In this episode, Dr. Peter Adia discusses his new book, Outlive: The Science and Art of Longevity, and explores the benefits that can be gained from exercise in just 3 hours a week, how small imbalances in diet can cause major problems such as diabetes and obesity, the difference between lifespan and healthspan, the soured reasoning behind the American food pyramid, and the scientific side of alternative diets. Dr. Adia also discusses the concept of healthspan and why it's important to focus on the quality of life, rather than the number of years you live, in order to maximize your chances of living to a good old age. This episode is sponsored by Daily Wire Plus, a seven-day trial that offers a limited-time, 7-day limited access trial to all my content. This will provide you with a full-time access to all of my content, as well as access to my 7 Day Trial, which represents some of my best work to date. This is my best to date, and I m beyond thrilled to be able to provide my listeners with access to some of the most challenging and challenging content I ve created over the past year. If you re interested in my work, you re invited to become a member of my team, and receive access to a 7 Day Free Trial + 7-A-Day Trial. This is a limited time offer, which means you re getting access to 7 days of my most challenging work, and a chance to receive 7 days worth of 7-a-month of all my work as well. - plus 7 days off of all of the work I ve done in total, plus a discount of 7 days for 7 days, plus 7-Day + a maximum of $100,000 in total value. We re giving you all access to access to the entire Daily Wire+ trial. I ll be giving you a discount code: Mentioned in this offer. . Subscribe to my new series, and receive a complimentary copy of my book Outlive the science and art of longevity, outlive the Science & Art of Longer than you ve ever heard of on my book, Outlive The Science & The Art Of Longevity by Dr. Peterson, outlive. and a free copy of the book to receive a copy of his book outlive: Outlive! I hope you enjoy the book and get a discount on the book.
00:00:00.960Hey everyone, real quick before you skip, I want to talk to you about something serious and important.
00:00:06.480Dr. Jordan Peterson has created a new series that could be a lifeline for those battling depression and anxiety.
00:00:12.740We know how isolating and overwhelming these conditions can be, and we wanted to take a moment to reach out to those listening who may be struggling.
00:00:20.100With decades of experience helping patients, Dr. Peterson offers a unique understanding of why you might be feeling this way in his new series.
00:00:27.420He provides a roadmap towards healing, showing that while the journey isn't easy, it's absolutely possible to find your way forward.
00:00:35.360If you're suffering, please know you are not alone. There's hope, and there's a path to feeling better.
00:00:41.780Go to Daily Wire Plus now and start watching Dr. Jordan B. Peterson on depression and anxiety.
00:00:47.460Let this be the first step towards the brighter future you deserve.
00:00:57.420Hello everyone. Today I'm speaking with physician, longevity expert, and now author, Dr. Peter Adia.
00:01:15.400We discuss his new book, Outlive the Science and Art of Longevity,
00:01:19.920and explore the immense benefits that can be gained from exercise in just three hours a week,
00:01:24.680how small imbalances in diet can cause major problems such as diabetes and obesity,
00:01:30.760the difference between lifespan and healthspan,
00:01:34.280the soured reasoning behind the American food pyramid,
00:01:37.700and the scientific side of alternative diets.
00:02:58.560But it really constitutes some measure of cognitive health, physical health, and emotional health.
00:03:04.300And at least two of those are intimately linked to age, which is to say they generally decline with age.
00:03:11.260But if we focus, I think, relentlessly on the pursuit of those things, we tend to get a better quality of life overall.
00:03:18.480And, by the way, I think you get for free a lot of lifespan benefits.
00:03:21.400Right. So, well, it's very important to get the definitions and the measurements right
00:03:29.200because systems optimize to maximize their score on what they're measured by.
00:03:34.040And I suppose living to 140 wouldn't be so good if you were senile for the last 70 years and institutionalized, for example.
00:03:41.900And so it sounds like when you talk about healthspan, you're intermingling two, what would you say, two quality of life issues.
00:03:50.460One would be the expansion of youth rather than longevity per se.
00:03:55.740And then something associated with the existential quality of life.
00:04:02.440So maybe we could start with, well, does that seem to capture, do the interaction of those two things seem to capture what you're talking about with regard to healthspan?
00:04:13.420I think that the cognitive and physical piece are the pieces that do decline with age.
00:04:18.540And we want to preserve those as long as possible.
00:04:21.840And we can be very specific about what those things are, by the way, right?
00:04:24.680We could drill into what is cognitive healthspan, what is physical healthspan.
00:04:29.260And then that other one that is not so age-dependent might be at least as important and probably, frankly, falls much more into your wheelhouse than mine, professionally at least.
00:04:41.840And that is about the quality of a person's life and the quality of their relationships, their sense of purpose, and things of that nature.
00:04:48.680The content I've created over the past year represents some of my best to date, as I've undertaken additional extensive exploration in today's most challenging topics and experienced a nice increment in production quality, courtesy of Daily Wire+.
00:05:05.240We all want you to benefit from the knowledge gained throughout this adventurous journey.
00:05:09.860I'm pleased to let you know that for a limited time, you're invited to access all my content with a seven-day free trial at Daily Wire+.
00:05:17.320This will provide you with full access to my new in-depth series on marriage, as well as guidance for creating a life vision, and my series exploring the book of Exodus.
00:05:28.900You'll also find there the complete library of all my podcasts and lectures.
00:05:32.640I have a plethora of new content in development that will be coming soon exclusively on Daily Wire+.
00:05:38.080Plus, voices of reason and resistance are few and far between these strange days.
00:05:43.760Click on the link below if you want to learn more.
00:05:46.740And thank you for watching and listening.
00:05:48.200Yeah, so a long while back, I was looking at interventions to improve people's lives.
00:06:08.200And I knew at that point that cognitive decline was a major problem, especially in terms of, well, productivity and general competence.
00:06:19.160And so it's a pretty pronounced linear downhill trend on the fluid intelligence front from about the age of 25 forward.
00:06:27.720And that can decline precipitously in, say, late 70s, early 80s, especially with the onset of degenerative neurological diseases.
00:06:36.120And I was looking at the literature on cognitive remediation.
00:06:39.540This is back in the times, about 10, 15 years ago, when there were a lot of online sites that purported to run you through cognitive exercises that could increase or maintain your IQ.
00:06:49.900There's never been any evidence for that, by the way.
00:06:53.900But what I did find, and I think this is extremely solid, is that if you want to maintain your cognitive function, that both cardiovascular exercise and weightlifting seem to do a pretty damn good job.
00:07:05.640And maybe that's because the brain is such an oxygen-demanding organ and other, obviously, it's energy-demanding and resource-demanding in other ways.
00:07:17.160And if you can keep yourself cardiovascularly fit, interestingly enough, that's the best pathway to cognitive health.
00:07:25.440Then I was looking on the psychological side, you know, and what I found was that there were interventions that helped people get their stories straight.
00:07:35.040Of course, psychotherapy is one of those, but there are written interventions.
00:07:37.900If people write about their past, about their past traumas, and if they write about their future plans, they reduce general uncertainty.
00:07:45.640That reduces their stress, and that seems to produce a relatively pronounced physiological benefit.
00:07:51.800And so there's an interesting interplay there that we can talk about more in terms of the emotional and the physical.
00:07:57.800It's pretty funny that if you want to improve your cognitive function or maintain it, you should exercise rather than think.
00:08:04.560And that if you want to improve your physiology, you should straighten out your story and face your traumas rather than, say, exercise.
00:08:12.400So what do you recommend in your book, in Outlive in particular, with regard to the expansion of health span?
00:08:23.100What do you think, and how do you practice this personally?
00:08:28.140So I think that exercise is empirically the most valuable tool we have for both the cognitive and physical components.
00:08:38.340So let's start with the cognitive, because I think here it was less intuitive.
00:08:42.440So about 10 years ago, when I really went down this rabbit hole, I had one of my research analysts spend a lot of time going through the literature.
00:08:52.380So we created a framework where we were going to look at every single intervention and how it impacted executive function, processing speed, short-term memory, long-term memory.
00:09:03.520Those were the four metrics we cared about because, as you point out, those are all bits of intelligence that decline with age.
00:09:16.040We looked at every possible thing that you could think of.
00:09:20.040And after about nine months of this, the thing that stood out above all else, beyond any diet, beyond the importance of sleep,
00:09:28.820and other things that certainly mattered, controlling blood pressure, lipids, et cetera, was exercise.
00:09:34.580And even though I was a lifelong exerciser and loved to exercise, I just couldn't believe it.
00:09:39.220It seemed so trite that exercise could have such a profound difference on the state of cognition,
00:09:46.560not just in terms of its performance as effectively a nootropic, but also in its ability to delay, if not outright prevent, dementia.
00:09:56.600So once we dug into the mechanisms, I think it became clear why exercise is so potent.
00:10:03.260And it's basically that it is acting on so many different levels.
00:10:06.420So as you pointed out, it's acting at a metabolic level.
00:10:09.740The brain is such an energy-demanding organ.
00:10:13.620As you know, and maybe your listeners do, you know, it weighs about 2% of your body weight,
00:10:18.420and it's responsible for 20% to 25% of your energy consumption.
00:10:23.200So therefore, anything that disrupts that is catastrophic.
00:10:27.000So when you look at the improvements in glucose disposal, insulin sensitivity, and all metabolic parameters,
00:10:33.740exercise is the most important tool we have there.
00:10:37.040When you look at the reduction of inflammation, vascular health improvements, again, exercise stands alone.
00:10:42.760When you look at the production of neurotropic growth factors, such as BDNF, again, exercise is basically a drug for neurons.
00:10:51.040And so I think I eventually came around after a year or so to realize that, again, as simple as it sounds, exercise is such a potent tool.
00:10:59.640And you look at the brains of people who exercise a lot, and you can see far less damage, not just microvascularly, but in terms of brain volume loss over time.
00:11:10.560Going online without ExpressVPN is like not paying attention to the safety demonstration on a flight.
00:11:17.660Most of the time, you'll probably be fine, but what if one day that weird yellow mask drops down from overhead, and you have no idea what to do?
00:11:25.420In our hyper-connected world, your digital privacy isn't just a luxury.
00:11:30.540Every time you connect to an unsecured network in a cafe, hotel, or airport,
00:11:34.800you're essentially broadcasting your personal information to anyone with a technical know-how to intercept it.
00:11:39.740And let's be clear, it doesn't take a genius hacker to do this.
00:11:43.060With some off-the-shelf hardware, even a tech-savvy teenager could potentially access your passwords, bank logins, and credit card details.
00:11:50.440Now, you might think, what's the big deal? Who'd want my data anyway?
00:11:54.100Well, on the dark web, your personal information could fetch up to $1,000.
00:11:58.520That's right, there's a whole underground economy built on stolen identities.
00:12:47.360So, let's talk about exercise from the perspective of a behavioral psychologist.
00:12:57.640So, one of the things you learn as a behavioral psychologist is that it's very difficult for people to change their attitudes or their actions.
00:13:08.320And it's very difficult for people to change their lives.
00:13:10.440And we all know this because we might tell ourselves, for example, to exercise.
00:13:15.260And we might be well-supplied with arguments for why that's a good idea, but that doesn't necessarily mean that we learn how to incorporate an exercise routine into our life.
00:13:25.000And often the reason for that, there's many reasons.
00:13:28.600I mean, exercise is difficult, and that's one reason.
00:13:30.960But it's also often the case that people don't form a strategy and break the problem down into steps that are simple enough to actually implement.
00:13:41.060So, they think things like, well, I'll go to the gym two hours a day, three times a week, and I'll start that next week.
00:13:46.040And truth of the matter is, they don't have six hours to spend, and they can't tell themselves what to do anyways.
00:13:52.860And so, what you do as a behavioral psychologist is you look at the simplest possible change that produces the maximal possible benefit.
00:14:00.140And so, for example, if people are listening and they want to begin to implement an exercise routine, like, what about a daily walk of 10 minutes in the morning?
00:14:22.700Yeah, so the good news is, first of all, and I accept the fact that not everybody is swayed by data, but I at least want to put it out there.
00:14:31.040So, if you're a person who's in the doing zero exercise per week camp, the very good news is the benefit you get from going from zero to three hours a week is a greater benefit than anyone gets along the exercise curve.
00:14:48.220Right? So, taking someone who's at five hours and taking them to 15 will produce less relative benefit than going from zero to three.
00:14:57.220So, in other words, I want that person to see some real incentive for making this change.
00:15:02.160Secondly, I'll put some numbers to it, right?
00:15:04.560So, going from no exercise to three hours a week approximately reduces your all-cause mortality, that is to say death, by every cause, by 50% at any moment in time.
00:15:19.840So, if you're standing there asking, what's the probability I'm going to die this year?
00:15:23.000Well, we can sort of actuarially figure that out, you get to cut that number in half by simply going from zero to three hours to exercise a week if you're a non-exerciser.
00:15:32.880So, again, there's going to be a subset of people for whom that's a very powerful piece of information they didn't know.
00:15:39.140So, then what I would say, well, how do you do that?
00:15:41.380So, I agree with you that you're much better off trying to do 30 minutes six times a week than three hours once a day or, you know, two hours, you know, in whatever fashion.
00:15:53.280So, what I would say is the most effective way to do that is probably about 90 minutes of low-intensity cardio.
00:16:03.460And for a person who's not particularly fit, that's going to amount to just brisk walking.
00:16:07.940Rather than tell them what to do, I tell them how to feel when they're doing it.
00:16:13.720So, what you want to feel is out of breath enough that you can barely carry out a conversation, but you could if you had to, but not so out of breath that you can't carry on a conversation, and not so easy that you can speak easily.
00:16:32.400Physiologically, we call that zone two, but I'm not going to bore them with that nomenclature.
00:16:36.320It's just basically 90 minutes, say, three times 30 or two times 45 a week where you're just out of breath enough that you don't want to talk, but you could if you had to.
00:17:31.240I don't think we have the fidelity of the data at that level because you generally don't push enough of a conditioning benefit.
00:17:37.540But I think what you're getting at, and we do this as well, is you want to separate between the behavior change and the physiologic change.
00:17:46.460And for some people, and James Clear has written a lot about this, but I think a lot of people have come to the same conclusion with any behavior change.
00:17:54.860If it's a person who's never done anything, you're right.
00:17:58.180The answer might be for every day when you wake up in the morning, rather than your normal routine of jumping in front of the computer, I want you to go and walk around the block once.
00:18:13.820But what you will get is you're going to start to reset a behavior, which is, aha, the first thing I do in the morning now is this other thing.
00:18:21.400And we'll slowly increase that, and at some point you will get a physiologic benefit.
00:18:26.560But what we're doing is planting the seed of how to change the behavior.
00:18:31.400Yeah, well, you could always expand that over a year.
00:18:34.180I mean, one of the things, another thing I learned as a behavioral therapist, and this seems obvious, but it's not obvious enough so that people think about it or put it into practice, is that your life is made up of the very small number of things that you repeat every day.
00:18:52.100And these are often things that people consider trivial.
00:18:54.740So, for example, lots of people sit down to have dinner with their family every evening, and they don't consider that special.
00:19:03.180But because you do it every damn day for an hour, an hour and a half, it's like 8% of your life.
00:19:09.120So, you only have to get 15 of those things in order, and you have your whole life in order.
00:19:16.280And so, if you started, say, walking for 10 minutes a day, well, that's 70 minutes a week, and that's 4 hours a month, or 50 hours, or 1 work week a year.
00:19:30.660That's about 2% of your life, your waking life, something like that, or at least 2% of your awake working life.
00:19:36.220And so, it's useful for everyone listening to understand that small changes that you maintain can be of radical importance.
00:19:44.940And once you're walking for 10 minutes a day, it's a hell of a lot easier to go to, say, 12 minutes than it is to go from zero to walking at all.
00:19:56.820So, what do you think, what did you conclude as a consequence of going through the literature with regards to, say, weightlifting rather than cardiovascular exercise?
00:20:09.600So, in biology, we look to integral functions to give us a sense of how valuable an input is.
00:20:20.280So, most people are probably familiar with something called a hemoglobin A1c.
00:20:24.940It's a blood test you get at the doctor, and if it's high enough, it tells you if you have type 2 diabetes.
00:20:29.780So, if the hemoglobin A1c is beyond 6.5%, that tells you that over the past three months, your average blood glucose has been 140 milligrams per deciliter, which is the cutoff for type 2 diabetes.
00:20:43.980So, in that sense, hemoglobin A1c is an integral of your behavior over the past three months with respect to glucose.
00:22:16.620Similarly, a person doesn't just wake up and have a lot of muscle mass or have a lot of great strength.
00:22:21.900Those things are the product of a lot of work.
00:22:26.420And I think that's why they are so potent.
00:22:29.060In fact, they are far more potent as predictors of a long life than all of the negative things you can imagine are predictors of a short life.
00:22:38.240So, when you look at things like smoking, type 2 diabetes, hypertension,
00:22:41.860even the presence of cancer has a lesser impact on the shortness of your life than those other variables have on the length of your life.
00:22:51.900Yeah, I've read that grip strength, for example, is a good marker of propensity for longevity, well, in everyone, but particularly in elderly people.
00:23:01.880And it isn't, as you pointed out, because grip strength per se is particularly important,
00:23:05.960but because grip strength happens to be a good marker for overall, what would you say, psychophysiological integrity.
00:23:11.880A hundred percent, a hundred percent, yeah.
00:23:14.680Grip strength is one of the most potent, so put it this way,
00:23:18.280if you compare the top decile to the bottom decile in grip strength,
00:23:22.100it's a 70% difference in incidence and death from dementia, all-cause dementia, not just Alzheimer's, every form of dementia.
00:23:29.820When I was in my mid-20s, when I was 21, 22, I weighed about 130 pounds, 135 pounds.
00:25:19.980And I think that that's what's being captured by these statistics.
00:25:22.840The people who are able to delay that loss of strength and muscle mass are the ones that are going to live the longest on average.
00:25:30.280Starting a business can be tough, but thanks to Shopify, running your online storefront is easier than ever.
00:25:38.280Shopify is the global commerce platform that helps you sell at every stage of your business.
00:25:42.400From the launch your online shop stage all the way to the did we just hit a million orders stage, Shopify is here to help you grow.
00:25:49.680Our marketing team uses Shopify every day to sell our merchandise, and we love how easy it is to add more items, ship products, and track conversions.
00:25:56.900With Shopify, customize your online store to your style with flexible templates and powerful tools, alongside an endless list of integrations and third-party apps like on-demand printing, accounting, and chatbots.
00:26:09.120Shopify helps you turn browsers into buyers with the internet's best converting checkout, up to 36% better compared to other leading e-commerce platforms.
00:26:17.500No matter how big you want to grow, Shopify gives you everything you need to take control and take your business to the next level.
00:26:23.260Sign up for a $1 per month trial period at shopify.com slash jbp, all lowercase.
00:26:29.660Go to shopify.com slash jbp now to grow your business, no matter what stage you're in.
00:26:37.600Yeah, so on the weightlifting front, we talked a little bit about, you know, what you could do simply to start working out on the cardiovascular front, and brisk walking is the simplest and most straightforwardly implementable strategy on that front.
00:26:56.120I would add one thing to that, Jordan, which is once a person reaches a certain level of fitness, the brisk walk may not be sufficient enough to produce enough cardiovascular stress.
00:27:09.200Depends where you live, but if you live in an area where you've got a lot of hills, that might not be the case.
00:27:13.020But for most people, you know, there's a limit in human gait to how fast you can walk.
00:27:19.320And for most people, it's about 3.5 to maybe up to 4 miles per hour.
00:27:24.640And again, at a certain point, that's not going to be fast enough.
00:27:27.320So what we can do for that individual, rather than have them transition to running, I like to put weight on their back called rucking.
00:27:34.440So you carry a military type of backpack with plates of weight in the back.
00:27:39.420And now you, without putting additional stress on the knees, put additional stress on the cardiorespiratory system.
00:27:45.340So just throw that out there as additional ways to get this done.
00:27:52.460As I said, in my 20s, I worked out with free weights, and I have an adjust set of adjustable free weights now.
00:27:59.280But what I found very straightforward and actually implementable is to use about 20, 25-pound weights, depending on how often I'm doing it.
00:28:09.120And I run through a set of exercises through my whole body, you know, starting with my calves and moving upward.
00:28:15.560And I can do a whole workout routine, about two sets of 15 exercises in about 20 minutes.
00:28:21.980And so, for everyone listening, it's also very simple to use to start weightlifting, because all you need is a couple of dumbbells.
00:28:30.720Size is going to depend on, you know, your size and your strength.
00:28:34.120But you can do an awful lot with two dumbbells.
00:28:37.160You can exercise your body in all sorts of ways.
00:28:40.160So that combined with walking, and you added another twist to that.
00:28:55.180I do, you know, every sort of exercise you can imagine.
00:28:57.500But sometimes I like thinking and debating with people, like, what's the single most important exercise you could do if you could only do one?
00:29:03.820And for the lower body, I think step-ups would be—so if you had just two dumbbells and a box, you can do anything, right?
00:29:14.020Because you're going to do forward step-up, backward step-up, side step-up.
00:29:37.920So taking three full seconds on that one leg to descend.
00:29:41.500And that's training what we think of as the breaks.
00:29:44.640So when we age, this is a particular form of strength that deteriorates, which is eccentric strength, the strength that a muscle exhibits while it is getting longer.
00:29:59.900And the mortality of a fall when you are above the age of 65 is staggering.
00:30:05.560So depending on the series you look at, 15 to 30 percent of people over the age of 65 who fall and break a hip will be dead within a year of that fall.
00:30:14.200Of those who survive, 50 percent of them will experience a reduction in class of mobility.
00:30:21.780So meaning people who walked normally will walk with a cane.
00:30:24.960People who walked with a cane will walk with a walker.
00:30:27.300People who walked with a walker will be wheelchair-bound.
00:30:29.640This is a profound change in quality of life.
00:30:33.600And a lot of it has to do with a loss of this type of strength.
00:30:37.560If you think about it, people are much more likely to hurt themselves stepping off a curb when they get old than stepping onto a curb.
00:30:47.540So, yeah, a set of dumbbells, which you can carry around, because that's really a very important piece of upper body strength is being able to carry something.
00:30:55.460That's where that grip strength is coming from.
00:30:57.300And being able to do step-ups, step-downs, squats, all sorts of things.
00:31:01.540Yeah, you don't want to let perfect be the enemy of good when it comes to initiating this type of thing.
00:31:16.380What you want to be able to do is work up to a height such that when the foot is on the box, the front leg is on the box, the thigh is parallel to the ground.
00:31:25.820So for most people, that's 16 inches, maybe 18 inches.
00:31:31.620A very tall person might be 20 inches.
00:31:34.200I recommend people start at a 12-inch step until they, you know, sort of, and you start with your body weight.
00:31:41.520I mean, for many people, just doing a proper step-up and step-down with body weight at 12 inches is right.
00:31:47.080And actually, in the book, it was becoming so difficult to write about this in detail that I did.
00:31:55.260There's a whole section where I write about how to do this.
00:31:57.040But in the end, we created a thing on our website where I just have a bunch of videos where I illustrate these things.
00:32:02.980So in the book, it directs people to where to go to just see, I think, eight or nine videos of the most important exercises that I think people should be able to do.
00:32:12.780Well, we should put that in the video description, so we'll have to remember to do that, yeah.
00:32:17.080All right, let's segue, if you don't mind, to nutrition and diet, and we can talk about obesity, diabetes, and inflammation on that front.
00:32:28.280I was interested in your comments on diabetes.
00:32:30.760So my understanding, and this is entangled with the problem of obesity, my understanding is that when physicians test for blood sugar, they age-adjust the norms.
00:32:44.620And that strikes me as, let's say, peculiar, because it seems self-evident that if you have normal levels of blood sugar at 40, but that would make you diabetic or pre-diabetic at 20, then you're actually diabetic or pre-diabetic.
00:33:04.120And what that implies is that the rate of diabetes, which is already ridiculously and preposterously and devastatingly high, is actually much higher than we think.
00:33:14.720So correct me if I'm wrong or elaborate on that, if you would, if you think I'm onto something there.
00:33:21.680I can't speak to what any other physician does, but in our practice, we hold everybody to the same standard.
00:33:30.120I think we will acknowledge on one metric, because we use a standardized dose of glucose, when we do what's called an oral glucose tolerance test,
00:33:40.960we will give women a little bit more latitude because they don't have as much muscle mass.
00:33:45.760So there's a particular test that we do where we give people 75 grams of glucose, and we time at 30, 60, 90, and 120 minutes what their glucose and insulin level is.
00:33:57.240And in that window of time, what you are testing is how efficiently do their muscles take up glucose.
00:34:05.520So you're measuring insulin sensitivity and glucose disposal.
00:34:08.300And in that window of time, that's the only place you can put the excess glucose.
00:34:14.260And because women have less muscle than men, we will tolerate a slightly higher glucose response, but we want the same insulin response.
00:34:24.300So that's, and it's a very subtle difference.
00:34:27.080But no, we don't age adjust for anybody.
00:34:29.800We sort of, we want a 60-year-old to be as effective at this as a 30-year-old.
00:34:34.520So can you outline for people what happens during normal Western aging, let's say, on the insulin and glucose metabolism front and what that implies for age-related degenerative diseases?
00:34:50.880It's a very interesting thing, and we're not entirely clear why, but there is an unmistakable decline in insulin sensitivity as a person ages.
00:35:04.200Now, it doesn't mean that you're destined to have insulin resistance or fatty liver disease or type 2 diabetes when you age.
00:35:11.360But what it generally means is, on average, a person needs to be more diligent as they age.
00:35:18.160And I've heard lots of theories offered for this, and my guess is they all play a role.
00:35:23.280There's clearly a reduction in testosterone as we age.
00:35:26.660Testosterone is a very pro-metabolic health hormone, right?
00:35:31.840So testosterone promotes lipolysis of fat by muscle.
00:35:38.240In fact, there was a clinical trial about a year and a half ago that looked at men without type 2 diabetes but who were pre-diabetic on and off testosterone replacement therapy.
00:35:51.480And you showed a significant reduction in the progression to type 2 diabetes in men on testosterone.
00:35:57.020So clearly, the decline of testosterone is playing a role in both men and women, by the way.
00:36:01.660We also see less expression or less activity of an enzyme called lipoprotein lipase, LPL, where it shifts more of its activity from muscle to fat.
00:36:15.740This is, again, an enzyme that is responsible for the breakdown of fat.
00:36:21.800There are also other things, as you pointed out, such as inflammation that increases with aging.
00:36:27.020And we also tend to be less active as we age.
00:36:32.180And one of the most important things to preserve insulin sensitivity is activity.
00:36:38.340So there's a really famous researcher at Yale named Jerry Shulman, who's one of the world's authorities on the etiology of insulin resistance.
00:36:45.700And when he does clinical trials, when he does experiments on human subjects at Yale, and he wants to study insulin resistance, the one criteria he must have is that the subjects can't be physically active.
00:37:00.660So, in other words, for him to figure out what insulin resistance looks like, even in a 20-year-old, he has to ensure that they are not exercising at all.
00:37:10.920So it's some combination of these things and probably some other things that are explaining why all of us have to work harder as we age to avoid this phenotype.
00:37:21.320So maybe you could define insulin resistance, describe its relationship to elevated blood sugar or to blood sugar in general, and then discuss the relationship between the elevated blood sugar, insulin resistance, and aging as such.
00:37:42.640So, think of the muscle maybe as a balloon.
00:37:49.840And the balloon is the only place where you can put air.
00:38:30.980So, again, just thinking about this in terms of physiology, glucose is a molecule that needs to be regulated very carefully in our bodies.
00:38:41.920Too much and too little is catastrophic.
00:38:44.540And so the body does a great job of trying to take excess glucose out of the circulation and put it into muscle cells.
00:38:50.940By the way, just to put this in context, Jordan, a healthy person has about one teaspoon of glucose floating around all of their circulation at any moment in time.
00:39:29.440So our body is amazing at doing this, but it's a very delicate dance between how much insulin do you need to make that happen.
00:39:36.840And the canary in the coal mine of insulin resistance is after a person is challenged with glucose, even if their glucose levels normalize, they needed supranormal levels of insulin to do it.
00:39:52.220That's the initial blowing too hard on the balloon.
00:39:55.360So when you develop insulin resistance and that progresses to diabetes, you literally can't produce enough insulin to get sugar into the muscles.
00:40:05.620Eventually, you cannot make enough insulin.
00:40:08.200And this is complicated by another factor, which ties into this cascade of metabolic disease, which is eventually fat starts spilling out from the cells that we are meant to use to store excess energy, which are our actual subcutaneous fat cells.
00:40:25.740And that fat starts spilling into other areas where we're not supposed to have it, into the muscle, which is what's causing the actual mechanism of insulin resistance.
00:40:35.500It's the fat in the muscle that is preventing the insulin signal from being heard effectively by the muscle cell.
00:40:46.480That's what's called fatty liver disease or non-alcoholic fatty liver disease.
00:40:49.540The fat starts to be deposited in the pancreas where insulin is made, and that creates an inflammatory environment to the insulin-producing cells.
00:41:00.760You need more insulin, but you can make less of it because of the inflammation.
00:41:05.100And this thing very quickly spirals out of control, and the end state is type 2 diabetes.
00:41:12.300So now you have two teaspoons of sugar in your blood instead of one teaspoon.
00:41:16.740And so what are the consequences of that excess sugar load, which in absolute amounts seems very trivial, right?
00:41:26.540I mean, one teaspoon in all of your blood seems like almost nothing, and two doesn't seem like much either.
00:41:31.420But the difference is at two teaspoons, the difference is starting to tip you towards what sort of illness.
00:41:38.580So you have two problems going on now.
00:41:40.460You have too much glucose and too much insulin.
00:41:43.760Because remember, when you have that high level of glucose, you're going to be treated with drugs that aim to increase insulin.
00:41:51.860And that can sometimes be insulin itself, or it could be drugs that produce more insulin.
00:41:57.160So let's start with the glucose side of the equation.
00:42:00.480The easiest way, I think, to think about this is too much glucose is bad for small blood vessels.
00:42:06.840Too much insulin is bad for large blood vessels.
00:42:09.900So what are those small blood vessels?
00:42:11.840The very first place this shows up is looking right into the eye.
00:42:16.680So I've always believed that a good ophthalmologist will spot metabolic disease before any doctor will.
00:42:24.080Because when they can look into the retinal artery and see the earliest indication of microvascular occlusion and inflammation,
00:42:31.820that is tied directly to what's called the glycosylation.
00:42:35.680So glucose sticking to proteins, including hemoglobin, in the blood that's basically creating microscopic, what we call ischemia, or lack of blood flow, to the most distal perfused organs.
00:42:49.820So other small vessels that are absolutely ravaged by glucose are the kidneys.
00:42:55.980So diabetes, along with hypertension, would be the most common driver of end-stage kidney disease.
00:43:02.620You also see it in the coronary arteries.
00:43:06.020And believe it or not, it's probably one of the most important physiologic drivers of erectile dysfunction.
00:43:11.620Again, very small blood vessels in the penis.
00:43:14.520And therefore, when these things succumb to this type of end-stage glycosylation, you're going to see damage all around.
00:43:22.920Conversely, on the insulin side, elevated levels of insulin chronically, it's a pro-growth factor.
00:43:28.440So it's very likely the explanation for why obesity is the second leading environmental contributor to cancer after smoking.
00:43:39.180And it also damages large and medium-sized blood vessels like the aorta, the carotid arteries, etc.
00:43:46.000So this cascade of, again, it doesn't sound like much of a difference, as you said.
00:43:51.520It's a chronic issue that over enough time leads to the destruction of most tissues.
00:43:59.380So can you lay out the relationship now between insulin resistance, excess blood sugar, and the propagation of fat tissue?
00:44:09.720Now, the fat is being used to store energy, but how does that actually occur?
00:44:13.320And how is that related to excess sugar?
00:44:15.300Yeah, so in many ways, we were doing really well as a species until, you know, 100 years ago, right?
00:44:24.720In that, you know, what allowed us to have this remarkable escape from all other species vis-a-vis natural selection was this ability to store energy and fuel our brains.
00:44:37.580So as we talked about earlier, like, the brain is such an energy-demanding organ that we couldn't have survived if we didn't have a way to keep energy portable with us.
00:44:49.880You know, how would we survive a day with no food if we didn't have a way to store energy?
00:44:55.860Because certainly more than one day, you have to use fat stores to get by.
00:45:00.240You can't just rely on glucose stores.
00:45:01.740So we have this very efficient way to do it.
00:45:05.260We have a very safe depot of subcutaneous fat where we can put fat in it, which is excess energy.
00:45:13.560And that's primarily fatty acids and also excess glucose can be stored in this form.
00:45:19.460And we can acquire it as we need it, right?
00:45:22.720So, you know, when energy stores are low, you go and you get that.
00:45:26.160Or when energy itself is low, you go and acquire this.
00:45:29.060The problem comes when you exceed the capacity of that.
00:45:33.880So the way I describe it in the book is everybody, and this is largely determined genetically, everybody has a bathtub.
00:45:40.560Some people have a really big bathtub.
00:45:42.560Some people have a really little bathtub.
00:45:44.280The bathtub is the total capacity of your fat cells to store fat.
00:46:35.100And the question is, where does that fat go once it spills over?
00:46:39.340And it's where it goes that causes all of the problems we're talking about.
00:46:44.980When it goes into the muscle, it impairs the muscle's ability to sense insulin and create the glucose transporter to bring in glucose.
00:46:53.440That's the syn-quanon of insulin resistance.
00:46:56.700When it goes into the liver, it creates inflammation, which can ultimately lead to cirrhosis and liver failure.
00:47:02.640When it goes into the pancreas, it secretes cytokines that impair the beta cells, which produce insulin, which exacerbates the insulin resistance problem.
00:47:13.200When it surrounds your organs as what we call visceral fat, it releases inflammatory cytokines that lead to cardiovascular disease disproportionately.
00:47:22.280So again, all of these things are happening, not because we're getting fatter in the right place, i.e. water in the bathtub, but because we're getting fatter in the wrong place.
00:47:34.300And this is another example of which it doesn't take a lot of fat to spill over.
00:47:38.500If a person has 20 kilograms of fat in their fat cells, it causes no issue.
00:47:47.640It's the two kilos that have spilled out into all those other organs that are driving all the damage.
00:47:55.580Yeah, and I read, too, this is another example of the dangers and sometimes benefits of the things that you repeat every day.
00:48:02.720I read at some point a while back that the obesity epidemic, such as it is, could be regarded as being caused by the additional consumption of one soft drink a day.
00:48:27.520Now, and so that is hard on the systems that use insulin to process sugar, but it also puts this demand on your body to deal with the excess glucose.
00:48:38.000How is that glucose converted to or stored in fat?
00:49:01.320It doesn't get the attention it deserves.
00:49:03.000To put, just to go back to one other thing, this whole teaspoon of glucose in your bloodstream, if that number gets to half a teaspoon, you'll die.
00:49:25.420So one of the other things that the liver does miraculously is it has the ability to turn fat into glucose.
00:49:33.380It has, pardon me, it has the ability to turn glucose into fat.
00:49:36.160And it has the ability to turn protein into glucose.
00:49:39.140So it can also change the orientation of molecules.
00:49:42.620And so the process of turning glucose into fat is basically an exercise in breaking glucose, which is a six-carbon molecule, down into two-carbon chunks, and then joining them in a long fatty acid chain.
00:49:55.040We would much rather store energy in fat.
00:49:57.740It's the most efficient chemical molecule in which to store energy.
00:50:03.060All the energy, of course, in our body is in the form of chemical energy stored in the bonds, carbon to carbon and carbon to hydrogen.
00:50:12.660And a fat is the most efficient vehicle to do that.
00:50:16.580So we would much rather actually store energy as fat than in glucose.
00:50:20.840And we don't store that much as glucose.
00:50:22.840So let me step sideways here for a moment.
00:50:28.840I'd like to talk about the food pyramid with you.
00:50:32.620And so I'm going to lay a little bit out about my understanding of the food pyramid and how it came about.
00:50:38.060And then we could talk about the standard Western diet and its relationship to insulin resistance and obesity.
00:50:43.940So my understanding is that the food pyramid was actually produced not by scientists or by MDs, although there were some MDs who were consulting, who were mostly ignored, but by the Department of Agriculture.
00:51:01.440And it was a marketing scheme, essentially, and that the consequence of the marketing scheme was that people were enticed and convinced to rely primarily on carbohydrates for their nutritional necessities.
00:51:20.900And perhaps carbohydrates at far too excess at a level.
00:51:25.600Now, carbohydrates are transmuted into glucose during metabolism.
00:51:30.620And we eat way more carbohydrates than we need to produce the amount of glucose that we need.
00:51:36.860Now, people have been getting fatter in a catastrophic way for about four or five decades.
00:51:41.860And that's really in no small part since the introduction of the food pyramid.
00:51:46.200Now, I do understand that part of the reason the Department of Agriculture did this was because carbohydrates, and this was particularly true of corn syrup, do provide a very inexpensive source of calories.
00:51:57.800And if you're dirt poor and you don't have enough to eat, I mean, just getting enough calories, period, is of vital importance.
00:52:04.060Not everybody can afford steak, for example, or more expensive foods of that type.
00:52:09.800But virtually everyone, poor or not in the West, can afford basic carbohydrates.
00:52:13.840But having said that, I also have read, and I think it's valid, that there was early evidence that this heavy carbohydrate-loaded diet that was being prescribed was going to increase obesity and diabetes,
00:52:27.800which is done at a level that makes the pandemic epidemic look like absolutely nothing.
00:52:34.000And this is still being pushed forward by people who are hypothetically on the nutritional front.
00:52:42.540What's your understanding of the derivation of the food pyramid, and what do you think about its recommendations for the typical diet?
00:52:50.020So, I think before getting to that, there's a broader point I want to touch on that you just sort of alluded to, which is what is the system optimizing for?
00:52:57.920So, in the book I talk about the standard American diet, which I forever abbreviate as the SAD.
00:53:04.920And the standard American diet is effectively, with or without food pyramid, the standard American diet is what is killing people.
00:53:14.340And so, the question is, where did the standard American diet come from?
00:53:18.140The standard American diet was nothing more than the solution to a business problem.
00:53:23.920So, the business problem was, we need something where we can produce lots of food.
00:53:30.660So, you had to have this quantity issue, right?
00:53:32.980So, that gets to part of the problem, right?
00:53:35.080We have too many people at the time who are undernourished.
00:54:19.020This, again, is just part of a business and marketing strategy.
00:54:21.140And what I argue, I guess, is that the solution to those four things is what we have today.
00:54:28.560Like, when you walk through a grocery store, all you're looking at is the solution space to a problem statement called those four questions, and it's called the standard American diet.
00:54:38.440Now, with or without a pyramid, I'm going to just argue that 95% of people, if they go through life eating the standard American diet with no attention to how much of it they eat or maybe certain things in it that they shouldn't eat, are going to be unhealthy.
00:54:56.880There just aren't that many people that have the genes to avoid the deleterious consequences of the standard American diet left unchecked.
00:55:05.960So, that was the least conspiratorial account of the American diet that I've heard, and that's fine.
00:55:22.080I mean, I do think that we could give the devil his due and say the consequences that we have today of this epidemic of obesity was, in fact, the consequence of solving a problem too effectively.
00:55:34.220I mean, the middle of supermarkets, the outside edges of supermarkets don't contain generally highly processed carbohydrates, let's say, but the center does, and they are cheap, and they are delicious, and they are easily provided, and they are portable, and so that did solve the problem of undernutrition on the pure caloric front.
00:55:55.460So, we're victims of our own success in that sense, and I suppose it's perfectly reasonable to dispense with the accusations that the food pyramid was nothing but a marketing scheme, because it did have to solve these four problems that you described, and did so.
00:56:10.240Yeah, I mean, I certainly don't want to give the food industry a pass.
00:56:14.380I mean, we can certainly delve into that, which is to say there's no question that data have been suppressed, right?
00:56:20.760There's no question that we're not having an honest discussion about the following.
00:56:27.340So, are all calories created equal from an energy balance standpoint?
00:56:33.460At an isocaloric level, if I give you 1,000 calories of Coca-Cola versus 1,000 calories of baked potatoes versus 1,000 calories of steak, it will have the same impact on your energy balance.
00:56:47.480But it won't have the same impact on your appetite and your ability to subsequently eat.
00:56:53.620I mean, to me, that's the most, I think, probably offensive aspect of where the food industry has failed, right?
00:57:02.280So, the food industry didn't set out to kill people any more than the tobacco industry did.
00:57:07.480Where these people are effectively liable is in that they're not honest about the discussion until, you know, it becomes too late.
00:57:14.960And the reality of it is junk food, I think, hijacks your normal appetite centers.
00:57:23.040And I know people who are very good at working within those confines.
00:57:31.160So, I know people who can eat junk food in small amounts and continue to eat nutritious food and stay in overall energy balance.
00:57:40.580They can track their calories perfectly, and they can have a couple of Oreos and some ice cream here and there and drink a soda here and there, and they're all fine.
00:57:47.880What I can just tell you clinically, taking care of actual people who are not robots, on average, more people than not struggle with that.
00:57:58.040And with the introduction of these very hyperpalatable foods that kind of hijack your appetite, it tends to produce overeating.
00:58:08.400And ultimately, that's the problem at hand here.
00:58:11.820When people overeat, from whichever part of the pyramid they're going to overeat from, we're going to get down that whole cascade we just spoke about.
00:58:19.320It just so happens that I think the things at the bottom of the pyramid are the things that are making it easier for you to be disconnected from the true driver of appetite.
00:58:32.580And there are lots of hypotheses here, right?
00:58:35.240There are some hypotheses that we are kind of hardwired to get a certain amount of nutrient value.
00:58:41.560And as the nutrient value of our food deteriorates, we have to eat more food.
00:58:48.520We have to eat more calories to get the certain nutrient density.
00:58:52.040There are people who argue we're hardwired to get a certain amount of protein.
00:58:56.300And as we're diluting protein content in food, we're eating more calories to get food.
00:59:01.400In other words, and by the way, I don't think any one of these particularly is necessarily the explanation.
00:59:05.860My guess is it could be a lot of the above, but it's probably the case that we are opportunistic omnivores, right?
00:59:14.500We grew up, you know, we evolved eating pretty much anything we could, but we didn't eat that much of it because we didn't really have that much of it, and we were wildly active.
00:59:24.920When you eliminate those two consequences, being opportunistic omnivores is not working for most of us.
00:59:30.380We have to be more selective to push back against the amazing success of our civilization.
00:59:39.660Yeah, well, it is a remarkable thing that you can walk into your local Starbucks, and there's one on every corner, and get an 850-calorie muffin for essentially nothing.
00:59:51.420And that it is delicious, and that it is addictive, and it is a hallmark of a certain kind of success.
00:59:56.540And I'm going to go sideways here for a minute, because I have something, I suppose, that's slightly more on the personal side to ask you about.
01:00:03.880So, as you may or may not know, my daughter was very ill with a plethora of immunological problems, including very serious juvenile arthritis.
01:00:13.540And that was, it just about killed her.
01:00:16.660It did destroy two of her joints, and she had another 38 that were affected, and so she was always in a lot of pain.
01:00:22.660And we, I looked into the role that diet played in arthritis through the scientific literature for a couple of years, and found two things, and they were somewhat contradictory.
01:00:33.960And one was that there was no real evidence that any specific elements of diet had been linked to juvenile arthritis specifically.
01:00:44.080But, and this was a major but, if people who were arthritic fasted completely, then their arthritic symptoms often disappeared.
01:00:56.060And so I thought that had something to do with the consequences of fasting.
01:01:00.620But then my daughter started to play, and my wife as well, very intensely with the diet.
01:01:05.880We went to a nutritionist who recommended an elimination diet at one point, because we did notice that she would react to strawberries and oranges.
01:01:13.600We could, and within a day, her thumbs would swell, or her toes would swell.
01:01:17.660And so we knew there were some things she was eating.
01:01:19.840We had her tested for immunological reaction to food, but when we tested her, she showed a hyperreaction to virtually everything they tested her for.
01:01:28.880And we concluded at that point, well, there's no damn way she could be reacting to everything she's eating.
01:01:35.580Well, she went on this elimination diet and showed a bit of reduction in symptom, but the elimination diet made no sense.
01:01:42.020Like, there was no rhyme or reason to what you could eat and what you couldn't eat.
01:01:45.200And so she started to experiment with more restricted diets, and eventually settled on, discovered, that if she only ate beef, and it turns out for her it has to be beef that isn't aged,
01:01:56.920then all of her immunological symptoms disappeared.
01:02:01.500And then my wife and I started playing with that diet.
01:02:03.960And so I've only been eating meat for beef, fundamentally, for almost five years now.
01:02:10.160And I've talked to hundreds of people, and we've had messages from thousands of people,
01:02:16.260showing that this is, first of all, radically effective as a weight loss strategy,
01:02:20.560and also seems to produce remarkable effects on the general disease symptom front.
01:02:27.600Back in November of 2021, there was a study published by a Harvard group,
01:02:33.260which wasn't a perfect study because it was retrospective self-report.
01:02:38.040But they followed 20, they assessed 24, 2,500 people who had been on a carnivore diet for six months,
01:02:44.840and showed something approximating a 90% reduction in all disease symptoms.
01:02:49.440And it was the only scientific paper I ever read where the surprise of the researchers was palpable
01:02:56.520between the lines in the scientific writing.
01:02:59.980Because, you know, in a scientific article, all that emotion, negative or positive, is pretty much ironed out.
01:03:05.700But these people were so shocked by what they found that it couldn't help leaking into the document.
01:03:11.020And so, well, this has been quite surprising to me, because I never imagined in my wildest dreams,
01:03:18.040number one, that you could just live on meat, and number two, that it would have such a salutary effect.
01:03:23.420So for me, I lost 52 pounds in seven months.
01:03:27.680I went from 212 pounds to 165, which is exactly what I weighed when I was 23.
01:03:33.240And I've maintained that weight since.
01:03:36.360I can put on muscle mass with no problem, even though I'm 62.
01:03:40.340I had a host of inflammatory conditions, some of which were quite serious, including peripheral uveitis,
01:03:45.660which sometimes blinds people in my right eye.
01:03:48.460And it disappeared completely, along with psoriasis and gastric reflux disorder.
01:03:53.700And, interestingly enough, gum disease, which is technically incurable, which is linked to cardiovascular degeneration,
01:04:02.340and which has gone away 100% in my case, according to multiple measures that my dentists have taken.
01:04:09.760And so, and I've talked to many people who've lost like 100 pounds in a year, you know, because they come to my talks,
01:04:16.140and who are just beside themselves, so to speak, as a consequence of experimenting with this diet.
01:06:58.260Or, like, for example, if you introduce vegetables, non-starchy vegetables, what happens, both symptom-wise and craving-wise?
01:07:08.480Yeah, well, for a while I was eating nothing but meat and greens, but I still had some residual symptoms.
01:07:17.640My wife has a host of immunological problems that are somewhat low-level, and I have a different host, and Michaela seemed to get all of them.
01:07:26.860And so, you know, maybe we're absurdly sensitive for reasons that wouldn't be true of other people.
01:07:31.940But it's definitely the case that I do better, and believe me, this isn't something I particularly want.
01:07:39.460It is the case that I do better if I just stick to beef.
01:19:20.360Do you suppose that's a possible consequence of the presence of cancer being a marker for, like, cumulative systemic failure?
01:19:32.380Is that if there's cancer somewhere, is it an indicator that many things have gone wrong at many levels?
01:19:39.380And so even if you treat the cancer, the probability that that's going to be life-saving is quite low?
01:19:44.660Or is it just a consequence of the tremendous capacity of metastatic cancers to spread?
01:19:50.280So there's a couple of things going on for cancer to take place.
01:19:57.240So the first critical step of a cancer is a genetic mutation has to happen.
01:20:04.880And largely speaking, these fall into two categories.
01:20:08.120There are genes that are promoting cancer growth.
01:20:13.200And then there are genes that suppress cancer growth.
01:20:17.600So anytime you get mutations in one of those systems, it becomes oncogenic.
01:20:23.680Now, fortunately, when a cell becomes cancerous, it starts to let out clues that it is not a normal cell.
01:20:33.900So when a breast cell goes from being a normal mammary cell to a cancerous mammary cell, it starts to look a little bit different.
01:20:45.900And the immune system, our immune system, the cellular immune system, is very good at patrolling the body for signs of things that are not self.
01:20:58.960So it's a very beautiful way to think about it.
01:21:02.000But the immune system is not programmed to recognize bad things.
01:21:06.020It's programmed to recognize things that are not self.
01:21:09.960This is done through something called thymic selection when we're basically very young.
01:21:15.760So, and by the way, too much of that problem leads to autoimmunity.
01:21:19.460So you can think about this through your own personal story, right?
01:21:22.440Which is there's a very fine balance here.
01:21:24.700Too much of knowing what is, you know, not self and too little of that are both equally bad.
01:21:33.520So there are always some cells that recognize this.
01:21:37.940In fact, Steve Rosenberg, who I did my postdoc with, recently published some really amazing data,
01:21:45.220which I find one of the most staggering statistics of all of cancer, and also one of the most hopeful,
01:21:51.680which is that 80% of epithelial tumors, epithelial tumors are the ones that kill people.
01:21:57.280That's the solid organ stuff, the breast, colon, prostate, etc.
01:22:00.68080% of those tumors produce what are called novel neoantigens, meaning they produce peptides, small proteins that are not self and are recognized by the immune system as not self.
01:22:17.920The problem is, the reason those 80% of patients don't go into spontaneous remission is they can't mount a strong enough immune response to that.
01:22:28.340So it's sort of like having some immune cells that recognize you have a virus, but not enough that they can actually kill the virus, and ultimately the virus kills them.
01:22:39.920To your broader question, which is, if you're listening to this, what do you do about it?
01:22:44.860It starts to me with, what are the two most clear environmental triggers of cancer, and how do you avoid them?
01:22:54.020And then secondly, what's the rest of your strategy?
01:22:57.620So when it comes to heart disease and neurodegenerative disease and metabolic disease, which are the other three horsemen,
01:23:05.780our ability to incorporate prevention is so significant that it plays the lion's share of our strategy.
01:23:15.160Because we have such an understanding of the risk factors for Alzheimer's disease, the risk factors for metabolic disease, and the risk factors for heart disease,
01:23:23.100your prevention strategy is not doing those 25 things or minimizing how much you're doing those things.
01:23:29.380With cancer, there's really just two big things, smoking and obesity slash insulin resistance.
01:23:37.520Now, the literature would just say obesity, but I add insulin resistance because I think that the literature is too blunt a tool to tease out what's really going on.
01:23:47.020And what's really driving it, I think, is the inflammatory and metabolic, i.e. the high growth factors such as insulin,
01:23:55.660that are coming with most but not all cases of obesity.
01:23:58.820So what we really want to avoid is being metabolically unhealthy and smoking.
01:24:53.960So I wouldn't be able to hang my hat on this as, well, my anti-cancer strategy is not smoking and being metabolically healthy and hoping that that's enough.
01:25:01.760We have to have another tool in this toolkit.
01:25:05.860And that tool is a very controversial one, but nevertheless, I think it's important, and it's very aggressive screening.
01:25:13.180And the reason for this is another observation that I don't think gets enough attention,
01:25:19.020which is when you consider two different individuals with the same cancer but at different stages who are treated with the exact same treatment,
01:27:46.660But you're confounding something, which is, at least in the Canadian healthcare system, that might make more sense because the government owns the risk for life.
01:27:58.460So at least if I don't, and I can't, you know, despite the fact that I grew up in Toronto, I can't really speak to the Canadian healthcare system with any authority.
01:28:05.140But at least that's something Canada has going for it, which is when you're 40 getting a colonoscopy, or when you're 50 getting a colonoscopy that catches a little polyp that costs nothing to remove and prevent it from going to cancer, you still own that life and that risk 10 years later.
01:28:25.640In the U.S., people are never really owned from a risk perspective by one entity for very long.
01:28:32.540So there is much, much less incentive in our system, unfortunately, to truly invest in prevention.
01:28:40.840And that's a, you know, if we were to talk about the structural problems of the U.S. healthcare system, that might be the single most important one.
01:28:48.300Well, the other problem on the prevention front, you know, is that prevention isn't dramatic because you get no credit for preventing 100 things that don't happen.
01:29:00.600You know, if you cure something, that's pretty dramatic because someone's ill and you cure them, and the fact that they're no longer ill is self-evident.
01:29:08.640But if you stop something cold in its tracks, all that happens is that people pay attention to other problems and other, let's say, more showy and noticeable cures.
01:29:20.680And so it's not only hard to fund prevention, it's also hard to market it, right?
01:29:25.740Because you can't give credit to the people who've managed it.
01:29:29.240And so that's a big structural problem.
01:29:31.400Like, it seems one of the logical conclusions from our conversation was that it would have been a much better investment on the government side and on the social side to have put a fair chunk of the money that was spent on cancer treatment into prevention of the entire range of diseases that we've been discussing.
01:29:50.240And primarily with a focus likely on, what, on obesity as the number one, is it obesity, do you think, that's the number one concern across all these classes of degenerative disease?
01:30:09.660But yes, metabolic disease would be the, you know, one that feeds and amplifies all the others.
01:30:16.620But there are other things that we haven't explored.
01:30:18.900Like, I don't think we have done a decent job remotely of understanding, just going back to cancer, what the impact is of other environmental toxins in cancer.
01:30:30.140And the reason I think it's so important in cancer to look at this is because smoking and obesity only explain so much of it.
01:30:36.940So in other words, I can't tell you what the number is, but it's knowable and it's large.
01:30:40.960The number of people who get cancer who are neither smokers nor have obesity or insulin resistance.
01:30:47.400And so there's still a big fraction of people for whom something else is driving their cancer.
01:30:53.880And I suspect there are other environmental toxins, whether they be pesticides, whether they be, you know, chemicals in the ground.
01:31:03.660Like, there are other things out there that might not produce a large enough signal to show up, either because of their ubiquity or because the direct impact is not as large.
01:31:12.380And the fact that we don't know this, to me, is problematic.
01:31:32.080By the way, I do want to say one thing about what you said, Jordan, that is very true.
01:31:36.220And there's no disease for which it's more tragic than with the dementing diseases, specifically Alzheimer's disease.
01:31:42.700So if you want to look at the amount of research that's gone into treatment versus prevention, it's in dollars spent, you'd need scientific notation to tell you what that ratio is.
01:32:25.500And yet, I think it's crystal clear that your trajectory towards Alzheimer's disease is probably much more malleable than your trajectory towards cancer.
01:32:34.900And we should have a very clear playbook on what that looks like, given how difficult it is to treat that disease once it's present.
01:32:59.320And people might say, well, everything can't be about money.
01:33:02.540It's like, well, without money, you can't market.
01:33:04.640And without marketing, you can't communicate.
01:33:06.520And so there's all sorts of obstacles that are quite subtle in the way of mounting an effective prevention campaign.
01:33:13.880But it does—it certainly seems—if you—let's close with two questions.
01:33:18.920One might be, if you could seize control of public health spending on the research and public policy front, where would you devote the bulk of resources now?
01:33:31.560I mean, like, one example might be, well, you know, would we start a campaign to reduce the consumption of carbohydrate, especially sugar?
01:33:41.340But we talked about other elements of prevention as well.
01:33:44.900If we were going to spend our money, research money, and our public health money efficiently and get the most bang for the buck, where do you think we should spend it?
01:33:53.560And what evidence do you have to support that?
01:33:58.020It's really hard to say because this is just as much a behavioral question as it is a scientific or medical question.
01:34:05.980Again, the numbers point back to exercise, Jordan.
01:34:09.480There's no ambiguity about that, right?
01:34:11.860You're going to get more benefit in a person's health if you get their VO2 max high, you put lots of muscle mass on them, and you create a high degree of strength.
01:34:22.340And that's going to be true for men, women, young, old.
01:34:29.440And therefore, you know, I would put most of my resources from a public health standpoint into how do you do that?
01:34:38.220How do you make exercise something that is interwoven from preschool onward at a level that is truly efficacious?
01:34:47.320And that's going to not just mean getting people to exercise.
01:34:50.680It's going to be figuring out ways to change the environment that supports being active more often so that you're being active even when you're not exercising.
01:35:00.380But it's also going to involve understanding that everybody's different.
01:35:03.160And there are some people who hate exercise, and what do you need to do to make it more enjoyable for those people?
01:35:08.240What kind of financial incentives do you put in place for people to exercise?
01:35:12.100Because I really do believe carrots can be more effective than sticks here.
01:35:16.520And, you know, simply, you know, I mean, we talk—people are sitting here talking about, you know, universal basic income as a potential way to alleviate some of the societal problems.
01:35:25.580Well, if we're going to be paying people, maybe paying them to exercise and providing, you know, a way for a really good incentive around this, because it's going to obviously save cost, but I think more importantly, improve the quality of a person's life.
01:35:40.880No individual cares about the cost, right, because they're not bearing the cost.
01:35:45.620So that's a—the arguments around that I don't think matter.
01:35:48.760I think the only thing that matters is, can we have you do something that's going to improve the quality of your life?
01:35:55.740I wonder what would happen if we took kids out for a 15-minute walk every morning as part of the school curriculum and made that habitual.
01:36:04.220You know, it would be good for the kids, too, because they might be able to sit down and attend a bit more if they actually had a bit of exercise before they were required to sit and do nothing for six hours.
01:36:12.720So, you know, to build—to start building those habits of activity in youth so that they persist.
01:36:19.920I mean, I would get rid of chairs—I would get rid of chairs in schools.
01:36:25.700I mean, there's—sitting is just a—it's not a particularly productive thing in the position we do it in, right?
01:36:30.920I mean, sitting in a squatted position is fine, but the angle that we're sitting at is really—it's not conducive to great biomechanics later in life.
01:36:39.960So, you know, if you watch a child—your kids are probably too old now, but mine are not—I can see the change in body mechanics as they go through more and more time in chairs.
01:37:00.320I mean, that might be the most fundamental impact of the education system, you know.
01:37:04.420I read an interesting book years ago called System Antics by a man named John Gall, and it's a set of aphorisms about how systems work, you know.
01:37:13.640And one of the aphorisms, which I never forgot, was the system does not do what its name says it does.
01:37:19.200And so, when you analyze a system—for example, one of the reasons I think that universities get away with charging tuition fees that are, like, absolutely unreasonable by any standard is that you have a pretty decent chance of meeting your lifetime mate if you go to university.
01:37:36.180And so, it might be that the fundamental function of universities is to aid in the process of assortative mating.
01:37:41.720Like, systems are very complex, and hypothetically, the education system educates kids, but its fundamental function, for all we know, might be to turn people into sedentary and obese adults.
01:38:02.020We touched briefly on the issue of emotional health.
01:38:06.040And so, tell me—just tell me your thoughts on that in general.
01:38:09.740What are your recommendations in Outlive, in your book, and how do you associate the issue of psychological and emotional health with the—well, with exercise and diet, for example, or any of the other lifestyle modification processes that we've discussed?
01:38:27.620So, I think emotional health ties into this longevity equation in many ways.
01:38:33.040So, you can start at a very extreme end.
01:38:35.320A low enough state of emotional health can be a direct threat to your life.
01:38:42.180So, again, the most extreme, extreme example of that would be suicide.
01:38:45.580But if you walk back from suicide, we talk about parasuicide.
01:38:49.360We talk about all the different behaviors that people engage in that are slow suicides.
01:38:54.060I can't speak to what the statistics are in Canada, but in the United States—and I suspect you know these more than I do, Jordan—if we look at three categories of deaths of despair—suicide, overdose, and alcohol-related death, so cirrhosis, things like that—the deaths of despair have been increasing at anywhere from 10% to 20% year on year on year over the past four or five years.
01:39:23.760Yeah, so just last year was the first year that overdose took more than 100,000 lives in the United States.
01:39:30.440So, yeah, well, you know, it's an open question how many people on the edge of depressive collapse were tipped over that edge by the lockdowns and the prolonged social isolation and the increase in fear.
01:39:43.680You know, up in Toronto, I still see people—and in L.A. too, it was quite noticeable.
01:39:49.240I still see people cowering behind their masks, and, you know, you have to have been made pretty chronically afraid to still be doing that.
01:39:58.040And the cost to people's health of the fear campaign that drove the lockdowns, we're going to see that—I mean, I don't know how that's contributing to the excess death statistics.
01:40:08.480I think it would be very difficult to say that those statistics I rattled off aren't impacted by COVID.
01:40:16.320So, what's going to be interesting is to see how that plays out going forward.
01:40:20.720My point, of course, is that these deaths of despair are a very extreme example of how emotional health impacts longevity directly.
01:40:30.380Right here, it's just truncating lifespan way too soon.
01:40:33.220In fact, overdose is now the leading cause of death in the United States for people aged 10 to 55.
01:41:09.160I think the next layer is how many people, because of their relationship with themselves, are unable to self-care.
01:41:18.360If we're really going to be honest about it, how often do we engage in not what would rise to the level of, quote-unquote, harmful behavior, but certainly things that are not in our best care?
01:41:32.600Eating a little bit too much, not exercising enough, not sleeping well, you know, engaging in behaviors or failing to engage in healthy behaviors.
01:41:44.320Now, again, I see this constantly with patients, where it's not that they don't know what to do.
01:41:51.520It's not that they don't know that they should exercise.
01:41:54.840But if you really push them, they have a negative relationship with themselves that is preventing them from taking care of themselves.
01:42:04.680And I would say that the impact on length of life there and quality of life is much bigger than the deaths of despair, but it's much harder to quantify.
01:42:16.360So then I'd go even one step further and say, okay, well, you're not in category one, where you're an immediate threat to your life because of your emotional health.
01:42:25.000And you're not even at the point where you're failing to take care of yourself, but now you maybe land where you're just not happy.
01:42:44.540And you're basically living without a sense of why, right?
01:42:47.940You're not, you know, as Esther Perel put it to me, what is the purpose of living longer if you're unhappy?
01:42:57.280And I think that that's probably the biggest circle.
01:43:00.400And that's, to me, one of the most interesting ones here.
01:43:03.340And again, for me personally, the one I wanted to explore the most in myself, which was how much of this obsession with longevity is about figuring out how to not die versus understanding how to live.
01:43:21.680And so what have you concluded on the treatment front in regards to that set of problems or the prevention front, let's say?
01:43:29.520Well, again, it's worth caveating that everything that I write about in the book, I come to it with some lens of expertise, right?
01:43:40.080It's what I've spent more than a decade researching.
01:43:43.160You know, I can speak with some authority about cancer and heart disease and dementia and exercise and nutrition.
01:43:49.400When it comes to this particular issue, I have no expertise.
01:43:53.520I come at this through the lens of a patient.
01:43:55.920And therefore, I think everything I say must be taken with the understanding that it's somewhat anecdotal and therefore needs to be explored with professionals who I think can bring to it, for example, the expertise you could bring to it.
01:44:37.980So there's kind of this view of hope, which is you don't have to throw out the baby with the bathwater.
01:44:44.940You can, again, in my case, you can take some of those adaptations, which produce, you know, hard work, discipline, all of these things.
01:44:52.880But you can get rid of some of the negative ones, such as the negative self-talk, the perfectionism, all of these other things that created a very negative impact on myself and those around me.
01:45:09.060And unfortunately, it's not something that lends itself to the faint of heart.
01:45:16.160Unfortunately, at least in my experience, I'd be much more curious at your experience, many people need to be at a local minima, you know, not necessarily the rock bottom, but close to a rock bottom, to start to probe those things.
01:45:30.320Well, I can tell you some of the things that I've learned, partly as a consequence of public lecturing and speaking to people constantly about how they might straighten up their life.
01:45:41.740The first thing I would say is we've run a series of studies on a set of programs I designed with my students and my previous graduates, my graduate supervisor, Robert Peel and Daniel Higgins.
01:45:53.720Peel was my supervisor and Higgins, my student.
01:45:56.500We developed a suite of exercises called the Self-Authoring Suite.
01:46:02.720And the past authoring program helps you write an autobiography and clear up that excess baggage.
01:46:10.320And the present authoring program helps you analyze your faults and your virtues rather programmatically so that you can start to generate a strategy to rectify your faults and to capitalize on your virtues.
01:46:22.180And the future authoring program, which we've studied most intently, helps you develop a vision for the next five years.
01:46:29.400And if we have people do the future authoring program before they enter university, if they do 90 minutes of developing a vision, 90 minutes, that's all.
01:46:40.260No preparation with no one reviewing what they've written.
01:46:43.340The probability that they'll drop out falls 50% and their grade point average goes up 35%.
01:46:49.940And it is tied to precisely what you described, is that people need a reason to live.
01:46:56.300And I also, in this exercise, we help people break down the reasons to live.
01:47:01.140And this touches on another point that you made regarding relationships.
01:47:05.540You can't be healthy psychologically in the absence of a network of functional relationships.
01:47:11.520You need a partner, you need a family, you need friends, you need business colleagues.
01:47:15.840You have to be nested in a functional social hierarchy.
01:47:19.020And so we walk people through this process of vision development.
01:47:23.960We ask them what they would like to have in five years if they could have what they wanted and needed.
01:47:29.480We ask them how catastrophic their lives would be in five years if they let their bad habits get out of control.
01:47:35.700That sort of sets the parameters, right?
01:48:22.400And this is precisely what we're talking about.
01:48:24.180But it turns out, just as in the case of exercise, you said you can get a walloping advantage from just going from zero to three hours, going from no plan at all to a hastily contrived 90-minute plan.
01:48:37.620And, well, like I said, that stops half the kids from dropping out of university.
01:48:43.680And so there's a large body of research showing that these sort of writing exercises to clean up your past and to structure your future are salutary on the psychological and the physiological front.
01:48:55.140So you can imagine there is a three-pronged approach to health span, right?
01:49:02.280Sufficient exercise, appropriate diet, and the development of something like a comprehensive account of and vision for your life.
01:49:12.100And that would be relatively inexpensive and all things considered relatively easy to implement.
01:51:15.900I still want to be able to walk up a flight of stairs.
01:51:18.000I still want to be able to carry a bag of groceries.
01:51:20.140I still want to be able to lift my suitcase up.
01:51:22.040But I look down and I see what a difference it is in terms of those relationships.
01:51:29.220It's a profound difference in the decade of that person's life and my ability to be a part of that life and for them to be a part of my life.
01:51:38.800And I say all of that because it's the why that matters a little bit here.
01:51:44.140Well, you know, that might be part of the magic bullet in relationship to prevention is that, well, why you should eat junk food is obvious.
01:51:53.320It's immediately gratifying and delicious.
01:52:00.480It's the same with abusive drugs like cocaine.
01:52:03.860We don't have to explain why people abuse cocaine.
01:52:06.140We have to explain why all people don't abuse it 100% of the time because it immediately activates the systems that mediate positive emotion.
01:52:17.500If you look at the alcohol cessation literature, what you find is quite a pronounced multi-decade set of conclusions that show that if you want to stop drinking, you need a reason.
01:52:30.060You need to find something to do that's better than drinking.
01:52:32.720And if you like alcohol, drinking is pretty good.
01:52:43.200It's a psychomotor stimulant for some people.
01:52:45.640It probably increases opiate response, so it's very rewarding.
01:52:49.640Well, the problem is that it ruins your life over a multi-decade period and blows your relationships to bits.
01:52:55.500But if you don't have a vision of yourself extending across that span of time, then why the hell should you care?
01:53:01.280And it might be the same on the exercise and nutrition front.
01:53:03.980It's like you're not going to take care of yourself unless you know you have something useful to do.
01:53:08.560And I've been talking to people all over the world about taking responsibility, partly because if you take responsibility for other people, it improves your relationships.
01:53:17.080And if you have better relationships, well, you're much more resilient and you have much more of an opportunity for positive emotion.
01:53:26.180And so if you take responsibility, you have a long-term vision of yourself as well.
01:53:30.760And so maybe the psychologists and the medical doctors can get together and figure out how to ally the work on exercise and nutritional improvement with motivation and produce prevention strategies that people will actually follow.
01:53:47.660Partly because they see a reason in following them.
01:53:51.380You need a reason to make sacrifice, you know.
01:53:54.320Yeah, I think that's the key point here.
01:53:57.300And I think that's the point I'm trying to make with respect to emotional health, which is if you don't have this why, we're just not robots that can be programmed to do all those other things.
01:54:08.740We have to have a reason, and I think your examples are great ones.
01:54:12.400Virtually everything that is bad for your health feels much better in the moment.
01:54:17.900So to say no to that, to offset the hyperbolic discounting problem of delayed gratification, you must have something that is stronger than the immediate hedonic pleasure of either not exercising, eating the wrong thing, staying up too late.
01:54:37.300Yeah, well, you know, when I want to have a banana split, which is reasonably often, I think, yeah, you know, but I'm pretty happy to have a physiological constitution that's a lot more like it was when I was 23 than I had when I was 50.
01:54:58.700And the value in that, I suppose, that marginal decade, for example, the value in that's palpable enough so that I think, yeah, well, it is a sacrifice, but it's probably worth it.
01:55:10.320So that's the question, hey, what's it worth making a sacrifice for?
01:55:14.160And it's a question you have to answer if you're going to put your life together and put your health together.
01:55:17.540All right, everyone watching and listening on YouTube, thank you very much for your time and attention.
01:55:24.000To the Daily Wire Plus people for facilitating this conversation, that's much appreciated.
01:55:29.140I'm here in Boise, Idaho today doing this conversation.
01:55:33.180Daily Wire always finds me a studio and a studio for my guests.
01:55:36.020To the film crew here, thank you very much for flawless experience.
01:55:42.200Dr. Adia, it was very good of you to talk to me today.
01:55:44.860I wish you the best of luck without living the book and in your own life.
01:55:49.040And I would also encourage those who are listening to continue to follow our conversation on the Daily Wire Plus platform,
01:55:58.500where we'll talk for another half an hour on more biographical and personal issues.