The Jordan B. Peterson Podcast - 360. Obesity, Diabetes, Cancer and You ｜ Dr. Peter Attia

00:00:00.960 Hey everyone, real quick before you skip, I want to talk to you about something serious and important.

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00:00:57.420 Hello everyone. Today I'm speaking with physician, longevity expert, and now author, Dr. Peter Adia.

00:01:15.400 We discuss his new book, Outlive the Science and Art of Longevity,

00:01:19.920 and explore the immense benefits that can be gained from exercise in just three hours a week,

00:01:24.680 how small imbalances in diet can cause major problems such as diabetes and obesity,

00:01:30.760 the difference between lifespan and healthspan,

00:01:34.280 the soured reasoning behind the American food pyramid,

00:01:37.700 and the scientific side of alternative diets.

00:01:41.760 No buzzwords.

00:01:43.300 Looking forward to the discussion today.

00:01:46.140 Dr. Adia, in your book, you talk about lifespan in general,

00:01:51.160 but you also concentrate on a concept called healthspan, termed healthspan,

00:01:57.980 and you're concentrating more on decades, let's say, of healthy life rather than absolute length of life.

00:02:05.500 Do you want to expand on the concept of healthspan and why you distinguish between that and longevity per se?

00:02:11.620 Yeah, longevity is really a function of lifespan and healthspan.

00:02:15.220 So lifespan is the easier of those two to understand because it's binary.

00:02:18.780 You're either alive or you're dead.

00:02:20.860 And I think when most people think of longevity, they think of the elongation of lifespan, understandably.

00:02:27.460 But, you know, that's really only part of it.

00:02:29.660 The other part, the part that might actually be more important to most people when pressed on the issue,

00:02:35.600 is healthspan, which is the quality of life.

00:02:38.640 And the medical definition of healthspan is not a particularly helpful definition in my view.

00:02:44.600 It's effectively the period of time from which you are free of disability and disease.

00:02:50.000 But I don't really think that captures what healthspan is to most people.

00:02:53.760 And so I think healthspan is a broader concept.

00:02:56.520 And it's not binary.

00:02:57.840 It is analog.

00:02:58.560 But it really constitutes some measure of cognitive health, physical health, and emotional health.

00:03:04.300 And at least two of those are intimately linked to age, which is to say they generally decline with age.

00:03:11.260 But if we focus, I think, relentlessly on the pursuit of those things, we tend to get a better quality of life overall.

00:03:18.480 And, by the way, I think you get for free a lot of lifespan benefits.

00:03:21.400 Right. So, well, it's very important to get the definitions and the measurements right

00:03:29.200 because systems optimize to maximize their score on what they're measured by.

00:03:34.040 And I suppose living to 140 wouldn't be so good if you were senile for the last 70 years and institutionalized, for example.

00:03:41.900 And so it sounds like when you talk about healthspan, you're intermingling two, what would you say, two quality of life issues.

00:03:50.460 One would be the expansion of youth rather than longevity per se.

00:03:55.740 And then something associated with the existential quality of life.

00:04:02.440 So 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?

00:04:12.420 Yeah, I think so.

00:04:13.420 I think that the cognitive and physical piece are the pieces that do decline with age.

00:04:18.540 And we want to preserve those as long as possible.

00:04:21.840 And we can be very specific about what those things are, by the way, right?

00:04:24.680 We could drill into what is cognitive healthspan, what is physical healthspan.

00:04:29.260 And 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.

00:04:41.840 And 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.

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00:05:46.740 And thank you for watching and listening.

00:05:48.200 Yeah, so a long while back, I was looking at interventions to improve people's lives.

00:06:08.200 And I knew at that point that cognitive decline was a major problem, especially in terms of, well, productivity and general competence.

00:06:19.160 And so it's a pretty pronounced linear downhill trend on the fluid intelligence front from about the age of 25 forward.

00:06:27.720 And that can decline precipitously in, say, late 70s, early 80s, especially with the onset of degenerative neurological diseases.

00:06:36.120 And I was looking at the literature on cognitive remediation.

00:06:39.540 This 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.

00:06:49.900 There's never been any evidence for that, by the way.

00:06:52.060 It's a pretty damn dismal literature.

00:06:53.900 But 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.

00:07:05.640 And 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.

00:07:17.160 And if you can keep yourself cardiovascularly fit, interestingly enough, that's the best pathway to cognitive health.

00:07:25.440 Then 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.

00:07:35.040 Of course, psychotherapy is one of those, but there are written interventions.

00:07:37.900 If people write about their past, about their past traumas, and if they write about their future plans, they reduce general uncertainty.

00:07:45.640 That reduces their stress, and that seems to produce a relatively pronounced physiological benefit.

00:07:51.800 And so there's an interesting interplay there that we can talk about more in terms of the emotional and the physical.

00:07:57.800 It's pretty funny that if you want to improve your cognitive function or maintain it, you should exercise rather than think.

00:08:04.560 And that if you want to improve your physiology, you should straighten out your story and face your traumas rather than, say, exercise.

00:08:12.400 So what do you recommend in your book, in Outlive in particular, with regard to the expansion of health span?

00:08:23.100 What do you think, and how do you practice this personally?

00:08:26.160 What do you recommend to people?

00:08:28.140 So I think that exercise is empirically the most valuable tool we have for both the cognitive and physical components.

00:08:38.340 So let's start with the cognitive, because I think here it was less intuitive.

00:08:42.440 So 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.

00:08:52.380 So 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.

00:09:03.520 Those were the four metrics we cared about because, as you point out, those are all bits of intelligence that decline with age.

00:09:11.480 So we looked at everything.

00:09:14.480 Okay, so we looked at every molecule.

00:09:16.040 We looked at every possible thing that you could think of.

00:09:20.040 And after about nine months of this, the thing that stood out above all else, beyond any diet, beyond the importance of sleep,

00:09:28.820 and other things that certainly mattered, controlling blood pressure, lipids, et cetera, was exercise.

00:09:34.580 And even though I was a lifelong exerciser and loved to exercise, I just couldn't believe it.

00:09:39.220 It seemed so trite that exercise could have such a profound difference on the state of cognition,

00:09:46.560 not just in terms of its performance as effectively a nootropic, but also in its ability to delay, if not outright prevent, dementia.

00:09:56.600 So once we dug into the mechanisms, I think it became clear why exercise is so potent.

00:10:03.260 And it's basically that it is acting on so many different levels.

00:10:06.420 So as you pointed out, it's acting at a metabolic level.

00:10:09.740 The brain is such an energy-demanding organ.

00:10:13.620 As you know, and maybe your listeners do, you know, it weighs about 2% of your body weight,

00:10:18.420 and it's responsible for 20% to 25% of your energy consumption.

00:10:23.200 So therefore, anything that disrupts that is catastrophic.

00:10:27.000 So when you look at the improvements in glucose disposal, insulin sensitivity, and all metabolic parameters,

00:10:33.740 exercise is the most important tool we have there.

00:10:37.040 When you look at the reduction of inflammation, vascular health improvements, again, exercise stands alone.

00:10:42.760 When you look at the production of neurotropic growth factors, such as BDNF, again, exercise is basically a drug for neurons.

00:10:51.040 And 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.

00:10:59.640 And 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.

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00:12:47.360 So, let's talk about exercise from the perspective of a behavioral psychologist.

00:12:57.640 So, 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.

00:13:08.320 And it's very difficult for people to change their lives.

00:13:10.440 And we all know this because we might tell ourselves, for example, to exercise.

00:13:15.260 And 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.

00:13:25.000 And often the reason for that, there's many reasons.

00:13:28.600 I mean, exercise is difficult, and that's one reason.

00:13:30.960 But 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.

00:13:41.060 So, 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.

00:13:46.040 And truth of the matter is, they don't have six hours to spend, and they can't tell themselves what to do anyways.

00:13:52.860 And so, what you do as a behavioral psychologist is you look at the simplest possible change that produces the maximal possible benefit.

00:14:00.140 And 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?

00:14:12.000 Like, where would you start someone?

00:14:14.040 So, it completely depends on their baseline.

00:14:15.940 But based on your question, Jordan, I'm going to take it as we're talking about someone who's doing no exercise.

00:14:21.620 Yeah, let's start with them.

00:14:22.700 Yeah, 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.

00:14:31.040 So, 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.

00:14:48.220 Right? So, taking someone who's at five hours and taking them to 15 will produce less relative benefit than going from zero to three.

00:14:57.220 So, in other words, I want that person to see some real incentive for making this change.

00:15:02.160 Secondly, I'll put some numbers to it, right?

00:15:04.560 So, 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.

00:15:19.840 So, if you're standing there asking, what's the probability I'm going to die this year?

00:15:23.000 Well, 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.

00:15:32.880 So, again, there's going to be a subset of people for whom that's a very powerful piece of information they didn't know.

00:15:39.140 So, then what I would say, well, how do you do that?

00:15:41.380 So, 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.

00:15:53.280 So, what I would say is the most effective way to do that is probably about 90 minutes of low-intensity cardio.

00:16:03.460 And for a person who's not particularly fit, that's going to amount to just brisk walking.

00:16:07.940 Rather than tell them what to do, I tell them how to feel when they're doing it.

00:16:13.720 So, 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.

00:16:30.520 So, there's that sweet spot in there.

00:16:32.400 Physiologically, we call that zone two, but I'm not going to bore them with that nomenclature.

00:16:36.320 It'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.

00:16:46.060 That's part one.

00:16:47.180 Right.

00:16:47.540 So, you push yourself slightly past your simple level of comfort.

00:16:52.960 That's right.

00:16:53.620 And so, let me push on you a bit with regards to three hours a week.

00:16:57.200 Again, from the perspective of taking someone from zero to somewhere.

00:17:04.280 What are the benefits, let's say, you talked about the benefits of walking something approximating 20 to 25 minutes a day.

00:17:11.420 That can be dispersed out in various ways.

00:17:15.280 You also mentioned like two 45-minute sessions or three 30-minute sessions.

00:17:19.200 If someone, what would happen if someone goes from zero to like 10 minutes a day or an hour a week?

00:17:27.480 Where do the benefits of that three hours start kicking in?

00:17:29.720 Yeah, that's a great question.

00:17:31.240 I don't think we have the fidelity of the data at that level because you generally don't push enough of a conditioning benefit.

00:17:37.540 But 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.

00:17:46.460 And 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.

00:17:54.860 If it's a person who's never done anything, you're right.

00:17:58.180 The 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.

00:18:06.960 It'll take four minutes.

00:18:09.120 And so I don't want to represent you're going to get a physiologic benefit from that.

00:18:12.940 You probably won't.

00:18:13.820 But 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.

00:18:21.400 And we'll slowly increase that, and at some point you will get a physiologic benefit.

00:18:26.560 But what we're doing is planting the seed of how to change the behavior.

00:18:31.400 Yeah, well, you could always expand that over a year.

00:18:34.180 I 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.

00:18:52.100 And these are often things that people consider trivial.

00:18:54.740 So, for example, lots of people sit down to have dinner with their family every evening, and they don't consider that special.

00:19:03.180 But because you do it every damn day for an hour, an hour and a half, it's like 8% of your life.

00:19:09.120 So, you only have to get 15 of those things in order, and you have your whole life in order. 0.94

00:19:14.220 Same thing applies to a daily habit.

00:19:16.280 And 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.

00:19:28.560 And that's a substantive change.

00:19:30.660 That's about 2% of your life, your waking life, something like that, or at least 2% of your awake working life.

00:19:36.220 And so, it's useful for everyone listening to understand that small changes that you maintain can be of radical importance.

00:19:44.940 And 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.

00:19:53.140 So, yeah.

00:19:55.160 So, okay, okay.

00:19:56.820 So, 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?

00:20:09.600 So, in biology, we look to integral functions to give us a sense of how valuable an input is.

00:20:18.420 And you don't get many of them, okay?

00:20:20.280 So, most people are probably familiar with something called a hemoglobin A1c.

00:20:24.940 It's a blood test you get at the doctor, and if it's high enough, it tells you if you have type 2 diabetes.

00:20:29.780 So, 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.

00:20:43.980 So, in that sense, hemoglobin A1c is an integral of your behavior over the past three months with respect to glucose.

00:20:52.000 We don't have a lot of those.

00:20:54.040 But we have two really amazing ones with respect to exercise.

00:20:58.960 One of them is around strength and muscle mass, and one of them is around peak cardiorespiratory fitness.

00:21:06.900 So, I'll just get to the punchline.

00:21:09.460 The punchline is, there is no metric that is more highly associated with living a long life.

00:21:15.960 Just this is purely based on length of life.

00:21:18.840 There's no metric anywhere in the medical literature that's more highly correlated with this than having a high VO2 max.

00:21:27.040 VO2 max is a measure of your peak cardiorespiratory fitness.

00:21:30.160 But the second most highly correlated metric of length of life is a composite metric of strength and muscle mass.

00:21:40.920 So, in other words, and people always ask me, why is it so important?

00:21:45.740 I think it's important because those things are remarkable integral functions.

00:21:50.980 VO2 max isn't just a number.

00:21:52.860 Do you want to define integral?

00:21:54.140 Oh, yeah.

00:21:54.500 Yeah.

00:21:54.720 So, they basically tell you, they add up the work that has been done to that point.

00:22:02.760 So, you don't just have a VO2 max because you woke up one day and decided to do something positive.

00:22:09.000 You have a high VO2 max because you've been training very hard for a long period of time.

00:22:14.680 In many cases, for years.

00:22:16.620 Similarly, a person doesn't just wake up and have a lot of muscle mass or have a lot of great strength.

00:22:21.900 Those things are the product of a lot of work.

00:22:26.420 And I think that's why they are so potent.

00:22:29.060 In 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.

00:22:38.240 So, when you look at things like smoking, type 2 diabetes, hypertension,

00:22:41.860 even 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.

00:22:51.900 Yeah, I've read that grip strength, for example, is a good marker of propensity for longevity, well, in everyone, but particularly in elderly people.

00:23:01.880 And it isn't, as you pointed out, because grip strength per se is particularly important,

00:23:05.960 but because grip strength happens to be a good marker for overall, what would you say, psychophysiological integrity.

00:23:11.880 A hundred percent, a hundred percent, yeah.

00:23:14.680 Grip strength is one of the most potent, so put it this way,

00:23:18.280 if you compare the top decile to the bottom decile in grip strength,

00:23:22.100 it's a 70% difference in incidence and death from dementia, all-cause dementia, not just Alzheimer's, every form of dementia.

00:23:29.820 When I was in my mid-20s, when I was 21, 22, I weighed about 130 pounds, 135 pounds.

00:23:38.520 I was 6'1", and so very, very thin.

00:23:41.180 And I spent about three years, four years intensely weightlifting and packed on about 35 pounds of muscle.

00:23:49.700 I had to eat like a mad dog for about three years to do that.

00:23:52.180 But one of the things I noticed that was really cool was that I also got to be a lot more coordinated.

00:23:57.960 I was using free weights, you know, because free weights help exercise all the little muscles and tendons.

00:24:04.580 But it also seemed to me to be unbelievably useful for facilitating, likely for facilitating nerve myelinization.

00:24:12.880 And I thought then, think now that that was probably a good marker.

00:24:16.760 That increase in coordination was probably a good marker for improved neurological function.

00:24:20.800 Yeah, and as you age, it doesn't get a lot of attention.

00:24:28.460 But sarcopenia, which is the loss of muscle mass, the wasting away that occurs with aging.

00:24:33.820 And again, this begins rather subtly.

00:24:37.360 We lose, you know, what are called type 2 muscle fibers first.

00:24:42.140 That's the hallmark of aging.

00:24:43.420 So the type of muscle fiber that's responsible for explosive power is the first one that begins to atrophy when we age.

00:24:49.860 Even at my age, I'm 50.

00:24:51.700 I'm already experiencing that to a great extent.

00:24:54.000 I don't have a fraction of the explosive power I had at 25.

00:24:58.480 Once you lose explosive strength, you start to lose overall strength.

00:25:03.600 And once you lose that, you're going to start to lose muscle size is the very last thing.

00:25:07.640 So by the time a person is 75, the decline in muscle size, which is already preceding strength, is significant.

00:25:17.760 Now, we can do a lot to prevent this.

00:25:19.980 And I think that that's what's being captured by these statistics.

00:25:22.840 The 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.

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00:26:37.600 Yeah, 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.

00:26:56.120 I 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.

00:27:09.200 Depends where you live, but if you live in an area where you've got a lot of hills, that might not be the case.

00:27:13.020 But for most people, you know, there's a limit in human gait to how fast you can walk.

00:27:19.320 And for most people, it's about 3.5 to maybe up to 4 miles per hour.

00:27:24.640 And again, at a certain point, that's not going to be fast enough.

00:27:27.320 So what we can do for that individual, rather than have them transition to running, I like to put weight on their back called rucking.

00:27:34.440 So you carry a military type of backpack with plates of weight in the back.

00:27:39.420 And now you, without putting additional stress on the knees, put additional stress on the cardiorespiratory system.

00:27:45.340 So just throw that out there as additional ways to get this done.

00:27:50.360 Yeah, well, okay, okay.

00:27:52.460 As I said, in my 20s, I worked out with free weights, and I have an adjust set of adjustable free weights now.

00:27:59.280 But what I found very straightforward and actually implementable is to use about 20, 25-pound weights, depending on how often I'm doing it.

00:28:09.120 And I run through a set of exercises through my whole body, you know, starting with my calves and moving upward.

00:28:15.560 And I can do a whole workout routine, about two sets of 15 exercises in about 20 minutes.

00:28:21.980 And so, for everyone listening, it's also very simple to use to start weightlifting, because all you need is a couple of dumbbells.

00:28:30.720 Size is going to depend on, you know, your size and your strength.

00:28:34.120 But you can do an awful lot with two dumbbells.

00:28:37.160 You can exercise your body in all sorts of ways.

00:28:40.160 So that combined with walking, and you added another twist to that.

00:28:44.460 That's not a bad initiation.

00:28:47.420 Anything bad on the weightlifting front?

00:28:49.260 Yeah, I think the other thing that I would say, and I think about this stuff all the time.

00:28:52.940 So I have a very elaborate gym.

00:28:55.180 I do, you know, every sort of exercise you can imagine.

00:28:57.500 But 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?

00:29:03.820 And 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?

00:29:14.020 Because you're going to do forward step-up, backward step-up, side step-up.

00:29:17.260 You can go heavy, you can go light.

00:29:19.300 You focus on the concentric phase, which is the phase of getting up.

00:29:24.100 Concentric is the phase of a muscle when it's getting shorter.

00:29:26.900 But then you really get to focus on how slowly you can step down.

00:29:29.980 So my typical—I'm doing box step-ups at least twice a week.

00:29:34.080 I do a count of one up, three down.

00:29:37.920 So taking three full seconds on that one leg to descend.

00:29:41.500 And that's training what we think of as the breaks.

00:29:44.640 So 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.

00:29:55.440 This is why so many old people fall. 1.00

00:29:59.900 And the mortality of a fall when you are above the age of 65 is staggering.

00:30:05.560 So 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.

00:30:14.200 Of those who survive, 50 percent of them will experience a reduction in class of mobility.

00:30:21.780 So meaning people who walked normally will walk with a cane.

00:30:24.960 People who walked with a cane will walk with a walker. 0.84

00:30:27.300 People who walked with a walker will be wheelchair-bound.

00:30:29.640 This is a profound change in quality of life.

00:30:33.600 And a lot of it has to do with a loss of this type of strength.

00:30:37.560 If 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.

00:30:45.560 It's this, it's these loss of breaks.

00:30:47.540 So, 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.

00:30:55.460 That's where that grip strength is coming from.

00:30:57.300 And being able to do step-ups, step-downs, squats, all sorts of things.

00:31:01.540 Yeah, you don't want to let perfect be the enemy of good when it comes to initiating this type of thing.

00:31:08.280 How high does the box work?

00:31:11.260 Can you use steps, stairs-like?

00:31:13.640 So I think a box is superior.

00:31:16.380 What 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.

00:31:25.820 So for most people, that's 16 inches, maybe 18 inches.

00:31:31.620 A very tall person might be 20 inches.

00:31:34.200 I recommend people start at a 12-inch step until they, you know, sort of, and you start with your body weight.

00:31:40.860 Let's be clear.

00:31:41.520 I mean, for many people, just doing a proper step-up and step-down with body weight at 12 inches is right.

00:31:47.080 And actually, in the book, it was becoming so difficult to write about this in detail that I did.

00:31:55.260 There's a whole section where I write about how to do this.

00:31:57.040 But in the end, we created a thing on our website where I just have a bunch of videos where I illustrate these things.

00:32:02.980 So 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.

00:32:12.780 Well, we should put that in the video description, so we'll have to remember to do that, yeah.

00:32:17.080 All 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.

00:32:28.280 I was interested in your comments on diabetes.

00:32:30.760 So 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.

00:32:44.620 And 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.

00:33:04.120 And 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.

00:33:14.720 So correct me if I'm wrong or elaborate on that, if you would, if you think I'm onto something there.

00:33:20.380 So we don't do that.

00:33:21.680 I can't speak to what any other physician does, but in our practice, we hold everybody to the same standard.

00:33:30.120 I 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,

00:33:40.960 we will give women a little bit more latitude because they don't have as much muscle mass. 1.00

00:33:45.760 So 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.

00:33:57.240 And in that window of time, what you are testing is how efficiently do their muscles take up glucose.

00:34:04.040 That's called glucose disposal.

00:34:05.520 So you're measuring insulin sensitivity and glucose disposal.

00:34:08.300 And in that window of time, that's the only place you can put the excess glucose.

00:34:14.260 And because women have less muscle than men, we will tolerate a slightly higher glucose response, but we want the same insulin response. 0.87

00:34:24.300 So that's, and it's a very subtle difference.

00:34:27.080 But no, we don't age adjust for anybody.

00:34:29.800 We sort of, we want a 60-year-old to be as effective at this as a 30-year-old.

00:34:34.520 So 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?

00:34:50.880 It'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.

00:35:04.200 Now, it doesn't mean that you're destined to have insulin resistance or fatty liver disease or type 2 diabetes when you age.

00:35:11.360 But what it generally means is, on average, a person needs to be more diligent as they age.

00:35:18.160 And I've heard lots of theories offered for this, and my guess is they all play a role.

00:35:23.280 There's clearly a reduction in testosterone as we age.

00:35:26.660 Testosterone is a very pro-metabolic health hormone, right?

00:35:31.840 So testosterone promotes lipolysis of fat by muscle.

00:35:36.160 It promotes insulin sensitivity.

00:35:38.240 In 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.

00:35:51.480 And you showed a significant reduction in the progression to type 2 diabetes in men on testosterone.

00:35:57.020 So clearly, the decline of testosterone is playing a role in both men and women, by the way.

00:36:01.660 We 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.

00:36:15.740 This is, again, an enzyme that is responsible for the breakdown of fat.

00:36:21.800 There are also other things, as you pointed out, such as inflammation that increases with aging.

00:36:27.020 And we also tend to be less active as we age.

00:36:32.180 And one of the most important things to preserve insulin sensitivity is activity.

00:36:38.340 So 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.

00:36:45.700 And 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.

00:37:00.660 So, 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.

00:37:10.920 So 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.

00:37:21.320 So 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.

00:37:42.640 So, think of the muscle maybe as a balloon.

00:37:49.840 And the balloon is the only place where you can put air.

00:37:53.700 In this analogy, air is the glucose.

00:37:56.540 So there are some balloons that are very easy to blow up.

00:38:01.380 And, you know, you can put the glucose into the muscle cell.

00:38:04.820 You can put the air into the balloon quite easily.

00:38:06.800 You don't have to blow very hard.

00:38:08.300 But imagine a balloon that's very, very difficult to put air into.

00:38:16.040 And at some point, you can get air into it, but you have to blow much harder.

00:38:19.840 So how hard you have to blow is the amount of insulin you need to put the glucose into the muscle.

00:38:26.940 At some point, you will not be able to do that.

00:38:29.400 You can't blow hard enough.

00:38:30.980 So, again, just thinking about this in terms of physiology, glucose is a molecule that needs to be regulated very carefully in our bodies.

00:38:41.920 Too much and too little is catastrophic.

00:38:44.540 And so the body does a great job of trying to take excess glucose out of the circulation and put it into muscle cells.

00:38:50.940 By 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.

00:39:00.880 One teaspoon.

00:39:02.260 One teaspoon.

00:39:02.980 A person with frank diabetes has two teaspoons.

00:39:07.400 That's the difference between healthy and nearly dying, right?

00:39:12.120 It's profound.

00:39:13.040 And how many teaspoons of sugar are in a bottle of Coke?

00:39:17.020 It's 30, I think, or 35.

00:39:18.640 About eight.

00:39:20.680 About eight teaspoons in a small bottle.

00:39:22.920 I guess I was thinking of a big, maybe I was thinking of a bottle.

00:39:25.080 In a big two liter.

00:39:26.060 In a big two liter, it would probably be about that.

00:39:27.880 Yeah.

00:39:28.740 Yeah.

00:39:29.060 Right.

00:39:29.440 So 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.

00:39:36.840 And 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.

00:39:52.220 That's the initial blowing too hard on the balloon.

00:39:55.360 So when you develop insulin resistance and that progresses to diabetes, you literally can't produce enough insulin to get sugar into the muscles.

00:40:04.520 That's correct.

00:40:05.620 Eventually, you cannot make enough insulin.

00:40:08.200 And 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.

00:40:25.740 And 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.

00:40:35.500 It's the fat in the muscle that is preventing the insulin signal from being heard effectively by the muscle cell.

00:40:43.880 It also expands into the liver.

00:40:46.480 That's what's called fatty liver disease or non-alcoholic fatty liver disease.

00:40:49.540 The fat starts to be deposited in the pancreas where insulin is made, and that creates an inflammatory environment to the insulin-producing cells.

00:40:59.300 So now you have the double whammy.

00:41:00.760 You need more insulin, but you can make less of it because of the inflammation.

00:41:05.100 And this thing very quickly spirals out of control, and the end state is type 2 diabetes.

00:41:12.300 So now you have two teaspoons of sugar in your blood instead of one teaspoon.

00:41:16.740 And so what are the consequences of that excess sugar load, which in absolute amounts seems very trivial, right?

00:41:26.540 I mean, one teaspoon in all of your blood seems like almost nothing, and two doesn't seem like much either.

00:41:31.420 But the difference is at two teaspoons, the difference is starting to tip you towards what sort of illness.

00:41:38.580 So you have two problems going on now.

00:41:40.460 You have too much glucose and too much insulin.

00:41:43.760 Because remember, when you have that high level of glucose, you're going to be treated with drugs that aim to increase insulin.

00:41:51.860 And that can sometimes be insulin itself, or it could be drugs that produce more insulin.

00:41:57.160 So let's start with the glucose side of the equation.

00:42:00.480 The easiest way, I think, to think about this is too much glucose is bad for small blood vessels.

00:42:06.840 Too much insulin is bad for large blood vessels.

00:42:09.900 So what are those small blood vessels?

00:42:11.840 The very first place this shows up is looking right into the eye.

00:42:16.680 So I've always believed that a good ophthalmologist will spot metabolic disease before any doctor will.

00:42:24.080 Because when they can look into the retinal artery and see the earliest indication of microvascular occlusion and inflammation,

00:42:31.820 that is tied directly to what's called the glycosylation.

00:42:35.680 So 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.

00:42:49.820 So other small vessels that are absolutely ravaged by glucose are the kidneys.

00:42:55.980 So diabetes, along with hypertension, would be the most common driver of end-stage kidney disease.

00:43:02.620 You also see it in the coronary arteries.

00:43:06.020 And believe it or not, it's probably one of the most important physiologic drivers of erectile dysfunction.

00:43:11.620 Again, very small blood vessels in the penis.

00:43:14.520 And therefore, when these things succumb to this type of end-stage glycosylation, you're going to see damage all around.

00:43:22.920 Conversely, on the insulin side, elevated levels of insulin chronically, it's a pro-growth factor.

00:43:28.440 So it's very likely the explanation for why obesity is the second leading environmental contributor to cancer after smoking.

00:43:39.180 And it also damages large and medium-sized blood vessels like the aorta, the carotid arteries, etc.

00:43:46.000 So this cascade of, again, it doesn't sound like much of a difference, as you said.

00:43:51.520 It's a chronic issue that over enough time leads to the destruction of most tissues.

00:43:59.380 So can you lay out the relationship now between insulin resistance, excess blood sugar, and the propagation of fat tissue?

00:44:09.720 Now, the fat is being used to store energy, but how does that actually occur?

00:44:13.320 And how is that related to excess sugar?

00:44:15.300 Yeah, so in many ways, we were doing really well as a species until, you know, 100 years ago, right?

00:44:24.720 In 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.

00:44:37.580 So 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.

00:44:49.880 You know, how would we survive a day with no food if we didn't have a way to store energy?

00:44:55.860 Because certainly more than one day, you have to use fat stores to get by.

00:45:00.240 You can't just rely on glucose stores.

00:45:01.740 So we have this very efficient way to do it.

00:45:05.260 We have a very safe depot of subcutaneous fat where we can put fat in it, which is excess energy.

00:45:13.560 And that's primarily fatty acids and also excess glucose can be stored in this form.

00:45:19.460 And we can acquire it as we need it, right?

00:45:22.720 So, you know, when energy stores are low, you go and you get that.

00:45:26.160 Or when energy itself is low, you go and acquire this.

00:45:29.060 The problem comes when you exceed the capacity of that.

00:45:33.880 So the way I describe it in the book is everybody, and this is largely determined genetically, everybody has a bathtub.

00:45:40.560 Some people have a really big bathtub.

00:45:42.560 Some people have a really little bathtub.

00:45:44.280 The bathtub is the total capacity of your fat cells to store fat.

00:45:52.280 So water goes into the fat cell.

00:45:54.020 That's the food you're eating.

00:45:55.640 There's a little drain at the bottom, which is all the energy you're expending that's coming out.

00:45:59.940 And therefore, the energy in less the energy out determines the balance of water in the tub.

00:46:05.380 If you're getting fatter, the water is rising in the bathtub.

00:46:09.780 At some point, the water gets to the lip of the tub.

00:46:14.280 You have now exceeded your capacity for safe storage of fat, or in this case, safe storage of water.

00:46:21.100 What happens next is the water spills over.

00:46:23.780 Now it's gone from being totally physiologically normal to total chaos.

00:46:28.620 Just as if water spilled over your bathtub, it would be total chaos, right?

00:46:33.660 It would ruin your house.

00:46:35.100 And the question is, where does that fat go once it spills over?

00:46:39.340 And it's where it goes that causes all of the problems we're talking about.

00:46:44.980 When it goes into the muscle, it impairs the muscle's ability to sense insulin and create the glucose transporter to bring in glucose.

00:46:53.440 That's the syn-quanon of insulin resistance.

00:46:56.700 When it goes into the liver, it creates inflammation, which can ultimately lead to cirrhosis and liver failure.

00:47:02.640 When it goes into the pancreas, it secretes cytokines that impair the beta cells, which produce insulin, which exacerbates the insulin resistance problem.

00:47:13.200 When it surrounds your organs as what we call visceral fat, it releases inflammatory cytokines that lead to cardiovascular disease disproportionately.

00:47:22.280 So 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.

00:47:34.300 And this is another example of which it doesn't take a lot of fat to spill over.

00:47:38.500 If a person has 20 kilograms of fat in their fat cells, it causes no issue.

00:47:47.640 It's the two kilos that have spilled out into all those other organs that are driving all the damage.

00:47:55.580 Yeah, and I read, too, this is another example of the dangers and sometimes benefits of the things that you repeat every day.

00:48:02.720 I 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.

00:48:16.700 Non-diet soft drink, obviously.

00:48:19.060 Because, of course, there's a lot of sugar, eight teaspoons, which is four times as much as you have in your blood if you're diabetic.

00:48:24.780 But you're doing it every day.

00:48:27.520 Now, 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.

00:48:38.000 How is that glucose converted to or stored in fat?

00:48:42.840 What's that mechanism?

00:48:44.220 So it's called, the technical name is de novo lipogenesis.

00:48:49.140 Lipogenesis making fat de novo from scratch.

00:48:51.560 So the liver can turn.

00:48:55.120 The liver is an amazing organ, by the way.

00:48:56.920 It's just, if we're going to give a shout out to any organ in the body, it might have to be the liver.

00:48:59.920 It's just an unsung hero.

00:49:01.320 It doesn't get the attention it deserves.

00:49:03.000 To 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.

00:49:12.500 Your brain won't have enough glucose.

00:49:14.600 But yet you're churning through that at a rate of a teaspoon every couple of minutes.

00:49:19.160 What's responsible for that titration?

00:49:22.780 The liver.

00:49:24.020 Never stops, right?

00:49:25.420 So one of the other things that the liver does miraculously is it has the ability to turn fat into glucose.

00:49:33.380 It has, pardon me, it has the ability to turn glucose into fat.

00:49:36.160 And it has the ability to turn protein into glucose.

00:49:39.140 So it can also change the orientation of molecules.

00:49:42.620 And 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.

00:49:55.040 We would much rather store energy in fat.

00:49:57.740 It's the most efficient chemical molecule in which to store energy.

00:50:03.060 All 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.

00:50:12.660 And a fat is the most efficient vehicle to do that.

00:50:16.580 So we would much rather actually store energy as fat than in glucose.

00:50:20.840 And we don't store that much as glucose.

00:50:22.840 So let me step sideways here for a moment.

00:50:28.840 I'd like to talk about the food pyramid with you.

00:50:32.620 And so I'm going to lay a little bit out about my understanding of the food pyramid and how it came about.

00:50:38.060 And then we could talk about the standard Western diet and its relationship to insulin resistance and obesity.

00:50:43.940 So 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.

00:51:01.440 And 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.

00:51:20.900 And perhaps carbohydrates at far too excess at a level.

00:51:25.600 Now, carbohydrates are transmuted into glucose during metabolism.

00:51:30.620 And we eat way more carbohydrates than we need to produce the amount of glucose that we need.

00:51:36.860 Now, people have been getting fatter in a catastrophic way for about four or five decades.

00:51:41.860 And that's really in no small part since the introduction of the food pyramid.

00:51:46.200 Now, 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.

00:51:57.800 And if you're dirt poor and you don't have enough to eat, I mean, just getting enough calories, period, is of vital importance.

00:52:04.060 Not everybody can afford steak, for example, or more expensive foods of that type.

00:52:09.800 But virtually everyone, poor or not in the West, can afford basic carbohydrates.

00:52:13.840 But 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,

00:52:27.800 which is done at a level that makes the pandemic epidemic look like absolutely nothing.

00:52:34.000 And this is still being pushed forward by people who are hypothetically on the nutritional front.

00:52:40.160 So, two questions.

00:52:42.540 What's your understanding of the derivation of the food pyramid, and what do you think about its recommendations for the typical diet?

00:52:50.020 So, 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?

00:52:57.920 So, in the book I talk about the standard American diet, which I forever abbreviate as the SAD.

00:53:04.920 And the standard American diet is effectively, with or without food pyramid, the standard American diet is what is killing people.

00:53:14.340 And so, the question is, where did the standard American diet come from?

00:53:18.140 The standard American diet was nothing more than the solution to a business problem.

00:53:23.920 So, the business problem was, we need something where we can produce lots of food.

00:53:30.660 So, you had to have this quantity issue, right?

00:53:32.980 So, that gets to part of the problem, right?

00:53:35.080 We have too many people at the time who are undernourished.

00:53:39.160 We can't have that anymore.

00:53:40.720 Everyone needs to be adequately nourished.

00:53:42.480 So, we need scale.

00:53:44.300 The next thing is exactly your point.

00:53:46.360 It can't cost too much.

00:53:48.500 So, we have to be able to do it at scale, and it has to be cheap.

00:53:53.220 The third question or problem statement was, it has to be non-perishable and portable, right?

00:54:01.060 So, you can't have abundant food if it needs to be consumed 10 minutes after it's made.

00:54:07.540 So, it has to be sort of non-perishable.

00:54:11.340 The third, sorry, the fourth and final parameter, I guess, there would be it has to taste really good.

00:54:16.520 We have to make food very palatable.

00:54:19.020 This, again, is just part of a business and marketing strategy.

00:54:21.140 And what I argue, I guess, is that the solution to those four things is what we have today.

00:54:28.560 Like, 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.

00:54:38.440 Now, 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.

00:54:56.880 There just aren't that many people that have the genes to avoid the deleterious consequences of the standard American diet left unchecked.

00:55:05.960 So, that was the least conspiratorial account of the American diet that I've heard, and that's fine.

00:55:19.700 That's perfectly appropriate.

00:55:22.080 I 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.

00:55:34.220 I 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.

00:55:55.460 So, 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.

00:56:10.240 Yeah, I mean, I certainly don't want to give the food industry a pass.

00:56:14.380 I mean, we can certainly delve into that, which is to say there's no question that data have been suppressed, right?

00:56:20.760 There's no question that we're not having an honest discussion about the following.

00:56:27.340 So, are all calories created equal from an energy balance standpoint?

00:56:32.980 Sure.

00:56:33.460 At 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.

00:56:47.480 But it won't have the same impact on your appetite and your ability to subsequently eat.

00:56:53.620 I mean, to me, that's the most, I think, probably offensive aspect of where the food industry has failed, right?

00:57:02.280 So, the food industry didn't set out to kill people any more than the tobacco industry did.

00:57:07.480 Where these people are effectively liable is in that they're not honest about the discussion until, you know, it becomes too late.

00:57:14.960 And the reality of it is junk food, I think, hijacks your normal appetite centers.

00:57:23.040 And I know people who are very good at working within those confines.

00:57:31.160 So, I know people who can eat junk food in small amounts and continue to eat nutritious food and stay in overall energy balance.

00:57:40.580 They 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.

00:57:47.880 What I can just tell you clinically, taking care of actual people who are not robots, on average, more people than not struggle with that.

00:57:58.040 And with the introduction of these very hyperpalatable foods that kind of hijack your appetite, it tends to produce overeating.

00:58:08.400 And ultimately, that's the problem at hand here.

00:58:11.820 When 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.

00:58:19.320 It 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.

00:58:32.580 And there are lots of hypotheses here, right?

00:58:35.240 There are some hypotheses that we are kind of hardwired to get a certain amount of nutrient value.

00:58:41.560 And as the nutrient value of our food deteriorates, we have to eat more food.

00:58:48.520 We have to eat more calories to get the certain nutrient density.

00:58:52.040 There are people who argue we're hardwired to get a certain amount of protein.

00:58:56.300 And as we're diluting protein content in food, we're eating more calories to get food.

00:59:01.400 In other words, and by the way, I don't think any one of these particularly is necessarily the explanation.

00:59:05.860 My guess is it could be a lot of the above, but it's probably the case that we are opportunistic omnivores, right?

00:59:14.500 We 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.

00:59:24.920 When you eliminate those two consequences, being opportunistic omnivores is not working for most of us.

00:59:30.380 We have to be more selective to push back against the amazing success of our civilization.

00:59:39.660 Yeah, 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.

00:59:51.420 And that it is delicious, and that it is addictive, and it is a hallmark of a certain kind of success.

00:59:56.540 And 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.

01:00:03.880 So, as you may or may not know, my daughter was very ill with a plethora of immunological problems, including very serious juvenile arthritis.

01:00:13.540 And that was, it just about killed her.

01:00:16.660 It did destroy two of her joints, and she had another 38 that were affected, and so she was always in a lot of pain.

01:00:22.660 And 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.

01:00:33.960 And one was that there was no real evidence that any specific elements of diet had been linked to juvenile arthritis specifically.

01:00:44.080 But, and this was a major but, if people who were arthritic fasted completely, then their arthritic symptoms often disappeared.

01:00:56.060 And so I thought that had something to do with the consequences of fasting.

01:01:00.620 But then my daughter started to play, and my wife as well, very intensely with the diet.

01:01:05.880 We went to a nutritionist who recommended an elimination diet at one point, because we did notice that she would react to strawberries and oranges. 0.93

01:01:13.600 We could, and within a day, her thumbs would swell, or her toes would swell. 0.98

01:01:17.660 And so we knew there were some things she was eating.

01:01:19.840 We had her tested for immunological reaction to food, but when we tested her, she showed a hyperreaction to virtually everything they tested her for.

01:01:28.880 And we concluded at that point, well, there's no damn way she could be reacting to everything she's eating.

01:01:35.580 Well, she went on this elimination diet and showed a bit of reduction in symptom, but the elimination diet made no sense.

01:01:42.020 Like, there was no rhyme or reason to what you could eat and what you couldn't eat.

01:01:45.200 And 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,

01:01:56.920 then all of her immunological symptoms disappeared.

01:02:01.500 And then my wife and I started playing with that diet.

01:02:03.960 And so I've only been eating meat for beef, fundamentally, for almost five years now.

01:02:10.160 And I've talked to hundreds of people, and we've had messages from thousands of people,

01:02:16.260 showing that this is, first of all, radically effective as a weight loss strategy,

01:02:20.560 and also seems to produce remarkable effects on the general disease symptom front.

01:02:27.600 Back in November of 2021, there was a study published by a Harvard group,

01:02:33.260 which wasn't a perfect study because it was retrospective self-report.

01:02:38.040 But they followed 20, they assessed 24, 2,500 people who had been on a carnivore diet for six months,

01:02:44.840 and showed something approximating a 90% reduction in all disease symptoms.

01:02:49.440 And it was the only scientific paper I ever read where the surprise of the researchers was palpable

01:02:56.520 between the lines in the scientific writing.

01:02:59.980 Because, you know, in a scientific article, all that emotion, negative or positive, is pretty much ironed out.

01:03:05.700 But these people were so shocked by what they found that it couldn't help leaking into the document.

01:03:11.020 And so, well, this has been quite surprising to me, because I never imagined in my wildest dreams,

01:03:18.040 number one, that you could just live on meat, and number two, that it would have such a salutary effect.

01:03:23.420 So for me, I lost 52 pounds in seven months.

01:03:27.680 I went from 212 pounds to 165, which is exactly what I weighed when I was 23.

01:03:33.240 And I've maintained that weight since.

01:03:36.360 I can put on muscle mass with no problem, even though I'm 62.

01:03:40.340 I had a host of inflammatory conditions, some of which were quite serious, including peripheral uveitis,

01:03:45.660 which sometimes blinds people in my right eye.

01:03:48.460 And it disappeared completely, along with psoriasis and gastric reflux disorder.

01:03:53.700 And, interestingly enough, gum disease, which is technically incurable, which is linked to cardiovascular degeneration,

01:04:02.340 and which has gone away 100% in my case, according to multiple measures that my dentists have taken.

01:04:09.760 And 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,

01:04:16.140 and who are just beside themselves, so to speak, as a consequence of experimenting with this diet.

01:04:22.180 So, well, so that's the story.

01:04:25.060 It's very strange.

01:04:26.460 I don't talk about it that much because I'm not a nutritionist and because I'm still shell-shocked by it.

01:04:31.060 But I'll tell you, it's something to be 60 and to have the same essential body morphology that I had when I was 23.

01:04:38.960 And that had all disappeared for me in my early 50s.

01:04:43.320 Yeah, you're not the first person I've heard this story from, Jordan.

01:04:47.120 And I have to be honest with you, I just don't know how to explain it.

01:04:50.340 The weight loss, by the way, is not the harder part to explain, right?

01:04:54.920 So, the more restrictive any diet is, the more one loses weight on average, right?

01:05:00.000 So, it wouldn't surprise me if we put a person on the all-potato diet if they would lose weight.

01:05:05.440 Whereas if you put somebody on the no-lettuce diet, nobody's going to lose an ounce.

01:05:09.700 So, more restrictive diets, ketogenic diets, which are not as restrictive as what you're doing, are also very effective for weight loss.

01:05:16.260 By the way, so is a zero-fat diet.

01:05:19.440 Now, it's an unpalatable diet, and I don't think it's a particularly healthy diet when you start restricting fat that much.

01:05:27.300 The more interesting question to me is, you know, and I can certainly understand if you would say,

01:05:35.560 I have no desire to experiment further by introducing other elements to see if I can preserve this phenotype.

01:05:41.840 But the most interesting question to me is, what are the other foods out there that you might be able to consume?

01:05:49.540 Or in the case of your daughter, right?

01:05:51.520 Like, is it—

01:05:52.000 I'm obviously interested in that, too.

01:05:54.040 But what I have found, because I have now and then tried to eat carbohydrates,

01:06:00.080 what I have found is that if I eat any of them, I start to crave them intensely.

01:06:04.740 If I don't eat them at all, they don't bother me.

01:06:07.800 Assuming—and this goes to the calorie restriction issue—

01:06:11.660 one of the ways of maintaining yourself on a keto diet or a carnivore diet, let's say, is to make sure you're never hungry.

01:06:18.700 And I eat a lot of meat and a lot of high-fat meat, and so I'm never hungry.

01:06:24.380 And I don't think that I'm calorie-restricted at all, because, you know, I can eat, well, a tomahawk steak sometimes in one sitting,

01:06:31.000 which is about 35 ounces of meat.

01:06:33.280 I never get hungry, and I eat high-fat carnivore snacks, too.

01:06:38.000 What I found is, as long as I'm never hungry, then I'm not inclined to cheat.

01:06:43.520 But if I do try something like an introduction of carbohydrates, first of all, some of my symptoms come back right away, like the GERDs,

01:06:50.740 and I start craving like mad.

01:06:53.780 So, well, so that's my experience.

01:06:55.800 Is it all carbohydrates?

01:06:58.260 Or, like, for example, if you introduce vegetables, non-starchy vegetables, what happens, both symptom-wise and craving-wise?

01:07:08.480 Yeah, well, for a while I was eating nothing but meat and greens, but I still had some residual symptoms.

01:07:17.640 My 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.

01:07:26.860 And so, you know, maybe we're absurdly sensitive for reasons that wouldn't be true of other people.

01:07:31.940 But it's definitely the case that I do better, and believe me, this isn't something I particularly want.

01:07:39.460 It is the case that I do better if I just stick to beef.

01:07:42.580 Now, could I have pork and chicken?

01:07:45.760 I had a very terrible bout of ill health, and I'm disinclined to do a lot of experimentation,

01:07:50.620 although I'll probably try again in the future sometime.

01:07:52.660 But I do know that beef works.

01:07:56.060 We've been hypothesizing internally in our family for what it's worth is that the reason that beef works

01:08:01.880 and that other ruminant animals, bison, so forth, lamb, goat,

01:08:08.140 is because they process what they eat through so many stomachs that by the time it is actually turned into meat,

01:08:15.860 there's pretty much nothing else there.

01:08:17.440 So it's a very purified form of nutritional, well, a very purified form of food.

01:08:27.260 Now, like I said, that's anecdotal, and this is partly why I don't talk about it.

01:08:31.100 But I can tell you, after you've talked to 1,000 people who tell you the same anecdote,

01:08:35.840 you don't have an anecdote anymore.

01:08:37.560 You have a hypothesis.

01:08:39.140 And it's really quite something seeing these people who show me pictures of what they looked like a year ago,

01:08:44.480 and, you know, they were carrying around an extra person with them,

01:08:47.880 and they're still shell-shocked by the transformation, you know,

01:08:51.200 because it's really something to lose, say, 150 pounds in a year.

01:08:55.280 And so, well, I don't know what to make of that.

01:08:58.980 I do know that it's been—the diet has actually been rejuvenating for my wife and I.

01:09:04.160 Like, its effect on muscle tone has to be seen to be believed,

01:09:07.700 and that's true even though both of us are 60.

01:09:10.120 Like, my wife is in better shape from a musculature perspective now at 63 than she was when she was 40. 0.89

01:09:18.400 And she was a very physically fit person who was exercising constantly and who was in pretty damn good shape.

01:09:23.840 And to see that reverse rather than just, you know, stop deteriorating,

01:09:28.720 I don't really know what to make of it.

01:09:31.720 I would love it to be studied prospectively.

01:09:34.860 I'm very curious as to what's going on, in particular with that.

01:09:38.680 I mean, there are lots of data out there showing the efficacy of a ketogenic diet

01:09:43.940 in the amelioration of type 2 diabetes.

01:09:48.500 I do think—I mean, look, when it comes to type 2 diabetes,

01:09:52.240 any amount of weight loss is going to produce a benefit.

01:09:55.880 But it seems that a ketogenic diet has the easiest compliance.

01:10:03.360 And there might be something to the fact that it's kind of removing the thing of which there is an excess, right?

01:10:12.040 By at least taking away the thing that is in most excess, it's easier to kickstart that.

01:10:18.400 A fast, of course, is also a great way to kickstart that, right?

01:10:21.240 Something about taking glycogen levels down in the liver and the muscle makes this easier.

01:10:26.960 Well, the advantage, too, of the diet, the carnivore diet in particular,

01:10:32.560 is because you can eat as much as you want.

01:10:35.340 It's actually not a diet.

01:10:37.280 You know, the problem with diets is that they require privation,

01:10:40.720 and they require almost continual privation,

01:10:43.080 and then they also tend to produce a yo-yo effect.

01:10:46.100 And that's partly because if you get in a fight with your hypothalamus,

01:10:49.920 which drives hunger, you're going to lose,

01:10:51.760 because it's there to make damn sure you don't starve.

01:10:54.740 And the probability that you can override it for any length of time,

01:10:58.520 well, it's very, very low.

01:11:00.180 And that probably varies from person to person for all sorts of reasons.

01:11:03.460 But you don't want to get in a scrap with your lower-level motivational systems.

01:11:07.720 Now, you know, if I ever start to crave a banana split, for example,

01:11:11.920 I can just eat another five or six ounces of steak, and then I don't care.

01:11:16.000 It's not like it wouldn't taste good, you know,

01:11:17.860 but it doesn't preoccupy me the way it would if I was hungry.

01:11:21.380 I've really noticed this when I go into grocery stores,

01:11:24.300 because if I go into a grocery store after having consumed enough meat,

01:11:30.040 then the provision of this infinite display of delicious foods really doesn't affect me much.

01:11:35.260 But boy, if I ever go into a grocery store when I'm hungry,

01:11:37.980 that's quite the pain in the neck, because everything's delightful and tempting, you know.

01:11:42.160 So the fact that you can eat enough or even as much as you want on a keto or carnivore diet

01:11:47.180 does seem to distinguish it in some ways from the diets that depend more particularly on mere calorie restriction.

01:11:54.560 Although I've seen a subset of people on ketogenic diets who gain weight.

01:11:58.500 So they somehow are eating past their necessary, their energy point.

01:12:06.740 I was on a ketogenic diet for three years, actually.

01:12:09.120 I used to write about it.

01:12:09.880 In fact, when I started blogging in 2010, 2011, it was basically to,

01:12:15.460 I was mostly talking about nutrition.

01:12:16.960 And for three years, minus one day on my wife's birthday,

01:12:21.820 one day in that three years, I had seven pieces of dessert.

01:12:25.120 But minus that one day, I was in a state of ketosis for three years.

01:12:30.800 And yeah, in many ways, I was the poster child for it.

01:12:33.400 Like the efficacy in me was out of this world.

01:12:37.680 And what did it do for you?

01:12:40.120 Oh, I mean, I lost 40 pounds.

01:12:43.320 I, you know, was probably, I mean, just from a body composition standpoint was,

01:12:47.640 you know, by DEXA, which is the gold standard, about seven and a half percent body fat.

01:12:51.400 Every metric of, every biomarker you could measure or possibly care about was in the,

01:12:58.100 you know, even by my standards, which are not to consider what's optimal,

01:13:02.260 but to consider what's exceptional.

01:13:04.020 Everything was great.

01:13:05.520 Even things that historically people think you can't do on a ketogenic diet,

01:13:10.000 like lots of intense exercise.

01:13:11.840 Certainly, initially, I couldn't do much of that.

01:13:15.800 But within about six months, I had regained much of my exercise ability.

01:13:21.640 And by 18 months, I had certainly no discernible reduction in extreme exercise performance.

01:13:29.600 Again, I don't have the counterfactual.

01:13:31.080 You could argue that that's still lesser than what it would have been had I not been on a ketogenic diet.

01:13:34.960 But, you know, some people sometimes say,

01:13:37.660 well, Peter, why aren't you on the ketogenic diet anymore?

01:13:39.520 Why did you stop in 2014?

01:13:42.080 It largely came down to, I think, just not wanting to be restrictive anymore

01:13:47.600 and wanting to kind of, you know, as my, at the time, daughter was getting a little bit older,

01:13:53.400 it was, you know, sort of wanting to enjoy more of the foods that I was limiting.

01:13:57.860 But the reality of it is, like, I don't, you know,

01:14:00.980 I'm certainly not as lean as I was when I was on that diet.

01:14:04.060 Yeah, yeah, yeah.

01:14:04.780 Well, the other thing I noticed, this is also very cool, and it's very important to me personally.

01:14:10.500 So I noticed that as I got older, my ability to concentrate when I was reading was deteriorating.

01:14:16.720 So when I was 25, 30, if I picked up a book and read it, I would shut everything else out,

01:14:25.880 and I would concentrate on, focus on, attend to what I was reading,

01:14:32.120 read every word and understand it with no problem.

01:14:35.720 But that started to deteriorate as I got older,

01:14:38.120 and I noticed that it took an increasing amount of effort to shut everything off,

01:14:41.980 and that instead of reading as deeply as I was, I was sort of glancing at the words.

01:14:47.700 And when I started this carnivore diet, that reversed, and I can now, I think,

01:14:52.780 I actually think this is true.

01:14:54.260 I think I can read faster and more efficiently than I could when I was in my 20s.

01:14:58.140 And I was pretty good at it when I was in my 20s.

01:15:00.820 And so the other thing that I've noticed, too, is that I don't have periods of time,

01:15:06.480 this was quite a problem for me,

01:15:07.900 and it might have had something to do with my immunological problems,

01:15:10.620 is that I would get hypoglycemic and lose the ability to concentrate

01:15:15.180 and get, what do they call it, hangry, you know, hungry and angry and irritable.

01:15:19.380 And that would happen several times a day, probably because I was working too much.

01:15:23.440 But in any case, that is gone completely.

01:15:28.000 And I really don't miss it.

01:15:29.900 You know, I wake up in the morning with a stable mood,

01:15:32.080 and my mood doesn't vary much throughout the day.

01:15:34.180 I'm also much more stress-tolerant and able to bounce back from stressors faster.

01:15:39.700 And in terms of endurance, you know, there were lots of times over the last three years

01:15:45.020 when I was walking 9 to 12 miles a day on a carnivore diet.

01:15:48.120 Now, I wasn't running, you know, but my experience is that I'm stronger

01:15:52.560 and I have more stamina than I did 10 years ago.

01:15:56.560 And that's quite something, given that I'm now 62.

01:15:59.900 That's a good direction, you know.

01:16:01.420 So it's one thing, like I said, it's one thing to halt the aging process,

01:16:04.680 but it's another thing entirely to see it start to reverse.

01:16:09.140 And so, you know, we don't know anything about a straight carnivore diet, very little.

01:16:13.580 And no one has done a prospective study.

01:16:15.660 It's one that I'm actually thinking about setting up funding for

01:16:18.580 if I can find researchers who are interested.

01:16:21.420 Because there's something there, and it was certainly established

01:16:24.340 by that initial study at Harvard.

01:16:26.720 So if you know anyone who's interested in doing that,

01:16:29.600 you could always hook them up with me.

01:16:30.960 Sure.

01:16:32.360 Some folks, there are some folks that come to mind, actually.

01:16:36.400 Okay, okay.

01:16:37.540 All right, so do you want to talk a little bit about

01:16:39.400 the other more common diseases that you deal with in the book?

01:16:43.320 You talk about heart disease, we've touched on heart disease.

01:16:46.880 You talk about cancer, neurological degeneration, Alzheimer's, for example.

01:16:53.120 Let's walk through that domain a little bit, if that would be okay with you.

01:16:57.240 Sure.

01:16:57.880 Where would you like to start?

01:16:58.660 Let's start with cancer.

01:17:03.020 Everyone's favorite.

01:17:05.040 Yeah, I think cancer is the second leading cause of death in the United States and globally.

01:17:12.640 Of what I describe as these four horsemen of death, cardiovascular disease, cancer, neurodegenerative disease,

01:17:20.020 and the metabolic diseases that we've already talked about, cancer hits its peak first.

01:17:25.700 So the other diseases rise monotonically with aging, cancer actually peaks in late middle age.

01:17:36.080 So cancer would be the leading cause of chronic death or chronic diseases of aging in the 40s and 50s and 60s,

01:17:46.280 before it's supplanted by cardiovascular disease and even neurodegenerative disease.

01:17:51.340 If you go back to the year I was born and you ask the question,

01:17:58.720 what is the probability that a person with metastatic cancer, i.e. cancer that has spread from its primary organ to a distant organ,

01:18:10.100 what's the probability they're going to be alive in 10 years?

01:18:12.760 Today, the answer was 0%.

01:18:15.360 Nobody was going to survive that.

01:18:18.740 Today, the answer is about 5%, maybe a little bit higher.

01:18:23.100 But it's really not been an enormous source of success.

01:18:28.720 So let's talk about what the bright spots are.

01:18:30.660 The bright spots are leukemias, lymphomas, testicular cancer.

01:18:35.140 These are areas where there has been great progress, and your survival today is so much higher than it was 50 years ago.

01:18:43.300 When you talk about the big killers, though, which are lung cancer, prostate cancer, breast cancer, colon cancer, pancreatic cancer,

01:18:51.160 those are the top five causes of cancer death.

01:18:55.860 Median survival, the length of time you survive, has increased by as much as a year, if not more.

01:19:05.140 But overall survival has not.

01:19:07.660 This is a very important thing to understand.

01:19:11.660 The risk of being dead in 10 years if that cancer has spread is the same as it was 50 years ago.

01:19:18.860 So if all that's the bad news—

01:19:20.360 Do you suppose that's a possible consequence of the presence of cancer being a marker for, like, cumulative systemic failure?

01:19:32.380 Is that if there's cancer somewhere, is it an indicator that many things have gone wrong at many levels?

01:19:39.380 And so even if you treat the cancer, the probability that that's going to be life-saving is quite low?

01:19:44.660 Or is it just a consequence of the tremendous capacity of metastatic cancers to spread?

01:19:50.280 So there's a couple of things going on for cancer to take place.

01:19:57.240 So the first critical step of a cancer is a genetic mutation has to happen.

01:20:04.880 And largely speaking, these fall into two categories.

01:20:08.120 There are genes that are promoting cancer growth.

01:20:13.200 And then there are genes that suppress cancer growth.

01:20:17.600 So anytime you get mutations in one of those systems, it becomes oncogenic.

01:20:23.680 Now, fortunately, when a cell becomes cancerous, it starts to let out clues that it is not a normal cell.

01:20:33.900 So when a breast cell goes from being a normal mammary cell to a cancerous mammary cell, it starts to look a little bit different.

01:20:45.900 And 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.

01:20:57.420 That's what it's programmed to do.

01:20:58.960 So it's a very beautiful way to think about it.

01:21:02.000 But the immune system is not programmed to recognize bad things.

01:21:06.020 It's programmed to recognize things that are not self.

01:21:09.960 This is done through something called thymic selection when we're basically very young.

01:21:15.760 So, and by the way, too much of that problem leads to autoimmunity.

01:21:19.460 So you can think about this through your own personal story, right?

01:21:22.440 Which is there's a very fine balance here.

01:21:24.700 Too much of knowing what is, you know, not self and too little of that are both equally bad.

01:21:33.520 So there are always some cells that recognize this.

01:21:37.940 In fact, Steve Rosenberg, who I did my postdoc with, recently published some really amazing data,

01:21:45.220 which I find one of the most staggering statistics of all of cancer, and also one of the most hopeful,

01:21:51.680 which is that 80% of epithelial tumors, epithelial tumors are the ones that kill people.

01:21:57.280 That's the solid organ stuff, the breast, colon, prostate, etc.

01:22:00.680 80% 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.

01:22:17.920 The 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.

01:22:28.340 So 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.

01:22:39.920 To your broader question, which is, if you're listening to this, what do you do about it?

01:22:44.860 It starts to me with, what are the two most clear environmental triggers of cancer, and how do you avoid them?

01:22:54.020 And then secondly, what's the rest of your strategy?

01:22:57.620 So when it comes to heart disease and neurodegenerative disease and metabolic disease, which are the other three horsemen,

01:23:05.780 our ability to incorporate prevention is so significant that it plays the lion's share of our strategy.

01:23:15.160 Because 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,

01:23:23.100 your prevention strategy is not doing those 25 things or minimizing how much you're doing those things.

01:23:29.380 With cancer, there's really just two big things, smoking and obesity slash insulin resistance.

01:23:37.520 Now, 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.

01:23:47.020 And what's really driving it, I think, is the inflammatory and metabolic, i.e. the high growth factors such as insulin,

01:23:55.660 that are coming with most but not all cases of obesity.

01:23:58.820 So what we really want to avoid is being metabolically unhealthy and smoking.

01:24:04.680 But here's the thing.

01:24:05.780 So that insulin overproduction also, in your opinion, facilitates cancer origination or growth once the cancer has propagation?

01:24:17.180 I don't think, yeah, I think it's a propagation issue, not an initiation issue.

01:24:21.120 Propagation.

01:24:21.360 Yeah, yeah.

01:24:21.900 Right.

01:24:22.100 And we know that because there are more than 20 cancers for whom your risk goes up by about a 2x factor if you're obese.

01:24:32.540 And I think the only thing that makes sense in that sense, in understanding that observation,

01:24:38.380 is the inflammatory and pro-growth environment that is in that individual.

01:24:42.900 So do we want to avoid that?

01:24:44.720 Absolutely.

01:24:45.200 But my point is, think of how many people who are non-smokers who are metabolically healthy who still get cancer.

01:24:51.460 That's a very long list of people.

01:24:53.960 So 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.

01:25:01.760 We have to have another tool in this toolkit.

01:25:05.860 And that tool is a very controversial one, but nevertheless, I think it's important, and it's very aggressive screening.

01:25:13.180 And the reason for this is another observation that I don't think gets enough attention,

01:25:19.020 which is when you consider two different individuals with the same cancer but at different stages who are treated with the exact same treatment,

01:25:31.080 their survivals are very different.

01:25:33.300 So if you take a person with stage 4 colon cancer, which means the cancer has spread to, say, the liver,

01:25:41.700 and you treat them with the same cocktail of drugs that you give a person at stage 3 cancer,

01:25:47.020 where it's just spread from the colon to the lymph nodes but no further, at least to the naked eye,

01:25:53.160 the survival for the people for whom it's spread to the liver is 0% at 10 years,

01:25:59.580 whereas the ones to the lymph nodes, it's going to be about 60% to 65% at the same period of time.

01:26:05.100 A fundamental difference.

01:26:06.860 They're getting the same treatment.

01:26:08.600 So it's the difference between treating somebody when they have a billion cells versus 100 billion or a trillion cells.

01:26:15.660 And the problem is that there's more mutational burden the more cancer you have.

01:26:22.200 You have more escape mechanisms for the cancer.

01:26:25.100 That's probably the best explanation for it.

01:26:28.040 And we could do this analysis for all other types of cancer, like breast cancer, etc.

01:26:31.800 What it points to is early detection is essential.

01:26:37.340 So what does that mean practically?

01:26:39.100 What do people have to do with their physicians in order to ensure that they're being optimally screened for the possibility of cancer?

01:26:47.720 And at what age does that start to become more crucial?

01:26:50.880 It's very difficult for me to provide a blanket statement because even when I'm talking about this with my patients,

01:26:56.120 I have a long discussion with them about the challenges of doing this.

01:27:01.600 So let's put aside the obvious challenge, which is cost.

01:27:05.160 None of the advanced types of screening or working at the advanced rate are going to be covered by insurance, right?

01:27:12.700 So in the United States, it's recently been changed to 45 from 50 for the initial colonoscopy.

01:27:20.500 That's an excellent step in the right direction.

01:27:22.540 I still think it's about five years too late.

01:27:24.360 I think even for a person without a family history of colon cancer, I would recommend,

01:27:29.400 and at least for our patients, I would recommend screening to begin at 40 instead of 45.

01:27:35.520 The frequency with which...

01:27:36.940 It's not cheaper.

01:27:38.080 It's not cheaper for the insurance companies to screen than it is to pay for advanced cancer treatment in hopeless cases?

01:27:45.520 Oh, it certainly is.

01:27:46.660 But 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.

01:27:58.460 So 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.

01:28:05.140 But 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.

01:28:23.840 In the U.S., that's not the case.

01:28:25.640 In the U.S., people are never really owned from a risk perspective by one entity for very long.

01:28:32.540 So there is much, much less incentive in our system, unfortunately, to truly invest in prevention.

01:28:40.840 And 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.

01:28:48.300 Well, 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.

01:29:00.600 You 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.

01:29:08.640 But 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.

01:29:20.680 And so it's not only hard to fund prevention, it's also hard to market it, right?

01:29:25.740 Because you can't give credit to the people who've managed it.

01:29:29.240 And so that's a big structural problem.

01:29:31.400 Like, 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.

01:29:50.240 And 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?

01:30:03.640 Oh, yes, yes.

01:30:04.760 If you're going to say, well, it's metabolic disease, right?

01:30:07.400 So obesity is just a proxy for that.

01:30:09.660 But yes, metabolic disease would be the, you know, one that feeds and amplifies all the others.

01:30:16.620 But there are other things that we haven't explored.

01:30:18.900 Like, 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.

01:30:30.140 And 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.

01:30:36.940 So in other words, I can't tell you what the number is, but it's knowable and it's large.

01:30:40.960 The number of people who get cancer who are neither smokers nor have obesity or insulin resistance.

01:30:47.400 And so there's still a big fraction of people for whom something else is driving their cancer.

01:30:53.880 And I suspect there are other environmental toxins, whether they be pesticides, whether they be, you know, chemicals in the ground.

01:31:03.660 Like, 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.

01:31:12.380 And the fact that we don't know this, to me, is problematic.

01:31:16.160 Right.

01:31:16.600 So that's another variant in some ways of prevention, to identify additional mutagenic agents.

01:31:22.180 We already know about that on the smoking front.

01:31:25.100 And then to take them out of the environment so that diseases don't occur to begin with.

01:31:31.260 Let's switch.

01:31:32.080 By the way, I do want to say one thing about what you said, Jordan, that is very true.

01:31:36.220 And there's no disease for which it's more tragic than with the dementing diseases, specifically Alzheimer's disease.

01:31:42.700 So 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.

01:31:56.240 Like, it's 99.9999999 to 0.00001.

01:32:00.740 It's not even close.

01:32:02.280 And the net result has been abysmal.

01:32:05.480 So there is no disease for which we have less to show for the work that's gone into it than Alzheimer's disease.

01:32:11.540 We have a couple of approved drugs.

01:32:13.800 I guess the other—go ahead.

01:32:17.460 Yeah, we have a couple of approved drugs that have virtually no efficacy.

01:32:21.160 At best, they might slow the rate of progression.

01:32:23.760 Zero reversal.

01:32:25.500 And yet, I think it's crystal clear that your trajectory towards Alzheimer's disease is probably much more malleable than your trajectory towards cancer.

01:32:34.900 And 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.

01:32:44.460 Right.

01:32:45.060 Well, I guess the other problem on the prevention front is that it's more difficult to monetize prevention.

01:32:50.520 It's quite straightforward to monetize drugs to cure or to not cure as long as they're administered to enough people.

01:32:56.740 But how do you monetize prevention?

01:32:59.320 And people might say, well, everything can't be about money.

01:33:02.540 It's like, well, without money, you can't market.

01:33:04.640 And without marketing, you can't communicate.

01:33:06.520 And so there's all sorts of obstacles that are quite subtle in the way of mounting an effective prevention campaign.

01:33:13.880 But it does—it certainly seems—if you—let's close with two questions.

01:33:18.920 One 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?

01:33:31.560 I mean, like, one example might be, well, you know, would we start a campaign to reduce the consumption of carbohydrate, especially sugar?

01:33:41.340 But we talked about other elements of prevention as well.

01:33:44.900 If 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?

01:33:53.560 And what evidence do you have to support that?

01:33:58.020 It's really hard to say because this is just as much a behavioral question as it is a scientific or medical question.

01:34:05.980 Again, the numbers point back to exercise, Jordan.

01:34:09.480 There's no ambiguity about that, right?

01:34:11.860 You'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.

01:34:22.340 And that's going to be true for men, women, young, old.

01:34:25.240 It doesn't matter.

01:34:26.580 There is no exception to this rule.

01:34:29.440 And therefore, you know, I would put most of my resources from a public health standpoint into how do you do that?

01:34:38.220 How do you make exercise something that is interwoven from preschool onward at a level that is truly efficacious?

01:34:47.320 And that's going to not just mean getting people to exercise.

01:34:50.680 It'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.

01:35:00.380 But it's also going to involve understanding that everybody's different.

01:35:03.160 And there are some people who hate exercise, and what do you need to do to make it more enjoyable for those people?

01:35:08.240 What kind of financial incentives do you put in place for people to exercise?

01:35:12.100 Because I really do believe carrots can be more effective than sticks here.

01:35:16.520 And, 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.

01:35:25.580 Well, 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.

01:35:40.880 No individual cares about the cost, right, because they're not bearing the cost.

01:35:45.620 So that's a—the arguments around that I don't think matter.

01:35:48.760 I think the only thing that matters is, can we have you do something that's going to improve the quality of your life?

01:35:55.740 I 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.

01:36:04.220 You 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.

01:36:12.720 So, you know, to build—to start building those habits of activity in youth so that they persist.

01:36:19.920 I mean, I would get rid of chairs—I would get rid of chairs in schools.

01:36:23.700 Every kid would have a standing desk.

01:36:25.700 I mean, there's—sitting is just a—it's not a particularly productive thing in the position we do it in, right?

01:36:30.920 I 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.

01:36:39.960 So, 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.

01:36:51.280 And it's true of adults.

01:36:52.340 Well, right.

01:36:52.860 Well, obviously, what we're doing in schools is training people to be sedentary.

01:36:59.000 Yeah.

01:36:59.400 Obviously.

01:37:00.320 I mean, that might be the most fundamental impact of the education system, you know.

01:37:04.420 I 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.

01:37:13.640 And one of the aphorisms, which I never forgot, was the system does not do what its name says it does.

01:37:19.200 And 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.

01:37:36.180 And so, it might be that the fundamental function of universities is to aid in the process of assortative mating.

01:37:41.720 Like, 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.

01:37:53.660 Because we don't know, right?

01:37:55.300 We're not smart enough to analyze the behavior of these complex systems.

01:37:59.360 Let's end with one final thing.

01:38:02.020 We touched briefly on the issue of emotional health.

01:38:06.040 And so, tell me—just tell me your thoughts on that in general.

01:38:09.740 What 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?

01:38:27.620 So, I think emotional health ties into this longevity equation in many ways.

01:38:33.040 So, you can start at a very extreme end.

01:38:35.320 A low enough state of emotional health can be a direct threat to your life.

01:38:42.180 So, again, the most extreme, extreme example of that would be suicide.

01:38:45.580 But if you walk back from suicide, we talk about parasuicide.

01:38:49.360 We talk about all the different behaviors that people engage in that are slow suicides.

01:38:54.060 I 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.

01:39:20.180 So, we just—

01:39:22.760 Wow, that's brutal.

01:39:23.760 Yeah, so just last year was the first year that overdose took more than 100,000 lives in the United States.

01:39:30.440 So, 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.

01:39:43.680 You know, up in Toronto, I still see people—and in L.A. too, it was quite noticeable.

01:39:48.380 I was there yesterday.

01:39:49.240 I still see people cowering behind their masks, and, you know, you have to have been made pretty chronically afraid to still be doing that.

01:39:58.040 And 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.

01:40:08.480 I think it would be very difficult to say that those statistics I rattled off aren't impacted by COVID.

01:40:16.320 So, what's going to be interesting is to see how that plays out going forward.

01:40:20.720 My point, of course, is that these deaths of despair are a very extreme example of how emotional health impacts longevity directly.

01:40:30.380 Right here, it's just truncating lifespan way too soon.

01:40:33.220 In fact, overdose is now the leading cause of death in the United States for people aged 10 to 55.

01:40:43.660 Wow. Wow. Oh, that's terrible.

01:40:46.380 So—

01:40:46.740 And so what do you see on the prevention front there?

01:40:50.960 Or do you have a solution?

01:40:51.720 Well, let's go even one layer further, because I'm sure there's someone listening to this who says, well, look, that's not me.

01:40:57.640 I don't drink to excess. I would never touch an illicit drug, and I'm in no danger of killing myself.

01:41:01.880 So that means emotional health is checked.

01:41:04.320 And I would say, no, not really, because that's just the first layer.

01:41:07.280 Let's go one layer deeper.

01:41:09.160 I think the next layer is how many people, because of their relationship with themselves, are unable to self-care.

01:41:18.360 If 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?

01:41:32.600 Eating a little bit too much, not exercising enough, not sleeping well, you know, engaging in behaviors or failing to engage in healthy behaviors.

01:41:44.320 Now, again, I see this constantly with patients, where it's not that they don't know what to do.

01:41:51.520 It's not that they don't know that they should exercise.

01:41:54.840 But if you really push them, they have a negative relationship with themselves that is preventing them from taking care of themselves.

01:42:04.680 And 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.

01:42:16.360 So 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.

01:42:25.000 And 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. 0.98

01:42:34.920 Your relationships suck, right? 1.00

01:42:37.220 You're a lousy father. 1.00

01:42:38.900 You're a lousy husband. 1.00

01:42:40.400 You're a lousy parent. 1.00

01:42:42.020 You know, any of these things.

01:42:44.540 And you're basically living without a sense of why, right?

01:42:47.940 You're not, you know, as Esther Perel put it to me, what is the purpose of living longer if you're unhappy?

01:42:57.280 And I think that that's probably the biggest circle.

01:43:00.400 And that's, to me, one of the most interesting ones here.

01:43:03.340 And 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.

01:43:21.680 And so what have you concluded on the treatment front in regards to that set of problems or the prevention front, let's say?

01:43:29.520 Well, again, it's worth caveating that everything that I write about in the book, I come to it with some lens of expertise, right?

01:43:38.720 I mean, it's what I do for a living.

01:43:40.080 It's what I've spent more than a decade researching.

01:43:43.160 You know, I can speak with some authority about cancer and heart disease and dementia and exercise and nutrition.

01:43:49.400 When it comes to this particular issue, I have no expertise.

01:43:53.520 I come at this through the lens of a patient.

01:43:55.920 And 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.

01:44:14.100 But I'll tell you what I've learned.

01:44:15.480 I've learned that most people probably have some degree of unresolved business in their childhood that has produced adaptations.

01:44:27.860 And in some cases, many of those adaptations are very good and should continue.

01:44:32.700 But some of those adaptations are negative.

01:44:35.200 And that is malleable, right?

01:44:37.980 So there's kind of this view of hope, which is you don't have to throw out the baby with the bathwater.

01:44:44.940 You can, again, in my case, you can take some of those adaptations, which produce, you know, hard work, discipline, all of these things.

01:44:52.880 But 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.

01:45:05.260 So, this requires very hard work.

01:45:09.060 And unfortunately, it's not something that lends itself to the faint of heart.

01:45:16.160 Unfortunately, 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.

01:45:30.320 Well, 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.

01:45:41.740 The 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.

01:45:53.720 Peel was my supervisor and Higgins, my student.

01:45:56.500 We developed a suite of exercises called the Self-Authoring Suite.

01:46:01.060 They're at selfauthoring.com.

01:46:02.720 And the past authoring program helps you write an autobiography and clear up that excess baggage.

01:46:10.320 And 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.

01:46:22.180 And the future authoring program, which we've studied most intently, helps you develop a vision for the next five years.

01:46:29.400 And 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.

01:46:40.260 No preparation with no one reviewing what they've written.

01:46:43.340 The probability that they'll drop out falls 50% and their grade point average goes up 35%.

01:46:49.940 And it is tied to precisely what you described, is that people need a reason to live.

01:46:56.300 And I also, in this exercise, we help people break down the reasons to live.

01:47:01.140 And this touches on another point that you made regarding relationships.

01:47:05.540 You can't be healthy psychologically in the absence of a network of functional relationships.

01:47:11.520 You need a partner, you need a family, you need friends, you need business colleagues.

01:47:15.840 You have to be nested in a functional social hierarchy.

01:47:19.020 And so we walk people through this process of vision development.

01:47:23.960 We ask them what they would like to have in five years if they could have what they wanted and needed.

01:47:29.480 We ask them how catastrophic their lives would be in five years if they let their bad habits get out of control.

01:47:35.700 That sort of sets the parameters, right?

01:47:38.120 Don't do this and do this.

01:47:40.140 And then we ask them seven questions.

01:47:43.740 What do you want in an intimate relationship?

01:47:46.480 What do you want in your friendships?

01:47:48.880 What do you want for your job and your career?

01:47:51.580 How are you going to educate yourself?

01:47:53.260 How are you going to take care of yourself mentally and physically?

01:47:55.560 What are you going to do with your time outside of work that's productive and generous?

01:47:59.540 How are you going to shoulder some civic responsibility?

01:48:03.320 I think that covers the fundamental domains.

01:48:05.740 Those are places that people generally find meaning in their lives.

01:48:08.960 And the upshot of all this is that almost no one has an explicit strategy for their life.

01:48:15.720 And that's a catastrophe.

01:48:17.580 What do they say?

01:48:18.920 The people perish without a vision.

01:48:20.940 This is literally the case.

01:48:22.400 And this is precisely what we're talking about.

01:48:24.180 But 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.

01:48:37.620 And, well, like I said, that stops half the kids from dropping out of university.

01:48:43.680 And 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.

01:48:55.140 So you can imagine there is a three-pronged approach to health span, right?

01:49:02.280 Sufficient exercise, appropriate diet, and the development of something like a comprehensive account of and vision for your life.

01:49:12.100 And that would be relatively inexpensive and all things considered relatively easy to implement.

01:49:18.080 So you never know.

01:49:19.260 Maybe we'll get smart enough to move hard in that direction as a society over the next couple of decades.

01:49:25.140 So I guess, is there anything else you would like to tell people before we close?

01:49:29.460 We're going to turn, just so everybody who's listening knows and watching, we're going to turn to the Daily Wire Plus platform.

01:49:36.280 I'm going to talk to Dr. Adia for an additional half an hour about the development of his interest in these areas over his lifespan.

01:49:42.240 That's usually what I do in that half an hour period.

01:49:44.900 But is there anything else, Dr. Adia, that you would like to relate to the viewers and listeners before we close?

01:49:51.700 No, I think those are three great principles there.

01:49:55.980 And I guess the only final thing I would say, and it kind of ties a little bit into the last one,

01:50:02.700 is there is an exercise I have my patients do called the marginal decade exercise.

01:50:09.360 So you write down on a piece of paper your age, so I'm 50, and you draw a line extending across the page,

01:50:17.000 and you tick off at 10-year increments, so 60, 70, 80, 90.

01:50:21.740 And then I do the same exercise for my kids.

01:50:24.280 So I have a 15-year-old girl, 9-year-old boy, 6-year-old boy, and I tick those out at the same 10-year increments,

01:50:31.800 so the daughter, 25, 35, 45, 55, et cetera, and they're lined up, okay?

01:50:37.160 And then I start to imagine when they might have kids.

01:50:40.940 So this is a little bit of guessing, but I start to put, you know, grandkid 1, grandkid 2, grandkid 3, grandkid 4.

01:50:45.920 Okay.

01:50:47.180 And then I go to what is the actuarial expectation of my life, which is, you know, low to mid-80s.

01:50:54.340 And I ask the question, what would another decade buy me?

01:50:57.620 And on one level, it doesn't look that interesting, right?

01:51:01.380 It's buying me the difference between being 83 and 93.

01:51:06.600 But if that 10 years is at a reasonable high level of function, and let's be clear, it's not going to look like it looks now,

01:51:13.460 but I define what that function is.

01:51:15.900 I still want to be able to walk up a flight of stairs.

01:51:18.000 I still want to be able to carry a bag of groceries.

01:51:20.140 I still want to be able to lift my suitcase up.

01:51:22.040 But I look down and I see what a difference it is in terms of those relationships.

01:51:29.220 It'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.

01:51:38.800 And I say all of that because it's the why that matters a little bit here.

01:51:42.940 Right, right, right, right.

01:51:44.140 Well, 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.

01:51:53.320 It's immediately gratifying and delicious.

01:51:55.940 So the why is a no-brainer.

01:52:00.480 It's the same with abusive drugs like cocaine.

01:52:03.860 We don't have to explain why people abuse cocaine.

01:52:06.140 We have to explain why all people don't abuse it 100% of the time because it immediately activates the systems that mediate positive emotion.

01:52:15.740 So that's a no-brainer.

01:52:17.500 If 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.

01:52:30.060 You need to find something to do that's better than drinking.

01:52:32.720 And if you like alcohol, drinking is pretty good.

01:52:34.860 It's a highly social activity.

01:52:36.660 It's not that expensive.

01:52:38.200 It's available constantly.

01:52:40.980 It's an anxiolytic.

01:52:43.200 It's a psychomotor stimulant for some people.

01:52:45.640 It probably increases opiate response, so it's very rewarding.

01:52:49.640 Well, the problem is that it ruins your life over a multi-decade period and blows your relationships to bits.

01:52:55.500 But if you don't have a vision of yourself extending across that span of time, then why the hell should you care?

01:53:01.280 And it might be the same on the exercise and nutrition front.

01:53:03.980 It's like you're not going to take care of yourself unless you know you have something useful to do.

01:53:08.560 And 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.

01:53:17.080 And if you have better relationships, well, you're much more resilient and you have much more of an opportunity for positive emotion.

01:53:26.180 And so if you take responsibility, you have a long-term vision of yourself as well.

01:53:30.760 And 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.

01:53:47.660 Partly because they see a reason in following them.

01:53:51.380 You need a reason to make sacrifice, you know.

01:53:54.320 Yeah, I think that's the key point here.

01:53:57.300 And 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.

01:54:08.740 We have to have a reason, and I think your examples are great ones.

01:54:12.400 Virtually everything that is bad for your health feels much better in the moment.

01:54:17.900 So 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.

01:54:35.940 Pick whatever it is.

01:54:37.300 Yeah, 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.

01:54:57.320 That's a pretty good deal, you know.

01:54:58.700 And 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.

01:55:10.320 So that's the question, hey, what's it worth making a sacrifice for?

01:55:14.160 And it's a question you have to answer if you're going to put your life together and put your health together.

01:55:17.540 All right, everyone watching and listening on YouTube, thank you very much for your time and attention.

01:55:24.000 To the Daily Wire Plus people for facilitating this conversation, that's much appreciated.

01:55:29.140 I'm here in Boise, Idaho today doing this conversation.

01:55:33.180 Daily Wire always finds me a studio and a studio for my guests.

01:55:36.020 To the film crew here, thank you very much for flawless experience.

01:55:42.200 Dr. Adia, it was very good of you to talk to me today.

01:55:44.860 I wish you the best of luck without living the book and in your own life.

01:55:49.040 And I would also encourage those who are listening to continue to follow our conversation on the Daily Wire Plus platform,

01:55:58.500 where we'll talk for another half an hour on more biographical and personal issues.

01:56:03.200 Thanks very much, everybody.

01:56:04.500 Thanks, Dr. Adia.

01:56:05.340 It's good to meet you.

01:56:06.640 Thank you so much.

01:56:10.080 Hello, everyone.

01:56:10.940 I would encourage you to continue listening to my conversation with my guest on dailywireplus.com.

The Jordan B. Peterson Podcast - May 25, 2023

360. Obesity, Diabetes, Cancer and You ｜ Dr. Peter Attia

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