Stay Free - Russel Brand - “Can Obese People Lose Weight? DR PETER ATTIA On Death, Obesity & Testosterone

00:00:00.000 Joining me now is a world-renowned physician and the author of Outlive, The Science and Art of Longevity, Dr. Peter Attia.

00:00:09.000 Dr. Peter, thanks so much for joining us.

00:00:12.000 Well, thank you so much for having me.

00:00:13.000 I want to talk to you about a wide variety of subjects.

00:00:16.000 This is a very beautifully published and produced artifact that you've sent us.

00:00:21.000 Thank you.

00:00:21.000 I really had to cleanse it from my dog saliva.

00:00:26.000 And I'll be honest, some of my own saliva as well.

00:00:30.000 The science of longevity is something that's changing.

00:00:33.000 I've noticed in the sort of, let's call it the post-Rogan era, the conversation around wellness has altered.

00:00:40.000 It seems that male wellness used to be a kind of niche interest, which is extraordinary because it included all of us.

00:00:46.000 And I'm not suggesting that your content is geared towards a particular gender.

00:00:52.000 I wonder if you have a question.

00:00:55.000 The quantitative model when it comes to life expectancy, that so many of us are living lives that are mired in misery, distraction, depression, doubt, feeling trapped, imprisoned, depressed, distracted, addicted, that prolonging the experience sometimes seems like an odd marker.

00:01:15.000 I'm certainly not suggesting alternative and certainly not suggesting interventionist measures, but Why is there an assumption that we should want to live you know forever endlessly and what does it tell us sometimes about what does it indicate around our fears around death?

00:01:34.000 So I think Russell you've hit on two very interesting points and given that we could literally spend an hour just talking about these two things because on the one hand you're asking the question what is it about our finitude that obsesses us?

00:01:48.000 Why are we trying to extend life?

00:01:50.000 And the other part of your question, you're basically asking, at least the way I would hear it, why the hell would you want to live longer if the quality of your life, and you're referring, I think, to perhaps the most important aspect of that, which is emotional health, is unwell?

00:02:05.000 So we could talk about both of those, and I'll just briefly offer my take.

00:02:10.000 So first, this is a book that took me seven years to write and three versions.

00:02:16.000 The first version of that book had no emphasis whatsoever on your first question, right?

00:02:21.000 It was really a Silicon Valley-esque, you know, how to hack your way into a longer life, inch by inch, but with no attention paid to the quality of that life.

00:02:32.000 And I think through my own sort of struggles, the final version of this book came to reflect a very different viewpoint, which is if your relationships to other people, to yourself, are suboptimal.

00:02:44.000 If you're living in pain, you know, living longer would actually be the greatest form of torture.

00:02:50.000 I think to your second question, why are we obsessed with it?

00:02:53.000 I think truthfully, I think mortality is a very difficult concept for us to accept.

00:02:59.000 So we can intellectually sort of say, well, you know, none of us actually matter that much.

00:03:04.000 Our time on this earth is incredibly small.

00:03:07.000 It's, it's a sliver of a sliver of a sliver, a degree of time relative to even just Homo sapiens, let alone life on this planet.

00:03:15.000 But yet emotionally, that fact is so difficult that you and I won't be here in 50 years.

00:03:21.000 I mean, we're, we're simply not going to exist anymore.

00:03:24.000 And I think we tend to want to claw at that as well.

00:03:27.000 So I guess those would be my high-level inputs on those two important questions.

00:03:34.000 What I feel sometimes, Peter, is that it's a war to remain healthy in a society that requires you to be sick.

00:03:41.000 I feel sometimes from some of the great guests we spoke to on our show that we're kind of, systemically at least, regarded as blobs.

00:03:49.000 Blobs to pump bad food into and sometimes questionable pharmacological remedies into. 1.00

00:03:56.000 And so sometimes to remain healthy can be a campaign that has to be almost militaristic.

00:04:04.000 How did health become politicized?

00:04:06.000 How did we arrive at the point where wanting to be fit and healthy was regarded as a, well, most recently it's been called a right-wing issue?

00:04:13.000 How has health become regarded in this way and how is it that our life has become a kind of commodity in itself where we're latched onto vampirically by parasitical big food and big farmer interests?

00:04:27.000 So again, I think you you ask these interesting questions, Russell, and there are several layers to it.

00:04:31.000 So so in the order, I think that you're asking it, I think there's a very important transition that has occurred in our species.

00:04:38.000 And even though our entire lives, meaning those of us that are talking here now and listening, all took place in one era in the arc of humanity, most of the time we died very fast deaths.

00:04:52.000 Right.

00:04:52.000 So if you think about our ancestors, they died from infections and they died from traumatic injuries.

00:04:58.000 And that was it.

00:04:59.000 And, you know, obviously infant mortality was enormous.

00:05:03.000 So mothers were dying all the time, giving birth to kids, many of whom would just die right away. 1.00

00:05:08.000 And if you somehow managed to survive childbirth and childhood, you were going to be mauled by an animal or die of an infection.

00:05:14.000 And that was the way it was for 99.9% of our existence as a species.

00:05:21.000 We, as a species, had this enormous victory in the late 19th and early 20th century, which was we basically figured out the remedy for how to stop fast death.

00:05:32.000 And that basically became sanitation, antibiotics, and all of the things that came with germ theory and around that.

00:05:43.000 Also, we developed things in medicine around critical care, trauma, acute care, things like that.

00:05:49.000 The good side of that was we stopped dying from those conditions.

00:05:53.000 The bad news was that toolkit for how to prevent people from dying quickly really had no efficacy against preventing people from dying slowly, which is how we all die today.

00:06:05.000 Most people today are going to die from cardiovascular disease, cancer, dementia, diabetes, things of that nature.

00:06:12.000 And the approach of wait till you're sick to treat those things doesn't work very well.

00:06:18.000 So that's why we have become these entities that, you know, we're kind of using the wrong playbook.

00:06:26.000 And you've alluded to a number of other things as well, right? 0.99

00:06:29.000 Which is our food sucks, our environment sucks, our stress levels suck. 0.96

00:06:34.000 I mean, all of these things are kind of working against us.

00:06:37.000 But I think of those as basically the flip side of a technology that also gave us a great advantage.

00:06:43.000 And we're just kind of out of balance with it, I think would be the simplest way to describe that.

00:06:47.000 Do you have anything to say on the politicisation of health and wellness?

00:06:52.000 It seems that during the pandemic era, like, get outside, get some vitamin D, natural immunity, all became sort of contested ideas, and there's no doubt that there can be a machismo attached to staying fit and healthy, participating in martial arts, and indeed pull-up challenges against RFK, which I'm personally Engaged in right now, I'm having a competition with Robert F. Kennedy to see who can do the most pull-ups.

00:07:16.000 Spoiler alert, it's him.

00:07:17.000 He can do 28.

00:07:18.000 I can't do nearly that many unless I start taking... In fact, I could do with some tips on that subject, Peter.

00:07:24.000 If there are any effective and immediate remedies to make your upper body strength treble, I'll take them.

00:07:30.000 And I don't care who invented them.

00:07:31.000 Moderna, Pfizer, you name it, I'll take it.

00:07:34.000 Even if, and I mean this sincerely, it's a suppository.

00:07:38.000 I'd probably prefer that.

00:07:42.000 We can talk about the pull-up tips later.

00:07:45.000 28 is pretty impressive for Robert.

00:07:48.000 Very few people can do that.

00:07:50.000 Don't feel bad if you can't, Russell.

00:07:51.000 Now, I'm somewhat surprised by the phenomenon you've described.

00:07:58.000 I saw an article yesterday, not yesterday, maybe last week that said something to the effect of, and this was a serious article, like it was in Time magazine or something.

00:08:06.000 And it talked about how the origins of fitness are racist.

00:08:11.000 And it went on this long rant about how it's really because of the KKK that we have the fitness industry or something like that.

00:08:19.000 And I don't know, truthfully, I'm just, I'm kind of apoplectic when I see stuff like that.

00:08:25.000 I do think you're right, by the way.

00:08:27.000 I think that during COVID somehow that became the entire entity of COVID became political and the people who said, you know, I would probably rather have My own immune system bolstered by being outdoors, exercising, being in the sauna, being fit, eating well.

00:08:47.000 That became a right-wing view, which it shouldn't be.

00:08:51.000 That should be, I think, the view of everybody.

00:08:54.000 And I think what we're seeing now is simply the snowballing extension of that.

00:08:59.000 Yet, Peter, life expectancy in the United States is the shortest it's been for a couple of decades.

00:09:06.000 Is that because our modern diet is killing us?

00:09:08.000 Because of environmental factors?

00:09:11.000 What is it that is decreasing life expectancy?

00:09:13.000 You've already given us a sort of a bit of an understanding that the causes of fatality were more environmental traumatic disease or an ID historically.

00:09:23.000 Why is there this incremental and sudden decline in life expectancy?

00:09:28.000 So, there's two separate things.

00:09:30.000 So, if you go back to, I don't know, 1880-ish, and you look at the change in life expectancy for the next hundred years, it doubled.

00:09:40.000 And it doubled only because the top eight causes of death, which were all infectious, came out.

00:09:49.000 So, you doubled human lifespan from roughly 40 to 80 by removing the eight most prevalent sources of infectious diseases and communicable diseases.

00:09:59.000 But, to your point, no real bearing on chronic diseases.

00:10:02.000 Now, to your question, why has UF's life expectancy been in decline, The answer is actually in the numbers, which is, it is the increase in the deaths of despair.

00:10:13.000 So it is not an increase in cardiovascular disease, cancer, diabetes, or dementia.

00:10:20.000 It is the increase in suicide, overdoses, and alcohol-related deaths.

00:10:26.000 So those three, which I lumped together as deaths of despair, are growing at such a clip that it is outpacing any incremental improvements we have in the others.

00:10:37.000 And as you probably know, Russell, in the past year, we've seen now over 100,000 people die in the U.S.

00:10:45.000 just on account of opioid poisoning.

00:10:48.000 That's astonishing and terrifying.

00:10:50.000 The gains that have been made as we advance beyond the era of dying like dumb apes as a result of infections is warping and metastasizing into the era where we're being killed by an ailing civilization that induces and perhaps you could even argue requires despair.

00:11:10.000 Now on that spectrum of addiction I would definitely include Eating disorders.

00:11:15.000 I've had an eating disorder when I was a young person, specifically bulimia.

00:11:21.000 And I've seen you talk about obesity and weight loss.

00:11:24.000 And while we're still on YouTube, I'll pose this question.

00:11:27.000 What is the real reason, Peter, that some people can never lose weight, no matter what they do?

00:11:34.000 But before you answer, we're going to leave YouTube now and we're going to do our show Exclusively over on Rumble, where we can speak freely and openly in the spirit of love, not so that we can convey misinformation, disinformation, malinformation, nor so that we can engage in senseless and pointless rhetoric of hate, so that we can freely and openly discuss ways that we might live better, individually and collectively, and there's no question that Peter's fine work is contributing on a grand scale to that endeavour.

00:12:02.000 Join us over on Rumble to hear the answer to the question, what is the real reason some people I'll preface this by saying I don't think I know the answer and I don't think anybody knows the answer.

00:12:11.000 Some people never lose weight.

00:12:13.000 What's wrong with them?

00:12:14.000 What's wrong with us?

00:12:15.000 Why can't they do it?

00:12:16.000 Why can't we do it?

00:12:17.000 What's going on?

00:12:18.000 I'll preface this by saying, I don't think I know the answer

00:12:22.000 and I don't think anybody knows the answer.

00:12:24.000 So I can posit several ideas.

00:12:26.000 And the reality of it is this, we are very, very hardwired, Russell, to store energy.

00:12:34.000 OK, so this is like the superpower of Homo sapiens.

00:12:40.000 So you go back 200 to 250,000 years ago, as our particular species began to diverge from others, chimps, Neanderthals, there are lots of reasons that we out-competed them. 0.97

00:12:54.000 We can talk about our capacity to work in concert with other members of our species in large numbers.

00:13:00.000 I think those things matter.

00:13:01.000 We can talk about a lot of things.

00:13:02.000 But from a biologic perspective, I think our superpower was our ability to store energy.

00:13:10.000 And that's what enabled the organ between our ears to be so prolific, right?

00:13:16.000 So your brain weighs like 2% of your body weight and consumes between 20 and 25% of your energy.

00:13:22.000 Just kind of reflect on that for a moment.

00:13:24.000 This tiny little organ is so energetically demanding that the only way our species could kind of leapfrog all the others was to make sure we never went without energy.

00:13:36.000 And to do that, we had to be able to store energy when food was plentiful.

00:13:42.000 And so we spend hundreds of thousands of years honing this genetic tool to basically be able to put fat into fat stores so that we can access it later on. 0.98

00:13:54.000 And until food became entirely plentiful a hundred years ago, that problem basically didn't, you know, come back to bite us in the ass.

00:14:03.000 I think it's important to understand that when we think about how we are mired in an epidemic of obesity, we need to understand that we are putting these very, very, very old genes in an environment in which they never had a chance to adapt.

00:14:17.000 We would never, in the current food environment, optimize around energy storage the way we have today.

00:14:25.000 The question then becomes, why are some people more genetically susceptible to this?

00:14:30.000 Why are some people more behaviorally sensitive to this?

00:14:35.000 Why are some people in an environment where, for example, they don't have the education, they don't have the means, they're in food deserts?

00:14:44.000 All of these things play a role.

00:14:48.000 It's easier for me to answer the question at the species level, why are we getting fatter?

00:14:53.000 It's harder for me to answer at the individual level, but I don't dispute for a moment that there are social and genetic factors that account for those differences.

00:15:02.000 interesting to ponder, Peter, where the distinction between genetics and behavior might lie, where that

00:15:09.000 particular line might be drawn, and also to reflect on the earlier part of our conversation

00:15:16.000 where we discussed the crisis of despair, and whether or not that is similarly the result

00:15:22.000 of finding ourselves suddenly in an environment more similar to a farm or a zoo than a forest

00:15:29.000 or a plane, where suddenly hundreds of thousands of years of evolution, obviously much longer if

00:15:34.000 you consider the entire lineage, are suddenly warped into an unnatural and perhaps, what do

00:15:43.000 I want to say, antithetical, punishing condition, that we have diets that are not reflective of our

00:15:50.000 We have systems of government that are not reflective of our needs.

00:15:53.000 We have relationships that are not reflective of our needs.

00:15:56.000 We have power systems that do not reflect our needs.

00:15:59.000 Our emotional and spiritual requirements are neglected, warped and misunderstood in the same way that, more observably, our dietary requirements have been inverted and reversed.

00:16:10.000 People that are storing energy in the form of obesity would have been hugely advantaged in previous incarnations of our civilization, and they would never have found themselves in that condition.

00:16:23.000 Furthermore, I was talking about the sort of the culture of reverence for elders, that revering elders makes sense in a culture where being an elder was an indication that you've survived, you've survived disease, you've survived the traumas and causes of death that you would have described.

00:16:41.000 So you can see an evolutionary, biological and psychological undergirding for the concept of elder worship and You know, perhaps even ancestor respect.

00:16:52.000 So those are interesting things to tie together.

00:16:55.000 I wonder about the carnivore diet, Pete.

00:16:58.000 A lot of folk like, you know, like Jordan Peterson comes on here a lot.

00:17:02.000 He's a friend of ours, a friend of mine.

00:17:04.000 And I know that he's not happy unless he's biting a lump out the side of a cow.

00:17:08.000 Is the carnivore diet just another fad?

00:17:12.000 Is it good for you?

00:17:13.000 I'm vegan, so like, you know, I've got my own little struggles.

00:17:17.000 What do you think about the carnivore diet?

00:17:19.000 Yeah, vegan and carnivore would be about as far apart as possible.

00:17:22.000 You know, it's funny, I did talk a little bit about this with Jordan when I was on his show a few months ago, and he posed the question, you know, genuinely from a place of curiosity, right?

00:17:32.000 And as you know, because you're close to Jordan, You know, his arrival at a carnivore diet was not some sort of ideologic choice, right?

00:17:40.000 This was a trial-and-error process brought on by his own physical ailments and a search for elimination, right?

00:17:49.000 How could he eliminate things from his diet that were causing him inflammatory symptoms?

00:17:57.000 I don't think we know the answer.

00:17:59.000 I would really like to see this diet studied more.

00:18:02.000 I think what we can say with relative clarity is that the carnivore diet, like any highly restrictive diet, will almost assuredly result in weight loss.

00:18:12.000 And when a person loses weight, a number of parameters in their health will improve.

00:18:18.000 But it's not clear that everything will improve, and it's not clear to me that any form of highly restrictive diet is in the long term going to be as healthy as a less restrictive, somewhat more balanced diet.

00:18:32.000 And in particular, with the carnivore diet, I think the one thing I would want to have better insight

00:18:37.000 into before embarking on it for the rest of my life would be what is the effect on, for example,

00:18:43.000 cardiovascular disease.

00:18:44.000 If a person said, look, I want to go on this diet and I don't want to address the consequences of my lipids,

00:18:50.000 because for many people when they go on these diets, their lipids go haywire, which is the non-technical way

00:18:56.000 of saying that they are increasing their risk, at least on paper, of cardiovascular disease.

00:19:02.000 So this hasn't been studied.

00:19:04.000 And there really isn't a great way to do these studies because there isn't a huge motivation

00:19:09.000 or incentive to study diets, right?

00:19:12.000 They're not really profit centers.

00:19:15.000 It's not like you package and sell a diet.

00:19:18.000 So who's the one that's going to pay $12 million to do, you know, even the three-year study on the carnivore diet, which is a pittance, right?

00:19:27.000 If you think about it, like, $12 million is a trivial sum of money in the pharma landscape, and we'll happily spend You know, frankly, close to a billion dollars to gain approval for any single drug as you go from IND to Phase III approval.

00:19:42.000 That's not an unlikely sum of money.

00:19:44.000 In fact, that's a little bit below typical.

00:19:46.000 But we would never spend that much money to understand the questions about diet, and I think that's just an unfortunate consequence of our existence.

00:19:54.000 One of the concerns I've had around the rhetoric around science recently is that it presents itself as neutral empiricism when the funding of clinical trials, the experimentation that is done, the experimentation that is not undertaken, can plainly be tracked By the interest that you've described.

00:20:19.000 Who is undertaking the experiments that do not lead to a profitable product?

00:20:26.000 Who is looking into the efficacy of natural immunity?

00:20:29.000 Who is looking into the efficacy of any behavior or habit that doesn't lead to some benefit for a financial interest?

00:20:41.000 Also, Peter, I wonder if the assumption, and it's certainly one that I lean into quite a lot, that if you are able to emulate our native conditions, that will be healthy.

00:20:53.000 For example, something like fasting.

00:20:56.000 Is intermittent fasting healthy?

00:20:58.000 Because presumably the biomechanical machine that we live within is organized around periods of fasting, and if you emulate that, you are rewarded.

00:21:11.000 Pretty much the same rationale that leads to obesity, I suppose.

00:21:16.000 Is there veracity in that type of, if not assumption, then, I don't know, what do I want to say, that framing?

00:21:26.000 Yeah, I think that's a fantastic question and one that I think people who are serious about this line of inquiry will always find themselves abutting.

00:21:34.000 And so let's use that example.

00:21:36.000 So there is no question that as our species evolve, we were faced with periods of nutrient deprivation.

00:21:45.000 Now, I've already made an example or provided an explanation of how we managed to thrive in that environment, which was, unlike other species, we became very adept at storing energy and we could go longer periods of time without nutrients.

00:21:59.000 It's also important to point out what our bodies did biochemically in that time of nutrient deprivation, which was we would undergo a process called autophagy.

00:22:08.000 I think I write about this quite a bit in the book.

00:22:09.000 So, autophagy, as its name suggests, autophagy, self-eating.

00:22:14.000 It's when the body basically begins to take cells that it deems suboptimal, right?

00:22:20.000 So, you might have some cardiac muscle cells and You know, some cells in your gut and some cells in your liver that are good, some immune cells that are good, and some that are not so good.

00:22:29.000 They're a little older.

00:22:30.000 And you basically, in the period of nutrient deprivation, will eat.

00:22:34.000 The cells that are not so good will self-eat and recycle the important components.

00:22:39.000 So it became a very efficient way for the body to thrive and prune cells that may potentially go on to be cancer, for example, or become diseased cells.

00:22:49.000 So now, fast forward to 2023, and the question is, Should we be replicating this behavior?

00:22:55.000 And it's an excellent question.

00:22:58.000 And it's frustratingly, to me, a question for which we don't have the answer.

00:23:02.000 So going back to, like, where should we be spending research dollars?

00:23:07.000 We should absolutely be spending research dollars on answering that question.

00:23:11.000 You know, I used to fast a lot, Russell.

00:23:13.000 So I used to do 7-10 days of water only fasting once a quarter and 3 days once a month.

00:23:21.000 month. So I was very aggressive in my use of fasting. And I have

00:23:28.000 no way of knowing if all the years of doing that added, you know, years to my life, subtracted years from my life.

00:23:35.000 We have no way of knowing this because we don't even have a biomarker for all those processes I spoke about.

00:23:41.000 Now, what I can tell you is after many years of doing that fasting, I lost a staggering amount of muscle mass, probably to the tune of 20 pounds over a decade.

00:23:52.000 And for me, now we're fast forward to the year 2020, I kind of took one more look at a DEXA scan, which is a body scan that shows you how much muscle you have and I realized that actually for something like over six years I'd lost 20 pounds of muscle.

00:24:08.000 I was like, you know, I think I've got to cut back on this fasting thing because one of the drawbacks of so much fasting is you just can't maintain lean mass.

00:24:17.000 But I had no idea what the dose should be.

00:24:19.000 And to this day, I don't know what the dose should be.

00:24:22.000 Which, again, ties into this frustration that says, boy, I wish we could study that problem.

00:24:27.000 Because if you took the amount of money that it takes to approve one drug, I believe we could answer all of these questions with respect to how much to exercise, what kind of exercise, how much to fast, for how long.

00:24:40.000 It truly is a distorted set of priorities.

00:24:44.000 Really is.

00:24:45.000 It shows you what a proper health industry should look like.

00:24:47.000 Not even health industry, health policy, a culture around health, a society that values and cherishes health and indeed proper vigorous scientific endeavour to provide us with real answers that aren't always generated in order to guide us towards profitable pursuits.

00:25:03.000 for establishment interest. I'd love to know the answers to some of those questions.

00:25:08.000 What I find myself talking about because of my age, because of the kind of circles I move in,

00:25:11.000 are how is it not that we prolong life? That's not what I'm thinking about yet,

00:25:14.000 because I'm not old enough to be concerned about that, I suppose, quite yet. I'm more

00:25:18.000 concerned about like, should I be taking testosterone supplements?

00:25:23.000 What do you think about the more natural testosterone enhancing products?

00:25:27.000 We know one of our sponsors, Black Forest, gives me things like Tercotestosterone and NMNs and things like that.

00:25:34.000 How effective are they if you want to put on muscle, if you want to be stronger, if you've got young children like me?

00:25:41.000 That for 15-20 years I'm going to have to be able to physically control them and sometimes strike them on the basis of how they're behaving at the moment.

00:25:49.000 What kind of supplements can I take that are effective and will allow me, when I'm in my 60s, to be an RFK-style pull-up machine?

00:25:59.000 Well, as you know, because RFK has talked about this publicly, I mean, he takes testosterone replacement therapy, which is a pretty common therapy for men as they age, because like women, we see a reduction in our sex hormones with age.

00:26:14.000 Why?

00:26:15.000 Because natural selection, frankly, didn't give a damn about you once you were done reproducing.

00:26:20.000 So, you know, for women, basically, by the time you're 40 and into your 40s and by 50, I mean, evolution had no concern with you. 0.87

00:26:28.000 You have served your purpose.

00:26:30.000 And your estrogen, your progesterone, they go away.

00:26:33.000 Now, for women, it happens immediately, right? 0.99

00:26:35.000 I mean, women within a period typically of 18 months will go from totally normal sex hormones to virtually none.

00:26:42.000 For men, it is a much more gradual decline.

00:26:44.000 So, you peak at your testosterone level in your late teens and early 20s.

00:26:51.000 And you have been on a slow decline since, but there's a threshold at which it starts to become apparent.

00:26:57.000 And the places where it starts to become apparent are going to be, you're going to start to see a reduction in muscle mass, a reduction in strength, a reduction in libido, and maybe even just a reduction in your overall mood.

00:27:08.000 Now, there are other things that can factor into all of these things.

00:27:11.000 Nutrition, exercise, training, I mean, the gamut is there.

00:27:14.000 And that's what I think makes testosterone replacement therapy not a very straightforward question.

00:27:20.000 We do this all the time in our patients.

00:27:22.000 I mean, this is kind of our bread and butter work in treating people, is understanding how does your testosterone, It's low, potentially contribute to this.

00:27:32.000 And if so, how should it be replaced?

00:27:34.000 How much should we be targeting?

00:27:36.000 And how do we know if we're doing the right thing?

00:27:38.000 And again, all of this can be done safely.

00:27:42.000 And there are a lot of unfortunate myths about testosterone replacement therapy.

00:27:46.000 To be clear, there is zero evidence that testosterone replacement therapy increases the risk of prostate cancer, though it might increase the risk of cardiovascular disease in susceptible men, specifically those with high blood pressure or sleep apnea.

00:27:58.000 So you always have to be careful that those things are treated before you assume testosterone replacement therapy.

00:28:04.000 But it is undoubtedly something that many men who start out with low testosterone feeling like they're horrible, you know, when you normalize their levels to that of a 30-year-old, a lot of men will say, this is the most remarkable thing I've experienced.

00:28:18.000 Just as many women will say the same thing when you replace their estrogen and progesterone after they go through menopause.

00:28:25.000 What about if it's someone like me who's, let's say, psychologically volatile?

00:28:31.000 These are some of my concerns, right?

00:28:33.000 Some of my mates are doing that testosterone gel. 1.00

00:28:36.000 I know other friends, like Rogan and stuff, that do testosterone replacement things.

00:28:42.000 I sort of want to, but here are my concerns.

00:28:44.000 One, I don't like the idea that it stops your body naturally producing testosterone.

00:28:48.000 I don't like that it does that.

00:28:50.000 I'm not even fully sure why I don't like that.

00:28:52.000 Also, what if it, and I don't mean this here because I can see you're a man with a shaved head, I'm going to lose these guys.

00:28:59.000 And what about the downstairs fella?

00:29:01.000 Even though he barely has any influence on my life anymore, and I might as well use him as a coat hook.

00:29:08.000 Is there any risks for testosterone in those areas?

00:29:11.000 Is it a safe thing to use?

00:29:13.000 And how effective are some of these things, like these supplement type things, Peter?

00:29:17.000 Okay, all great questions.

00:29:18.000 So let's start with testosterone replacement therapy specifically.

00:29:22.000 So that means giving you testosterone.

00:29:25.000 And you can do that in a number of ways.

00:29:26.000 You can do it as a gel, although that's hands down the worst way to do it.

00:29:30.000 So an injection is by far the best way to give testosterone.

00:29:32.000 We could talk about why, but let's just pause it for a moment.

00:29:36.000 If you're going to take testosterone replacement therapy, you should probably have it injected.

00:29:39.000 What will happen?

00:29:41.000 uh within a very short period of time your body will stop making its own testosterone you are absolutely correct and the reason for that is When the brain, when the hypothalamus and the pituitary gland sense the presence of testosterone being high, which it will from the injected testosterone, it's going to say, well, great, we don't need to make any more.

00:30:01.000 So the hypothalamus will stop sending the message to the pituitary, which will stop sending the message to your testes to make testosterone.

00:30:07.000 So you will stop making it and your testes will shrink.

00:30:10.000 So that's real.

00:30:12.000 Right.

00:30:12.000 OK, fair enough.

00:30:14.000 So we're going to lose.

00:30:15.000 Some of them guys are going to have the pep taken out of their step.

00:30:19.000 Yeah.

00:30:19.000 Now you won't feel that because you're going to have more testosterone than you had in the first place, but you'll notice that you're, you got smaller, you got a smaller sack.

00:30:27.000 The next thing that's going to happen, you brought up hair loss.

00:30:29.000 Pass that Peter!

00:30:30.000 That's going to ruin my Wednesday!

00:30:32.000 If I, like, when I'm doing my regular nut checks and not for testicular cancer, simply as a hobby, if I noticed that I've gone from Conker to Malteser, and could I use any more British examples than that?

00:30:45.000 Um, from, uh, I don't know, I don't know, ping pong ball to chocolate raisin.

00:30:52.000 Like, then I'm gonna be, uh, that's gonna, I'm not gonna like that, Peter.

00:30:56.000 So, firstly, that's gonna be a shock when I do my regular checks.

00:31:01.000 Does it matter?

00:31:03.000 There's another hormone you could take in combination with testosterone called HCG, which will preserve testicular volume.

00:31:13.000 So some guys who are hyper-concerned with that side effect will take that supplement.

00:31:18.000 Peter, that's robbing Peter to pay Paul.

00:31:21.000 That's robbing Peter to conserve ball.

00:31:24.000 Like, I don't think that's a... You can't keep doing... You can't do that.

00:31:27.000 You can't keep meddling with the nut bag bank to that degree, can you? 1.00

00:31:33.000 Again, I don't think it makes sense to.

00:31:35.000 I tell patients, if you're going to take testosterone replacement therapy, you should just accept that reality.

00:31:41.000 Those tiny little dangling little mosquito bites down there in the ball bag.

00:31:46.000 Okay, but does it matter if you're not making your own in-house testosterone anymore if you're importing rather than running on homebrew?

00:31:54.000 Does that matter?

00:31:55.000 Not physiologically, no.

00:31:58.000 So would you do it?

00:31:59.000 And should I do it?

00:32:00.000 Well, it's really funny.

00:32:02.000 I am, I am 50 years old now, and I have been running with relatively low testosterone for the better part of a decade.

00:32:10.000 And I am really getting close to considering it for myself because I absolutely notice a lot of the signs and symptoms.

00:32:19.000 Um, and truthfully there's, I mean, this sounds crazy for someone with my Appetite for self-improvement.

00:32:27.000 I'm just a bit lazy when it comes to this, like the thought that I've got to inject myself twice a week with this thing.

00:32:34.000 It's one more thing to do.

00:32:36.000 And frankly, I feel some of your reservation, which is look, after a year or two of doing this, I'm going to be dependent on this for life.

00:32:44.000 So that's a legitimate concern.

00:32:47.000 Now, truthfully, I will very likely at least give it a three-month stint to see how much better I feel.

00:32:54.000 Because at three months, nothing irreversible happens.

00:32:57.000 At three months, if I say, you know what, I've taken this testosterone, my numbers have gotten a lot better, I don't feel any better, you can stop it and you've lost nothing.

00:33:07.000 Your testes will come back, you will resume making testosterone.

00:33:10.000 So I think that's a worthwhile empirical approach to the problem.

00:33:14.000 And frankly, that's the approach we take with all of our patients that we put on testosterone replacement therapy is if you don't feel better, it doesn't matter if your numbers got better.

00:33:23.000 Right.

00:33:24.000 Yeah, that's true, isn't it?

00:33:25.000 Who cares about the abstract?

00:33:27.000 The data becomes abstract when it's just numbers on a page compared to the subjective experience of being you.

00:33:33.000 And this is, of course, the sort of the hard problem in the endeavor of science.

00:33:39.000 How do we ever describe that subjective experience?

00:33:42.000 I'm astonished to hear you say that you can't be bothered to do it.

00:33:44.000 You might as well have written a book called, I Outlive the Science and Art of Longevity, If You Can Be Bothered, by Dr. Peter Atiyah.

00:33:53.000 Also, there were a few other questions.

00:33:55.000 Compared to the, let's call them the pharma hardcore testosterone, how do the more natural ones perform?

00:34:04.000 Are they worth considering or are they not effective?

00:34:07.000 Yeah, nothing is remotely as effective as either testosterone itself or other hormones that tell your body to make testosterone, provided you still have the capacity within the cells of your testes.

00:34:20.000 So the two most common versions of that are a drug called HCG, which is a,

00:34:25.000 this is actually taken from, it's going to sound crazy.

00:34:29.000 It's taken from the urine of pregnant women. So this is, you know, you hear when, 0.97

00:34:33.000 when a woman gets a pregnancy test, they're testing her HCG level. 0.91

00:34:36.000 So this hormone goes way up during pregnancy and it is an exact replica of a

00:34:41.000 hormone we make called luteinizing hormone that tells our body to make

00:34:45.000 testosterone.

00:34:46.000 So you can inject luteinizing hormone effectively and you will make more

00:34:51.000 You can also take another fertility drug that women use during IVF called clomiphene or Clomid, and that will tell your pituitary gland to make LH and FSH, which will tell you to make testosterone.

00:35:06.000 I personally am not a fan of the latter.

00:35:10.000 The former is reasonable.

00:35:12.000 I would say that the former, HCG or testosterone, would be the preferred way to do this.

00:35:17.000 The reason I don't like using Clomid is, among other things, it is blocking the signal of estrogen at the brain.

00:35:29.000 Believe it or not, estrogen is a very important hormone to men as well as women.

00:35:34.000 Men actually need to be in perfect estrogen balance.

00:35:37.000 If they are not, they can have depressive symptoms, lower libido, even in the presence of normal testosterone.

00:35:44.000 So, my bias is actually against clomid or clomiphene and in favor of testosterone or HCG.

00:35:50.000 A lot of the supplements out there, Russell, A, they just don't have the efficacy, and B, you have absolutely no capacity to quality control them.

00:36:01.000 They are completely unregulated, over-the-counter molecules.

00:36:04.000 And truthfully, we have a hard enough time regulating Drugs in the United States through the FDA.

00:36:10.000 I mean the FDA's track record of regulating drugs is decent, but not stellar.

00:36:16.000 There is nobody paying attention to the regulation of the supplement industry.

00:36:19.000 So when in doubt, I always would prefer a pharmacologic regulated product to an unregulated one.

00:36:27.000 And I think in the case of hormones, you will also find greater efficacy.

00:36:32.000 elsewhere in our content we have such skepticism and cynicism in particular about the conduct

00:36:36.000 of the FDA, the manner of their funding, that it's difficult for us to endorse being reliant

00:36:42.000 on them elsewhere, even though I know there's so much complexity in subjects like this and

00:36:46.000 so much expanse that's being covered. But my general tendency is in favour of remaining

00:36:54.000 kind of natural wherever possible. I was once told that you're a complex individual. If

00:37:00.000 you start introducing endocrinal agents into your operating system, you might have unexpected

00:37:09.000 results. I've got a history with addiction issues, mental health issues, all that kind

00:37:13.000 of stuff. I feel like it requires for me, I have to expose myself to cold temperatures,

00:37:19.000 hot temperatures, meditate, go to group therapy, drink green juice, exercise, do Brazilian

00:37:24.000 Jiu-Jitsu, Yoga, and then I might feel alright for that day.

00:37:28.000 You know, like, that's the level of endeavor required for me to retain balance.

00:37:33.000 So, the idea that there's, you know, when there's people like, take this drug to stop you eating, take this drug to make your nuts bigger, take this one to make the nuts go back to a normal size, you know, and I feel like, bloody hell, I can't take that Level of intervention, you know, so how do you embark on such a bold and I know much-loved and extremely successful project knowing that many of the people you're talking to will be cynical about pharmacological remedies, doubtful about authority more broadly and in a cultural climate where exercise itself can be regarded as a

00:38:10.000 An entrepreneurial notion that emerged at the KKK.

00:38:15.000 How do we keep this stuff plain and accessible to all?

00:38:21.000 Well, you know, it's interesting.

00:38:22.000 The book, as long as it is, which in the US at least is about 500 pages, contains very little about anything to do pharmacologically.

00:38:29.000 So I really say, look, there are basically five things that you can manipulate with respect to how long and well you live.

00:38:36.000 Everything that has to do with what you eat and how you eat.

00:38:39.000 Everything about how you move and exercise.

00:38:41.000 Everything about your sleep.

00:38:43.000 Everything about the tools you can manipulate around emotional health.

00:38:46.000 You've already addressed a number of them.

00:38:48.000 And then pharmacology and hormones and supplements being the fifth and final one.

00:38:52.000 This book really focuses on the first four.

00:38:55.000 I think if a person comes into this with a very skeptical view of pharmacology, I don't really think that precludes you from taking 80% of the steps that are, in my view, helpful at turning the odds in your favor.

00:39:06.000 Now, when you want to think about these things, I believe that the data are unequivocal that exercise is the most potent of these tools, both in terms of its impact on the length of your life, But also in terms of the quality of your life, because what I don't think people are paying enough attention to is this idea of the marginal decade.

00:39:31.000 The marginal decade is the last decade of your life, and everyone has a marginal decade.

00:39:37.000 You don't know the day that you enter it, but you will figure it out pretty quickly when you're in it, when you are down to that last roll of toilet paper.

00:39:47.000 And what I don't think people are thinking enough about is what steps am I taking to make sure that I'm physically robust enough during that decade?

00:39:56.000 So how old are you, Russell?

00:39:59.000 God, you know, I was gonna say, like, Prince, like, stopped answering that question because he was like, I'm beyond age.

00:40:06.000 I'm beyond names.

00:40:07.000 I'm a symbol now.

00:40:09.000 Bloody record industry's been gypping me for years.

00:40:12.000 But then his notion that he was beyond age was challenged by the fact that he died.

00:40:18.000 I was like, oh no, perhaps you can't cheat death, Prince, because you are now dead.

00:40:24.000 The simple truth is, Peter, I'm 48.

00:40:27.000 Alright.

00:40:28.000 And you, tell me about the age of your kids again.

00:40:31.000 Two weeks.

00:40:33.000 One of them's been here two weeks.

00:40:35.000 One of them's been here six years.

00:40:38.000 That one's got a lot to answer for.

00:40:39.000 And one of them is five. 0.97

00:40:41.000 Between the three of them, I'd say it's a real trifecta of arse pain. 0.98

00:40:48.000 Well, as much as the ass pain is there, I would also bet it's a great source of joy. 0.97

00:40:52.000 And as they continue to grow, you'll probably continue to find things you absolutely love doing with them.

00:40:58.000 And the reality of it is, at some point, those three kids are going to have their kids.

00:41:02.000 And if, you know, what I see in people is true, it sometimes is better to be a grandparent than a parent.

00:41:10.000 My point being is at some point you're going to be in your 80s and you have a choice, right?

00:41:15.000 You can be a decrepit 80 year old who, you know, can't sit on the floor with a grandkid, can't pick a grandkid up off the floor, can't even get up off the floor under your own strength, can barely walk up the stairs.

00:41:27.000 I mean, that's the kind of thing that is in line for many people if they're not deliberate about the choices they make with respect to training and exercise.

00:41:37.000 And what I think is It doesn't matter what your view is on drugs.

00:41:41.000 It doesn't matter what your view is on nutrition.

00:41:43.000 It doesn't matter what your view is on most of these things.

00:41:46.000 If you simply focus on what type of exercise do I need to do to make sure that when I'm in my 80s, I function like a person who would ordinarily be in their 60s, which A, is completely attainable with the right amount of exercise.

00:42:00.000 I think that brings the greatest quality of life in that final decade.

00:42:06.000 Peter, I don't want to be floundering about on the floor, hopeless and facile, like a mollusk, clutching for the last roll of toilet paper that you... It sounds like I'm going to spend the last 10 years of my life shitting on a grandchild, grinning from ear to ear. 0.88

00:42:23.000 It's the last thing I want. 0.97

00:42:25.000 I want to be strident and priapic, with lovely, perfect-sized nutbags like Mick Jagger.

00:42:31.000 I demand that from you, Peter, or I want a refund on this book.

00:42:35.000 I've got some questions from our audience, mate.

00:42:40.000 May I pass them on to you, please, Doctor?

00:42:42.000 Absolutely.

00:42:44.000 What's that?

00:42:44.000 That better not be some of that woman's wee-wee you're drinking to fight back the march of time.

00:42:50.000 It is.

00:42:51.000 How can you tell?

00:42:52.000 Just the colour.

00:42:53.000 This is from Alpine Lake.

00:42:55.000 How do we avoid ending up with the pill cocktail when we're seniors?

00:42:59.000 How do we do it, Doc?

00:43:02.000 You've got to do the investment when you're younger.

00:43:04.000 If you want to reap the benefits of being a fit and healthy person in the final decade of your life, you have to put the time in earlier.

00:43:12.000 Just like saying, how do I end up not being bankrupt and broke when I'm 80?

00:43:16.000 You've got to save money when you're 40.

00:43:19.000 Brilliant.

00:43:19.000 Jane says, what is your exercise program?

00:43:23.000 Jane71 in our chat there.

00:43:25.000 Join us in Locals by the way.

00:43:26.000 Press the red button.

00:43:26.000 You can become a member of our Locals community.

00:43:29.000 They get to join these conversations live when they're happening in the event that we have high profile guests that are challenging to book because of their busy schedules like Dr. Peter Attia.

00:43:37.000 And you can join us live and ask questions like Jane71 who asks, what does your weekly exercise program entail if you're so fantastic and better than us all?

00:43:46.000 Dr. Peter, I added the last bit to add some hostility.

00:43:51.000 Um, well, I always say, look, I'm happy to tell you what I do and I will, but I also want to say that you don't have to do what I'm doing, right?

00:43:57.000 You can do half of what I'm doing and still get a lot of benefit.

00:44:00.000 But I, I really enjoy exercise.

00:44:02.000 I am in the weight room, uh, four times a week for probably a total of six to eight hours.

00:44:08.000 I'm on a bike four to five hours a week doing at various forms of intensity.

00:44:13.000 A lot of 80% of that's at a very low intensity.

00:44:15.000 20% of that is at very high intensity.

00:44:18.000 And I also really like this activity called rucking where you walk around with a very heavy backpack.

00:44:23.000 So I have a backpack on with somewhere between 50 and 80 pounds, and I'll go out and walk up and down the hills

00:44:29.000 for an hour three or four times a week.

00:44:32.000 And then finally, I like to carry heavy things.

00:44:35.000 So I do a lot of exercises where I will carry, for example, my body weight for 30 seconds and then rest 30 seconds

00:44:43.000 and then carry it 30 seconds and rest 30 seconds.

00:44:45.000 So all told, I probably spend about 14 or 15 hours a week doing some form of exercise.

00:44:51.000 That's pretty good and impressive.

00:44:53.000 I'm a bit threatened by it.

00:44:54.000 Especially the bit where he was carrying a doppelganger you around on your back like our lord and saviour on his way to Calgary.

00:45:03.000 What also, HeyNavigator asks, big agriculture, big business, big pharma, all developed cheaply made food drugs, seed oil, sugar saturated, highly processed foods that give us dementia, diabetes and chronic illness.

00:45:15.000 What are the strategies for giving them up completely doc?

00:45:19.000 Yeah, this listener is right.

00:45:21.000 In Pharma's effort and Big Ag's effort to solve one set of problems, it created another.

00:45:28.000 One strategy that I always tell people, and it's certainly not my own, I don't take credit for it, is, if you're grocery shopping, one, don't do it when you're hungry.

00:45:38.000 Two, stick on the perimeter of the store.

00:45:40.000 So, there's really nothing that can be gained from walking down the aisles of the grocery store.

00:45:44.000 That's where the most concentrated, most processed, most garbage food resides.

00:45:49.000 And I believe in setting a default food environment that is healthier, so that in your moments of weakness when you're hungry, you're surrounded by better food choices.

00:45:58.000 I don't have the willpower to surround myself with a pantry of garbage.

00:46:03.000 If there's garbage in the pantry, I will eat it.

00:46:05.000 But I do have a little bit of willpower to show up at the grocery store not hungry, make good food choices, put those in the home, and then when I'm hungry, I kind of have no choice but to eat reasonable food.

00:46:17.000 That's good.

00:46:18.000 And don't say that you can't be bothered because you just said you carry a knapsack on your back with another you in it for 30-second struts.

00:46:25.000 You're out of control, Peter.

00:46:26.000 There's no doubt about it.

00:46:28.000 Okay, so have you got any final advice for me before I confront RFK in what is said to be the pull-up challenge of the century?

00:46:37.000 Anything I can change about my diet?

00:46:39.000 Should I start injecting my nut bag with testosterone immediately?

00:46:43.000 What is the solution?

00:46:45.000 You know, I think for the listeners, I would say, look, this is a 17 chapter book that of which 16 chapters focus on all dimensions of physical health.

00:46:55.000 But I did include a 17th and final chapter that deals with emotional health.

00:46:58.000 And we started this discussion by talking about deaths of despair, purpose and things like that.

00:47:04.000 And I just want to make sure that people who are coming to this discussion because they are interested in living longer do not neglect the other side of it.

00:47:12.000 Don't neglect the why. 0.72

00:47:14.000 There's no reason to live longer if your relationships suck.

00:47:18.000 There's no reason to live longer if you are unhappy.

00:47:20.000 So, you know, please be sure that you are putting as much effort into that as you are figuring out, you know, which drug to take, which food to eat or which exercise to do.

00:47:30.000 Yeah, otherwise we're kind of life misers just clinging on to a perennial winter, which you described earlier as scrambling about on the floor like a spineless slug, clutching a Kleenex to dab a forever drooling butthole.

00:47:48.000 And I believe that's chapter 18 in your book.

00:47:53.000 Hey, Dr. Peter Atiyah, thank you so much for making time for us.

00:47:57.000 All the success in the world, not that you need my good wishes, for Outlived, the Science and Art of Longevity.

00:48:03.000 Fantastic book.

00:48:04.000 And please stop complaining about our British version of it, which I have on good authority, is much better.

00:48:10.000 And let's face it, the language you wrote this in is the language we invented.

00:48:15.000 Thank you very much, Peter Atiyah.

00:48:17.000 Thanks so much, man.

00:48:18.000 Join us again tomorrow, not for more of the same, we'd never insult you with that, but for more of the different.

00:48:22.000 Until next time, stay free.

00:48:24.000 We can't make our wonderful content or put on events like Community without our wonderful sponsors.

00:48:29.000 Mudwater is a coffee alternative with four adaptogenic mushrooms and Ayurvedic herbs.

00:48:34.000 Plus, it contains only a fraction of the stinking caffeine in a dirty old cup of coffee. 0.99

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Stay Free - Russel Brand - August 18, 2023

“Can Obese People Lose Weight? DR PETER ATTIA On Death, Obesity & Testosterone

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