'll share with you one sort of illustration so i've been working on this book for uh four years now and it's evolved a lot because it started out mostly just being a book about the science of longevity so you know to me a very very technical book but one that i was incredibly proud of and one that i think would have been read by the 15 most respected scientists in the field who would have thought it was amazing and nobody else would have read it so then it basically got reworked and it became you know more accessible and more personal and it kept getting reworked and reworked until it basically got to a point where it was a pretty good overview of every single thing we've talked about today except for this emotional and mental health piece um and and that's you know that's that's basically the piece that's delaying it but it is that realization which said there could be no greater torture than to figure out how to live longer and how to preserve cognitive and physical health but without that emotional peace being in check in other words to extend a miserable life is is torture so at the at the root of what we're trying to figure out here is how do we cultivate inner peace in our peace of mind piece of emotions during our life that's a big component to health span right it is and i won't represent that i fully have this figured out i mean in fact that would be the hubris to declare that would be embarrassing but i think for me i like the word joy um because it just it kind of captivates one of the things that i have found to be central in my journey in this space which is it captures the peace about being with others that i've so historically ignored um you know i had a i i'm very fortunate to have a few therapists three actually so i actually have a therapist in each of those disciplines right so i have somebody that i work with on the behavioral side on the psychotherapy side and on the pharmacology side and the person who is my psychotherapist so she's the one that i speak with weekly about this you know the how am i feeling stuff yeah her name is her name is um esther perel oh i love esther i've had her own times she's she's she's amazing and and you know she said to me a couple of years ago maybe maybe two years ago and she said look you know you've you've run a playbook that has only had three plays in it you've you've you've executed them as well as anybody could execute those three plays but you were really at the end of this and it's it's and those three plays were um obsession detachment and rage and that's it yeah those are the only three tools you have and you they're the only tools you've had since you were five years old and you've gone very far with them but you know it's led to incredible isolation incredible pain and you know and all these other things and it took a while to understand how that could be the case and how to begin to fix that but as i and it's not something that you change overnight of course but what i'm so much more appreciative of now is the fundamental difference that comes from fighting back the urge to detach so so again this is just one very very narrow example but there are probably some people who can appreciate this which is in periods of fear it's it's sometimes easy to pull back and to retreat and to me that's a joyless state right that's that's basically saying i don't want to be connected to anyone i don't want to have i don't want to be relational to borrow a word from another amazing therapist i had terry reel who actually met through esther um so so once you sort of stop living a relational way um i i just i mean it sounds very cliche for someone who's so interested in science as i am but i think once you cease to live in a relational way i think you're on that path to a very slow death when you isolate yourself more and you don't cultivate strong relationships you die faster is that i'm here you say or you well whether you feel where whether you die faster in the dearths in the death certificate or not some data would suggest you do but i think those data are difficult yeah you suffer more so what does it matter like even if you don't even if you don't end up in a casket sooner you might as well because you're suffering you're suffering yeah you're lonely you're isolated so what are the three and you're miserable and you're you what were the three plays that you added to bring more joy in your life well i think it's i think it's basically looking at how to reverse each of those patterns and and working very hard to do so and that's been a that's been a lifelong i shouldn't say lifelong journey it's only something i've been working on for three years but it's it's definitely harder than anything i've ever done so so from rage to uh what would be the opposite for that oh to to an expanded emotional vocabulary right so so you could so so rage for me think of a funnel where every possible every possibly every possible negatively valenced emotion funneled into rage anger and rage yeah anger becomes rage fear becomes rage um uncertainty becomes rage anxiety becomes rape defensiveness becomes rich resentment yeah rage right okay so so the first step in that is is mindfulness so so meditation obviously is a very important exercise that we can do to learn how to stop and identify that and so if you look at me today versus if you look at me three years ago when you know i literally was on the verge of you know killing somebody in a parking lot at some point a big difference is now if something upsets me i now have the gap between stimulus and response to examine the emotion and say oh you know that email really upset me because the person implied something that is um threatening to my credibility or something like that right so it's like it's like having the space to go through that process and then having the vocabulary now to do it now literally it means i've had to print out worksheets like i'm in grade school again with sheets and and i go through exercises so i have homework every single week where i go through okay when this happened how did you feel what was that emotion signaling to you um so there's you know part of it is going through going through that type of an exercise um so i think that's that's been the biggest tool there um i i think as far as the obsession goes part of it has been that's been more of a displacement so that's been more of um you know i created a contract basically much in the same way that a person who goes into a 12-step program does so i do consider myself a recovering addict um and i just think that i i have more of a socially acceptable addiction so i think right we look at people yeah perfectionism and hard work are socially acceptable addictions but the reality of it is they can be quite damaging to your offspring which is i think for most of us our biggest fear is that we hurt our kids um and so after going into you know i i did effectively go into rehab um and after doing that i i you know have a contract and i have people that function as my sponsors and there has been some very very deliberate changes in practices um and it sounds silly but it it had to start out with creating very structured things that you wouldn't think a parent would need to do but you know mandatory 30 minutes of play time each day i just think people have lost the art of joy and play it's one of the reasons i have a it's funny i'm in this like you know high-end condo building here in los angeles right in the middle of century city i'm not sure if you've been this area but there's a lot of corporate buildings and so everyone's in their suits and ties and i literally am right next to my studio about two blocks away and i have a scooter that i get on not a electric scooter uh i have like a manual scooter where i push myself on a scooter i come down the elevator with a scooter and walk out my front building hallway and there's literally every luxury car you can think of every one of a kind lamborghini to ferrari it's kind of obscene these types of cars that you see the rolls-royces all of them we're in like the heart of beverly hills and i come on scooter and i just don't care i'm scooting around i don't care what people think about me i'm gonna have fun because i've i feel like a lot of people lost the art of being a child of joy of play and i'm trying to enjoy it myself and also cultivating others hey it's okay to just be goofy and playful and have fun right so mandatory playtime i think is a powerful thing this is a big part of the playbook it's just it's it's i mean it's it's grunt work actually but it you you have to do it to create new habits and it doesn't take as long as you would think um i thought it would take a lifetime to change and yet i would say even even when i look at how much i've changed in the last six months i would have never believed this much change was possible in this short period of time how important is health span and lifespan related to healing the past whether that be yesterday's past event childhood past relationship past all past hurt how important is healing the past with healthspan i don't think at first again that's a very good question assuming we're not talking about things that are so suppressed that we can never understand them but which we could debate how much that could still be impacting today and the answer is it could still be a lot and it probably is i'm a huge believer in in understanding previous trauma and in fact i've interviewed several people on the podcast about that laurie gottlieb who i think you've had on the show she's excellent a very close friend and a remarkable psychiatrist paul conte corey mccarthy i've talked about this with a lot of people corey was a guy who was incarcerated for many years kind of turned his life around in jail but again you could peg so much of his tragic life story to you know getting molested at a ballpark when he was a seven-year-old boy and so i don't think you can disentangle these things and i you know just as i said at the outset we are we're in a world where people don't want to talk about mental and emotional health as much i think that's changing by the way and i think people like lori and paul are a huge part of that change i hope with that comes an understanding that we have got to figure out a better way to deal with trauma and it and trauma is not all big t trauma it's not all yeah it's all a lot of little t traumas add up and most of us i think have had some sort of adaptations to things in our past that have come at a cost and so so a lot of those adaptations are positive right a lot of adaptations are what got us through those things and that's why i think many people are reluctant to right face them and say hey this thing's bad i mean i certainly refuse to ever acknowledge any of my traumas as problematic even though i always i never had an issue not understanding what they were but i just thought well they're very productive like in a very convoluted way they they told a story that i thought was very good and they resulted in all of these traits like rage obsessiveness and isolationism you got results i got amazing results if you you know you can put your head down and do anything so it's when you sort of let that armor down when you put that guard down and you allow yourself to sort of crack open and lori wrote about this in a way that i thought was beyond amazing in her book which is why i wanted to interview her there was a particular story about two of the people she wrote about in her book that i thought most amazingly demonstrate how a traumatic past can just you know create for a devastating life no matter the success it feeds into all of the above so i think that to answer your question does that impact the physical yes does that impact the emotional yes and i'll share with you a story that i think even paul and i discussed which was about six years ago i had a patient who had looked you know was really on the verge of being diabetic so she wasn't but she was close and she was probably 20 pounds overweight and was very frustrated because she was um incredibly compliant with everything i asked her to do right so you know i said we're going to change your nutrition this way she did it we're going to change your exercise this way i need you to sleep more this way we did everything right and her numbers got a bit better she didn't really lose any weight she wasn't really feeling much better and i i was really feeling like if it were anybody else i would say she's probably not doing what i'm asking but i really knew she was and one day we were just sort of sitting there talking and i don't know how it came up i knew that her father had died when she was young like in college but something about the way it came up this time made me think it was it was creating a much bigger imprint that had been dealt with now she'd been on an antidepressant since college and this she's now she's in her mid-40s so we're talking 25 years later but i just wondered i said is there an issue here is there sort of a psychological pain that is literally impairing her body's ability to get better so i said look this is going to sound crazy but i'd like you to go and see this other doctor he's a psychiatrist but he's he's really really smart and i i want to explore this mind-body connection in a way that doesn't sound so hokey are you would you be up for this and to make a long story she said yes and within a year you couldn't recognize her you know yes he'd made changes in her medications so maybe it's possible that some of the medic you know changing her from one type of antidepressant to another could have made a difference but i do believe that a bigger part of the difference was just that she got so much more in touch with what had happened and came to grips with it and had began had begun to work through that trauma that kind of letting that go and you've probably read the body keep score and there there are lots of people who have really talked about this idea and i've seen now enough empirical examples of this that i'm inclined to believe this is true and therefore it shouldn't be ignored what do you think are the main causes of emotional and mental health disease i guess what are the main causes of the lack of a strong mental and emotional well-being if you come at it through the lens of trauma so so let's take off the table for a second the sort of genetic causes because there's a clear genetic relationship with mental health so i know for example in my family there is a non-trivial amount of genetic mental health problems um so i had i had an uncle who had schizophrenia um i had a i had i basically have the following in my family i think schizophrenia depression and probably maybe some bipolar so there's there's clearly a genetic component i'm inclined to think that trauma plays a great role in this and i think trauma comes in different flavors so the most obvious form of trauma is abuse and can be physical sexual uh spiritual um those would be sort of you know obvious forms of abuse um another one would be neglect so neglect is a form of trauma um and that can be a kid who grows up in a house with two parents who never lay a hand on him or her but completely ignore him and you know don't parent him at all or you know he's raised by a nanny but but you know really never gets the attention that a child needs from a parent abandonment is another form of trauma so this is different from neglect this is you know obviously more extreme and it's it's when a child is actually abandoned by one or more parents another form of trauma that most people don't think of uh is enmeshment so this is when a child basically has to grow up too quickly and is forced into the role of sort of being an adult with one of their parents and you know that doesn't at all imply a sexual connotation or anything but it's it you know the responsibility is very early yeah that's right or and and also just the emotional burden that comes with it right so you know an example might be a single mom who basically relies on her ten-year-old son as her confidant yeah or her as a exactly as a confidant and complains to him about her boyfriend and um you know and and basically makes you know he has to grow up far too quick and and and things like that and then i think another part of of uh of trauma is basically witnessing tragic events and that could be like in the case of my patient you know losing her father suddenly or um you know post 9 11 many people were obviously traumatized by you know things like that um so so there are lots of you know tragic events that can do it now within each of those lewis any two people can have a totally different response so based on your emotional tools that you have based on your resilience to begin with so again one of my favorite examples of this is do you know who rick elias is that name ring a bell i'm not sure if i do so amazing guy he was on that u.s air flight that crashed in the hudson river um 11 years ago january 2009 um he has a beautiful ted talk it's very short it's like seven minutes long that talks about it and it's titled something to the effect of the three most important lessons i ever learned in life and it's basically what he learned in the couple of minutes thinking he was dead rick is one end of the spectrum right he lives through this plane crash that night he was back on a plane to fly home to charlotte like crazy you know right like four hours after he's almost dead he's back on a plane flying his life is taken off they had a 10-year reunion for the survivors where they all got to meet up with you know captain sullenberger you know the the guy who did this yeah captain sully you know he mentioned to me there were people from that night whose lives have been destroyed and who've never been able to get on a plane since oh man so think about that for a second the exact same experience will produce an entirely different set of responses in people and that's why i think we have to be very humble when we think about trauma and that's why i get a little annoyed when i hear people say well you know this person had this happen to them and look at how great their life turned out and somehow they say that as though to minimize what has happened to somebody else yeah and to me that's just utter nonsense and judging people's experiences and making them wrong or telling them you know step up or whatever is what i'm hearing you say is not the best approach which is probably something i would have done in the past as this football mindset of like just tough it up and quit being a wussy and you know could crying about some scrapes here and there um but that's not the best approach no it's not it's not it's not a great long-term approach we we have to be we have to be pretty nuanced in this and we have to be we have to be able to really kind of treat everybody's pain like it's their own pain and nobody else is and right and now yeah yeah i went through all these tragic events and i'm able to deal with it but you went through this little trauma and you're stuck on this not doing that yeah the two fastest ways to not recover from trauma are to compare yourself to others and to minimize your pain it sounds crazy but the mo and and i you know believe me i went through i could tell just horrible experiences of going through kind of this this journey and and having to to fight the the fight the urge to do those things but just the constant desire to minimize and say it's not that bad it's not that bad it's not that bad let's stop making a big deal out of this or yeah but this person went through so much worse and you know none of that matters you know like this this you know whatever 100 people on that airplane all experienced the same external truth which was the plane crashed but there's a hundred different internal truths that came out of that so emotional resilience is a massive key and what i'm hearing you say in some of the ways to develop more emotional resilience is to have psychotherapy par uh as a pharma therapy and behavioral therapy to gain tools awareness acceptance forgiveness i would say when indicated you know certainly most people probably don't need pharmacotherapy meaning they don't need any medications to aid in these things but there are you know i mean there is such an amazing toolkit of medications out there that do aid in the increasing this buffer this this this you know what i think of as this bandwidth of distress tolerance right so again if you it's the difference between if you think about a person who can only live between the temperature of 97 and 98. boy they're going to be in for a tough life compared to somebody who can live between 95 and 105. so so similarly a person who anytime they fall below here they're going to be depressed and anytime they go above here they're going to flip into a fitter rage that's a miserable life compared to somebody who can live here what would you say are some of the things besides going to therapies as as gaining tools what would be some of the things that we could develop more emotional resistance or emotional fitness as someone like tony robbins calls it emotional fitness to be able to you know stay more calm on the range of emotions kind of like when you see tom brady where you throw an interception or you throw a touchdown it's a similar emotion and not allowing yourself to get too high or too low how do we what are some key tools we could do to develop more emotional resistance in your mind from your personal experience you know for me i think um it's been several things i i do think mindfulness meditation so a buddhist style of meditation or a vapasana style of meditation has been very helpful because it is a tool that teaches you to examine your mind and that's effectively what we're dealing with here so when when somebody is all over the place with respect to their emotions what is probably happening is they're being hijacked by thoughts that's generally what's happening and that's okay because that's innate like that's that's as common as the day is long is mental illness negative emotional fitness i guess is that our thoughts are being hijacked over and over in a negative way and therefore we get stuck in states of depression or yeah this and again this is so complicated right because you want to separate out some of the really clear pathologic states that i think fall outside of the purview of this but i'm you know but i think for many people it's you have a genetic predisposition to depression or dysthymia that then gets exacerbated with negative thought patterns and so the question is how do you break that cycle i think step one is learning to recognize it so just do you see it being aware of your thoughts are you even aware that you're thinking like you know i don't know if you meditate louis but for most people when they go when they become early in their meditative practice it's like the first time they realize how much they're thinking some like when they're not doing anything else like they're walking down the street and you realize oh my god i'm thinking um you know dan harris who's a good friend who dan is one of my favorite people to talk about this stuff with because i think he's so down to earth and being able to communicate sort of the humor of this right and his book 10 percent happier which is actually the reason it was his book 10 happier that got me to start meditating um he just does such a funny job of explaining um how ridiculous our minds are like the dumb dumb dumb stuff we keep saying to ourselves and like the loops of just complete stupidity right so step one is recognize that step two can you not judge it can you instead just label it unemotionally oh that's a that's a a planning thought oh that's a regretful thought oh that's a judgment thought okay so that to me that's really hard to do and if i can do that uh 20 of the time i'm doing well but being able to do that 20 or 25 of the time which is probably where i am has had like an 80 improvement in the quality of my life which i actually wouldn't have expected that i would have thought you needed to get to 80 there to have 80 elsewhere so it tells me that some of the other things i'm doing are probably moving the needle as well and a big part there is journaling so yeah another good friend i love a doctor is telling us to journal you know our physician is telling us the journal yeah have you interviewed ryan holiday yeah a few times yeah so so so you know this ryan is a big proponent of journaling and i find it to be really productive and at times i go in a structured way meaning like there have been periods where i've said look i'm only i'm going to journal through these three things every single day so i'm going to journal something that i thought about that upset me something that i'm really proud that i did you know something blah blah blah blah and so you sort of force yourself to come up with these three things but that becomes a very that becomes a very good pattern because it now gets you into that thinking process and then other times like right now i'm not doing structured journaling but i'm doing you know really sort of deep deep insightful journaling on on on sort of threads that are relevant um and that i sort of bring into therapy and they become kind of the substrate for those discussions how important is it for you to have consistent therapy whether it's weekly or monthly but having something consistent to go to to share thoughts feelings and emotions and where would your life be if you didn't have it in a consistent base would you be able to do it on your own or is the accountability so much greater than self-discipline mental uh fitness before we continue this video make sure to subscribe below and turn on the notification bell right now so you don't miss out on these great videos every single day there are some things that just naturally come to me and i don't need any accountability on them so exercise is one of them i love exercise i've loved it since i was a kid it's you know there are probably times when it's bordered on unhealthy and addictive um that said once a week i still work with this amazing woman named beth lewis and there's a great structure that's provided and you know she sometimes prevents me from you know doing more than i should and and is constantly fine-tuning and honing what i do in terms of mental health i've you know i've struggled with this a lot in the sense that it there have been many periods even recently where there's still a tiny bit of shame associated with it like there's this thing that says man why am i not more together as a person like why why does my wife not need to do this and i still need to do four hours of therapy a week and am i going to be doing this for the rest of my life you know because i don't think there's ever going to be a day when i'm not going to be doing therapy maybe it will be just two hours a week but i don't i mean personally i'm not sure i see a day when i'll ever be you know just not not doing it i don't think it's possible i i think it's um i don't ever want to go back to where i was so so similarly it's sort of like the alcoholic who says i'm in a 12-step program it's really working for me i go seven days a week am i going to be going seven days a week in 10 years maybe not but i'm probably still going to be going and it might be once or twice a week you know it's interesting you say that because i wrote a book a few years ago called the mask of masculinity actually three years ago this next week coming up it's the anniversary and it's all about the the mask that men wear to project something a false image in the world with their friends at work sports all that different stuff and as i was doing this kind of book tour during this time there was a lot of women that would actually show up because they wanted to understand the men and their lives better but why the men are acting this way why they're not emotionally have a range of emotions uh seemingly and so the rooms were typically 50 percent men and 50 women and i would ask the rooms i would say okay for the the women in the room raise your hand if if once a week you get together with a couple of girlfriends or a girlfriend and you talk about your your issues your body image your stresses your concerns your fears your insecurities about relationships and career almost 100 of the women raise their hand and i go keep your hands up if you do this daily you're on the phone with a girlfriend you have tea you're eating for lunch almost all of them keep their hands up i go for the men in the room put your hand up if once a month you get together with a group of guy friends and you talk about your emotions and your feelings and your body image and your insecurities around this at work maybe two or three people would put their hands up in the whole room and i would say are you guys part of a church group that kind of forces you and schedules this so you can show up and do this and most from like yes very rarely would be men that say i do this on a regular basis because i enjoy it and imagine and i would say to the women imagine not doing this only doing this once a month never doing this once a year now 10 years never talking about these things how to make you feel and i'm not saying it's right or wrong for what the way men have shown up and the actions that men have done in history to to harm people but i tell women they're like yeah drive me crazy i would be unswell i would be sick i would be emotionally unstable if i didn't have a friend to communicate to and whether that's therapy in a private setting or a friend you trust or a group of friends i just think it's important to have these conversations and share and not hold back our shame because i think that's what makes us emotionally mentally sick i couldn't agree more with that and i think it's important for for men and women and all human beings to have some consistent conversations and for you it's been therapy that's works really well and i think i'm a big proponent of it so i'm glad you're talking about it and i'm glad that this is the thing that's part of your book that's you're adding more and more of this because the more i hear you talk about these things i just feel like the emotional resilience it's like you can even with some of your students your your clients it's like you've given them all the practical things on the physical the nutritional and they still weren't having the ultimate breakthrough until the mental health emotional health breaks through yeah i i'm pretty privileged in that my my patients give me an interesting um insight into the world because many of them are very successful people so many of them have i've been able to learn at sounds awful but at the expense of some other people that all the success in the world isn't necessarily enough so i've seen that money is virtually not correlated with happiness so um and and by the way money is not correlate correlated with quality of a person so i've seen some people that are staggeringly wealthy who are the most beautiful souls you'll ever meet and you know damn well that they were beautiful souls before they had money basically money just became a multiplier of how good they are and similarly i've seen people that have a staggering amount of money and they're just the nastiest creatures on the face of the earth and their money has just given them a megaphone to be more obnoxious and and the same thing is true of happiness and misery and all of these things so i think the thing that has has has been sad to watch is the people who have for example in the case of resources the ability to do so much for so many but they don't understand how to share because they don't have this joy right like they just like you know if it sounds ridiculous to say this but you know can you imagine meeting somebody who's who says look i you know i'm only worth half a billion and it drives me nuts or i'm only worth two billion dollars and i can't stand it and i'm not saying that to be critical of them by the way because i would argue that i say things equally nonsensical though maybe not about money right but it's you sort of realize like that is important to address that contributes to the quality of their life and in that case probably to the quality of countless other people's lives if their focus could shift if you could give one main thing for people to focus on in each of these categories cognitive physical and emotional resilience uh if all they had time to get started was to think about one thing for each to apply to their life what thing should they apply after this hmm um improve the quality of their health span which would hopefully improve the quality of their lifespan well maybe we could do it the other way we could do it through the sort of through the food the exercise the sleep and stuff like that i mean on the food front we didn't really talk about this but i would say there's i think there's sort of three variables that you're constantly able to manipulate with respect to food one is how much you eat intake um yeah well and just how much like a little bit or a lot the second is when you eat uh you know do you go 12 hours not eating in 12 hours eating or 16 hours and not you know what people refer to as time restricted feeding and then the quality of what you're eating uh so for example you know are you like eating anything you want or are you limiting certain things in the nutrition so we call that last one dietary restriction the middle one time restriction the first one caloric restriction the most important piece of advice i would give on nutrition is you should always be incorporating one of those restrictions one of those restrictions you should always be doing at some throughout the day sometimes you should be incorporating two of them occasionally incorporate all of them so these days i am pulling very hard on my dietary restriction lever so i'm being much much more diligent about what i'm eating the quality of your food the quality of my food is extraordinary i'm not paying any attention to how much i eat i'm just eating until the point where i'm satiated um and i'm not paying outrageous amounts of attention to when i'm eating so i'm not like fasting forever though i probably only eat within an eight hour window most days sometimes 10. but i'm not you know doing a very long fa i'm not certainly not doing any major fast or anything like that but i'm really pulling hard on that dietary restriction lever now if i were to let up on that a little bit and relax a bit on what i ate i would have to start pulling harder on the other two you would need to do longer uh times of restrictive or intermittent fasting or just restrict the amount that i'm eating when i eat of calories yeah yes yes exactly interesting so right now you're focused more on the quality of the food which is one of those main foods that you're eating that you believe are increasing the the quality of your health span and your lifespan so basically the things that i'm avoiding in spades are any form of refined carbohydrate so i i'm just not eating any junk food i'm i have zero added sugar in my diet at this point um so you know the carbohydrates that i'm eating are virtually all vegetables plus berries uh quite a bit of like macadamia nuts and almonds i'm eating a lot of uh venison is you know it was one of my main sources of meat a lot of fish and yeah i mean like pretty pretty simple repetitive meals um i eat the same thing pretty much every day chicken broccoli and sweet potato and i restrict the sweet potato at night yeah and i'm just eating that pretty much throughout the day yeah i i i could probably eat the same thing i'm sort of eating two meals a day um and they're they're sort of being repeated and what i'm avoiding is just what i what i'm prone to do um during periods where i'm not paying enough attention which is eating off my kids plates and nibbling on you know crap in the pantry between here and there yeah yeah yeah so if you could i asked this question to uh rhonda patrick and i said if you could only eat five foods a day that would help you know you be a healthier human being and live longer what would those five be i'm curious what would those five foods a day be for you that for me or for not so not necessarily one but for well it's hard right because you know you know you take somebody who has an apo e4 gene um that you know you might have to deal with this in a different way so i don't i don't think one could actually answer that question definitively for people i could tell you for me what it would probably be sure um if i had to limit myself to five foods i would probably rotate you know i'd say oh boy that's tough um if you're on an island and you gotta live off these five foods to have a quality of life so i'd take avocado for one because i could get a huge amount of monounsaturated fats so i would want my i need a spreadsheet to figure this out louis because i would want 50 of my cal i want 50 to 60 of my calories probably to come from fat and i'd want most of that to be monounsaturated so i'd probably want the avocado to be high from a protein perspective um i'm a huge fan of eggs i think the choline is an awesome source you know it just does so many amazing things for you but i'm also a huge fan of salmon because of the dose of epa and dha that you can get at such a low mercury content i'm also really really fond of wild game but i guess we don't want to waste all of that in terms of a vegetable standpoint now we're getting pretty limited because you want to be able to balance enough insoluble and soluble fiber you're certainly not going to waste it on something like lettuce i'm a huge fan of like string brains sting string beans and broccoli i i don't know if they quite have the nutrient density i guess i would say louis i don't know that there's a way to pick just five things sure sure do a great job but it's probably in the ballpark of what i just described i like that what's your thoughts on fruit you know it's one of those things that really fits in because because you didn't say you didn't say fruit here at all well fruit fruit wouldn't make my top ten not not a chance right so um you know again i i think fruit being described as one homogeneous class of foods is as ridiculous as describing men as one homogeneous class of species right like it just doesn't make any sense right so you know to put you know blueberries and raspberries in the same categories as mangoes and bananas and you know grapes they have virtually nothing in common right the latter is basically all sugar the former is very little sugar so if we're optimizing for antioxidants then the goal would be to have as much of an antioxidant as we can have but with the lowest cost possible from a sugar standpoint and then you know the manner in which you take it dried food versus not you know smoothies versus not so you know the only thing that you can do to make fruit worse is to you know put it into a shake or as you know to juice it right so if you take the fiber away from it that's the worst it's all sugar yeah you basically reduce the one thing nature put in there to regulate the speed at which it hits your liver your liver of course is the primary though not the only organ that is responsible for metabolizing fructose which is the primary sugar in fruit so you want to think about fruit through that lens so whatever benefits come in fruit and there are certainly benefits it comes at a bit of a cost just depending on your metabolism so do i like fruit yeah i like berries um i like an apple here and there i mean i love all fruit but i'm not i never eat dried fruit and it's pr outside of you know when i'm on vacation like we you know we love going to hawaii and there's an area where you can get like you're fresh coconuts yeah yeah yeah when you can when you can do that kind of stuff i'm going to go all in of course but these aren't parts of my staple diet because the glycemic response is just too high so i've i've heard this from other doctors that i've had on that are not a fan of fruit really at all i mean very limited fruits or smaller apples opposed to the bigger modified apples that people talk about and um you know i've had some some backlash from people that are all fruit eaters who love fruit who see the benefits of fruit who are like fruit is not the enemy so don't say it is the enemy um what is the balance there from your research on and the facts saying like okay have some fruit every now and then but every day apples bananas lots of the dose makes the poison and it really comes down to the individual i mean i think the real challenge is when people try to talk about things as universally true in science uh and and especially in medicine so um we talked earlier about non-alcoholic fatty liver disease so this is the most rapidly increasing epidemic in the united states bar none um in about a decade it will be the leading indication for liver transplantation in the united states what is this called not non-alcoholic fatty liver disease so how do we get that yeah that's the great question so it used to be that the only way you got fatty liver disease was from drinking too much so a lot of alcohol led to fat accumulation in the liver which ultimately led to scarring of the liver which led to cirrhosis which led to liver failure you know we're talking mickey mantle here which led to liver transplant okay if you were lucky so in the 90s this other thing started showing up it had probably been there longer but we didn't really pick it up until the 90s and we were like but we're seeing a lot of people with this alcoholic fatty liver disease who claim to not drink including little kids what's going on couldn't be distinguished by the way from alcoholic fatty liver disease but because it showed up so often people who weren't drinking it had to be renamed instead of being alcoholic fatty liver disease it became non-alcoholic fatty liver disease or d and we now know pretty clearly that fructose is probably the biggest driver of that which shouldn't be that surprising um given the similarity between fructose and ethanol um and so you would blame the majority of that probably on sugar intake not necessarily fruit inside candies cakes refined sugar absolutely and and and by the way now sugar is created equal liquid sugar seems to be much more damning than solid sugar so you know sugar sweetened beverages and juice would be the biggest uh culprits by far so then the question becomes well what do you do about this well we have patients with non-alcoholic fatty liver disease in fact there's zero chance somebody listening to this podcast doesn't have non-alcoholic fatty liver disease given that you know at this point probably 20 percent of the country has it to some extent so if you have non-alcoholic fatty liver disease you should not be eating fruit like that's as as sure as god made little green apples if you have nafld you should not be eating fruit until that thing is better you have to be restricting fructose you have to be eating more choline you have to be probably restricting calories in general you should be exercising where you'd be doing a lot of things because you're on a very slippery slope towards diabetes along with the liver damage that comes with it now at the other end of that spectrum if you're metabolically healthy fit as a fiddle can you be eating four or five servings of fruit a day sure so you know nobody's right when they say it's all this or it's all that you got you got to know how to you got to know how to tailor the therapy to the individual and then identify who's at risk and and you know again like our patients with non-alcoholic fatty liver disease we are limiting them to less than 10 grams of fructose per day which you know if they wanted to use it all in fruit would be like a handful of berries like a a bite of an apple would be that yeah i mean maybe a bit more but you know you have to make the exception because as you said there are other forms of carbohydrates that still come with sugar like most bread is still going to have some sugar in it and you want to make those allowances if they're still consuming things like bread what about rice so rice doesn't have any sugar no it rice has rice is pure glucose so that you know that still can contribute to diabetes wildly if you're an individual who's susceptible but it does not seem to contribute to nafld as much and this was demonstrated pretty elegantly by three people on two uh very well done studies by disclosure i led an organization that funded one of those studies um so to disclose that but i had no part of the studies um that looked at kids with nafld and asked the question if you just restricted fructose but not glucose could you fix it and the answer appears to have been yes in other words you in the kids with nafld you didn't have to restrict carbohydrates in total you just had your restricted fruit you just had to restrict the fructose so in those kids at least the rice and the potatoes were still okay but you had to cut the fruit especially the juices and the sugars to fix the problem and what's the difference between fructose and glucose so they look very similar but they're slightly different as a molecule uh fructose is sweeter sugar is made up of one molecule of each so fructose sorry when fructose and glucose are connected that's what makes sucrose or sugar table sugar or high fructose corn syrup to a first order approximation but the biggest difference the bar none heavyweight champion difference is every cell in your body can metabolize glucose and we have an infinite capacity to store it and it's not toxic in any way you can you know you could make you as you know fat as can be because as you noted eventually you'll put it into your fat cells but there's no toxicity associated with in that sense whereas fructose can really only be metabolized by the liver in any meaningful quantity and its metabolic byproducts are quite toxic uric acid being an awful metabolic product of it and as you start to accumulate it it becomes quite inflammatory so as the liver starts to accumulate fat it becomes very inflamed and this this fat accumulation leads to another process called steatosis and ultimately cirrhosis so it's a much bigger problem so sugar is death essentially the more sugar you eat the the worse you are there's zero upside to consuming sugar and they were varying but there are varying degrees of downside depending on the individual right so the upside is it feels good for the moment it tastes good and your brain gets a hit of uh adrenaline or dopamine or whatever and that's yep and then the other 99.9 is a downside that's right and for some people there's you know relatively small downsides there are some people for whom look they get away with it and it you know doesn't cause big issues and that's great you know probably 10 to 20 percent of the population is largely immune to the metabolic downsides but for most of us that's not the case and there is a toxic dose and i don't mean acutely toxic i just mean chronically toxic yeah and how much of an impact does sugar make on our mental and emotional health well i mean i think there's certainly emerging data that is there was a paper that actually just came out two weeks ago looking specifically at fructose metabolism in the brain as one of the you know very important pathways of promoting alzheimer's disease in fact um i think there's a subset of alzheimer's disease that is effectively an energy disorder uh disease so in other words there's a subset of alzheimer's disease that looks like diabetes in the body so you could think of it as like this brain diabetes so in that subset of people who are really becoming susceptible to that illness you couldn't do anything worse than continue to consume sugar and that says nothing of course on the short-term side as you said um you know for many people sugar creates highs and lows that probably itself doesn't lead to emotional lack of resilience but contributes to it indirectly by probably narrowing somewhat that that band of tolerance that we have most people agree when they eat better they cope better with stressful things and also most people acknowledge that when we're under stress we tend to drive ourselves towards short-term comfort foods and we stress eat to get that short-term hit that you referred to mm-hmm i feel like we've just scratched the surface of so many topics i want to go down but uh hopefully we can get you back on for another two three hour uh interview because i felt like this went by like that but uh just scratching the surface peter i really appreciate this i've got two final questions for you before i ask those i want to make sure people check out your content uh peter atiyah drive the podcast you're gonna get a lot more information on this uh go check out that podcast there uh also you're on social media a lot i loved your article about topochico and the uh the downside potential downsides of sparkling water i'm a big sparkling water guy myself you have a fascinating blog where you write about a lot of stuff with the research and the science backing everything make sure to check out your website uh peteratiammd everywhere twitter instagram facebook as well with lots of great content and hopefully the book coming out in the next year so make sure to be maybe two to be on the newsletter subscribe to podcast so you can stay up to date when that comes out uh this is a question i ask everyone at the end two two questions this one's called the three truths so i'd like for you to imagine for a moment a hypothetical question scenario that you're you live as long as you want you figured out the the rules of hacking of living health span lifespan you've you're 150 200 years old as you want to be and you're healthy but for whatever reason it's your last day and you've accomplished every dream you've put out all the content you want to put out there you've got a great family life everything but for whatever reason all your content has to leave this world and no one has access to your information anymore the interviews are gone videos books they're gone with you to the next place but you get to leave behind three lessons that you've learned that you would share with the world and this is all we would have to remember you by are these kind of three lessons or what i like to call the three truths what would you say are your three truths so we didn't talk about this today but i think an important principle of knowledge acquisition is differentiating the search for truth versus the the need to being right so i would say the first thing is knowing the truth is more important than being right i guess the second one we did talk about today which is that the pursuit of joy is a good thing uh although we didn't get into it you know there's a belief i think that many people have that says joy would reduce productivity would reduce drive would reduce ambition or all these things i'm not convinced those things are true and even if they are who cares right um and then i think the final thing which at least to date has been a big part of this journey has been realizing that eulogy virtues matter more than resume virtues so if you think about who are those people that are going to be there at the end and what's going to matter to them versus what your cv says that is a principle that i think is worth preserving those are beautiful i love those three truths peter i want to acknowledge you for a moment man this has been a highly insightful for me very powerful and i'm just so appreciative of your joyful drive to finding the truth doing the research diving in to serve all of humanity and serving us to live healthier lifespans and longer lifespans so i really acknowledge you for the gifts you are and the curiosity and the the effort you put in now gratefully in the last couple years in a joyful state um to serve humanity i really uh think that more people need to be like you so i'm grateful for your existence and for being here and my final question for you is what's your definition of greatness i think it has two components and i i want to make sure i represent that i've never figured out how to achieve this but i've seen it i've been able to see it on a couple of occasions and it's really special um the first is the obvious one which is domain mastery right it's like a true mastery of whatever the domain is whether it be intellectual physical whatever but the few people that i've seen that i think about as great did something beyond that which is they do it with a level of humanity that elevates everyone around them to a place where those people have also never been before so we do see the we do see great athletes who do this uh but just as much we see great community workers who do this i mean there's this you know missionary doctor who's one of my heroes in this world and you know these these people are exceptional at what they do but equally important is they somehow everybody around them is at their best when they are in their orbit so to me that it's those two things that are almost impossible to find together um that's cool peter tia thank you so much for being here my man thank you for having me if you're looking for more greatness in your life make sure to check out this video right here and also check out our free pdf the three secrets to unlock the power of your mind to help you change your life download it right here

Channel: Lewis Howes

Views: 1,467,290

Keywords: Lewis Howes, Lewis Howes interview, school of greatness, self help, self improvement, self development, personal development, inspiration, inspirational video, motivational video, success principles, millionaire success habits, how to become successful, success motivation, peter attia, peter attia interview, peter attia fasting, peter attia joe rogan, peter attia jocko, Peter attia ted talk, how to live longer, health tips, reverse type 2 diabtetes, how to never get sick

Id: EpBPa_sC8lY

Length: 109min 50sec (6590 seconds)

Published: Wed Dec 16 2020