Kind: captions
Language: en
out all right in this episode with my
boy peter attia we discuss everything
you're doing right now to shorten your
life why your insecurities are
definitely holding you back how to live
a life worth living and why nutrition
isn't everything
hey everybody welcome to health theory
today's guest is dr peter ratia md he's
a former cancer surgeon and researcher
who got his md from stanford was the
resident of the year at johns hopkins
hospital where he trained for five years
and authored a comprehensive review of
general surgery he also spent two years
at the nih as a surgical oncology fellow
and just because he can he also has a
bachelor's of science degree in
mechanical engineering and applied
mathematics and to round it all out he's
also an ultra long distance swimmer who
has completed such ridiculously arduous
journeys as swimming from la to catalina
island in shark infested waters
but what i want to know is as somebody
whose practice now focuses on longevity
is living forever possible as you know
that is a goal of mine and uh why don't
you want to live forever
well i to your first question i don't
think it is possible i don't and i don't
see anything on the horizon that makes
it possible at least not within the way
that we think of what it means to be
alive meaning to be respiring cellularly
it's very difficult to imagine
immortality when you untether and
uncouple
the
not dying part with the preservation of
health span so specifically
cognitive performance and physical
performance
and
i think more about those things now than
i probably ever have before i think a
lot about sort of the physical stuff so
what does it really mean to be a hundred
but function
like a
well to do 50 to 60 year old
and and even if you're alive how happy
would you be i mean it would be i think
for many people it would be quite
frustrating or you know if you had
grandkids or great-grandkids and you
couldn't play with them
you couldn't tie your shoe i mean we
actually used tying a shoe is one of the
metrics to evaluate sort of flexibility
and certain physical performance so most
people our age don't think of tying
their shoe as a physical performance and
yet when you would start to lose those
things i think you'd have a radically
different view of
you know what am i doing but how do you
get there and and
look perform and feel like
the way we imagine a 60 year old today
i'm a fit six-year-old because i know
some six-year-olds that are just amazing
right so how do you how do you take that
to a hundred and what would have to
happen for us like what do we really
need to figure out is this uh
um flexibility problem joints burning
out problem atp problem like what what's
the good question um
so far my my exploration to this topic
has has suggested a couple of things so
one is we do tend to disproportionately
load joints over muscles
so in an ideal world you would want to
figure out a way to exercise where you
can maximally load the muscle while
minimally loading the joint so there is
a lot of joint failure that becomes
problematic i mean and i'm separating
the obvious which is there's just too
many people who aren't exercising enough
or correctly at all and so they're just
sort of withering away but if you
come at this through the lens of okay
well what if we're dealing with a subset
of people who are committed to figuring
out how can they exercise best in many
ways it's just a lack of specificity
right so
most people who exercise can't actually
tell you why they're doing what they're
doing the 99.9 percent of us who don't
get paid to play a sport and who aren't
even really competing at a serious level
outside of professional ranks
i don't think we know what our sport is
and i think the sport should be
being the most kick-ass 100 year old
that ever lived
so what would that look like like what
does it mean to be the most kick-ass 100
year old and i think you have to then
reverse engineer all of the things one
should be able to do
so a kick-ass 100 year old should be
able to
i don't know i'm making this up because
i haven't fully codified this yet but
they should certainly be able to carry
two 25-pound bags from a grocery store
they should be able to lift a 30 or 40
pound bag over their head to put it in a
you know compartment of an airport of an
airplane they should be able to
have a you know 25 pound little terror
run at them you know by either great
grandchild or dip down into a squat and
grab them and pick them up they should
be able to jump down on the floor and
play with cars or dolls and stand up
without assistance and if you start to
map out the 25 or 35 things that becomes
a new decathlon
so instead of saying the decathlon is
running this distance jumping this far
swimming this far it's like great those
are kind of arbitrary now we're going to
come up with like real world things that
you have to be able to do when you're
100 if you want to live
what i would describe as potentially
a more fulfilling physical life to enjoy
the fruits of having not died by that
point in your life
all right so how do we build towards
that i love this by the way like i
always tell people i want to live
forever i'm well aware that as of right
now i'm going to die
so my thing is how do we stay alive long
enough to give time for these step
function breakthroughs to happen so what
do i do like what are the things that i
train or the hormone replacement
therapies that i need to go what do i
need to watch what are those things that
i should be doing
taking a step back i would say three
years ago eighty to ninety percent of my
energy went into how to not die
which basically is strategy yeah which
is tantamount to how do you delay the
onset of chronic disease so the
mathematical equivalent of longevity
from a lifespan perspective is creating
a phase shift in disease onset
if you want to live to 100
it basically means you have to delay the
onset by about two decades of every
major chronic disease so it doesn't mean
you can't get cancer or heart disease or
any of these other things but you better
figure out a way to get them 20 years
after the average person gets them
i would say now that occupies 50 of my
brain wave energy whatever and much more
time goes into two other things which is
how to minimize suffering which is kind
of an emotional problem and then how to
be this kick-ass 100 year old so to the
latter
um
the model i have in my mind is that of
sort of bruce lee bruce lee
sort of looked at each and every
discipline of martial arts including
boxing and wrestling and things like
that and said
let me extract from each of these
disciplines that which i believe is
useful discard those that i think are
useless and create a perfect fighting
form that is truly geared towards
self-defense so it is not a sport there
is no tournament there is no rank there
is no belt there is no sensei it is can
you handle yourself in a life or death
situation
if i go to a yoga class or if i do a
pilates class invariably there's
something in there that i think is
really valuable and truthfully there's a
bunch of stuff that i'm like i don't
need this this is just if i had infinite
time this would be fine to do but i
don't have infinite time
so now you apply a constraint to the
problem which is not only do you want to
be sort of the best 100 year old
imaginable what if you're only willing
to spend 10 to 12 hours a week preparing
for that
and so you say okay well so there's a
new sport which we defined some of the
parameters of that's your new olympics
and that olympics is 50 years from now
how will you train for it if you're only
willing to spend 10 to 12 hours a week
training for it
well my guess is you will take a lot of
things
from various disciplines discard a lot
of things and sort of have to build a
very bespoke routine around it that will
involve the maintenance of muscle mass
joint integrity flexibility
functional movement balance things that
we don't even really think about anymore
how many times does someone who's 90
fall because they've lost their balance
and it's that fall that ultimately leads
to their demise how much of that the
balancing do you think is neurological
and how much is
physical they're just not doing enough
physical [ __ ] to figure out to maintain
that my guess is it's probably both
there's a stability issue that starts to
go away as you age also the consequences
of a fall become much more apparent so
it's probably not just the case that
someone who's older falls that much more
it might be that the
the severity of the injury becomes so
much more severe so right now if i were
walking here and i tripped on that stair
and fell
you know maybe on a really really bad
day i break my wrist right but most
likely nothing happens
in 50 years if i do that same thing the
probability that something bad happens
is going to be much greater
but that said i already can tell my
balance is not what it was when i was
20. when i was 15. i mean i used to do i
used to be able to do this exercise when
i was 15 where i would do a with
blindfolded i could do a single leg
squat with the up with the non-squatting
leg straight out in front of me so i
could go all the way to the floor and
all the way up arms crossed blindfolded
i could do 20 each leg i can't do that
once today with my eyes open
so admittedly i'm nowhere near as strong
as i used to be so there's a strength
component but i also just clearly lack
the balance
and so so the question is
now maybe that activity is a bit over
you know it's just unnecessary
and again i don't know what the answer
is i don't know if this means i need to
get out there and practice on a
tightrope or something like but there's
there's something that needs to be done
so
every time i do some sort of
really well thought out workout i find
myself thinking god like some percentage
of this is so essential
all of those things need to be put into
this new discipline this new sport which
is called for lack of a better word
being a kick-ass hundred-year-old
i definitely like the sport now one
thing that i found really interesting is
so people complain a lot about lower
back pain talking about unnecessarily
loading the lumbar
i've found that if i don't deadlift my
lower back hurts not if i do deadlift
now some of that's probably that i have
decent form it's certainly not
exceptional but i have decent form i
know how to avoid injury
um but it is so weird to me that doing
nothing will end up causing me pain in
my lower back but if i'm religious and
i'm doing it you know once or twice a
week every week i feel bulletproof
the advantage of deadlifting and
squatting to me is
they reveal all of your errors in
movement right like they are
i don't know how to describe it but you
can't hide from those movements like you
can't
take bad form into those things and not
get revealed right
so i like that the question is is it an
unnecessary risk
right am i one bad deadlift away from
doing something stupid
where and again i
you know i'm as empathetic and in love
with those movements as anybody
but
i also don't know if i need to do that
to be the best version of myself as a
100 year old so the stuff i've been
doing for the last
four to six weeks
i basically haven't had more than 155
pounds on my back in six weeks
and but by changing the form of what i'm
doing and making everything a single leg
movement
so a lot of curtsy squats lateral lunges
incredibly strict lunges where you are
so specifically loading the front leg
glute
i gotta tell you like i'm not and then
doing a lot of single leg body weight
squats
but with
meticulous form so that i'm fully
loading the glute not overloading the
quad which is my absolute common mistake
by doing these things i don't feel like
i've lost a step
but i absolutely know i'm loading myself
less
now the question is does that matter and
i don't think i know the answer yet so
unfortunately i feel like i'm still too
early in this process to know what the
finish line looks like
and there's other problems that we
haven't even touched on right like what
vo2 max
and what aerobic base are necessary as a
minimum threshold
yeah talk to me about that because i
hate cardio but it's one of those if i
have to to have the kind of longevity
then so be it and the term cardio is
itself so confusing right because
even if you think of what is vo2 max i
mean most people think well that's
really
a heart lung issue it's actually not
it's more of a muscle issue interesting
because that's where the the bottleneck
is not in how much oxygen can you get in
your lungs
the bottleneck is how much can your
muscles utilize
so when you look at
you know the winner of the tour de
france or you know the gold medalist in
you know cross-country skiing or the
person who wins the boston marathon like
when you when you look at the most
extreme endurance athletes who have
these very high vo2 maxes
what's unique about these people is
their muscles which is counterintuitive
because they're usually very slender
individuals but their muscles are
so efficient at aerobic metabolism that
they are able to
extract so much oxygen out of blood
when you and i
you know
are at our maximum capacity we're still
breathing out you know
80 percent of the oxygen we breathed in
so it's really not a gas exchange
problem it's a muscle problem
that said vo2 max is a very specific
energy system that probably gets a
little more credit than it deserves so
what are the alternatives well um so so
vo2 max is really as its name suggests
it is
so the definition is what is your
maximal extraction or utilization of
oxygen
the way to experience what that is is go
out and run for four minutes as hard as
you possibly can
that is that energy system but there are
other energy systems right there are
in cycling we talk about seven different
energy systems but again you can really
simplify this and say there's sort of
the energy system we're in right now
which is the smoking and joking energy
system at the far under end of the
spectrum is this neuromuscular area
where you're basically doing the most
explosive movement imaginable for you
know 10 to 15 seconds
and i suspect that for
each of those energy systems there's an
there's a minimum threshold that you'd
want to be above as you age
so ways that you could test that would
be i mean even someone our age probably
knows if you carry two bags of groceries
up four flights of stairs those people
are feeling that very few people get to
the top of that fourth i know that
because that's my apartment's on the
fourth floor so like in new york i'm
always that you know i'm always paying
attention to like
what will happen when when the day comes
that this is not pleasant like when i'm
deciding i have to take the elevator up
these four flights of stairs
um
and so if that becomes the minimum
threshold then you and that you want to
be there at 100
then you need to be there at 60 and you
need to be there at 50 and you need to
be there at 40. and so i think part of
it is just defining those things and
that determines then what's the level of
training you need to do but i do think
in this current environment of everybody
loving high-intensity interval training
which i love just as much as the next
person
that's really only training one energy
system and i think
you if you ignore these other energy
systems you're you're sort of not fully
optimizing around your performance
translating that to this new sport this
100 year old kick-ass sport
i think it's just going to require a
little more thought i'm talking to
orthopedic surgeons and saying okay
talk to me about the injuries that are
killing people
because there's two types of orthopedic
injuries that kill people there's fast
death and slow death so fast death is
patient falls and you know within a day
or so is dead from whatever the injury
was so they you know break their femur
they have a fat embolism they're dead or
they fall and they hit their head and
they you know have a cerebral vascular
accident they're dead
um but then there's also the slow deaths
right and these ones are to me
far less
talked about but in many ways more
tragic um
so so one of my closest friends his
father died recently um 89 years old
complications of alzheimer's disease
he'd been diagnosed eight months before
he died so in some senses you could say
well the good news is he was spared he
and his family were spared a lot of
suffering because you know he was
diagnosed in january he died in august
but when i went home for the funeral
i was sort of struck by
how difficult it had been for him since
he was 81. the two things he loved most
in life which were golf and tending to
his yard he couldn't do because of more
chronic orthopedic injuries so he spent
the last decade of his life kind of
watching tv
and to me that's the thing we have to be
able to avoid
and you know for me i don't know what
it's going to be when i'm 100 but i know
that today if i had to start
saying if someone said well you can't
drive a race car and you can't shoot a
bow and arrow and you can't lift weights
it doesn't doesn't matter how heavy it
is right but you can't do these
movements or you can't lay on the floor
to play
uh if i start if i had to give those
things up i'm not sure how much i'd want
to kick around and so talking to these
orthopedic surgeons is giving me a real
insight into where those failures are
coming from and the single most
important insight i've gained from them
is something you alluded to at the
outset which is just joint overload
you know so much of what we do is
even while trying to be good meaning
trying to exercise these things is just
disproportionately taking on risk so
i'll give you one silly example right a
military press is there a time and a
place for military press absolutely does
it have any role in my life absolutely
not
right why not first of all i don't need
to load my spine in that way and
if i could get 80 of the benefit that i
get out of a military press by doing
loaded activities below
my shoulder line below my neck and using
more static loaded movements above
and that gives me eighty percent of the
benefit at twenty percent of the risk
that's exactly the kind of compromise
i'm willing to make and yet i don't
think we're applying that level of risk
reward to how we exercise
that's really interesting and i
do you have a fundamental insight into
the way that humans are that you think
leads us to do that because it
you you once said and i forget what you
were talking about but you said people
just don't run the math
and this is a very
good example people just don't run the
math
well we are
innately really really bad at estimating
risk
and oddly enough makes me wonder about
you and race cars
so what is it that draws you to race
cars do you think you're accurately
assessing the risk on that
i i will say you know that's not an
unusual question i get asked a lot i i
think that i feel safer in a race car
than i do in my street car really
absolutely i feel far
far more frightened in the drive i have
to take tonight from here to san diego
because i'm going to be on the 405 and
the five
and i know that 80 of people at some
point on that drive are going to be
checking their phone
or
losing focus or not paying attention
i don't know what percentage of them
maybe 10 of them are also going to be
under the influence of alcohol
and
they pose a
infinitely greater threat to me than i
feel like i could ever face in a race
car so other than driving what are some
just grotesque misjudgments of the risk
in terms of behaviors that people do
just on a daily basis
i think i think automotive is is a very
big one so yeah it's good that we got
that one first i think another one that
people sort of misunderstand
is
alcohol
you know i mean
i i enjoy alcohol as much as anybody but
i don't think people understand how once
you get beyond one to two drinks
like how harmful it is on your liver
and
it's sort of like tylenol right like at
any dose tylenol is really hard on your
liver
but for most of us because tylenol has
no
good feeling associated with it we don't
really tend to use it more than we
should we you know if we have a headache
we take it and it makes the headache go
away and but but we don't find ourselves
like taking four tylenol every day just
because of whatever reason and yet i'm
constantly amazed at how much
people drink
even when there's no apparent reason for
it right so so there's always a reason
to have a drink right there's you can
always come up with a great reason of a
drink but
there's too many sort of blah reasons
that people are drinking so i think that
um that that to me is an asymmetric and
unnecessary risk meaning the pleasure
that they're getting from that you know
those four shitty budweisers that they
have
isn't anything worth the potential
downside it's causing in the long run
which says nothing by the way of how
often i think people do get behind the
wheel of their car when they've had a
drink in them and if there's one thing
i've learned in the simulator it's how
even one drink compromises your ability
when it matters so i remember later a
driving simulator yeah so i have a
driving simulator at home which is where
i do much of my learning um but i
remember one day i was like yeah i was
gonna go drive the sim after dinner and
i had a glass of wine with dinner
i remember getting in the simulator and
i was like what in the hell is wrong
with me here like i am missing every
apex my i'm just a little bit off i'm a
little bit off and i realized oh i had a
glass of wine even one glass of wine is
compromising me
um
so how many times have i gotten a car
having two glasses of wine
at a restaurant the answer is tons was i
legally drunk no it was well below 0.08
but if even if i'm 0.06
i'm legally fine
is that still a reasonable strategy
right and
and i think the answer is probably not
you think there are dietary things that
people are doing that have just an
asymmetric risk reward
yeah you know i'm probably kind of a
huge advocate for caloric restriction
at least intermittent bouts of caloric
restriction so i believe that the
short-term discomfort of not eating for
five days
once twice four or five times a year
going through a cycle like that i think
that the short term
inconvenience of that
is
trivial compared to the potential
benefit of of a true fast you know water
only fast for some period of time and i
still don't know what that minimum is i
think it's probably a minimum of three
days are necessary to start to get some
of the real benefits of autophagy
mitophagy and things like that but
what's the difference between autophagy
and my topic autophagy is the cell
eating itself and mitophagy specifically
is the recycling of the mitochondria
okay
um
so i think when someone says and i have
many patients or friends or family
members who have said like
yeah that's just there's no way i'm ever
gonna i could never give up food
even transiently i think
that's that's an ace it comes from
like
not not even being willing to give it a
shot
like what's the emotional
hang up
because you were you used to be
literally the epitome of the robotic
eater
just insanely strict and you said about
three years ago you were like nope not
doing that anymore and i think to quote
you exactly i no longer have the
intestinal fortitude to eat like a robot
so there was something in you that it no
longer was worth it
yeah that became much harder than what i
do today
which is
so so back then
i wasn't doing any time restricted
feeding i wasn't doing any fasting it
was a pure form of dietary restriction
so my my sort of mental model for
nutrition is everybody is starting out
on one side eating the standard american
diet
abbreviated as sad which is an
appropriate abbreviation
and the thing i always tell patients on
day one is like look the good news is
you can't get any worse than this the
only thing if you're starting at the sad
the only thing you can do to make it
worse is eat more of the sad right
but it's like the standard american diet
and i don't believe this was deliberate
right i don't think there's a conspiracy
theory here
but just through a lot of bad luck
uh has arrived at the absolute worst
combination of macronutrients you could
possibly imagine like you couldn't come
up with a way to confuse someone's
metabolism
than to combine fats and carbohydrates
in the ratios that they are combined in
most of the foods that we would eat by
default if we were left to our druthers
so from there i say look there's kind of
two introductory moves which are not
mutually exclusive but you can pick one
or the other the first is
time-restricted feeding where now you
don't limit what you eat you just limit
when you eat it and then the second is
dietary restriction you don't restrict
when you eat you don't restrict how much
you eat which you also don't restrict in
time or feeding but you restrict certain
elements of what you eat so
for those three years that i was on a
ketogenic diet which is
i mean probably one of the most
demanding subsets of dietary restriction
you know i'd pull that lever as hard as
it could be pulled
then you move into diets that sort of
mimic fasting
which is basically just another way of
saying hypocaloric diets for transient
periods of time
and then ultimately even beyond that is
fasting just you know water only also
for limited periods of time
nowhere in there do i include
constant caloric restriction so you know
reducing by 20 30 percent your energy
intake indefinitely i i think the data
are pretty clear that that is not a
winning strategy there's something about
the cycling into and out of
catabolic versus anabolic state
you're basically clearing house right
you're sort of getting the cells that
are themselves defective and hopefully
the ones with the most effective
mitochondria we'd love to target those
the most for other reasons
um
what you want to see is the regrowth you
want to when you refeed you want to see
the selective repopulation of the better
cells
the most robust experiments done on this
in primates
did not really suggest that
as the diet got better the benefits of
caloric restriction got better in other
words the worse the diet the better the
benefit of caloric restriction which
points us to this idea that dietary
restriction should still always be some
component of a healthy nutrition
strategy meaning like if you're eating
like [ __ ] stop eating like stop eating
if you're losing yourself if you really
really if you're if you're committed to
never eating anywhere but mcdonald's
caloric restriction will have a much
bigger effect on you positively
than you know if your baseline intake is
you know the way you would eat for
example
that kind of stuff at like the deep
cellular level about where we're going
and what this is going to look like is
is really fascinating to me definitely
not something that i have the kind of
grip on even remotely close to what you
do but nonetheless seems like if you're
really going to get to 100 at a high
level it seems like you're gonna have to
take that pretty seriously now you've
talked a lot about one of the tests that
you want to make real is the ability to
check for autophagy to see in the blood
um you've thrown out a couple times that
this is like a you probably know the
people that would be creating this test
um and b that it wouldn't be you know
it's not measured in the billions so
what what would that really take um
is it something that could be
commercialized and would give people the
impetus to put the capital up for it or
what does that future look like from a
funding perspective again this is not
like
the world's hardest problem to crack
but i if i'm going to be completely
truthful i don't know how commercially
interesting it is as a general rule
diagnostic tests are not very
commercially interesting
my interests are not remotely commercial
my interest is in just knowing what to
do it's like i want this test to tell me
exactly what the right fasting protocol
needs to be
should i be fasting three days a month
seven days every three months 14 days
once a year like i want to know that
and there's no amount of money that
would make it worth
you know not knowing the answer to that
question um wow that's a bold statement
well think about it i'm not to suggest
that like money doesn't matter and money
you can't do great things with money
like i want money just as much as the
next person
but never at the expense like i don't
want anything to get in the way of the
knowledge that can drive living longer
that to me is such a priority
that i would rather be
poor but know how to
you know live longer and have all the
money in the world and lose my health
i totally get that but i will say one
thing i want to talk about is you said
that um one you've said that you think
that you eat dysfunctionally even if you
don't have an eating disorder which i
actually thought was really interesting
and then you said that part of why you
gave up the robotic eating was you were
worried about how it's affecting your
daughter's view of food talk about that
because i think certainly in this the
movement that we're all going through
right now there's a real risk of that
that if i had had kids five years ago
when i was like
tara i was shredded i was so myopically
focused on everything that went my mouth
and i loved it about myself and i would
rave about how much discipline i had
so for sure if i had kids they would
have been wildly influenced by how much
pride i took in not eating
and so yeah i do worry what that would
have done i thought it was super
sensitive of you to recognize that and
change
yeah i mean my brother um actually was
the
he brought this point to my attention
first but he said you know be thoughtful
about how you describe your own
interactions with food
and when you're
giving you know your kids input on what
to eat or what not to eat try to tether
it less
to you know
body dysmorphic ideas and trigger it you
know
peg it more to performance issues for
example right because those things are
still true right if you if you eat well
or eat poorly it affects your
performance it affects your cognition it
affects a lot of things um and if the
focus is more on those things than you
know sort of
daddy why aren't you eating this because
i don't want to be fat well you know
that's
and look there's a truth to it like i
mean i'm a vain person i i
i'm not you know i've come to a place
where i've accepted the fact that i can
i won't look like i used to look like
because i'm not willing to put in that
amount of sacrifice ever again
you and i have the luxury of being old
enough to be able to think through that
in a slightly uh less emotional way
and at least
make that make that choice when i think
people who are younger
i don't know i just don't know if
they're equipped fully with the tools to
make all of those decisions i want to
ask you about change
you have changed a lot
in your life like multiple times from
starting out and getting your degree in
engineering and mathematics and then
ultimately pulling the first switcheroo
over into medicine then leaving medicine
and becoming a consultant then going
into
hardcore research and
doing non-profit work and then now back
to medicine what what has allowed you to
constantly make those jumps or what
propels you to make those jumps i have
been able to internalize something that
i think is not innate to most people
which is the fallacy of a sunk cost
so
the sunk cost fallacy is something that
gets talked about in you know any econ
101 class right so you've uh
you know you're
you're building a bridge and the you
know the cost of the bridge is 10
million dollars and you're 9 million
dollars into it and the contractor says
ah it's going to be another 11 million
for many people they are evaluating that
based on how much money they have
already put into the project
and that becomes a very dangerous game
because you can't get those dollars back
so instead you have to evaluate it from
the standpoint of exactly where you're
standing at that moment in time
and for whatever reason
i've
i've been able to
stand at any point in my life and sort
of say
i want to do x
i'm going to evaluate that only through
the lens of how many years do i have
left on earth and not at all through the
lens of what have i already put into
this
and i think that's just made it easier
to
do things that on the outside look odd
look orthogonal and then to leave
medicine um
whatever it was 12 years ago
that was something that
a lot of people came to me and said you
got to reconsider this like you've put
far too much into this and i just said
like
look i'm going to do something for the
next 40 years
i want it to be exactly what i want to
do
and that's way better to me than saying
well i'm going to do something that i
don't really really want to do because
i've spent the last 10 years doing it
which is where i was i'd put 10 years
into
medical school and training
postgraduate training
and it was like look that's
that's 10 years i can't get back
and it's
that's a fraction of the time that's
still in front of me so it just it just
seemed very logical to me to always
pursue my bliss
[Music]
and also i mean going back to something
you said i think we're in a different
world now i mean i think the days are
long gone of you do one thing for your
whole life i mean i think
for some people that will be the way to
do it and that's that's great but
it's no longer so ridiculous to have a
career change every five years
i don't
i don't know what i'll be doing in 10
years but i'd be shocked if it looked
exactly like what it looks like today
like i think
you know if you're not growing if you're
not constantly being reminded of
how much more how much higher you have
to climb
i suspect it's i suspect life becomes a
lot less fun
what drives you
i mean truthfully i wish i could come up
with a whole bunch of pleasant you know
sort of nice things to say i think in
reality unfortunately a lot of my drive
is insecurity
um that is shocking
and i've heard you say that before um
and
the first time i heard you say it i
thought that's really fascinating
because you're somebody who gives me
insecurity so the fact that you feel
insecurity is pretty fascinating
and so as a driver in what way does that
drive you david foster wallace said in
in what is unquestionably my absolute
favorite 22 minutes that one could ever
listen to which is his commencement
speech from 2005 called this is water so
and and the first time i ever heard this
i it didn't resonate with me i needed to
hear it a few times before it really
resonated where he said
if
if if you if you worship power you will
forever feel powerless right and and
that doesn't really resonate with me
because i'm not a power seeker but i
absolutely
worship intellect
and and when he's with the next words
out of his mouth are you will forever
feel like a fraud i'm like that is so
true
i find myself at least on a daily basis
thinking
dude i hope people don't find out how
much i don't know wow and and i wish i
wasn't saying that i mean i wish i could
i really wish i wish i could say all of
my motivations are pure
it's all i'm you know i'm mother teresa
i just want to fix every problem and
make the world a better place but the
reality of it is like i think a
significant amount of my motivation is
just this
complete desire to not be found out as a
fraud who doesn't know stuff
i love that for two reasons
one i think that and i'll speak very
much for myself from the moment i met
you i was like this guy [ __ ] with my
head like there's just certain people
where i'm like i it's hard to feel smart
around you so the the fascinating thing
is you know to hear that
uh that there's some of that driving you
um and then two hopefully people
listening to this that that um
aren't comparing themselves to you but
yet are looking at you going this guy is
[ __ ] fascinating i'm really
interested and they have like a warm
feeling for you
that's probably equal parts like oh he's
compassionate towards humanity and
that's rad and then equal parts like
wow he's [ __ ] smart that's you know
he's got cool [ __ ] to say
and so for them to hear that you can be
so
um open and honest about oh yeah i have
insecurity and
it's low self-esteem that's pushing me
forward because they they will look at
you and think it impossible that you
could possibly have low self-esteem
which i think is
really really good for people to see
that that never goes away and one of the
things that i've always thought was i'm
going to call it a superpower but
something that i've been glad that i
have for myself is my motives are always
apparent to me even when they're ugly
and petty
and
yeah i mean there are times where like
what's driving me for whatever reason is
ugly it's petty it's um
it makes me feel worse about myself
whatever but at least i have clarity on
what it is
yeah i wish i could say i always could
see it i don't think i can i think it
requires
a lot of
i don't think two years ago i could have
acknowledged
um
what i can be much more brutally honest
with myself about today what happened
that made that i mean you know i've
always seen therapists my you know
there's been very rare has there been a
season in my life where i wasn't sort of
searching for some sense of
you know
why do i feel so tormented and
you know one of them said the most
insightful thing to me i've ever heard
you know
your entire life
your entire life has been basically
driven by um three
skills three things that you do
um
that you're really good at and they're
not good things by the way right
emotional detachment
rage and obsession
those are like the only three tools you
are a guy that has a toolbox that has
three tools and those are the three
tools
and she said look you've got a lot of
good stuff out of those tools there are
a lot of people who get those three
tools and they just end up in jail
so
you've managed to through a lot of luck
um
you know
wind up not in jail wind up as a
quasi-successful human being a
contributor to society a father like
you've done some good stuff but she also
said you're sort of at the end of your
rope with those three tools like you
can't get any more juice out of
squeezing those things there is no
combination of emotional detachment
obsession and rage that is going to
produce anything of value and you're
actually now at the diminishing part of
the curve so now you're actually you're
regressing
so you're gonna need new tools and you
know so in many ways i think that's what
has allowed me to go back and say okay
well what
what is the impetus of that why is the
why are these things happening what
you know who do i want to be in five
years right because i can't fathom what
i
like i can't fathom being any different
in five days so i have to think bigger i
have to think of like okay in five years
you want to be it's not like what we
talked about the outside if when you're
100 you want to be able to do these
things you can back out of that and say
this is what you have to do when you're
you know 70 or 60. and similarly if in
five years when my kids are aged this
this and this
i want to be this kind of a person
and right now i'm not on a path to be
anywhere near that in fact i'm on a path
to be
completely different in a completely
different place
okay so start backing out what the
person who can do those things in five
years has to be able to do what
in a month how would they react in this
situation versus how do you always react
in a situation people like me who are
very good at doing things where harder
work produces better results
like when that's your playbook and you
are now confronted with trying to do
something where that playbook doesn't
work
it is
ego demoralizing
right like if the answer is just swim
further
like all you have to do is just keep
swimming don't stop swimming i got it
like i that is my book man but if the
answer is no you now have to be able to
control your emotions in a certain way
you now have to be able to as you said
recognize in a moment
when you have an emotional reaction why
it's what it's really about because it's
never about what you think it's about
it's about something else
can you stop yourself in the moment and
recognize that
that is a new skill
and i'm a baby trying to learn that
skill and my old trick of just work
harder just work harder it fails
so
in many senses it's like the most
intimidating thing i've ever tried to do
right
what's your process and all this like
how are you actively getting better
one is just showing up every day right
so it's
like
you know the last time i or
last week when it was the last time i
spoke with one of these therapists i
just had a really miserable day i mean i
just didn't want to talk to him at all
you know i was in a really really bad
mood
and
so part of it i guess is you set
yourself up around people who
are never going to take your [ __ ]
right so you have
therapists so for me having these these
collection of people around me it's like
they absolutely positively don't let me
get away with anything
you know
i guess part of it too is just having
really patient people around you because
you're going to make a lot of mistakes
in this process right so you have to you
know in my case i feel very fortunate i
have a spouse who is uh
you know i would say more forgiving than
probably she should be
she believes in the in the sort of like
this is what you could be in five years
this is this is the guy you can be so
when someone believes in that they're
much more willing to help you
when you fall they'll pick you up as
opposed to point out that you fell
and do you have like a specific vision
of yourself that you're
building towards or chasing
i mean i do um
and it's not
it's not a professional version of me
it's a personal version of me if i get
away with a magic wand what kind of a
husband what kind of a father am i and
the reason i use those two as an example
is unfortunately the people who are
closest to me who always see the worst
of me
and so most of what i think about is how
do you
how do you show up for those people
because if you can show up as the best
version of you for those people the
trickle effect is everyone's gonna be
fine like you will be a great version of
you with everybody so it's it's less
about
how do you show up at the tsa check gate
when the person's obnoxious i'm not i
don't worry about that that much that's
a relatively easy thing to control
but
when you're taking out your problems on
your kids or on your spouse
you know to me that's that's the stuff
that's just gotta stop
and um
[Music]
and if you can get to that to me that's
like that's the hill of the mountain
that's like that's the hill when you
climb that well at that point
you're gonna be treating everybody the
way that they deserve to be treated
including yourself by the way i mean as
you probably know
those of us who are the biggest
you know
sort of jerks to others are usually
jerks to ourselves
you're quite aware of how hard you are
on other people when they make mistakes
do you realize how hard you are on
yourself look do you know what your
self-talk is when you're making errors
and i started paying attention to it and
i was like wow
that's really that's harsh
that's very harsh that you would that
you that you think these things of
yourself which again it all kind of ties
back to this insecurity and at the
outset i i said um
you know whatever five years ago or four
years ago
90 percent of my bandwidth was on like
how to not die and today that's only 50
of my bandwidth the other 50 is the
whole physical stuff we talked about and
then it's this right it's this
um
what does an examined life mean and
is it a life worth living
because
you know
i do think we suffer so much in our own
heads
more than we suffer any any other way
[Music]
and i don't know the answer to that
here's what i know i know that that's
way harder than reducing the risk of
heart disease
i know that's way harder than you know
addressing that is way harder than
fasting or doing all of these other
things that are even non-pharmacologic
interventions that i think can fix all
those other things and certainly for
someone like me it's harder than
you know exercising or being disciplined
about all these other things um
and i suspect in part because it's less
amenable to doing right right the things
that we do
um
tend to be a little bit easier but this
is this is tough stuff so
i don't know
maybe part of the reason to want to live
longer is to just give more runway to
figure this out
no question
all right man with that before i ask my
last question tell these guys where they
can find you online
oh um
so website is peteratiamd.com
and uh you can find everything there so
the podcast although it's of course on
all the usual places you know itunes and
such um and then it's peter t md on
social as well
awesome
my final question what is one thing that
people could change that would have the
biggest impact on their health
you're gonna hate my answer man
it's going to depend on where they are
on each of these four metrics to begin
with meaning where they are on exercise
sleep
nutrition and management of distress so
in other words the biggest impact will
be the one in which you are most lacking
for each of those so for example
somebody whose sleep is completely you
know abysmal if they could address their
sleep that will probably have the
biggest impact for somebody whose
nutrition is atrocious
addressing that will have the biggest
impact
if you ask that question in reverse it's
a little easier
a catastrophic interruption to which of
those four things will have the greatest
detriment on you it's probably sleep
oh right so again not really appreciated
but if you take an extreme posture
how long can you go without eating
two months
how long can you go with not sleeping
without becoming completely psychotic i
don't know days yeah right maybe six
seven days i don't know the answer but
but you're going to
more quickly
uh completely lose it if you don't sleep
than if you're blowing any of those
other things so
um if someone's sleep is a is a real
mess
it's it's remarkable what you can fix
and how much of bad sleep permeates into
other things
awesome great answer peter thank you so
much for coming on the show man that was
amazing
guys
this is somebody who is one of the most
extraordinary humans i've ever met the
way that they think about the world the
way that they're not afraid to change
the way that he has constantly evolved
that he's constantly pushing himself i
literally could have talked to him all
day the number of topics that we didn't
get to cover is even longer than the
ones that we did uh from everything you
know why he does racing the way that he
does and why that pushes and drives him
to
some of the extraordinary things that
he's learning in the field of medicine
and nutritional science is just
absolutely astonishing i highly
encourage you to follow his podcast
called the drive with peter tia it is
amazing the the breadth of things that
he can talk about with just absolute
clarity is really really astonishing but
the coolest thing about him is that he
is never afraid to say that he doesn't
know and that when you find somebody
that is hell bent to get great at
something and at the same time they're
just never afraid to say that they don't
know and you just saw the he's
raw and real and not afraid to talk
about the things about himself that he's
working on and pushing and trying to
approve he doesn't posture he's not
trying to look cool
but [ __ ] that makes him cool so i hope
that you guys will dive into his world
he is somebody that's had a tremendous
impact on me and i think he will have a
similar impact on you all right if you
haven't already be sure to subscribe and
until next time my friends be legendary
take care
thank you again man
that was wicked thank you guys so much
for watching and being a part of this
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