The Peter Attia Drive - #103 - Looking back on the first 99 episodes： Strong Convictions, Loosely Held

00:00:00.000 Hey everyone, welcome to the drive podcast. I'm your host, Peter Atiyah. This podcast,

00:00:15.480 my website and my weekly newsletter all focus on the goal of translating the science of longevity

00:00:19.800 into something accessible for everyone. Our goal is to provide the best content in health

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00:00:37.320 the end of this episode, I'll explain what those benefits are. Or if you want to learn more now,

00:00:41.720 head over to peteratiyahmd.com forward slash subscribe. Now, without further delay,

00:00:47.740 here's today's episode. Welcome to a special episode of the drive to celebrate our 100th

00:00:56.020 anniversary. We have decided to try something a little different. The title of this episode is

00:01:03.420 strong convictions loosely held. And what that basically comes down to is Bob asking me questions

00:01:12.080 about things that I've kind of changed my mind on over the past year and a half. So we definitely go

00:01:19.240 into a lot of areas where I had a strong point of view or a reasonable point of view on something.

00:01:25.740 And then after either preparing for a podcast or going through a discussion, I sort of came away

00:01:32.500 with a different point of view and it's, you know, usually changed my behavior for the better.

00:01:37.540 So we thought this would be kind of an interesting and maybe even clever way to go about doing a

00:01:42.560 retrospective on the first 99 episodes. And of course, we also do take a moment to sort of

00:01:48.760 talk about some of the things, highlights, things that I've maybe enjoyed the most or that Bob's

00:01:53.280 enjoyed the most. If you like the style of this episode, by the way, please let us know because

00:01:57.940 I'd be open to doing it again. I actually found it quite fun to reminisce. So again, if you find this

00:02:04.600 interesting, please let us know. I'd be happy to repeat this every 50 episodes or so. And I guess

00:02:09.840 without any further delay, I hope you enjoy episode 100 of The Drive.

00:02:19.700 So for episode 100, as I alluded to in the introduction, we're going to do something a

00:02:25.540 little bit different and I can't take any credit for this idea. So if you like it, Bob gets all the

00:02:32.440 credit. If you dislike it, well, hopefully you won't dislike it. But many of you know Bob Kaplan,

00:02:39.840 the guy behind the guy behind the guy. And one of the things that Bob has had the luxury of doing,

00:02:46.240 if you can think of it as a luxury, is sort of helping me get ready for many of the past 99

00:02:52.500 episodes of podcasts. And there's a lot that goes into making this sausage known as the podcast.

00:02:59.460 Once in a while, I just get up there and wing it. But I think more often than not,

00:03:03.640 a lot of thought has to go into who do we want to interview? What do we want to talk about?

00:03:08.560 What do I need to know in order to have this discussion in sort of a thoughtful way?

00:03:13.820 And throughout that process, my opinion on things can change. And sometimes not necessarily through

00:03:19.720 the podcast per se, but just through the evolution of learning and what it means to sort of scour

00:03:26.540 information and test a hypothesis and see data that conflict with your preexisting way of thinking

00:03:34.020 about things. I mean, all of these things have led to an enormous evolution over a period of time

00:03:40.380 in the way I think about things and do a lot of things. And I think, I know that on some levels that

00:03:46.140 might sound like a real cop-out to think that one can change their mind on how things work. But

00:03:51.540 I think that when I've written this before, I think in politics, that may be a cop-out,

00:03:56.140 but I don't think in science or in medicine that should be viewed as a cop-out. I think

00:03:59.580 one should always be malleable and willing to sort of lean into new information. And in fact,

00:04:05.960 the title of this podcast, Strong Convictions Loosely Held, is a phrase that exists in various

00:04:11.980 different forms. So sometimes it's strong opinions loosely held, strong opinions weakly held,

00:04:17.620 strong convictions weakly held. I've seen many different versions of it. But in particular,

00:04:21.540 this version of it, Strong Convictions Loosely Held, is something that I remember one of my

00:04:25.840 patients telling me a couple of years ago in reference to one of his mentors in the investment

00:04:32.540 space. So this patient of mine is himself an investor, and he came out of a very successful

00:04:39.580 hedge fund. And he spoke very affectionately about how he was mentored there. And he said that that was

00:04:46.100 sort of one of the things that allowed them to be so successful was they had very strong convictions,

00:04:50.800 and they would make bold investments based on those things. But they were very loosely held

00:04:55.020 convictions, and they were always looking for ways to change their information. So in that spirit,

00:05:00.940 I am joined today by Bob Kaplan. And I think Bob has, along with maybe two or three other people

00:05:10.180 around me clinically, as good an insight into some of the various things I've changed my mind on.

00:05:16.840 And so, Bob, how do you want to do this? Do you want to just ask me about things I've changed my

00:05:21.380 mind on or point them out to me or call me on what you want to do?

00:05:23.740 Yeah, I think that works. Call you out on things you've changed your mind. But again,

00:05:27.560 I think it's really important. That's a feature, not a bug. One of the quotes that I heard or

00:05:32.060 somebody talking about this idea of the Strong Opinions Weekly Held is, it was on a blog actually,

00:05:39.420 and it's Richard Feynman, just to confuse everyone, Richard Feynman, the other,

00:05:42.180 the SUNY biochemist, who said that a colleague at NIH said...

00:05:47.280 And by the way, that's SUNY S-U-N-Y.

00:05:49.980 Just to confuse people even more.

00:05:51.440 Just to really confuse people now. It's not the Shia Richard Feynman. It's, yeah, forget it. 1.00

00:05:59.260 Yes. So he had a colleague, at least he wrote this in his blog, and he said,

00:06:03.640 what you do in science is you make a hypothesis, and then you try to shoot yourself down. And I think

00:06:08.480 that that's really succinct. And the podcast for over the 100 episodes, Peter has a lot of

00:06:15.160 hypotheses, which is great for me because I think I share a lot of those and I get to dig into them

00:06:19.180 as an analyst. And so I think from a selfish perspective, what I see in podcasts and the

00:06:25.180 episodes and why Peter's so successful, other than his rugged good looks, is that he has a lot

00:06:31.420 of hypotheses. He has a lot of ideas and he's not afraid to just say whatever he thinks and try to

00:06:39.300 find the people who are the absolute experts or even just somebody who disagrees with him and his

00:06:44.480 take on something. Try to dig into it further to see, basically, to see if he can shoot it down,

00:06:48.380 because I think the more hypotheses you can shoot down, actually, things get a little bit simpler,

00:06:52.820 even as much as we're waiting in a lot of this uncertainty.

00:06:56.440 But a lot of that actually occurs behind the scenes. I mean, I hear what you're saying,

00:07:01.540 but I think most of the shooting down is not actually done in the podcast. It's actually done

00:07:07.880 in the preparation for it and some of the analyses that come after the fact. So I also could imagine

00:07:14.740 somebody listening to this saying, well, your podcasts aren't really that contentious. It's not

00:07:18.460 like you're getting into rip-roaring fights. It's not like our podcast is sort of an environment where

00:07:24.760 we're always just trying to come up with a contrarian point of view or an antagonistic

00:07:29.760 point of view. I think a lot of the places where my minds have been changed has been in getting

00:07:36.040 ready to do it. And sometimes, frankly, it just doesn't have to do with the podcast, but I do

00:07:40.300 think this is a great excuse, as any, to be 100 episodes into this thing and say, hey, two years

00:07:45.240 ago, what did I do or what did I think or how did I behave in a way that was different from today?

00:07:50.160 So yeah, hopefully we've got some interesting ones to talk about. I've seen that you and Nick have

00:07:53.880 been comparing notes. We have. I've got a good mixture here of hard topics and maybe a little

00:07:59.780 softer. So we'll see if we can sprinkle them in. This might be on the harder side. Metformin.

00:08:06.960 So maybe think about, I guess in the context of the episodes, it was probably, it was a summer of,

00:08:12.720 was it 2018 or so you started the podcast. Since then, how have your strong convictions,

00:08:18.980 if you had them changed at all since then? Well, in the summer of 2018, I was taking metformin. I had

00:08:25.660 been taking it for about seven years. I think I started in 2011 and that was based on a lot of

00:08:33.100 research that I had seen and read and a white paper we had written internally that looked at the

00:08:41.060 benefits of metformin in people with type 2 diabetes and in people without type 2 diabetes,

00:08:46.700 but with obesity, which was probably just a proxy for hyperinsulinemia, but it's not entirely clear.

00:08:53.140 But the benefits were not subtle. In particular, the benefits were around a reduction in cancer

00:09:00.180 mortality and survival with cancer as well. So both a reduction in the incidence of cancer and an

00:09:07.200 increase in the survival of cancer. And we certainly weren't the only people to figure this out in 2011.

00:09:13.320 There were people who figured this out long before us, but we were sort of, I think, a little bit

00:09:17.520 early on the cusp of viewing metformin as a drug that might have a benefit for people who were not

00:09:24.620 type 2 diabetic, but looking for sort of a boost in longevity. And truthfully, not a lot of our

00:09:31.320 patients in the practice were taking metformin. One, because my convictions, I guess, weren't that

00:09:36.900 strong. They were strong enough that I was willing to take it because I could also kind of monitor a bunch

00:09:41.960 of things in the background, but not strong enough that I felt like it should be dispensed like you

00:09:46.000 would dispense chiclets or Tic Tacs to people. I don't know why I said chiclets are...

00:09:50.580 Because you dispense them like candy anywhere you go. We know you're the chiclets and Tic Tacs guy.

00:09:56.660 Whenever I don't know the last time I had a chiclet or a Tic Tac. Do they even make chiclets anymore?

00:10:01.600 I think they do.

00:10:02.900 I don't even remember seeing these things in a grocery store.

00:10:06.040 I know they make Tic Tacs.

00:10:06.540 I've seen Tic Tacs, but I don't think I've seen a chiclet in a long time. I miss chiclets.

00:10:10.540 So that said, a lot of patients over time would say, hey, I've heard about this drug called

00:10:16.240 metformin. Kind of interested in it. What's your take on it? And sort of share our white paper with

00:10:20.560 them. And in the end, we ended up prescribing it for a number of patients. I would say off-label,

00:10:25.720 meaning these aren't patients that were hyperinsulinemic or diabetic.

00:10:30.160 Perfect. So fast forward. Well, actually we had an interview with Nir Barzilai, who is certainly

00:10:36.780 one of the world's experts on this topic. That was a very interesting podcast. I learned a few

00:10:42.780 things there that I didn't even know before, which again, given that I'd been spending so much time

00:10:47.160 thinking about metformin, I think that really speaks to Nir's depth of knowledge on that front.

00:10:51.940 But somewhere along the way, something changed. And the first clue was December of 2018. So in

00:11:01.600 December of 2018, which was when I first became interested in zone two training, it was the first

00:11:08.960 time I'd ever been checking my lactate levels under low levels of exertion. And it was the first time

00:11:15.940 I'd been just checking lactate levels in a while, since I hadn't been doing much lactate testing since

00:11:21.520 I stopped competing in sports where that mattered. And I was kind of surprised at how high my lactate

00:11:28.140 levels were, especially my fasting lactate, just baseline, like not exercising lactate levels.

00:11:35.080 And that got me poking and poking and poking and coming to the obvious conclusion that metformin is

00:11:42.360 a weak mitochondrial toxin. And as such, it probably shouldn't be surprising that you'd have a higher level

00:11:49.200 of lactate. In medical school, every student learns that one of the potential rare complications of

00:11:56.900 metformin is lactic acidosis. I'm sure somebody in an ER somewhere has even seen it. So again,

00:12:03.320 it's not a huge stretch that you would see elevated levels of lactate. But it did get me thinking,

00:12:08.500 which is, wait a minute, what if the benefits of metformin are only going to be most pronounced

00:12:15.200 in people who have otherwise quite defective mitochondria to begin with and or people who

00:12:21.020 can tolerate a slight hit in the sort of mitochondrial performance because of all the

00:12:27.480 other benefits they're getting? And what if that doesn't hold true for someone who's otherwise quite

00:12:31.920 healthy and looking to really maximize mitochondrial health and throughput? And basically since that time,

00:12:40.740 I would say that more and more literature have probably emerged suggesting that we might want

00:12:47.260 to think about metformin different in people who are quote unquote sick versus healthy. I hate using a

00:12:54.540 stupid division like that, sick versus healthy, but I mean, I could sort of explain what I mean in a bit 0.99

00:12:59.560 more detail, but I think people get the gist of it. What if this is a drug that still offers 1.00

00:13:04.860 a sizable benefit to people who are metabolically ill, but that benefit sort of evaporates in people

00:13:13.080 who are not? And so I would say that my position today, so I've stopped taking metformin after

00:13:18.880 making this observation in December of 2018, I then spent the next six months, maybe not that long,

00:13:24.780 maybe the next four months experimenting a lot with it. So only dosing it in the evening,

00:13:31.420 but not in the morning, reducing the dose, like making a whole bunch of changes to see if I noticed

00:13:37.060 any difference before ultimately stopping it and then stopping it altogether. And then realizing a

00:13:42.440 couple of things. One, yeah, my lactate levels went down and my zone two efficiency as measured by

00:13:48.120 lactate went up, but also my glucose levels are a bit higher. There's no question it was suppressing

00:13:53.380 glucose levels and that was probably a good thing. So I have no way of knowing if the net benefit of

00:13:59.720 stopping metformin has been positive or negative, but I now would say I reserve metformin prescriptions

00:14:07.280 for patients who obviously are in need of it from the standpoint of glucose and insulin regulation,

00:14:13.820 but I don't view it really as a pro longevity agent yet. Again, very likely we'll be having a

00:14:20.780 discussion in two years, Bob, and I'll have changed my view again. There will be some new data that will

00:14:25.880 have emerged that will have told me that yes, despite the elevated levels of lactate,

00:14:31.240 it's still a net positive, even in someone who's metabolically healthy. And we've obviously looked

00:14:36.520 at a bunch of other papers that look at the impact of metformin on muscle mass and training effects,

00:14:42.280 though a lot of those studies seem suboptimal because they don't include some of the more

00:14:46.440 functional analyses of the muscle that you'd want to see. So I don't think this is not an open and

00:14:51.520 shut case. We have a lot to continue to learn, but as of today, I have a really different point

00:14:56.560 of view than for the previous decade. And I don't think the jury's necessarily out that in the next

00:15:02.160 900 episodes that you do going forward, you'll probably have a few that are on metformin and

00:15:07.360 you may change your thinking on it down the road, I imagine.

00:15:10.880 Yeah. I mean, I think one big thing that's going to be interesting is to see if TAME, 0.78

00:15:14.660 which is the study that Nir Barzilai spoke about on our podcast, does TAME actually get funded?

00:15:18.800 Because again, if TAME is done correctly, it's really not going to be weighted towards people

00:15:24.980 with diabetes. It's going to be looking at people without diabetes and asking the question,

00:15:28.940 can this extend life indirectly via mitigating the onset of chronic disease? So in the end,

00:15:35.380 nothing matters more than that is health span and lifespan. All of these other things that we're

00:15:39.820 looking at, such as lactate levels and zone two efficiency or muscle mass, those are proxies for that.

00:15:45.980 So in a large enough study, if we could actually go after the thing that matters,

00:15:50.160 that would hold great weight.

00:15:52.320 Okay. So I'm going to bring in a little social media into this. On Instagram, I think it's pretty

00:15:57.360 clear that anybody who follows you, that you recently got a dog. You're snuggling up with that

00:16:01.940 pup. And along the same lines, have you changed your mind on having a dog? Because I believe in some

00:16:07.280 of the podcasts, maybe we've talked about in the AMAs and other times about the reluctance to get a dog

00:16:12.060 and maybe you caving at some point down the road. Yes. We do have a puppy. Four weeks ago,

00:16:19.820 we got her, little Molly. And you are absolutely correct that, remember that scene in Planes,

00:16:26.900 Trains, and Automobiles when, I think it was John Candy's character who says something to the effect

00:16:31.660 of, if I'd woken up with my head sewn in the carpet, I would have been less surprised. Remember

00:16:35.840 that line? I think I thought the day that we were going to get a dog was never. I just thought it'll

00:16:43.720 never happen because I don't have the bandwidth to absorb any additional work. My wife is already 1.00

00:16:51.720 functioning at the level of three wives. And it's just like, why would we do that to ourselves?

00:16:58.260 And even though our daughter was the one begging, it's not like she can take care of a dog when she's 0.88

00:17:04.280 at school or whatever. So I was just like, no, this is never going to happen. And then I don't know

00:17:08.860 what, I mean, I just don't know what happened for lack of a better way of describing it. Somewhere in

00:17:14.300 there, the resistance just weakened. And I was in Australia and I must admit prior to that Australia

00:17:24.060 trip, we had gone and looked at a couple of puppies in a dog shelter nearby. And I must admit there were

00:17:31.900 some cute little puppies in there, but I still kind of came away from that experience thinking

00:17:35.880 we just need a couple more years. We just need the two guys to be a little bit older and

00:17:41.760 a little less dependent on us. And then somehow they just went to the dog shelter. When I was in

00:17:49.580 Australia, they FaceTimed me from there and said, there's this little girl, little puppy, Molly,

00:17:55.920 she's perfect. And they gave me all the reasons why she was perfect. And I actually went out to

00:18:04.340 social media to seek an opinion. This was like one of the few times social media was actually helpful

00:18:08.660 because this puppy was the runt of her litter and she was visually impaired. And I really wanted to

00:18:17.920 know if we were biting off more than we could chew. And so I asked that question broadly and the

00:18:21.920 feedback was overwhelming actually, both on Twitter and Instagram. And people said, she's going to make

00:18:26.560 an awesome puppy. And I will say this a month in, it's way more work than I expected. And not so much

00:18:32.700 for me, but certainly for my wife and for my daughter and for me too, but I'm taking on 10% of the additional

00:18:39.400 work. But I think people were right that a dog that doesn't see perfectly, perhaps coupled with some

00:18:46.980 other characteristics of just being a rescue dog. She's amazingly gentle and sweet and kind. And 0.75

00:18:55.340 I don't know. So I don't regret it, even though it's harder than I thought it would be. And there

00:19:01.580 have been a number of accidents that have required significant cleaning, but I think I'm getting the

00:19:09.360 point that people had been trying to make for years when I had been saying, why would anybody get a

00:19:16.460 dog? Which is, I think there are these intangible benefits that come from a dog that you don't

00:19:21.320 appreciate. If you try to just think about it with your logical brain, you guys have a dog, right?

00:19:25.880 We do. The dog has passed. We're going to get another one. But yeah, I mean, I definitely share

00:19:30.820 your feelings about it. It's funny. It sounds a lot like having a kid where you think you get older.

00:19:37.980 I think if you don't pop one out when you're younger and you're older, you're trying to think of like,

00:19:41.640 when's the right time? We need to line up all these things. It's just like, there's never the right time.

00:19:46.460 Although probably any time is probably the right time if you don't have a kid and then you raise

00:19:50.920 that child. And there are probably accidents along the way as well, whether it's a dog or a person.

00:19:56.300 This is completely inappropriate, but I thought of it when you were talking about loving a dog.

00:20:00.380 This is a joke. This is not my joke. It says, want to know who loves you more? Put your spouse and

00:20:05.500 your dog in the trunk of a car and drive around for an hour. When you open the trunk, who's happy to see

00:20:10.880 you? I honestly, I think like that joke, I don't know. I'd heard it recently, but I would always be

00:20:20.380 amazed that you just think of like dogs and you come home every single day. And it's like,

00:20:24.100 you went to Afghanistan, a tour of duty for three years and you came back and you get that kind of

00:20:29.280 reaction every single day. And it's pretty amazing. I'm a big fan. So I have a...

00:20:36.880 So I'm in the club now.

00:20:37.900 Yeah, I'm in the club. It was interesting too. I caught one thing, which is great is that

00:20:41.940 when people ask you, where does Peter Atiyah get his second opinions, you can say Twitter and Instagram,

00:20:46.820 which is a nice thing.

00:20:49.980 When it really counts.

00:20:53.440 We're going to go back to the pharmaceuticals. We've got rapamycin.

00:20:58.380 How have your feelings changed on this one?

00:21:00.340 Well, this is sort of been another area of real interest of mine for many years, not quite as far

00:21:09.480 back as the sort of Metformin interest, which started, I think around 2010, 2011 for me, but

00:21:15.720 probably by about 2012 and certainly by about 2014 when the first, that sort of really interesting

00:21:25.560 Everolimus paper was published by Joan Manick, Lloyd Clickstein and others in December of 2014.

00:21:34.480 That was a real, real peak to my curiosity. That was a paper that showed that the strength of

00:21:42.820 vaccination in healthy subjects who were, I believe about age 65 could be augmented by basically a

00:21:51.980 rapamycin analog, which again is counterintuitive, right? That's the adaptive immune system getting

00:21:58.420 better with rapamycin. Very counterintuitive because of course, rapamycin's on label use

00:22:05.700 is specifically to suppress the adaptive immune system. And that's what makes it such a efficacious

00:22:13.800 tool for mitigating organ rejection. But of course, what that study would show was a couple of things,

00:22:20.680 which is there are different ways that you can dose it. Two of the three treatment arms in that

00:22:26.660 study were only being given rapamycin once a week, one at five milligrams, one at 20 milligrams,

00:22:31.980 by the way, I said rapamycin. I almost use Everolimus and rapamycin interchangeably, but it was not

00:22:38.200 rapamycin. And that study was sort of the turning point for me. And what it really led to was the next

00:22:49.140 four years, just a deeper and deeper look into all of the literature. We've had, I think, two podcasts

00:22:59.360 that have been dedicated to rapamycin and mTOR, one with David Sabatini, one with Matt Caberline. I feel

00:23:05.080 like we're overdue for another one, by the way, because I know those were very early.

00:23:08.540 Yeah. A little inside baseball, but those interviews were, I think, like in 2017.

00:23:14.020 That's right.

00:23:15.240 That was at Sabatini and it was the summer. We went over there, you gave a talk.

00:23:19.020 That's right.

00:23:19.580 Talked to some autophagy geeks.

00:23:21.380 Yep. August of 17. So we're way overdue to go back and revisit that. But basically just more and

00:23:28.460 more data, both in animals and in humans, really got me to a point where I felt really comfortable

00:23:36.880 that one, I was taking enough, because you've probably heard me talk about this before, that

00:23:41.780 you always think of two risks when you're taking a medication that you don't have an immediate

00:23:47.560 biomarker for. So if you're talking about taking a statin or taking a PCSK9 inhibitor, well, you have

00:23:55.420 a very clear biomarker that at least tells you if the drug is working. And similarly, you have either

00:24:02.340 clinical signs or biomarkers that tell you if things are going awry. Clinical signs might be, you know,

00:24:07.960 muscle aches and you might see outside of complete breakdown of muscle, you might still see

00:24:13.980 significant elevations of CK or significant elevations of liver function tests or things

00:24:19.000 like that. You have some sort of bearing on either symptoms that would cause you to revisit your

00:24:25.160 decision to use the medication or lack of efficacy or other signs that tell you, hey, this isn't a good

00:24:31.520 idea. But with rapamycin, you don't have any of that. I mean, on the symptom side, obviously,

00:24:37.540 if you take too much, you're going to start to see some of the symptoms like mouth sores and things

00:24:41.460 like that. But you don't really know if you're taking enough and you don't know if you're taking

00:24:46.400 too much beyond some of those symptoms. And so you really have to be able to triangulate on what the

00:24:52.360 right dose is. And so that's what basically took me about four years. Once I sort of felt like,

00:24:58.980 I think this makes sense, there was still, I couldn't quite get to the point where I could

00:25:04.820 understand what to do, how to do it. And I think that was sort of the big switch that flipped in,

00:25:10.740 well, probably about 18 months ago, kind of in the fall of 2018. And I would still say that here I am

00:25:15.960 a year and a half later, I'm still really eager to figure out ways that we can have biomarkers that

00:25:23.700 can lend some insight into this. Probably more so on the efficacy side, there's still a lot of

00:25:31.000 questions I have on the use of rapamycin, even though I'm using it. I sort of cycle it a little

00:25:36.900 bit. I think there's lots to be asked there. Is it the right cycling? Is it the right period? Is

00:25:43.200 the right on versus off? All of those things are, we don't have enough answers yet, but my convictions

00:25:48.660 are now high enough on the side of something that looks like what I'm doing right now is probably

00:25:53.960 beneficial. One thing interesting too, just about the metformin and rapamycin is, I think you might've

00:26:00.520 talked about this with Nir. That was like January of last year. So about a year ago is him and a few

00:26:08.420 other colleagues. I think Steve Ostad was one of them. They were talking about what is the trial

00:26:12.700 that we want to do? And I think there was a lot of debate and healthy conversation around whether

00:26:17.640 they should use metformin or rapamycin. And I wish that there was enough resources in the world to try

00:26:24.060 both, but it sounded like they had to do one. Then it was metformin. Yeah. I remember actually

00:26:30.160 having that discussion with Steve Ostad over dinner about four years ago at the time before TAME had

00:26:36.300 been fully formulated and saying, if you're only going to get one bite at this apple, rapamycin might

00:26:41.880 be the more interesting agent to study. I think their concern was the monitoring was going to be more

00:26:47.340 complicated. Just the economics of trying to understand how the immune system was potentially

00:26:54.780 changing was going to make that sort of cost prohibitive study, unfortunately.

00:26:59.080 On the subject of apples, I don't know why this is apples. I think of archery and shooting an apple

00:27:03.960 on someone's head, but are you still practicing archery?

00:27:07.760 I am. I practice a lot. I think archery and driving are the two things that I really sort of

00:27:14.940 just try to carve out time for every single day that I'm not traveling.

00:27:19.160 Luckily, I travel a lot less than I used to, so that means more practice.

00:27:22.980 How do you think that goes? I was just thinking that in terms of getting better,

00:27:25.580 the more you practice it, is it just, do the gains become more and more incremental,

00:27:29.220 or do you always feel like you're learning something each session, so to speak? And I mean,

00:27:33.860 just in terms of archery, I think it's more objective where maybe you can take your score and say,

00:27:39.020 on average, I'm improving over time with those things.

00:27:41.380 Yeah. I mean, I think they're both so different and yet so similar. I think that with archery,

00:27:48.140 it's so hard to explain how addictive it is if you've never done it. But I think anybody who's

00:27:52.740 fired a compound bow, I think most people are like, oh, wow, I can see why this is really something

00:27:58.780 else. First of all, there's no ceiling to how much one can improve. That's the beauty of something

00:28:04.820 like this is you have so much ability to measure how you're doing that you can never say, I've kind

00:28:12.400 of plateaued, you know, I've kind of hit my limit. Like there's just always a place to go up. And

00:28:18.400 really it's many different sports in one. There's sort of, there's the indoor target, you're shooting

00:28:23.820 at 20 yards and at 20 yards, you're expected to be able to hit something the size of a quarter.

00:28:28.980 So if you think about that, something 60 feet away, you have to be able to hit a quarter 60

00:28:33.540 feet away. And in a perfect round, you would take 60 shots and do that 60 times. How many times do

00:28:41.720 you think I've done that so far, Bob? A hundred. Zero. See what I did there? Very nice. Very nice.

00:28:49.020 Yes. The hundredth episode. No. So I have yet to score a perfect 300 round, like a perfect 360 round,

00:28:56.580 which is what that would be. So anyway, it's meaning all 60 were in the tiny little X. And to

00:29:02.720 be clear, there are days when I find that fact infuriating. Like there's times when I get so

00:29:07.620 close and then I blow it at the end. And then there's times I just blow it in the first shot

00:29:11.900 and I'm like frustrated and I don't even want to finish. But you also realize that archery is kind

00:29:17.920 of a great metaphor for life and you can't focus just too much on your target. You really have to

00:29:24.400 focus on the process or you're not going to get better. So one of the things we do a lot in

00:29:28.120 archery is called blank bailing, which is taking a shot at a huge target. Like there are these big

00:29:34.140 bales without actually looking at a target, like literally not having a target there. So there's

00:29:40.540 nothing for you to fixate onto so that you can just go through the sequence. And when I'm traveling,

00:29:46.040 I take this thing called a shot trainer with me, which is like a little string attached to

00:29:52.220 something that sits in your hand that sort of mimics the feeling of the riser.

00:29:56.640 And I'll take maybe 20 to 40 shots a day in my room, hotel room or whatever, that are obviously

00:30:04.220 not aimed at a target or not doing anything, but just going through the muscle memory of where are

00:30:09.260 my feet? Where is the pressure on my hands? How am I feeling the contraction of my rhomboid? All those

00:30:15.300 sorts of things. Again, if you're listening to this and you're thinking, oh my God, how did that guy

00:30:20.600 just manage to waste the last three minutes of my life telling me that? Again, I don't think you have

00:30:26.000 to like archery to appreciate the notion of mastery. And I do think that as people, we sort of crave

00:30:35.440 getting better at something. And that can be lots of things. It doesn't just have to be sort of a

00:30:41.240 physical domain. It can be an intellectual domain. It can be an emotional domain or a relational domain.

00:30:46.000 But anyway, for me, this habit with archery, this curiosity started three years ago.

00:30:52.360 And now it's something I can't imagine. If a day goes by that I don't do it, I feel like I'm missing

00:30:58.020 something. I think there's something to that process. I mean, I think about my childhood,

00:31:02.820 the intellectual pursuit. I just always, I had these things uncoupled that I just wasn't very good.

00:31:08.160 I was not a very good student. 1.44 grade point average in high school.

00:31:12.360 So what?

00:31:13.180 Don't fire me.

00:31:15.380 That's actually really hard to graduate with that kind of GPA.

00:31:17.960 It's not just hard to graduate. How do you even get a grade point average of 1.44?

00:31:21.600 The secret is not showing up. That's how you do that.

00:31:25.260 What were you doing?

00:31:27.660 Having fun. At least what I thought was having fun at the time. But I was also,

00:31:31.900 I guess, to the larger point here, not get into my childhood too much.

00:31:36.380 Wait a minute. You can't throw out the 1.44 without explaining it, but okay.

00:31:39.860 Yeah. I was also playing hockey and that's a totally different sport, but I excelled at it.

00:31:46.940 And I went through the, like, you don't automatically excel at a sport like that.

00:31:50.620 I probably, particularly in Massachusetts, like you got to really work at it.

00:31:53.860 And it instilled a lot of stuff in me. And I never made the connection until later in my life

00:31:57.880 that intellectual pursuits and educating yourself and things like that, it's not very much different. 0.96

00:32:03.580 It's like, in order to be good at blank, you are going to suck at blank.

00:32:07.660 Like, if you have a few of these victories, Peter, you have so many of these things.

00:32:12.260 I think you're, in a way, obsessed with mastery and you have so many different things that you've

00:32:16.200 pursued excellence in that you realize, even if you have no idea what this thing is,

00:32:21.480 if you put the time and the effort in, that you can get better at it.

00:32:25.160 And so I would just, I would put a plug in for anybody at a younger age.

00:32:28.240 Maybe it's like, I never thought about musical instruments that way, but maybe it is.

00:32:31.580 It's like, I know Olivia plays the drums and that's something you first start and you're

00:32:35.500 just like, you can't keep a, can't keep a beat and then check in a few months later and

00:32:41.280 you can see that progress and you just know that work and work and effort and time.

00:32:45.920 I mean, it sounds like grit, those kinds of things, but they apply to so many different

00:32:49.500 things.

00:32:50.180 And just with this podcast is, I mean, I think there's a parallel there with all the episodes

00:32:54.200 and all the, all the information that goes into the prep with the guests.

00:32:57.980 And I think that you have a predilection to guests who have a healthy obsession, let's

00:33:03.420 call it healthy, a healthy obsession with these topics as well.

00:33:06.120 And they just, they know a lot about these things, probably through similar practice with

00:33:11.000 those things.

00:33:11.940 It's funny you bring that up, by the way, I actually had this discussion with Olivia two

00:33:15.800 days ago and I don't know why, oh, I know how it came up.

00:33:18.980 We were sitting there at dinner and I was just sort of complimenting her on how

00:33:23.460 impressed I was with how hard she's been studying this year, which was a real switch

00:33:29.920 that flipped in her.

00:33:30.900 And it's like, you don't have to ask her to do her homework.

00:33:33.840 She just wants to do it.

00:33:35.520 And she makes cue cards and is always like just going out of her way to really try to

00:33:40.560 learn stuff in a way that I just didn't see her doing before.

00:33:44.120 And so I was just saying, hey, that's so great, blah, blah, blah.

00:33:46.020 And then she sort of asked me, she's like, well, when you were my age, how much did you

00:33:49.860 study?

00:33:50.240 And I was like, Olivia, you have no idea.

00:33:53.980 You couldn't have done less than I did. 1.00

00:33:56.040 I was categorically a moron in school. 0.99

00:34:00.200 Again, there's a fine line there. 0.99

00:34:02.060 And really what it was, was I wasn't interested in what was happening.

00:34:05.400 And so my interests were elsewhere.

00:34:07.140 But the point I made to her is exactly the point that you made, which was the reason that

00:34:12.460 I was ultimately able to do well in school was fortunately I had spent all of that time

00:34:16.920 still trying to master something.

00:34:19.920 And it was that sort of pursuit of that that became transferable.

00:34:24.240 And so I agree.

00:34:26.700 I just think I do pity the person who's never found it interesting to try to get better at

00:34:33.160 something.

00:34:33.920 And to be clear, you can take it too far.

00:34:36.280 I don't consider archery for me to be the greatest form of recreation because I am very internally

00:34:43.600 competitive and I'm sometimes too focused on the result and not the process.

00:34:54.000 So there are days when archery is like meditation to me, just being out there just feels so amazing

00:35:00.140 and the sun is shining and the wind is blowing and I can sort of disregard the outcome, but

00:35:07.320 that's not often the case.

00:35:08.800 And so I, when you think about the podcast with Ryan Holiday, where we talk about stillness,

00:35:12.840 I would say that archery for me does not constitute stillness because stillness can't really have

00:35:20.260 an objective.

00:35:20.820 And I think for me, archery carries with it too much of an objective.

00:35:25.140 So I still think that one has to have those other things in there.

00:35:30.380 This is sort of funny.

00:35:31.140 I didn't even think of it this way, but I think this is one thing I've noticed about having

00:35:34.240 a puppy, frankly.

00:35:35.400 A puppy is as kinetic as she is.

00:35:38.440 It is kind of a form of stillness for me, like taking her out and walking her and picking

00:35:43.080 up her poop. 0.98

00:35:44.480 There's nothing else to be doing and there's no outcome associated with it. 0.98

00:35:48.540 There's no objective.

00:35:49.460 It's literally just a forced reason to be outside and to be observing the completely

00:35:57.920 comical nature of a puppy.

00:36:00.780 So yeah, I think it's funny, even though we didn't pose it this way.

00:36:06.080 If you want to ask me about another really big change in the way I think about things

00:36:11.680 over the past couple of years, it's a huge appreciation for how essential it is to have

00:36:18.260 something that is not object-oriented, outcome-based in your life.

00:36:24.060 Like not everything in your life can be outcome-based.

00:36:27.080 I've recently gone back to swimming, actually.

00:36:29.180 This might be a good segue to another topic, but it's funny when you were talking about

00:36:33.460 stillness and how some of these little things that you don't even realize are stillness or

00:36:37.440 stillness.

00:36:37.920 I was going to use the example of washing dishes and then I realized you've got the

00:36:41.680 forks and spoons and knives game.

00:36:43.820 So you turned that into a competition.

00:36:45.640 Even though a lot of people just wash the dishes and it's like, it's therapeutic for

00:36:49.120 them because it's stillness for them.

00:36:50.260 Yeah, yeah.

00:36:50.640 You turned it into a competition.

00:36:52.380 But things that were once like, you know, I was saying a second ago, I mean, even swimming

00:36:55.060 for me now is something that is really a form of stillness.

00:36:58.280 So I just started swimming again a couple months ago and I go like once a week and I don't keep

00:37:06.200 track of how far I'm swimming.

00:37:07.820 I know I'm not swimming too far.

00:37:09.900 I'm in the water maybe 45 minutes to an hour and all I'm doing is swimming.

00:37:15.640 I'm not doing workouts.

00:37:17.840 I'm not looking at the pace clock.

00:37:20.120 I'm not doing intervals.

00:37:21.860 I literally just get in the water with no agenda other than to get wet and hear the sound

00:37:27.600 of water going by my ears.

00:37:29.460 Probably I'm not even swimming hard enough to get into zone two, truthfully.

00:37:32.760 I doubt my heart rate's above 120.

00:37:35.600 That's the next topic.

00:37:36.860 Yeah.

00:37:37.100 That's where I think this is a good segue.

00:37:38.620 All right.

00:37:38.820 If you think about it, you can talk about it, but I think that's one of the things is

00:37:42.940 like a governor putting a rate limiter on your performance when you do zone two, that it's

00:37:48.180 almost like for a lot of people it is.

00:37:50.040 For me, doing this reminds me kind of of stillness, although I might read on the bike or things

00:37:55.180 like that.

00:37:55.720 But can you talk about zone two importance and how your thinking has changed on that?

00:37:59.400 Yeah, when I stopped riding a bike with a purpose, which was for me a time trial, so that would

00:38:06.000 have been late 2014, early 2015, I kind of really just stopped doing any low intensity

00:38:14.400 aerobic training.

00:38:15.680 So anyone who does ride a bike or swims a lot has plenty of that activity in them.

00:38:21.540 So even if you're training for the 200 meter individual medley, which is a race that's very

00:38:27.840 short, very quick, and very painful, you still put in hours and hours a week of aerobic-based

00:38:33.120 training.

00:38:33.660 Similarly, if you're training for a one-hour all-out time trial, you still put in hours

00:38:39.900 a week of low-end aerobic-based training.

00:38:43.300 But when I stopped doing that, I was like, well, I don't need to do this anymore.

00:38:46.920 And I went from cycling to rowing and running.

00:38:52.120 And I was sort of obsessed with just being as efficient as possible.

00:38:57.600 So everything was all out.

00:38:59.360 I mean, if I was running, it was going to be a six-minute mile.

00:39:02.480 It wasn't going to be a nine-minute mile.

00:39:04.340 I think especially through the interactions that I had with Inigo, who I met about a year

00:39:12.220 before I had him on the podcast, which was just recently, it was sort of meeting him and

00:39:17.900 kind of going back through the literature on that type of training and the benefits that

00:39:25.600 it could have, both from the standpoint of metabolic benefits such as glucose, insulin-dependent

00:39:31.160 and insulin-dependent glucose-mediated disposal, looking at just sort of mitochondrial function,

00:39:37.700 mitochondrial health density, and then looking at sort of the sort of neurotropic factors,

00:39:42.460 the BDNF secretion that can come from this type of activity.

00:39:45.060 All of these things were just pointing towards this was a glaring hole in my training that

00:39:52.040 I needed to get back.

00:39:53.720 And so that has been great.

00:39:55.060 And like you said, I mean, one of the things about Zone 2 that I really enjoy is it's just

00:40:00.240 not that hard.

00:40:01.680 You know, like frankly, sometimes it's just nice to get on the bike and I probably spend

00:40:06.560 three or four hours a week doing it.

00:40:08.220 And that is my time to listen to podcasts and audiobooks.

00:40:11.140 And I really enjoy it.

00:40:12.480 I can't wait to get on that bike.

00:40:14.480 As sort of boring as it seems to be sitting on a stationary bike for that long, there's

00:40:19.480 never been a day when I've been like, I don't feel like doing this.

00:40:22.120 I just, I always look forward to it.

00:40:23.200 And I think in large part, it's because I also get to combine it with learning, which

00:40:28.300 you wouldn't be doing if you're out there crushing intervals.

00:40:30.720 And not that there's something wrong with that.

00:40:32.280 I think each of these things has this time and a place, but I think that we can do Zone 2

00:40:37.060 our entire lives, we can do it safely and it just yields enormous dividends.

00:40:43.840 What's nice about that too, for I think a lot of your training is you've got the smart

00:40:47.120 erg, so you can tie yourself to the mast that the output, whether you pedal faster, it's

00:40:52.600 going to give you the output that you pre-desired.

00:40:54.860 So you can't start cheating, which is what I find myself doing when I don't have it on

00:40:59.200 smart, just the erg that I find myself pedaling faster, just unconsciously, just wanting to

00:41:04.580 push myself harder.

00:41:05.840 Do you use a Wahoo Kicker?

00:41:07.440 What's your device?

00:41:08.620 Are you on a Wahoo Kicker?

00:41:09.860 Yeah, a Wahoo Kicker.

00:41:11.220 So you can set it to either smart or set it at a certain level.

00:41:15.140 Yeah.

00:41:15.700 Yeah.

00:41:16.480 I love my Wahoo Kicker.

00:41:18.360 Yeah, me too.

00:41:20.040 Did you ever have a CompuTrainer back in the day?

00:41:22.560 I did, yeah.

00:41:24.360 I had it on an old Windows computer, I remember that.

00:41:26.620 I had the little CompuTrainer and then it's connected to the bike trainer.

00:41:30.860 Yeah.

00:41:31.000 I tried simulating the Tour de France one year, just in terms of the time.

00:41:35.320 Yeah.

00:41:35.620 So I talk about the time over summer, I had a bucket.

00:41:38.880 My wife now, I can't believe she's my wife now. 1.00

00:41:41.120 I was living in Las Vegas and it was the middle of our, I would sit in our apartment with a

00:41:44.580 bike trainer and had a bucket with ice of water bottles and things like that and eggs.

00:41:50.500 I would think I was doing a ketogenic diet.

00:41:51.880 So I was eating eggs at the time, but I don't know if that was stillness.

00:41:56.280 I wasn't going anywhere.

00:41:57.460 It was stationary biking.

00:41:58.300 So on this topic, moving along, the importance of deadlifts as an adult, how has your thinking

00:42:05.260 changed on this?

00:42:06.260 I like your history on this one.

00:42:07.460 So maybe even take it back to in school when you were doing powerlifting before it might

00:42:12.760 have been in vogue.

00:42:13.880 Yeah, yeah.

00:42:14.420 Long before it was in vogue, one of my best friends in high school who was also involved

00:42:19.820 in boxing and martial arts, we would go to the Scarborough campus of the University of

00:42:24.640 Toronto every day and lift weights.

00:42:27.100 And it was, it's still one of the fondest memories I have of what a gym could be like.

00:42:33.220 It would certainly be the, it was certainly not the sunny, warm golds in Venice, but it

00:42:40.240 had some of those features, which was old school, lots of iron, nothing fancy.

00:42:46.380 Of course, unlike a nice gym, this was like two stories below ground.

00:42:50.660 So there were no windows, poorly ventilated.

00:42:53.520 So in the summer, it was staggeringly hot.

00:42:57.180 In the winter, it was so cold.

00:42:58.780 You felt like you were getting frostbitten by touching the iron.

00:43:02.440 And aside from me and my friend, there were no kids there.

00:43:06.180 We were 14, 15, 16 years old.

00:43:08.240 And it was this group of men who to this day, I think back and like, can't believe how strong

00:43:15.380 they were.

00:43:16.340 And most of them competed in powerlifting.

00:43:18.580 And so that sort of got us interested in powerlifting.

00:43:21.080 And that's how we sort of started putzing around with it.

00:43:23.780 And as most people know who are listening, or I guess people might know who are listening,

00:43:28.420 powerlifting is different from Olympic lifting.

00:43:30.800 Powerlifting is three lifts, the deadlift, the squat and the bench press.

00:43:34.840 And so yeah, make a long story short, grew up doing a lot of deadlifting, a lot of squatting,

00:43:39.720 a lot of bench pressing.

00:43:40.820 Was always very horrible at bench press, much better at squatting and deadlifting.

00:43:45.720 Fast forward to, I don't know, a few years ago, maybe three years ago, I had an injury

00:43:53.240 where I kind of tore or partially tore one of my obliques.

00:43:59.560 I don't even remember how I did it. 0.98

00:44:01.300 I remember it was very stupid, whatever I did. 0.97

00:44:03.660 And everything went- 0.98

00:44:05.500 Tearing a phone book?

00:44:08.600 That would be great.

00:44:09.440 Possible.

00:44:09.720 But everything went kind of sideways after that.

00:44:12.720 And I really was never able to fully deadlift again without some discomfort.

00:44:19.440 And so again, this is now take it back to maybe 2016.

00:44:24.380 I sort of decided, you know what, maybe the deadlift has reached its point of futility and

00:44:33.580 maybe I've extracted all I'm going to out of that.

00:44:36.840 And there's no denying what a wonderful movement it is in terms of being a total hip hinge compound

00:44:42.960 movement.

00:44:43.360 But I was like, look, I could probably get most of the benefits of a deadlift doing things

00:44:48.380 that place me under less load.

00:44:50.880 And also, again, in the spirit of thinking about longevity, I thought, why does one need

00:44:55.180 to subject themselves to twice their body weight or more in an axial load?

00:44:59.840 So I sort of got away from it.

00:45:01.680 And then I think all that kind of changed when I started DNS, Dynamic Neuromuscular Stabilization,

00:45:07.560 which I started about 18 months ago.

00:45:09.540 And we're going to have a podcast on this topic because it's just, there's so much I

00:45:14.740 want to talk about here.

00:45:16.080 And so actually, I think today we got an email about how we're trying to make some time for

00:45:20.640 this podcast.

00:45:21.140 So we'll definitely, if you're listening to this and you don't know what DNS is, Dynamic

00:45:24.440 Neuromuscular Stabilization, by all means, you should go read about it.

00:45:27.440 But we're going to have at least one solid podcast on this.

00:45:30.800 But it was through that process that I realized, actually, the deadlift for me was going to be

00:45:37.500 beneficial, not because of the metabolic benefits.

00:45:41.280 I was not going to be doing Tabata deadlifts like I used to, or even by trying to set records

00:45:47.140 for how much I could lift or anything like that, but rather because it becomes a beautiful

00:45:51.760 audit for everything working perfectly.

00:45:54.740 So I deadlifted this morning.

00:45:56.640 So today's a Monday.

00:45:57.860 I deadlifted on Saturday.

00:45:59.240 I deadlifted a few days before that.

00:46:01.260 Like I deadlift at least twice a week, often three times a week, both straight bar and trap

00:46:06.720 bar and Bob, I don't go that heavy.

00:46:09.740 I don't know the last time, maybe I've had 400 pounds on one of those on the trap bar in

00:46:15.180 the past year, but I usually sort of stop at about 350 to 375 on the straight bar.

00:46:22.860 I'm even lighter, maybe 185.

00:46:25.320 I do a lot of slow eccentrics.

00:46:29.020 I film every single rep of every single set and I study it and I send it to Beth Lewis,

00:46:37.820 who is my coach.

00:46:40.120 And we do so much around making this deadlift perfect.

00:46:46.440 And I'd rather take a lightweight and deadlift it perfectly several times a week.

00:46:52.660 And I'm not doing like killing crusher sets.

00:46:55.140 Like, I mean, it's today was four sets of 10, five sets of 10, maybe.

00:46:59.460 And at no point was I like past my limit.

00:47:02.420 So again, I can push myself harder doing other things, but what I could get out of doing that

00:47:07.620 deadlift perfectly is do I have just the right amount of thoracic extension?

00:47:13.820 Do I have just the right curvature in the lumbar spine?

00:47:17.320 Am I activating my glutes?

00:47:20.340 Am I activating my hamstrings?

00:47:22.700 Am I pulling back instead of pulling up?

00:47:25.100 Am I wedging correctly?

00:47:26.820 Like all of this little stuff translates biomechanically to the activities of daily living that matter

00:47:33.440 to me, like getting up off the floor, picking up one of my kids, lifting a piece of luggage

00:47:39.620 or something like that.

00:47:40.800 And so if I can do the deadlift and it feels right, then I know I'm ready to do everything

00:47:46.440 correctly.

00:47:47.060 And when I'm deadlifting and I feel like, hey, this isn't correct, this doesn't feel right.

00:47:51.600 Well, first of all, now I've really learned what that feeling is.

00:47:54.200 And secondly, I've now learned the steps that I can go back and reconstruct what needs to

00:48:00.140 be done.

00:48:01.000 And so one of the things I definitely want to do at some point in the next year is actually

00:48:04.580 put together kind of a video on deadlift and deadlift preparation.

00:48:08.560 Because I think that there are probably 10 exercises that I do as a way to get ready to deadlift.

00:48:15.580 And they don't take long.

00:48:16.760 Like this, my deadlift checklist is like 10 to 15 minutes.

00:48:19.720 So it's not so onerous.

00:48:21.960 It's almost like ketosis the way we were talking about it in the past, right?

00:48:25.480 Which is, it's not even clear if it's the ketones themselves that can sometimes be the

00:48:30.740 benefit versus the metabolic conditions that allow you to make them, right?

00:48:35.280 In other words, I'm not even sure how much of the benefit is the actual deadlift versus

00:48:40.480 all of the things you have to do to do the deadlift correctly.

00:48:43.080 And one of the most exciting things just on this, the last thing I say on this is it never

00:48:49.060 occurred to me up until a year and a half ago that you could actually deadlift in a way

00:48:53.220 that puts your spine under traction.

00:48:55.760 That's very counterintuitive.

00:48:57.560 You would think that anytime you're lifting under an axial load, your spine is under compression.

00:49:02.320 But it turns out when you learn the right positioning and you understand how to create

00:49:07.840 intra-abdominal pressure and you know how to elongate your spine, you can actually deadlift

00:49:13.820 and create traction in the spine actively.

00:49:16.640 And that's why deadlifting is the most important thing I do before I get on an airplane.

00:49:22.320 Because when you're on an airplane and you're sitting there for five or six hours, what you

00:49:26.160 really want to do is not let your spine be compressed.

00:49:29.120 And the deadlift primes me to then go and sort of maintain that activated form of traction.

00:49:37.240 Yeah.

00:49:37.480 It's a significant investment, but I would say it's worth it that you'll bring your hex

00:49:41.180 bar to the gate before your flight and pump yourself up and bang out a few sets.

00:49:47.140 I mean, I don't know what it is about the TSA guys.

00:49:49.200 They get so wigged out when you have your hex bar there at the gate.

00:49:52.080 Putting that overhead?

00:49:52.940 Yeah.

00:49:53.260 Yeah.

00:49:54.000 If you're TSA pre, they don't mind as much.

00:49:56.420 But if you're not TSA pre, they just lose it.

00:49:59.220 Sticklers.

00:49:59.860 They're sticklers.

00:50:01.120 Yeah.

00:50:02.120 Separate topic.

00:50:03.320 A little lighter, maybe.

00:50:04.880 Have you read any good books lately?

00:50:07.020 I am about a third of the way through Andrew Solomon's Far From the Tree.

00:50:13.140 Have you read that?

00:50:14.140 No, I have not.

00:50:15.380 It's super interesting.

00:50:16.600 It's a long book.

00:50:17.720 So yeah, it's going to take a while.

00:50:20.220 But I've actually thought it would be probably really interesting to have Andrew on the podcast.

00:50:25.340 He's obviously just one of those guys that when you're in the process of writing a book,

00:50:29.960 you probably shouldn't be reading their books because they just make you not want to write

00:50:34.500 yours anymore because you're so bad. 0.89

00:50:36.200 You're like, oh, how does he do it?

00:50:38.180 It's like Sid Mukherjee.

00:50:39.420 You know, it's just one of these people who are just so, so exceptional in their ability

00:50:43.500 to write.

00:50:44.320 Not a word is wasted.

00:50:45.740 Everything is just perfect.

00:50:48.120 So prior to that, I reread Stillness is the Key for the third time.

00:50:53.280 I know we interviewed Ryan a few months ago.

00:50:55.800 That is a book that has just spoken to me probably more than anything else Ryan has written.

00:51:00.120 And he's written some really great books in that series.

00:51:02.860 And just overall, the other two books in that series, Ego is the Enemy, which I'm also a huge

00:51:08.160 fan of, and The Obstacle is the Way.

00:51:11.020 But Stillness is really the one that kind of captivates me.

00:51:13.700 And that's why I've just finished it for a third time.

00:51:16.040 I've also gifted that book probably half a dozen times.

00:51:19.260 And so, yeah, I suspect there'll be at least a fourth reading of that book in my future.

00:51:23.620 What about you?

00:51:25.040 Good question.

00:51:25.700 So I was thinking in the context of the podcast, and there's so many books, I guess it's not

00:51:30.780 recently, but for the guests, just reading a lot of their books is, it's great.

00:51:35.280 It's a pleasure.

00:51:35.880 I actually think of Gary Taubes and how you read Why We Get Fat, and you had a list of questions,

00:51:40.000 and you asked him all those questions.

00:51:41.240 And there's a version of that where I get to read these books, and I have a list of

00:51:45.200 questions, and I'll ask you to ask the questions or ping them off of you.

00:51:50.100 So actually, what I'm reading right now, it's not out yet, but it's really interesting, which

00:51:54.860 is Vinay Prasad, who probably be right around the time of this episode, I guess, or no, we

00:52:00.540 record it around that time.

00:52:02.060 And he has a book called Malignant, which is really interesting.

00:52:05.280 It gets into public health policy and cancer.

00:52:07.360 It's funny about the books that you reread.

00:52:09.860 There's like a Taleb quote.

00:52:11.440 It's funny.

00:52:11.920 He's now like the, I would say Einstein or Lincoln, but you attribute all these kind of

00:52:16.620 quotes to him.

00:52:17.740 He has a lot of aphorisms.

00:52:20.120 Is it better to read five books or to read one book five times?

00:52:23.740 I think it depends on the quality of the book.

00:52:26.320 Azra Raza is another guest on the podcast, hasn't come up yet.

00:52:30.520 That's right.

00:52:31.140 The first sell.

00:52:31.900 We'll be talking with her very soon.

00:52:33.980 That looks like a great book.

00:52:35.760 I'm waiting.

00:52:36.600 When you had Sid Mukherjee on too, he talked about a PBS that they're going to do another,

00:52:40.080 a follow-up, which is not a book.

00:52:42.700 But for that podcast, I went back and I read The Gene and The Emperor of All Maladies and

00:52:47.660 The Three Laws, which is like a, I guess it's a TED book.

00:52:50.500 It's almost like a TED talk in a book.

00:52:52.040 And that is really, really interesting.

00:52:53.600 And you went into each law in depth there.

00:52:56.860 My thing is I usually go in the sauna about an hour a day and I either print out a stack of

00:53:02.280 papers that I want to read for research or just read a book in there.

00:53:07.080 So I should probably just write all these, put these down in a spreadsheet and see what

00:53:10.840 I'm accumulating as far as reading.

00:53:13.480 But a bunch of it has been on the podcast prep.

00:53:17.160 I also read that Stillness is the Key, which I found that's definitely worth reading again.

00:53:22.540 I've got a bunch of others, but we'll move on.

00:53:24.740 So baby aspirin and the use for prevention of blood clots or thrombosis during a flight.

00:53:32.960 Yeah.

00:53:33.560 So I used to be of the mindset that anybody who was on a flight, on a long enough flight,

00:53:39.620 should be taking a baby aspirin for prevention of deep vein thromboses.

00:53:45.020 And I just sort of assumed that that was the case.

00:53:47.960 I mean, it's widely understood that baby aspirin or aspirin in general inhibits platelets and

00:53:54.380 platelets, of course, are one of the cellular matters in blood that's responsible for clotting.

00:54:00.100 So it just struck me as sort of reasonable.

00:54:01.920 And then, I don't know, again, maybe about a year, year and a half ago, kind of did a little

00:54:07.300 digging into this and found that there really wasn't much evidence that aspirin or baby aspirin

00:54:13.720 had any efficacy in mitigation of deep vein thromboses, especially on an airplane.

00:54:19.620 And in digging around, we sort of found that, well, the gold standard would, of course, be

00:54:24.140 heparin, which could either be fractionated or ultra low molecular weight heparin.

00:54:29.660 But these are not very practical.

00:54:31.120 I mean, intravenous heparin is obviously not something you're going to do before a flight.

00:54:34.820 And even the low molecular weight heparins have to be injected.

00:54:38.080 So we found a couple of supplements online.

00:54:42.580 One was called Flight Tab, I think.

00:54:45.780 I think it was F-L-I-T-E Tab.

00:54:48.600 At the time, you could buy it on Amazon.

00:54:49.960 I haven't looked in a while to see if it's still there.

00:54:51.660 But it was a pretty potent agent that actually had pretty remarkable evidence that it prevented

00:54:58.320 DVT.

00:54:59.100 And then the other is something that is also pretty easy to get over the counter called

00:55:02.400 natokinase.

00:55:03.900 And I think that the natto is a plant. 1.00

00:55:06.280 It's plant derived.

00:55:07.480 I think it actually kind of, it's like sort of a sort of stinky odor is sort of the types

00:55:12.300 of foods that it occurs in naturally or certain types of mushrooms or, you know, cheeses or

00:55:16.000 things like that.

00:55:16.700 But these are things that actually turned out to have far more evidence.

00:55:20.860 And they were both things I'd never heard of until we sort of really dug into this question.

00:55:26.380 So that was a bit of a humbling experience because you think, well, look, on first principles,

00:55:32.120 aspirin's got to be thinning the blood.

00:55:33.620 It's got to be good for this.

00:55:35.180 And then you realize, well, wait a minute, when you, even something as simple as that,

00:55:38.860 when you actually really antagonize the literature, it turned out not to be the case.

00:55:43.680 And the things that did seem to have some efficacy are things I'd never even heard of.

00:55:47.740 So it's a little scary because it makes you wonder how many times is that happening

00:55:51.520 throughout the course of my life?

00:55:52.940 Yeah, this sounds apropos in terms of strong convictions held loosely.

00:55:59.400 You're feeling on generic drugs.

00:56:01.640 Obviously, Catherine Eban was a guest there. 0.57

00:56:04.040 What do you think prior to that and some of the stuff that you were seeing in, I guess,

00:56:08.140 the clinic or at least some of your patients and taking generics?

00:56:11.680 Yeah, I mean, Catherine's podcast is, I mean, it would be hard to say that that hasn't been

00:56:15.880 one of the 10 most important podcasts that we've done in this first hundred.

00:56:19.860 If you haven't listened to that, I suggest you just hit pause on this now and go back

00:56:23.900 and listen to it.

00:56:24.660 What number was it?

00:56:25.360 Do you know?

00:56:25.980 You can search Eban, E-B-A-N in your podcast player and it'll show up.

00:56:29.640 But I think prior to that, my view had always been generics are great.

00:56:33.460 They're the exact same as branded, except they're a fraction of the cost and branded drugs are

00:56:37.900 a scam.

00:56:39.100 That was sort of my default thinking all through medical school.

00:56:42.000 I'd say in the last couple of years, I began to wonder if maybe there were a couple generics

00:56:49.480 that weren't great because in the case of certain drugs where you do have a very clear

00:56:56.480 biomarker for use, such as a statin, you put a patient on Crestor, but of course they

00:57:02.560 don't get Crestor, they get resuvastatin.

00:57:04.380 And you look at their blood level two months later and there's no change in anything that

00:57:10.720 you would expect to see a change in.

00:57:13.220 And when you query them, they tell you they've taken it every day and you believe them because

00:57:19.220 there's nothing they need to lie.

00:57:20.900 They can easily say, I forgot if they did.

00:57:23.520 And you see a couple of those things and you start to wonder if maybe not all generics are

00:57:28.240 created equal.

00:57:28.900 But then of course, in the discussion with Catherine, I came away thinking, oh boy, this

00:57:32.700 is a totally different way of doing things.

00:57:34.240 And it's frankly, it's completely changed the way we do things in the practice now.

00:57:37.800 So we work primarily with one pharmacy that will either at our insistence or the patient's

00:57:45.140 insistence only issue branded drugs, sometimes even when it is a little bit costly.

00:57:50.280 And when we do generics, we do it through the lens of looking at the companies specifically

00:57:57.240 that make them and at least taking a first order pass at cross-referencing that with sort

00:58:03.400 of an FDA list of potential bad actors.

00:58:06.420 So I don't think that has completely mitigated the problem, but I think it's probably taking

00:58:12.960 care of three quarters of it.

00:58:14.840 Another one, this one is a omega-3 fatty acids.

00:58:20.280 Your thoughts on that, and obviously Bill Harris is somebody who came on the podcast

00:58:23.900 recently.

00:58:25.240 So Catherine Eban was number 71, that was in September of last year.

00:58:30.240 And Bill Harris was in December of last year, and he came on and talked about omega-3 fatty

00:58:36.100 acids.

00:58:37.240 So what's your take on omega-3 and how has it changed?

00:58:40.220 This is funny.

00:58:40.820 I think I'm still sort of in my evolution on this.

00:58:42.840 I mean, I think I've longly held the, for a long time held the view, longly, is that

00:58:47.320 even a word?

00:58:48.120 Did I just make that up?

00:58:49.760 Longly?

00:58:50.200 I have longly held the view.

00:58:51.960 I have for a long time held the view that EPA and DHA are beneficial.

00:58:57.620 Obviously had some questions as to, again, how much of it was the other things that you

00:59:03.880 got when you ate things that were high in EPA and DHA versus just the supplemental thing.

00:59:09.020 I would say that my thinking has evolved to the point where EPA and DHA by themselves

00:59:13.340 are quite potent drugs, and we really ought to think of them in that way.

00:59:17.360 So that, in fact, you look at a drug like Visepa, which is just pharmaceutical grade

00:59:21.900 EPA at the tune of four grams.

00:59:25.100 I mean, that is as potent as any anti-cardiovascular disease drug that we have.

00:59:31.860 So clearly EPA has a benefit to it, especially in patients that are at risk for cardiovascular

00:59:39.400 disease.

00:59:40.520 I think with DHA, the clinical trials data are still not clear.

00:59:48.160 There's a pretty interesting setback on a clinical trial in the fall that was looking at a combination

00:59:53.700 of EPA, DHA, and it was a trial that was stopped for futility.

00:59:56.960 So there was no harm from it, but there wasn't the big bang benefit that we frankly expected

01:00:02.420 to see based on the earlier trial with Visepa, which was just EPA.

01:00:06.600 I think the discussion with Bill Harris certainly increased my level of confidence in the necessity

01:00:14.180 of EPA and DHA, and also probably drove me to a point of thinking about it being a higher

01:00:19.120 level that we should strive for.

01:00:20.660 We used to generally look at an RBC or red blood cell membrane level of about 8% to 10%,

01:00:29.140 but I think I came away from the discussion with Bill Harris thinking we could really push

01:00:33.360 that up to 12%, 14% without undesirable side effects, and also getting more value or more

01:00:39.400 benefit from it.

01:00:40.940 I think one area that Bill had a very strong conviction on that I've also, I've kind of

01:00:47.340 had the opposite conviction too, so I think I'm still in the space of wanting to learn this.

01:00:51.660 So I think my strong conviction had generally been that excessive amounts of omega-6 polyunsaturated

01:00:58.640 fatty acids or PUFAs were generally not a good thing, and the associative data there is

01:01:03.780 not hard to understand.

01:01:05.600 But again, the problem with the associative data is things that are full of omega-6 PUFAs 0.96

01:01:11.780 are often crap.

01:01:13.560 So it's easy to see an association with high omega-6 polyunsaturated fat and disease, chronic 0.99

01:01:20.220 disease.

01:01:20.760 But Bill's point was that the omega-6 polyunsaturated fats aren't harmful, it's just that diets that

01:01:28.980 are rich in them tend to be void in EPA and DHA.

01:01:31.580 So his real takeaway was, don't think about omega-6 polyunsaturated fats, you just need

01:01:36.260 to add more EPA and DHA in.

01:01:38.020 That's the issue.

01:01:39.160 And so I think you and I have been talking about this actually over the past couple of

01:01:42.820 weeks, but I think I'd really like to go back and do a podcast that looks specifically

01:01:46.540 at the omega-6 polyunsaturated fatty acid discussion and really kind of dive into the whole PUFA

01:01:51.920 literature from an omega-6 standpoint.

01:01:54.720 Because again, this is a very polarizing topic.

01:01:57.720 People just on both sides of this.

01:01:59.420 Both sides, I think, have people that I think are quite bright.

01:02:01.960 So I'm a bit confused on that.

01:02:04.120 And for me, it's not really a huge issue personally because I just don't gravitate towards those

01:02:10.000 oils.

01:02:10.400 Like I find them to be kind of gross and I don't know why you'd want to consume.

01:02:15.180 It wouldn't occur to me to put canola oil on a salad when I could put olive oil on or

01:02:20.140 something like that.

01:02:21.400 So on a personal level, I think the point is somewhat moot because N6 PUFA don't make 0.97

01:02:26.940 up much of my diet.

01:02:28.360 But I do think it has huge implications for public health.

01:02:32.300 And I think it has implications for our patients when we think about people who are potentially

01:02:36.540 eating a lot of PUFA.

01:02:38.220 Okay.

01:02:39.000 One question here.

01:02:40.840 One theme in recent episodes, not overly related to medicine.

01:02:44.420 has been the idea of saying no.

01:02:46.640 I think of Jason Freed, Rick Elias, actually probably Jason Freed twice have talked about

01:02:53.820 this thing and how you viewed this sort of in the past and now today, this idea of saying

01:03:00.200 no, how good you are at it, when you think it's applicable, and if you've improved on this.

01:03:05.600 I've definitely improved on it in the sense that there was a day when I couldn't say no

01:03:09.340 or wouldn't say no to anything or anyone.

01:03:11.460 The pendulum was pretty far off on one side where I was basically on a treadmill of sort

01:03:17.340 of saying yes to anything and everything that was asked of me.

01:03:21.340 Began to realize that I just couldn't do that anymore.

01:03:24.100 And I'm getting a lot better at saying no.

01:03:28.520 And I don't think I'm doing it at a level that's unhealthy either.

01:03:32.480 I mean, you can obviously take these things to far extremes on both sides and you could

01:03:37.000 sort of say no to everything and become sort of dysfunctional in that way.

01:03:42.500 It's hard to do.

01:03:43.900 It is hard to do.

01:03:45.140 And I remember there was a podcast that there was someone that Tim Ferriss had on his podcast.

01:03:51.400 God, I want to say like a year and a half ago.

01:03:53.560 I forget the name of the person, but hopefully we'll find it for the show notes.

01:03:57.480 It was a really good episode on saying no.

01:04:00.140 And I remember that was actually the first time I started really contemplating it.

01:04:04.140 And I remember shortly after listening to it, I had someone who I really liked, respected,

01:04:09.000 called me and said, hey, I really like you to be on the board of such and such. 0.99

01:04:13.000 And I mean, deep down, I knew it was going to be a pain in the ass. 0.99

01:04:18.060 I knew it was just going to be so much work. 0.99

01:04:21.340 And even just the travel of getting to the board meetings was like, wasn't in a place

01:04:25.760 where there was easy access and all these other things.

01:04:28.140 And I remember like thinking, I just, I just got to do this.

01:04:30.680 I just got to do this.

01:04:32.340 And I remembered one of the lessons in that podcast was don't answer, just say, can I get

01:04:38.300 back to you?

01:04:39.840 So I pulled the, can I get back to you on this? 0.99

01:04:42.660 And then with the benefit of a little bit of distance, I realized, Peter, you're crazy. 0.97

01:04:46.640 Like you can't possibly do this thing. 0.84

01:04:48.800 You already lament the time you don't get to spend at home.

01:04:53.220 So then the next day I just called him back and said, hey, I can't do this.

01:04:56.340 I'm sorry, but here's why.

01:04:57.660 And just like this person in the podcast with Tim said, the guy understood.

01:05:02.160 It wasn't like I'd committed some grievous, heinous crime in declining this.

01:05:07.840 So I think that's just an important thing to remember.

01:05:10.220 And yeah, I continue to look forward to refining my no saying skills.

01:05:15.660 It's interesting.

01:05:16.400 I think it's always hard for ourselves to do it.

01:05:19.140 But then when you think in the context of how you work and operate with other people

01:05:22.900 or decision-making, you'll very easily say no.

01:05:25.660 If it's whether it's like having more patience in the practice, if it's not going to benefit

01:05:29.060 what you have going on, then you're usually very matter of fact.

01:05:32.780 But I think it's almost like a, it might be like the ego getting in the way or something

01:05:36.720 where you just, you want to tackle everything.

01:05:39.240 I mean, I think it's, this is probably a little cathartic, but it's getting into some of this

01:05:42.940 research where you'll have to tell me no, as far as the deep dives and the rabbit holes

01:05:47.200 that I want to go down or say like, we're just, we're on a mission.

01:05:50.540 I don't want to give the milk analogy, but for a lot of these episodes and a lot of the

01:05:54.440 guests, a little bit of the deep diving can help.

01:05:56.800 But oftentimes it's really about the stuff that you say no to helps shape the things that

01:06:02.220 you actually are focusing on day to day that matter.

01:06:05.440 Yeah.

01:06:05.500 That's the insight that I think Jason Freed brought to his episode really well, which

01:06:10.500 was when you're saying yes to something, you're actually saying no to something else.

01:06:14.740 You just don't know what that something else is yet.

01:06:16.900 That's a very important insight.

01:06:19.440 And again, I would, anybody who struggles with saying no, I think would, would benefit greatly

01:06:23.860 from actually both episodes with Jason.

01:06:25.600 Cause I think we touch on them in both.

01:06:27.560 Yeah.

01:06:28.580 Yeah.

01:06:28.980 It's funny.

01:06:29.300 I think of Tim Ferriss just himself talking about saying no and his evolution.

01:06:33.320 He's probably done his own podcast talking about that.

01:06:35.820 And I always think of a, I do a lot of reading on Charlie Munger and Warren Buffett, but if

01:06:39.860 you look at their schedules, they're like practically empty.

01:06:42.660 I think Munger refers to himself as like a book with legs that all he does is he just reads

01:06:48.420 and that's how he gets smarter.

01:06:49.920 And so he jealously guards his time.

01:06:52.880 You would look at the schedule and you'd say, oh, it's wide open.

01:06:55.220 It looks like, you know, if you're the secretary and say, yeah, it looks like his schedule's

01:06:58.080 wide open.

01:06:58.680 Nope.

01:06:59.280 It's more about saying no and what that schedule can be open to if you have all those

01:07:03.080 vacancies there.

01:07:04.560 Yeah.

01:07:04.780 I have great envy for that.

01:07:06.620 And I, I hope to one day get to that point where my calendar doesn't look like it does

01:07:10.280 now.

01:07:10.660 And it's much more last minute things that are being scheduled where you can actually

01:07:15.920 say like, Hey, do I want to have this meeting tomorrow?

01:07:18.600 As opposed to, do I want to have this meeting in three months?

01:07:21.060 So I think maybe one more question, if you want to take it, I know this one is difficult

01:07:24.860 because it's like, what is the thing?

01:07:26.540 It's like asking you like, which of your children is your favorite.

01:07:29.740 But as far as the episodes go, do any of them stand out in your mind?

01:07:34.000 Maybe even just like the style or the way it's happened or separate question as far as

01:07:39.140 just doing a podcast, hosting a podcast and interviewing people and having conversations.

01:07:43.460 Are there things like going into this that you thought, I mean, part of it was like you

01:07:46.880 never wanted to do a podcast.

01:07:48.580 And now I think that you might have a different opinion about that.

01:07:51.040 So how about that strong opinion, maybe a little more loosely held today as far as doing

01:07:56.980 a podcast?

01:07:57.580 Yeah, you're absolutely right.

01:07:58.840 I mean, I think the first time the idea of a podcast was floated to me was about 2014.

01:08:04.760 And I mean, it was the worst idea I ever heard.

01:08:09.760 And it was mostly due to a fear of the amount of work that would go into it.

01:08:15.240 Because at the time I knew a few people who were doing podcasts and it was sort of the

01:08:21.040 only thing they did.

01:08:22.180 It was like, well, that's a non-starter.

01:08:24.140 I just don't have the time to do something where it's the only thing I'm doing.

01:08:28.600 So it's just not going to happen.

01:08:31.000 And I sort of kind of kept that point of view, frankly, until about two years ago when we,

01:08:38.500 or maybe a little less than two years ago, actually, when we decided to give it a try.

01:08:41.140 So yeah, that was a very strongly held or strong conviction, fortunately loosely enough held

01:08:47.780 that I was able to sort of get out of my own way on that.

01:08:51.060 And yeah, I really can say that I have enjoyed it a lot.

01:08:57.280 It is hard.

01:08:58.060 It is a little more work than I thought, but also we have such a big team that works on

01:09:04.800 it that I have it easier than probably a lot of people who do a podcast in that I have a

01:09:11.180 great research team.

01:09:12.540 We have two people that work exclusively on the podcast and Travis and Nick.

01:09:17.620 So all the heavy lifting of making show notes and things like that, none of that falls on

01:09:21.940 my shoulders.

01:09:22.720 So all I really have to think about is having discussions with people and, and trying to

01:09:28.020 think of topics that I want to meet people who can speak to those topics.

01:09:32.040 So I've loved it.

01:09:33.640 And it's hard to believe we're at a hundred because you sort of realize there's not that

01:09:37.760 many podcasts that sort of get into the territory of multiple hundreds of episodes.

01:09:42.700 And I mean, barring some unforeseen thing, we're going to one day be that podcast that's

01:09:47.240 on our 300th episode or something crazy.

01:09:49.160 Now to your first question, honestly, I just, I've thought about this a lot and I do, I

01:09:53.980 get asked this question a lot, Bob, which is what is my favorite episode?

01:09:57.960 And I just, it's so hard because they are so different.

01:10:02.520 There are some that are, I've really enjoyed from a technical standpoint.

01:10:06.360 I think the Rick Johnson podcast and the Keith Flaherty podcast really stand out to me as

01:10:15.220 podcasts that I have gone back and listened to several times because of the technical content

01:10:21.640 in them.

01:10:22.380 So there are probably half a dozen that are like that for me, where they're just, just

01:10:27.700 so much interesting information that I can't wait to go back and listen to them again, which

01:10:32.240 I don't listen to most of the podcasts.

01:10:33.740 I think on the other side of the coin, there are experiences for me, like interviewing Damon

01:10:38.720 Hill was just unbelievable.

01:10:41.540 And just to have him be so open and so just available to talk through his own difficulties

01:10:50.160 and obviously everything that went into his career and beforehand, that was a really special

01:10:55.280 episode for me as just a fan of his and such a fan of F1 and obviously a fan of Senna, who

01:11:00.960 was his teammate when he died.

01:11:02.300 I thought the Rick Elias podcast really, even though I knew Rick really well and there was

01:11:07.640 nothing we talked about that I didn't know, but I just, as it was unfolding and we were

01:11:11.800 having the discussion, I remember thinking, you know what, I think a lot of people are

01:11:15.240 going to really benefit from this episode.

01:11:17.640 I know I was.

01:11:19.060 And then we've already touched on some, but you look at the Catherine Eban podcast, which

01:11:23.560 is just an unbelievable opportunity to, I think, help people with information, which

01:11:30.100 is also kind of part of the itch that we're trying to scratch here.

01:11:33.200 So the irony of it is if I sat here long enough, Bob, I could tell you something special about

01:11:37.800 all 99 that came before this with the exception of the AMAs.

01:11:41.180 I could probably rattle off something special about 80 of these podcasts through the lens

01:11:46.720 of one or more filter.

01:11:49.280 Yeah.

01:11:49.340 I'm going to bring Tom Brady into the podcast.

01:11:51.560 I mean, it's probably a record as far as how long I've waited.

01:11:55.340 I think he's often asked the question, what's his favorite Superbowl ring?

01:11:59.080 And he says the next one.

01:12:01.400 So I think maybe you think about that with the episodes.

01:12:03.740 What's your favorite episode?

01:12:05.000 Might be the next one.

01:12:06.240 For me, I mean, that's how it is for me.

01:12:08.200 I like reflecting on these episodes, but the research that goes into these guests.

01:12:12.260 And I think we just have a lot of similarities as far as our interests.

01:12:15.600 So for me, for me, for you to be creating the podcast that you would want to listen to,

01:12:21.580 having ZDogg, who's your buddy, Stanford, from ZDogg to Marty.

01:12:26.100 I don't know.

01:12:26.580 Is it Macari?

01:12:27.560 Macari.

01:12:28.720 Macari.

01:12:29.280 I usually say Macari.

01:12:30.400 To Marc Messier to say like, why hasn't somebody sat down for a multiple hour podcast with

01:12:35.180 Marc Messier and just talk about the Oilers?

01:12:37.700 One of the greatest teams, if not, I'm sure you would say maybe the greatest team ever

01:12:41.660 in any sport.

01:12:42.500 I mean, that stuff to me is so cool.

01:12:46.080 Yeah.

01:12:46.220 I think about it that way that it's similar.

01:12:48.160 It's, I could talk about each one of them and how great they are, but I'm hopefully looking

01:12:52.700 forward to the ones that come too.

01:12:54.640 Well, I mean, I am as well.

01:12:55.780 I think we're, I just, I know we're getting better at this.

01:12:58.800 And I remember having, I think I may have even mentioned this once before on a podcast,

01:13:03.780 whether it was ours or someone else's, that I had this little tiny fear when we started

01:13:07.980 that we were going to run out of things to talk about and run out of people to interview.

01:13:11.180 And I was sort of reluctant to start this thing and then realize, well, after 50 episodes,

01:13:16.640 there's nothing left to do.

01:13:18.060 And I think you can attest to the fact that our list of people we want to have on is growing

01:13:24.620 at the same rate as our AMA list of questions.

01:13:27.420 Like we can't interview people quick enough at the rate that we want to learn stuff.

01:13:33.340 So I have a feeling we're going to be able to do this for a very long time.

01:13:37.160 And I do look forward to getting better at it.

01:13:39.760 It is a craft and it's hard.

01:13:41.220 I do try to listen to some of the podcasts to learn from them.

01:13:44.860 And I've, I've certainly picked up a number of things I could be doing better.

01:13:48.440 And as I think I talked about on Tim's podcast, I enjoy listening to other really good podcasts

01:13:53.840 for, for some insight into how to do this thing better.

01:13:57.140 But anyway, I'm excited about it and it's hard to imagine what the next hundred have to

01:14:02.060 hold actually.

01:14:03.340 Yeah.

01:14:03.620 Well, I'm looking forward to it.

01:14:05.000 I think maybe we cheers, have some champagne or you can wrestle a centenarian to commemorate

01:14:10.100 the moment.

01:14:10.460 I'm sure that's what you probably have that on your schedule anyway.

01:14:13.740 Yeah.

01:14:14.100 I've got a little bit of centenarian boxing this afternoon.

01:14:17.240 So yeah.

01:14:19.580 Well, Bob, this was a good idea.

01:14:21.740 I don't know if it was your idea or Nick's idea, but maybe both of you guys deserve credit

01:14:25.060 for this.

01:14:25.480 But I think this was a fun way to commemorate a hundred kind of looking back and looking

01:14:29.540 forward.

01:14:30.300 Absolutely.

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The Peter Attia Drive - April 06, 2020

#103 - Looking back on the first 99 episodes： Strong Convictions, Loosely Held

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