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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 100 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 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 youa 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 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 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 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 community if you haven't already be sure to you're going to get weekly articles on building a growth mindset cultivating grit and unlocking your full potential
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