The Peter Attia Drive - #248 ‒ OUTLIVE book： A behind-the-scenes look into the writing of this book, motivation, main themes, and more

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

00:00:15.500 my website, and my weekly newsletter all focus on the goal of translating the science of longevity

00:00:19.820 into something accessible for everyone. Our goal is to provide the best content in health and

00:00:24.780 wellness, full stop. And we've assembled a great team of analysts to make this happen.

00:00:28.900 If you enjoy this podcast, we've created a membership program that brings you far more

00:00:33.320 in-depth content. If you want to take your knowledge of this space to the next level,

00:00:36.860 at the end of this episode, I'll explain what those benefits are. Or if you want to learn more

00:00:41.340 now, head over to peteratiyahmd.com forward slash subscribe. Now, without further delay,

00:00:47.780 here's today's episode. Welcome to a special episode of the drive. As many of you may know

00:00:55.060 by now, after more than six years of planning and background research, writing, editing,

00:01:00.180 rewriting, rewriting, rewriting, my first book outlive the science and art of longevity is out

00:01:06.760 on March 28th. And so for today's episode of the drive, I'm joined by my coauthor, Bill Gifford,

00:01:13.100 to answer a lot of questions that you guys have posed over the past few months on the book. This

00:01:18.560 conversation is really a discussion around the book and the behind the scenes look at the past

00:01:24.900 six years that it took us to write this book leading to where we are today. It includes a lot

00:01:31.000 of details around process that I haven't really spoken about elsewhere and also about really,

00:01:36.300 frankly, why it took so long. My hope is that for those of you that end up buying the book and

00:01:40.780 reading it, this discussion today will prove useful. It will provide a lot of the background and

00:01:46.900 hopefully explain why we wrote about what we did and perhaps even why we omitted certain things.

00:01:53.080 Before we get to the episode, as cheesy as this probably sounds, I do want to thank everyone who's

00:01:57.300 listening for all your support. And I think that without you, there wouldn't be a podcast. That's

00:02:03.080 just the truth of it. And frankly, without a podcast, this book wouldn't be half as good as I

00:02:08.940 believe it is. As I note in the acknowledgement section of the book, the best part of the podcast

00:02:15.380 is having this forcing function to learn. I'm forced to prepare in great depth to interview

00:02:25.000 someone or to be basically interviewed in response to the AMAs. And in doing that, I'm generating

00:02:31.640 knowledge that I'm able to translate into this book. And so I really mean it when I say this,

00:02:35.900 if there weren't podcast listeners, there wouldn't be a podcast. And if there wasn't a podcast,

00:02:41.640 there either wouldn't be a book or there would be a book. And it would be a fraction of the book

00:02:46.340 that I believe this has turned out to be. And so without further delay, here's this week's special

00:02:50.880 Outlive episode of The Drive.

00:02:58.100 Here, Bill, how are you guys doing?

00:03:00.560 Doing all right. Doing good.

00:03:02.480 This is the first time we've ever done three people in person. So we'll see how it goes.

00:03:07.840 It should be fun. And I think what we're here to talk about is the book. So by the time

00:03:11.840 this comes out, the book will be out, which is still kind of crazy to think about. More so for

00:03:19.080 probably both of you who have been much more involved in the process than me. But I think

00:03:24.880 what we did is we collected a ton of questions from the audience on wanting to understand the

00:03:31.900 process of the book, who Bill is, what the cover means, what's talked about, all of that stuff.

00:03:37.140 And so we collected those questions. We're going to cover them today. And it should be kind of a fun

00:03:41.460 way to learn more about the book, what's involved, kind of that inside baseball story about it.

00:03:47.560 So with all that said, I think the first thing we should start with is, Peter,

00:03:52.000 how's the voice doing?

00:03:53.140 I would say it is like 80% of the way back to normal.

00:03:57.080 Do you want to tell people who are maybe unfamiliar how the book tried to kill you through your voice?

00:04:02.120 I think the book has tried to kill us in many ways. But I think most recently,

00:04:06.180 between reading the book for the audio book, and then getting some virus, and then having a hectic

00:04:14.460 travel schedule to try to do some podcasts, I basically just developed the worst case of

00:04:19.800 laryngitis. And I had a pharyngeal abscess that caused my vocal cords to stop working.

00:04:26.460 Oh, yeah. Which in your profession, you kind of need. So it's good that they're made their way back.

00:04:32.300 Yes. But I will say this. I really enjoyed not speaking for two weeks.

00:04:35.860 Sort of a vow of silence kind of thing.

00:04:37.780 I mean, it was just amazing. I was like, it was amazing how many things I got to tune out.

00:04:41.460 Like, I'd hear people call my name. And I'd be like, I can't do anything about it. So I'm just

00:04:46.420 going to sit here.

00:04:47.140 How did the family take that? Did they use that to their advantage?

00:04:50.340 Oh, they absolutely loved it. The boys were, what was really funny was the first couple of days,

00:04:54.940 everybody else got very quiet in response to me being quiet. Actually, it's very interesting.

00:05:00.380 One of the few times social media turned out to be insightful and helpful. After I posted,

00:05:04.780 I think the second video of the direct laryngoscopy, someone, a very astute, actually,

00:05:10.820 several commenters said, hey, Peter, by the way, don't whisper. Because that was basically all I

00:05:15.500 could do. I could go like, I can sort of do this. And they said, don't whisper. Whisper is a bad form

00:05:20.420 of phonation. It's actually teaching you the incorrect movements. Either don't speak or speak

00:05:25.380 normally, but at the lowest volume possible. I was like, well, that really makes a ton of sense

00:05:30.040 because my throat was actually starting to hurt from all the whispering, utilizing muscles

00:05:35.200 incorrectly and stuff like that. So anyway, so I'm talking very quietly. And my boys, who,

00:05:39.360 as you know, are not, you can use a lot of words to describe them. Quiet would not be on those lists.

00:05:44.060 Definitely not one of them.

00:05:45.280 They got so quiet in response to me being quiet that I was like, I got to figure out a way to

00:05:50.520 just do this enduringly. Next time you have people over, you need to just be under control.

00:05:56.100 Dad can't talk to you.

00:05:57.880 So you learned a parenting hack.

00:06:00.000 Yes, totally. The quieter you are with your kids, the quieter they are back.

00:06:03.820 One of the questions that we'll get to later is, will you ever write a second book? Which you say,

00:06:09.640 no, I'm curious what Bill thinks, but maybe if you do, that could be the parenting hacks one-on-one.

00:06:16.340 Just lose your voice. So I think we'll kind of get into it. And we have a lot of questions to get

00:06:20.520 through, but the first one, which I think makes the most sense on which to start with, which is

00:06:24.300 relevant to the book sitting in front of us and the cover is people would ask, we understand

00:06:29.500 outlive and what that means, but where does the science and art of longevity come from? And

00:06:34.340 why was that so important to include in the title?

00:06:37.060 The title was actually an evolution. So the first title I had in mind when I wrote my manifesto,

00:06:44.440 which was an awful title, but it was the longevity manifesto, which of course, for obvious reasons,

00:06:48.640 got scrapped immediately. But the working title during, call it 2016, when we were shopping the

00:06:57.140 proposal around was the long game. So that was kind of the working title that pretty quickly got

00:07:03.680 replaced by outlive for, I think, obvious reasons. And I think I've talked about why I like that title

00:07:10.060 so much and why, I don't know, we never really even questioned it, right? I don't think there was

00:07:14.080 ever a point where we thought of something else for the main title. There was a moment when I think

00:07:19.240 a previous publisher questioned it, but it's just very evocative and it's very simple.

00:07:25.820 And it's an action.

00:07:26.960 Yeah. It could mean different things to different people, but I think of like, you're going to outlive

00:07:31.360 your expectations or outlive your parents or your grandparents. Your fate is not set in stone is

00:07:38.440 kind of the idea.

00:07:39.900 So to your question about the subtitle, art and science is a pretty common term. People understand

00:07:45.040 that this is the art and science, this is the art and science. But I felt that there were two things

00:07:49.760 that needed to be communicated. One, the study of human longevity is part science and part art,

00:07:55.280 but the science should come first. So that's why I wanted to flip that order and say, it's the

00:08:01.080 science and art of longevity. And I think in the book, we make a pretty good case for where the

00:08:07.180 application of each comes. If this were a book about mouse longevity, it could just be the science

00:08:12.140 of longevity. Because in mice, you can do all of the definitive experiments and answer all these

00:08:16.760 questions. And in humans is readily apparent. We will never know definitively what the answers are.

00:08:24.760 And therefore we always have to have some art involved. So Peter, another question we got is

00:08:29.120 you often talk about longevity, having two components, the lifespan piece, which is how long

00:08:33.560 you live and the health span piece, which is how well you live. The lifespan piece is kind of covered

00:08:38.840 a little bit without live, but we did get a question of someone wondering, was it purposeful that

00:08:43.360 health span didn't make the title or kind of what was the thought process there?

00:08:48.960 See, I think outlive encompasses both truthfully to Bill's earlier comment. Outliving is more than

00:08:55.860 about the chronological years of life. It's about the quality of life as well.

00:09:01.780 And so I think next, the most common question we got as it related to the cover is, can you explain

00:09:07.540 the cover art? And I know for those listening or watching, it went through a lengthy,

00:09:13.360 process of a lot of different iterations. So do you maybe kind of want to talk about that?

00:09:18.620 Why you ultimately settled on this and kind of to you, what it means?

00:09:23.560 The cover is interesting because there were two things that in the back of my mind were enormous

00:09:28.960 stressors as we got closer and closer to the finish line. And by that, I mean, basically by about the

00:09:36.000 spring of 2022, exactly a year ago, you know, we had a manuscript that was, we knew it was too long.

00:09:42.460 It was probably about 190,000 words at that point. So we knew it was going to get a big haircut,

00:09:47.740 but we knew we basically had the book at that point. But these two things that kind of nagged

00:09:52.840 at me and kept me up at night were how could this be represented in a cover and who is going to read

00:09:59.220 this book for the audio book? Those two things just created such a low level anxiety for me. I can't

00:10:05.260 even talk about it. And so as the spring turned into the summer and our publisher is like, okay,

00:10:12.440 we need to get on this cover thing. And they've got kind of a checklist of, okay, for the book to

00:10:17.040 come out in March, we have to have this thing designed by here. And I just didn't even have a

00:10:22.720 sense of what one does because I couldn't, as Bill can say, I have very strong opinions about

00:10:28.740 everything. I couldn't even offer an opinion on the cover. All I could say was I want it to be

00:10:35.180 elegant. I want it to be kind of timeless. I don't want it to be too busy. Like I had vague

00:10:40.180 ideas of what I wanted. And as you know, I'm a font fanatic. So I kind of understood the fonts I

00:10:46.080 wanted, but no sense artistically of what was wanted. So then Bill sent, this is probably August,

00:10:52.860 right? You sent over an email of a guy named Rodrigo Carell, who I'd never heard of before,

00:10:59.460 but you sent over, I think his website. Yeah. My sister is a book designer. He's revered in those

00:11:05.740 circles. And we looked at some of his designs and they really kind of popped. And I was like,

00:11:10.320 yes, this is elegant. And while that's happening in parallel, the publisher is churning out

00:11:19.260 designs as well. And I'm kind of like, okay, there's a couple of these that are,

00:11:24.580 I could see iterating on. And we weren't really making a ton of progress until we, I think just

00:11:33.200 collectively decided. And really, I think Bill has contributed a lot of things to the project.

00:11:37.800 But if I was going to say the single most important thing Bill contributed was being adamant that we

00:11:43.480 engage with Rodrigo. And this was late in the game. This was October, if I'm not mistaken.

00:11:48.000 And I remember where I was, I was on a flight and I got an email from Bill. It was said something to

00:11:55.520 the effect of, cause we were looking at something that I was almost going to capitulate on. It was

00:12:00.260 a design. I remember what the design was. And I basically was saying, it's a solid seven out of

00:12:06.520 10 and I'm too tired to do anything about it. And Bill was like, this is bullshit, man. We've worked

00:12:13.500 way too hard on this book to have a seven out of 10 cover. We go and get Rodrigo and it doesn't matter

00:12:19.540 how much it costs and it doesn't matter how much it slows the process down. We do it. And I was like,

00:12:23.740 yeah, Bill's right. I don't want to regret this. I don't want to be sitting here in 10 years going,

00:12:29.060 why did we do that? So then we reached out to Rodrigo, had a long call with him. And I guess this

00:12:36.400 is what makes great artists, great artists is even having this call, just talking with him about the

00:12:45.300 book. He didn't have a chance to read the whole book because it's long. And I mean, within three

00:12:49.800 days, he threw up 30 covers. And they're all different.

00:12:54.380 Totally different.

00:12:55.360 But all sort of evocative. There were some images that I liked and that you liked and other people

00:13:00.900 liked, but different ways to kind of evoke this concept of longevity and outliving and

00:13:07.060 living better and all that stuff. It's really easy to also get that wrong visually. I was telling

00:13:13.480 Nick about the Korean cover of my book, Spring Chicken, that portrayed as a fat guy on a beach

00:13:19.780 chair, like frying an egg. And that's supposed to mean longevity. So there's many ways it can go off

00:13:25.560 the rails. So there was something about this. I don't think this was your favorite at first.

00:13:30.800 It wasn't at first, but it was in my top six. So I remember he sent over 30 and I think we each

00:13:36.620 decided to pick our top five or top six. This was on for all of us. It had a very different font.

00:13:43.560 There were a number of things about it that were different at the time. And I think the font threw

00:13:47.240 me off the first time around. Font guy.

00:13:49.580 Yeah. Font guy. I'm very particular about my fonts. And to make a very long story short,

00:13:54.500 we ultimately decided this was the one we were going to make the winner. And, you know,

00:14:00.700 I wish I could sit here and tell you that the blue, green, yellow, pink all signify something.

00:14:07.060 I can't tell you that. What I can tell you is it signifies a bunch of things to me.

00:14:11.560 It signifies kind of a keyhole that you're walking through. It's a passage,

00:14:15.340 but it also looks like a target. And that's a big part of this. There's a very subtle theme

00:14:20.560 in this book about lots of metaphors that revolve around archery. Anyway, I could talk about it

00:14:26.180 length. I'm not sure, Bill, what you think.

00:14:27.880 It's different. I showed it to different people, like my partner, Martha, and various other people.

00:14:33.420 And everybody kind of liked it, but they had a different reason. They say, I like it because

00:14:37.460 it's like an aura. I like it because it's like you're going into the beyond, into the future.

00:14:43.280 You know, the little guy there, let's not forget him. He's an important part of the design.

00:14:47.600 So it was different things to different people. And that spoke to the art side of it, science and art.

00:14:51.780 And I think that speaks to what art is, right? Art means different things to different people.

00:14:56.180 And in that sense, I think the cover, I just wanted a cover that I would like to look at.

00:15:00.460 I have certain books that I love looking at their covers. And so I wanted this to be one of them.

00:15:05.460 It is interesting too, as you kind of mentioned, what makes Rodrigo so good. And when we saw

00:15:10.580 that list of 30, you were just, every time you would look at another one, you're like,

00:15:15.540 this could easily be it.

00:15:17.240 There literally wasn't a bad one on his list of 30. That's the thing. Like every one of those,

00:15:21.780 was reasonable. And there were a handful that were exceptional. And there was one that was perfect.

00:15:27.960 Yeah. It just shows people who are experts at their craft, how good they are and how they can

00:15:32.920 think so differently. And this cover, it turned out really, really well.

00:15:37.620 And I think I drove everybody absolutely insane with all the font changes I made.

00:15:44.120 I was going to say, I think to say you're fanatic about fonts does not do it justice,

00:15:49.760 how fanatic you are about fonts.

00:15:52.520 Yeah. One little inside baseball thing here. If you go with this font, the commas work out to be

00:15:58.680 much cruder. And so I was like, nope, we can't do that. We have to use a different font for the

00:16:04.380 comma. Cause the comma, I really wanted to be serif to a sans serif font otherwise. And everyone was

00:16:11.240 like, only Rodrigo was like, yeah, that totally makes sense. Everyone else was like, Jesus Christ.

00:16:15.900 Yeah. Everyone else was like, this comma is going to cost this book, not actually getting done because

00:16:21.420 the cover won't be done on time. So I think it kind of pivots to the next question. And Bill,

00:16:25.800 you hinted at a little bit, but a lot of people were kind of curious who is Bill Gifford? What's

00:16:31.140 his backstory? How did he get involved in the book? So do you kind of want to give a little rundown of

00:16:35.780 kind of who you are, your story, and then ultimately how you initially got connected with Peter and

00:16:41.000 the project, which was six years ago now? End of 2017. Yeah. I got an email out of the blue.

00:16:48.480 For me, right? Yeah. I knew who you were. I think in particular, I'd read your insane 13 part

00:16:54.040 series about cholesterol. I was like, this is epic. I had read that in the course of researching my

00:17:00.520 own sort of more personal book about longevity, Spring Chicken, which came out in 2015. I thought I

00:17:06.680 was done with longevity, honestly, but this seemed interesting, but sort of to reel back where other

00:17:13.200 kids' dads were throwing the football, passing the old baseball around. My dad took me to the library.

00:17:19.160 So I became a writer eventually, and I just love writing and words. And I thought I would be a

00:17:25.440 poet at one point when I was in college, but then I realized I like writing to people and sort of

00:17:31.240 connecting with people and evolved from sort of general journalism into writing more and more

00:17:38.100 about scientific and medical topics and writing about like sports performance and then doping and

00:17:44.360 cycling and then more general health-related topics. And then got interested in, like Peter did,

00:17:51.080 you know, you reach a certain age and you're like, huh, what is happening here? You know, I'm not the guy I

00:17:56.280 was 10 years ago. And there's this interesting process going on. It's this big sort of biological

00:18:02.600 mystery. It's super fascinating. And it has not been solved. It still has not been solved.

00:18:08.160 So I ended up writing about longevity. And I write a lot about athletes too. So I found myself writing

00:18:13.560 about older athletes as well. Like Phil Mare, the skier, came back to racing when he was 50. So I followed

00:18:20.820 him around and he was competing against 22-year-olds. So that kind of longevity kind of fascinates me as

00:18:26.140 well. Peter, I actually don't know if I know the story, but you mentioned you first reached out to

00:18:30.240 Bill. So what caused you to do that throughout the writing process? So in 2016, I was working with an

00:18:38.560 agent. This book got sold to a different publisher and I was the author of the book and I'm working on

00:18:45.140 it nights and weekends, you know, while I'm doing my day job. And I finally have kind of the first

00:18:51.100 part of the book to submit. It was just under 40,000 words. And I submit it to my agent who then

00:18:59.680 submits it to the publisher. Now, by this point, the editor who had bought the book had left. So

00:19:06.880 there was this woman who's at the publisher and I seem to like her and I thought she really got the

00:19:11.520 concept of the book. But unfortunately, and I guess this is not uncommon in publishing,

00:19:15.300 within a couple months of me coming on with the publisher, she gets a better job at another

00:19:21.340 publisher. So she's gone. So now another editor basically comes on and it's now her book, but she

00:19:26.240 doesn't really have as much invested in it. And so I submit this first section to them and it is met

00:19:31.900 with a very lukewarm response. And they really had two huge criticisms of it. The first was it's too

00:19:40.300 technical. I can see why that's the case. The second was there was no story in it, right? There

00:19:46.120 was no narrative. It was mostly just a scientific treatise on the subject matter. I guess both my

00:19:53.500 agent and the publisher said, look, we think you should bring a coauthor in who can help massage

00:20:00.660 and smooth this out and make it a better book for the lay person to read. So I said, okay, how do we go

00:20:07.800 about doing that? And they said, we've got a long list of people to introduce you to. I said, great.

00:20:12.180 So sure enough, the courting began. This is back when I was in New York constantly. This was back

00:20:17.360 when I traveled a lot to work there. So basically every week that I'm in New York, I'm meeting another

00:20:22.320 author. And usually what would happen is they would send me one of their books. I'd read as much of the

00:20:27.280 book as I could get through or skim it or something and then sit down with them. And I kind of went

00:20:32.140 through five or six of these. I was like, there's no way this person gets it. This person has no

00:20:37.720 clue what I'm trying to write about. And this is not going to work. Then I talked to Bob Kaplan

00:20:42.720 and I said, Bob, here's the problem. Do you have any ideas? He goes, yeah, let's go find somebody

00:20:47.580 who's already written about what you find interesting and see. And the very first thing

00:20:53.900 that I remembered, what year did you write that Bloomberg piece on rapamycin? Was that 2015?

00:20:58.660 I think that came out 2015. Yeah. Early.

00:21:02.580 It's actually interesting that you wrote it back then because this was still sort of pre-hype

00:21:07.280 of gyroscience. But there was an article in Bloomberg, I guess, 2015 that because I was

00:21:13.560 obsessed with this stuff, I read everything that came out. And this was the first one that I read

00:21:18.540 that I was like, this is a very good article. Most of them were so simplistic. They just missed the

00:21:23.680 point. But this was a very good article. So I said to Bob, I said, this is the guy because he already

00:21:31.720 gets it. I'm not going to have to explain to him this, that, or the other thing. Or at least I said,

00:21:36.720 my intuition is that he will get it. Did I contact you through Twitter? I do remember reaching out

00:21:41.740 to you. Was it through your website? I think you just emailed me.

00:21:44.240 So somehow I just got Bill's email. Maybe it was on the article. I don't remember what the email

00:21:48.100 said, but I do remember we met for dinner on the Upper East Side one day in late 2017.

00:21:53.480 I think I probably just said everything I just said now, which is,

00:21:56.040 so what did I send you to read? What was the version I had sent you at that point?

00:22:00.140 It wasn't the 38,000 word. It was more like, it was kind of the proposal. It was like 5,000

00:22:07.660 something. And interesting, I was just thinking about it. I think some of the DNA of that

00:22:11.860 is definitely in part one. If you did a text analysis, you'd probably find some bits of that

00:22:19.200 sprinkled in there. It had the central ideas in part one. So you had to start. Starting is super hard.

00:22:26.020 And then keeping going is even harder. And then figuring out that you're done is the hardest

00:22:32.640 of all. So you had to start. I had no idea how hard this would be. I mean,

00:22:37.600 I'm sure every first-time author says that, but this was so much more difficult,

00:22:43.560 so much more time-consuming than anything I could have imagined. I do remember in the early days,

00:22:49.700 we spent a lot of time in front of a whiteboard in my office.

00:22:53.180 Yes. And that was the easiest way for me to communicate kind of broad strokes was,

00:22:59.320 this is how I think of these as pillars. This is how I think of these as foundations. This is this,

00:23:04.480 this is that. Yeah. We had a lot of pillars and foundations.

00:23:06.780 Yeah. Frameworks.

00:23:08.140 Lots of frameworks. And I feel like that was the easiest way, I think, to get us on the same page

00:23:15.240 about how I was thinking about it. But the structure that emerged in the final book,

00:23:22.320 which is basically three big sections that communicate each important and builds on the

00:23:27.560 other. I feel like that didn't really crystallize until, gosh, I mean, 2019.

00:23:34.040 2018 is a blur to me. I don't remember the difficulty. I mean, I do in some ways, but

00:23:40.800 if version one of the book was what we just talked about, the sort of pre-bill,

00:23:44.680 then there was version two, which was the book that got written basically from the beginning of

00:23:50.720 2018 through the beginning of 2020. And it, even in that period, the two things I remember,

00:23:57.440 first of all, I remember you ordered about half the menu at that Turkish restaurant and the waiter

00:24:02.600 was like all for you. This was back when I was eating just one meal a day. So it was like,

00:24:07.520 I would fast all day and then basically throw down 3000 calories at dinner.

00:24:12.000 So I was like, whatever this is going to be, it's not going to be dull.

00:24:17.160 Then the other thing is sort of, we had a basic template. We kind of outlined, okay,

00:24:21.420 what's the book going to be? It's going to be 25% kind of this part one's manifesto stuff.

00:24:28.040 And then it was going to be basically a biology of aging book. I mean, that was kind of where we

00:24:33.680 were going, you know, the rapamycin stuff and the kind of mechanisms that, you know,

00:24:38.740 the hallmarks of aging, almost like the molecular cellular level stuff. You were like, oh, you know,

00:24:45.160 10% tactics.

00:24:46.060 I didn't want any tactics in it.

00:24:47.380 Maybe 5% tactics.

00:24:49.360 We can make an appendix with a couple of tactics in it.

00:24:51.480 Now we have 200 pages on tactics.

00:24:54.120 What did the publisher say when you said, I'm actually not going to tell anyone what to do

00:24:57.900 in this book?

00:24:58.860 They were apoplectic.

00:25:00.120 You know, you mentioned it was so hard to kind of write and it obviously took a very long time.

00:25:07.400 What do you think was so hard about the process? Was it translating the science into something that

00:25:12.800 was more of a story? Was it figuring out how to verbalize the frameworks? Was it just

00:25:19.080 getting what was in your head cohesively on paper?

00:25:22.440 I think there are a couple of things. So first of all, I love writing. I've been blogging for as

00:25:27.420 long as I can remember, but that's a very different style of writing. You know, Bill was

00:25:32.320 talking about my 13 part cholesterol series. You don't have any constraints when you're blogging.

00:25:38.900 You can go as deep as you want to go because you are attracting an audience of similar weirdos

00:25:46.540 who are going to go as far down the rabbit hole as you will take them. And so I think the biggest

00:25:51.880 struggle I had switching to this kind of writing, and it's so funny for me to look at this version

00:25:57.940 of the book now and compare it to what I was writing in 2018. And I remember Bill really tolerated a lot

00:26:06.200 of my stupid things that I was writing. And basically how he tolerated it was he made a lot

00:26:12.360 of footnotes. He was like, all right, I really want to delete all of this, but we're going to make

00:26:17.260 it a footnote. And of course, four years later or three years later, I was the one deleting those

00:26:22.240 footnotes. And I was like, this is so gratuitous. Like it doesn't matter that much. That to me is a

00:26:28.140 remarkable evolution, I guess, that everyone has to go through. You know, Bill presumably went through

00:26:33.480 this 30 years ago, right? But for me, that was new. That was like, no, but I do need to explain

00:26:39.780 the extracorporeal circulation of the liver in this section. And Bill is like, I don't think that's

00:26:45.720 really important. And I was like, no, no, Bill, you don't understand. If the reader doesn't

00:26:49.080 understand portal blood flow here, they will never understand why glycogen gets there. And he's like,

00:26:54.980 Peter, I can assure you there are seven people who give a shit about that. And I was like, no,

00:27:00.120 no, Bill, it's important. He's like, let's make it a footnote. Fine. Let's make it a footnote. I was

00:27:03.200 pissed. And then of course, two years later, I'm like, that's so goddamn irrelevant. Get rid of it.

00:27:08.580 But you have to know it though, to be able to write intelligently, like you have to know it and

00:27:13.100 you have to know what's going on. But then you also have to decide, you're talking about like

00:27:17.600 getting in the weeds and you have to know all the weeds to write well about science. But then you

00:27:22.740 also have to ultimately both got pretty good at this, get pretty harsh about what you're going

00:27:27.560 to leave out. And we left out a lot of stuff. I mean, so much. Stories and science. Yeah.

00:27:33.360 I mean, I think I've told this story before, but I remember when I was writing probably my first or

00:27:37.580 second scientific paper, you do a lot of experiments, most of which don't make it into

00:27:42.860 the paper. I forget who it was that told me this. I think his name was Dan Powell was one of the

00:27:46.960 postdocs that I was in the lab with. And he said, you just have to learn how to kill your babies.

00:27:51.340 You're going to throw out 90% of this. And I just think that that for me was hard getting to that

00:27:58.160 point of if the reader doesn't know all of this stuff below the surface, can they appreciate the

00:28:04.440 piece of the iceberg above? And I think ultimately the readers will determine if we've struck that

00:28:10.360 balance correctly. I think we have. And I'll tell you why I think so. I think it became readily

00:28:15.400 apparent when I read the audio version of the book, because when you're reading it out loud,

00:28:22.420 it's very different from when you read it the way one edits their own writing. You're obviously

00:28:28.260 reading it much slower and you realize the unnecessary interruptions of endless footnotes

00:28:35.100 that are incremental in what they're adding. It's interesting to hear you talk about it because

00:28:41.160 I haven't read the first iteration, which I think you said practically none of it made the final version,

00:28:45.940 right? Certainly in direct content, absolutely not. In spirit, some of it.

00:28:51.260 I just can't imagine what it was is if you handed them a whole manifesto, zero tactical advice and

00:28:58.060 literally explaining every little nuance of the liver. Like I would just love to see the face of

00:29:03.060 the person who came in after that publisher left and read this and just was like, what the hell are

00:29:07.680 we going to do with this thing? I'm sure they were freaking out.

00:29:10.780 You mentioned it there, but there's three main parts of this book, right? So let's talk about

00:29:15.840 what ultimately made it into this final version. Do you kind of want to walk through

00:29:19.860 what the structure of the book is? Kind of some of that content. We don't have to get into

00:29:24.920 detail, but just kind of what people can expect to read about.

00:29:29.380 There's three parts. I think the first part sets up the structure of the book. It gets the

00:29:35.000 frameworks across. You'll certainly as a reader understand the problem statement. Again, I think

00:29:40.980 you can't solve or even attempt to solve complicated problems if you aren't asking the right questions and

00:29:47.580 you don't have the right frameworks. That's something that we posit very clearly here.

00:29:51.260 And that's really what part one is about. And that's not just explaining what longevity is and

00:29:56.060 isn't, but it's explaining something called medicine 3.0, which is the vehicle through which

00:30:01.140 you pursue this thing. Then part two, probably the most technical part of the book where we get into

00:30:08.940 the scientific underpinning of everything coupled with get to know your opponents. There's no denying

00:30:16.300 this. A big part of this book is trying to figure out how to live longer. Now, not in terms of science

00:30:22.020 fiction living longer, but I think we argue very convincingly that a person reading this book who

00:30:28.200 puts these principles into practice is really thinking about it, elongating their life by five

00:30:32.560 to 10 years. But to do that, you really have to understand what are the things that are coming to

00:30:36.620 take your life. So we kind of go through all that in part two. And then part three is how do you put

00:30:41.640 this into practice? It is that which I initially didn't want to write about, but ultimately think

00:30:47.040 that section just turned out better than I ever could have imagined it.

00:30:50.920 It kind of organically evolved and kept growing and changing. But going back to part two,

00:30:58.120 we were looking at, because we're both fascinated by centenarians, we were looking at that chapter and

00:31:03.240 kind of hammering out that chapter. And we kind of had a little bit of a revelation where it was like,

00:31:09.520 it's not like a big mystery how these people live to 100 when most people live to 80. They get heart

00:31:15.820 disease much later, if at all. They get cancer much later, if at all, or maybe never. And they

00:31:22.520 get neurodegenerative disease later or never. And so it's kind of like, that's the ball game, right?

00:31:28.920 You've got to figure out how to delay all of those diseases, which you call the horsemen.

00:31:34.180 And we didn't even contemplate writing these chapters at the beginning. Then we decided,

00:31:38.560 we have to, because we have to know the enemy, know the opponent.

00:31:42.540 That's right. Yeah. The first version that we wrote, which is the second version of the book,

00:31:47.500 was way heavier in the molecular science of aging. So we came at this much more through,

00:31:55.240 let's go really deep into autophagy. Let's go really deep into nutrient sensing pathways. Let's

00:31:59.900 go really deep into all of these things, which of course I found super interesting.

00:32:03.500 But ultimately we pivoted much more towards this insight, which is there are two completely

00:32:13.240 different strategies to live long. One is figure out a way to extend the period of time you live

00:32:19.640 once you have a disease. And by the way, that's everything medicine 2.0 does. Wait till you have

00:32:24.560 a disease and we're going to figure out a way to just drag you through that and keep you from dying.

00:32:29.560 Okay. That strategy has worked a little bit. Strategy two, which is medicine 3.0 is no way.

00:32:35.320 We have to figure out the time. We have to figure out a way to drag out the time you live without a

00:32:39.900 disease. And you can't play that game if you don't know everything about these diseases. You have to

00:32:44.880 become so intimately familiar with each of the horsemen. And of course, therefore each of those

00:32:50.320 horsemen has a very robust chapter. As I'm listening to you talk, I'm kind of curious, do you think

00:32:55.620 for as tough as it was to write the book and all the pain to go through that process over the years,

00:33:01.780 do you think how you practice medicine with your patients, kind of what we talk about on the podcast,

00:33:07.500 weekly newsletters, how all that's structured, do you think it would evolve to what it is if you

00:33:12.540 didn't write the book? I think they help each other for sure. You can't write well if you don't

00:33:17.280 think well. And you could argue it's hard to think well if you're not able to write well.

00:33:21.520 So I think the relentless process of streamlining and figuring out how to get to the point sooner,

00:33:29.040 all of those things would absolutely force me to reconsider how things were happening.

00:33:34.380 By the way, I think a lot of what's written in there comes out of just the conversations I'm having

00:33:38.520 with patients. I know there were certain times when I even asked patients, hey, do you mind if I

00:33:43.360 record our Zoom today? Because I just want to be able to go back and listen to how we talked about

00:33:50.220 it. And they'd be like, sure. And so I would walk them through all of their cardiovascular disease

00:33:54.800 risk and then go back and listen to it after and go, okay, yep, this is a good version of this talk.

00:33:59.580 Because I give the same talk to patients constantly. Sometimes they hit better and sometimes they

00:34:04.260 don't. And so having some recordings of those was really helpful to kind of go back and remember

00:34:09.160 what worked. When you started the podcast, I think it was about six months into the book writing

00:34:16.740 process. I think that gradually that made you more cognizant of how to communicate science and

00:34:24.080 medical topics. Maybe by nature, you're a very data-driven kind of mathematical guy and you'll

00:34:30.800 want to maybe just present numbers and facts straight up. And I think doing the podcast,

00:34:36.840 you kind of learned how to speak and introduce these subjects in a more sort of user-friendly way.

00:34:42.440 It was an interesting progression. We started the podcast in June of 2018. And I remember in

00:34:48.360 the summer of 2017, so before we were still working, when I was still working on version one,

00:34:52.900 I was effectively podcasting, but without podcasting. In other words, I was flying around

00:34:57.700 interviewing people, going up to Boston to meet with David Sabatini, meeting with Matt Caberlin,

00:35:03.100 meeting with the postdocs in their labs, sitting down and recording these interviews with them.

00:35:08.000 And it was effectively my foray into podcasting without, but it was all for the book.

00:35:12.260 These were all just interviews that were used to drive the book. And yes, what an evolution in

00:35:17.100 that. That's another, we'll save that for another discussion, but boy, how difficult podcasting is

00:35:21.580 too. It's kind of funny because some of those initial interviews ended up being some of the

00:35:27.940 first podcasts we released. That's right. I think we did end up using at least three of probably a

00:35:33.280 dozen of those as actual podcasts. And I think too, the first interview we did with Inigo

00:35:38.760 and Rick Johnson that stemmed from you wanting to go talk to them or the book. And we just kind of

00:35:45.800 double dipped. So it is kind of funny to think about. A lot of those interviews would, you'd come

00:35:51.120 back and you'd be like, you got to listen to this bill. You got to listen to Inigo. And those fed into

00:35:56.540 the, not only the writing of the book, but sort of the evolution of thinking behind the books.

00:36:01.440 So, and it kind of fits in with a question we got asked quite a bit, which is it took you six years

00:36:07.120 to write the book. There was a lot that changed in those six years as it relates to science.

00:36:12.660 There's a lot that's going to change in the next 10 years. And you, when you announced the book,

00:36:17.920 you kind of wrote about your goal with this book is it would still be applicable in 10 years.

00:36:23.340 People were curious, you know, how do you think about one, writing a book that can stand the test

00:36:29.500 of time to what changed a lot in your mindset and where did you evolve in that whole process?

00:36:38.200 I mean, I think a lot of things changed in me in the six years. Some of them just obviously very

00:36:43.200 personal things, some of which I've written about in the book, but I think more it has to do with

00:36:47.460 emphasis. There were things at the beginning that were much more the emphasis in my mind.

00:36:53.340 And other things became more important over time. For example, at the outset of the writing of this

00:37:00.780 book, I probably placed more of an emphasis on nutrition than exercise as one of the important

00:37:09.260 drivers, one of the important levers we have at our disposal. And I would say that my views on that

00:37:15.460 have flipped. I think that exercise has a bigger impact than nutrition. And certainly on the positive

00:37:22.620 side, nutrition can have a pretty big negative impact, but once it's corrected, it doesn't have

00:37:28.040 this enormous upside. Whereas exercise has an enormous downside in its absence and an enormous

00:37:33.780 upside in its presence. So that's, you're reading a different version of this book than you would

00:37:38.900 have read six years ago with respect to that. Or two years ago. Yeah. One year ago. Obviously this book

00:37:44.860 written five years ago would have not had anything about emotional health. There's not a lot on it,

00:37:49.620 but there's something on it that I think it's relevant. It's very framework focused, which I

00:37:55.840 think lends to a more timeless piece because frameworks or scaffoldings are there upon which

00:38:03.360 to place information and substitute information. So if the framework says delay the time that you do not

00:38:11.740 have disease, that's relatively timeless as a strategy. Now we're going to learn different things

00:38:17.860 about these diseases. In 10 years, my hope is that taking one example, liquid biopsies should be a

00:38:23.400 heck of a lot more valuable in 10 years than they are today. That's going to completely change our

00:38:28.300 approach and our efficacy of screening. You'll have a different tactic that you'll use in a toolkit

00:38:33.800 to go about the strategy, but the goal is still the same. So you're talking about liquid biopsies for

00:38:40.580 cancer detection. Yeah. So if you can detect cancer much earlier, treating it's a whole different

00:38:46.740 thing. Yeah. It's interesting because anyone who's listened to the podcast for a long period of time

00:38:51.420 will know, hear you talk about things in a different way as you learn more information. And I think

00:38:56.300 sometimes a natural reaction from people is to be frustrated at that and like, well, why did you say

00:39:02.640 this one time? And then you kind of change your mind. But I think to what you just said, which is

00:39:07.540 really important, it's probably worth spending a few minutes on it is you will focus heavily on

00:39:11.620 objective strategy tactic. And that's probably the reason why in the initial version, it had

00:39:17.600 zero tactics, which a lot of people are probably like, how do you write a book that doesn't tell

00:39:22.040 people what to do? But for you, it's how do you write a book that tells people it's all about

00:39:26.620 objective and strategy? Because as new information comes in, the tactic may change, but the objective

00:39:33.440 and strategy doesn't. Do you kind of maybe want to talk people through how you think about that

00:39:38.300 objective strategy tactic? Because I think it is applicable for anyone who's going to read the

00:39:43.060 book to really understand that or knowing how to take this information and still make it applicable

00:39:49.640 years down the road, not just months down the road. Well, there's a whole chapter on it in part one,

00:39:54.980 which is, you know, why is it that we spend so much time hammering this idea? And it's a simple

00:40:02.200 concept, but it's amazing how often it's ignored. So for starters, you do have to define the objective.

00:40:08.740 I won't say any more on that now, but again, the objective, you'd be amazed at how many people would

00:40:14.380 struggle to define their objective. Oh, I'm taking this 27 different supplements because I'm hacking

00:40:19.400 my, you know, whatever. And it's like, okay, what is your objective? And if you can't clearly state

00:40:23.980 that, then there's so much fog around this. The strategy is very important. And again, we open each

00:40:29.880 chapter with a quote, but of the quotes, my favorite has to be the one that opens that chapter,

00:40:34.080 which is the Sun Tzu quote about strategy tactics without strategy as the noise before defeat or

00:40:39.620 something. That's right. So we go to great lengths using lots of examples to really help a person

00:40:46.520 understand the difference between a strategy and then the tactics that they employ. And we do this

00:40:52.120 because we say the tactics are the most malleable things here. They're the things that are going to

00:40:56.260 change the most. And to your previous question, those are the things that have already changed

00:41:00.200 the most, right? So give you another example. How much emphasis did I used to place on fasting?

00:41:04.400 How much emphasis do I place on fasting today? Totally different. I am positive that there is

00:41:09.120 some set of drugs that I am either not taking now or don't even know what they are now that I'll

00:41:14.440 probably be taking in 10 years. And similarly, there's probably something I'm taking now that in 10

00:41:19.000 years, I'm going to say the evidence for this sucks. I'm not going to do it. So if I can't take that

00:41:24.040 and anchor it back to a strategy, which is the reason I would take this or wouldn't take this

00:41:28.920 is because it feeds into one of these three overarching principles that guides the subjective.

00:41:34.740 I'm really just doing a bunch of random things that aren't in concert.

00:41:39.860 But you're also able and open to changing your mind. One of the things I noticed early on is you're

00:41:47.220 not like a dogmatic person. If you get information or a new interpretation of the existing data that

00:41:54.240 kind of causes you to see something differently and fasting is a big one. I was a little bit

00:41:59.940 relieved actually, because I knew I was going to have to do it myself just to be able to write about

00:42:05.100 it, but I wasn't looking forward to it. But then you kind of got off the fasting. It served a purpose

00:42:11.140 for you. And again, there's still times when I think it makes sense. But yes, it just is one

00:42:15.260 specific example of, you know, this isn't something that everybody needs to be doing.

00:42:19.140 Well, one of the questions we got was, what areas of the book do you think within the next 10 years

00:42:24.100 will evolve the most? You know, you mentioned there like liquid biopsies and cancer detection.

00:42:29.020 Is there anything else that you kind of think about when you write this book? If you're like,

00:42:33.100 if I was going to update this in 10 years and I had to make a guess on which sections I would want

00:42:38.400 to refocus on, is there anything that you would think? Another way to think about it is,

00:42:42.480 you know, what in this sphere are you kind of really excited about progress in the next 10 years?

00:42:48.160 We've gone out, taken a very aggressive posture on cancer screening for the reason that Bill alluded

00:42:52.800 to a moment ago, which is certainly in doing research for this book and getting really deep

00:42:57.580 in the weeds, there simply is no ambiguity that the earlier you catch cancer, the better your odds

00:43:04.520 are at treating it while it remains local. Given the exact same histology of cancer,

00:43:10.220 treating it when there are a billion cells versus treating it when there are a hundred billion

00:43:15.380 cells with the exact same therapy has such dramatically different outcomes that there

00:43:21.420 should be no question about that. You basically have to put yourself into different camps. Are you of

00:43:28.020 the mindset that we will come up with systemic cures for cancer regardless of size and stage in the next

00:43:38.480 couple of decades? Or do you think it is more likely that we will get better and better at finding

00:43:44.160 cancer when it is smaller and smaller and treating it with existing therapies? Now, those don't have to

00:43:49.920 be mutually exclusive, but the question is which one of those do you think is more likely? And I think

00:43:54.740 the latter is much more likely. And, you know, we present it as such. Goal number one, don't get cancer.

00:44:01.520 Goal number two, if you do get cancer, catch it as early as possible. And then, and only then,

00:44:07.800 goal number three is we get into what are the most promising things. So I think that's another area

00:44:13.720 where what we're seeing right now with immunotherapy is so exciting. And I think we are right on kind of

00:44:23.140 the verge of unlocking the next layer of immunotherapy. And by the way, I think this gets to another part of

00:44:29.780 your question, which is what else would I be excited about in 10 years that is not in this book?

00:44:34.580 Because I think it's too soon for prime time. But if we could reprogram immune cells,

00:44:40.500 so you've heard a lot of talk about reprogramming. Well, reprogramming gets talked about nonstop and

00:44:44.880 there's so much nonsense there, but there is one subset of the human body that if it could be

00:44:49.220 reprogrammed would change the game and that's the immune cell. And by the way, that's much easier to

00:44:53.220 reprogram than like your heart or your liver or things like that, in my opinion, because of how easily

00:44:58.120 we can access those cells. If we could epigenetically reprogram T cells, I think it's a totally different

00:45:04.720 game when it comes to cancer therapy and cancer incidents.

00:45:08.500 I would say maybe neurodegeneration.

00:45:10.820 Yeah, that's a good one too.

00:45:11.880 But that's someplace where we're kind of nowhere in terms of effective treatments for

00:45:16.400 Alzheimer's disease or Parkinson's disease.

00:45:19.000 Hopefully better data on prevention. You know, right now, and we do this in our practice as well,

00:45:23.960 we're taking very much a kitchen sink approach, which is there are a handful of things that,

00:45:28.940 especially for dementia, less clear for the movement disorders. There are a handful of

00:45:32.720 things that unambiguously reduce your risk of dementia. There seem to be at least three, four,

00:45:37.760 if we were going to be right, clear. Exercise, management of lipids on the AD and dementia side,

00:45:44.200 sleep, and not having diabetes. Those things you can take to the bank. We talk about 27 other things

00:45:50.900 for which the data are not clear yet. To have more clarity around that would be great.

00:45:57.640 And as someone who's not in the scientific field, how you talk about cancer makes a lot of sense in

00:46:04.920 the idea of if you have better treatment, the earlier you catch it, you want to screen as early

00:46:09.840 as possible. But you talk about in the book, kind of the difference between medicine 2.0 and 3.0

00:46:15.100 and how that's not the case now. Why do you think that's, I don't want to say controversial

00:46:19.640 approach to it, but why is that not the norm? Because from the outside looking in,

00:46:24.780 it's hard to poke holes in that idea. Do you mean why is the traditional view of cancer screening

00:46:31.760 different from the view we present? Yes.

00:46:35.400 If I'm going to be fair and charitable to the outside view, it would be that we're basically asking

00:46:40.860 two different questions. The question and the solution that we're proposing is at the individual

00:46:46.660 level. The outside view, I think, is at the population or societal level. So there was a recent

00:46:51.600 study that got a lot of attention in Europe. I think it was published in the New England Journal of

00:46:55.440 Medicine that looked at colonoscopies. The study took a large group of people and they were randomized

00:47:01.880 into two groups. So one group was standard of care, don't do anything. The next group was suggested

00:47:07.960 that they should have a colonoscopy in the next decade. The end of the decade, they were compared

00:47:11.700 for rates of colon cancer and colon cancer mortality and all-cause mortality. And while there was a

00:47:17.200 slight benefit to the group that were recommended to get a colonoscopy, it was nothing to write home

00:47:22.840 about. The relative and absolute difference in colon cancer and colon cancer deaths, while statistically

00:47:28.720 significant, didn't seem very clinically significant. And opponents of colonoscopy said, look,

00:47:35.200 this is proof positive that colonoscopies don't save lives. The route of it is no. It's proof positive

00:47:40.440 that telling people to maybe get a colonoscopy once every 10 years, when, by the way, I think less than

00:47:46.260 40% of them actually did, probably doesn't save lives. That's very different from the example and the

00:47:51.740 approach that we take. I'm 50. I've already had three colonoscopies. I get them every three years. And I will

00:47:57.660 continue to do that until my life expectancy is so short that it becomes irrelevant. Again, totally

00:48:03.640 different approach. Am I suggesting that everybody get a colonoscopy every three years? Of course I'm

00:48:07.800 not. What I'm suggesting is that everybody think about their own risk reward trade-off and decide

00:48:13.420 what's the cost benefit analysis. So there's an enormous cost to doing that. My insurance company

00:48:18.540 doesn't pay for most of those. They've paid for one of the three. There are risks of bowel preps. You do a

00:48:24.640 bowel prep in a person who's significantly older, who runs risks from the electrolyte abnormalities that

00:48:30.800 come from those things. I certainly wouldn't want my 86-year-old dad getting a colonoscopy under any

00:48:35.720 circumstance. That ship has sailed. The bowel prep alone could injure him, let alone the sedation of it. So one

00:48:41.540 has to be very thoughtful and measured in how they think about doing these things. The long answer to your

00:48:46.700 question is, I think when people talk in blanket statements like cancer screening is bad, they're generally

00:48:53.120 speaking through the lens of policy and population.

00:48:55.640 And it kind of leads to another question we saw come through quite a bit, which is

00:49:00.640 sometimes on the podcast, it can get technical, can kind of get in the weeds. A lot of people were

00:49:06.420 curious, how is the book compared to that in terms of technicality? Is it something that obviously if

00:49:13.520 you're an MD, PhD, you're going to be able to understand, but what about for just the layman? Do you

00:49:20.260 think they'll be able to get as much out of the book? And was that kind of the hope in how you wrote

00:49:25.780 it? And my guess is we can get Bill's response too.

00:49:28.820 I was actually going to turn this question over to Bill first, and then I'll chime in,

00:49:32.360 but I'd like to hear Bill's thoughts on that. I have a strong thought on this.

00:49:35.720 I think we're both fascinated, probably you more than me, and kind of go down these rabbit holes of

00:49:41.160 the technical details, which I call the alphabet soup. Once you start stringing together a lot of

00:49:47.360 acronyms like APOE and PSEN and all this stuff, it turns into alphabet soup. I sort of think of

00:49:54.140 the podcast as like your playground to go deep with these scientists. And it's tremendously valuable,

00:49:59.900 right? Because they don't have really other, you can't go on fresh air as a scientist and get into

00:50:05.340 that level of detail. But I would say it's considerably less technical than the podcast,

00:50:11.460 but the basic message, we cover a lot more ground. So we can't really go too deep on any one

00:50:17.340 particular topic. Like I was listening to the episode about HDL. Super interesting,

00:50:24.060 but like mind-bogglingly complicated. And we just didn't have the time or the need to go

00:50:29.940 that deep. And I do hope that they figure out how to enhance the function of HDL,

00:50:36.720 but we couldn't go that far. There were probably some sections.

00:50:38.620 Actually, that's interesting. The cardiovascular section-

00:50:40.960 Pretty detailed, actually.

00:50:41.840 We go pretty detailed in that section.

00:50:43.080 And again, I think part of it is we're trying to add enormous value in writing this. There's a lot

00:50:48.680 of kind of me too books out there on this subject matter. And by me too, I just mean like, it's just

00:50:52.800 another book that is literally adding no value.

00:50:56.540 Saying the same thing.

00:50:57.100 Yeah. It's just saying the same thing. And our goal here was like, there's no chapter in this book,

00:51:01.600 none, that should ever just be another version of checking that box. And so on the chapter of

00:51:08.980 atherosclerosis, I mean, yeah, I think we do go probably deeper than certainly our editor would

00:51:14.400 have wanted. She was kind of to her credit, just accepted the fact that she might not understand

00:51:20.340 every word of it, but you don't need to necessarily understand every word of it to understand what to

00:51:24.660 do about it. And if you do want to go deeper, because we do get into HDL and we do comment on

00:51:28.960 the fact that HDL functionality is not captured by HDL cholesterol and HDL particle number and APOA

00:51:35.420 concentration and all of those things. And we do have to talk about the Mendelian randomizations

00:51:40.260 and what they've taught us with respect to HDL cholesterol and what they haven't taught us and

00:51:44.840 things like that. So that's probably a little more technical than maybe the average person would want.

00:51:49.000 But I think that overall, this book is very readable by a person who is curious. And I agree that it is

00:51:59.100 definitely a notch below the technical depth of what we often do in our podcasts.

00:52:06.320 It's not meant to be a textbook either, but kind of the way I think of it is you want people to learn

00:52:12.320 more than they expected without even realizing that they're learning. Kind of like package it in a story

00:52:19.180 or a metaphor. And the atherosclerosis chapter is a good example of that because everybody knows about

00:52:26.180 good and bad cholesterol. I think Peter got a little triggered by that and we just we're just

00:52:30.760 going to go to town. And in the writing process, how is that like between the both of you in sense of

00:52:37.420 were you often trying to keep Peter in check in terms of the scientific aspect of it trying to

00:52:43.320 bring stories in kind of how would you both do that throughout? Because obviously, the book is a good

00:52:50.040 chunk. Now, it clearly could be four times as long if you went into the detail that you could

00:52:56.180 go. So where in the writing process did you decide, okay, this deserves to go deep, this doesn't?

00:53:02.060 Was there ever disagreement about that? Or kind of how did that work?

00:53:05.620 I think Bill always thought about it through the lens of the reader. And I think there was a very

00:53:12.760 healthy tension between us on those things for sure. And I say healthy because I think both of us

00:53:20.180 would sit here and say, never once did we have a disagreement that was about ego. We had lots of

00:53:25.160 disagreements about content. But it was like Bill saying, I don't think a reader needs to know this.

00:53:30.020 And I'm saying, Bill, I think a reader does need to know this. And it wasn't about like,

00:53:34.200 I want to put this in because it's mine. It was never about that kind of stuff. So yeah,

00:53:38.720 I think there was always a great and healthy tension about that. I think once, you know,

00:53:43.260 there's a backstory here, which we didn't really get into, but this book basically got killed in 2020.

00:53:48.680 2020. And then it died. It was left for dead. And it only got revisited with a whole new publisher

00:53:54.740 and a whole new editor and a whole new process. And so that process, which was now 2021 into 2022,

00:54:02.460 introduced a new player into the mix, which was our editor at Penguin. And I don't have anything to

00:54:09.440 compare Diana to as far as other editors, but she struck me as relatively hands-off. Would she be

00:54:14.820 described as more of a hands, more of a conceptual editor as opposed to a line editor?

00:54:19.640 Yeah. And she gave great sort of guidance. You know, she had some give and take, but I think

00:54:24.800 between you and I, like it took us about six months to kind of get the right voice and register.

00:54:30.400 Who are we writing this book for? Yeah. I think you weren't quite clear.

00:54:34.460 No, I think initially I was, I'm writing this like I would write a scientific article. I'm writing

00:54:40.680 this like I would be writing in a journal, a scientific journal. For people who know.

00:54:45.140 And I think Bill initially was like, no, no, no. We're going to write this more like,

00:54:49.240 I'm making this up. It's not what was actually said, but like, we're going to write this for USA

00:54:52.600 today. And I think in the end, we probably settled on the New Yorker slash the New York

00:54:58.240 Times slash the Wall Street Journal. It's halfway in between and it's the right voice. It is. And again,

00:55:04.720 I go back to, I finally realized it's absolutely written the way it should be based on how it

00:55:10.560 sounded when I finally read the book out loud, which by the way, we dodged a bit of a bullet

00:55:15.080 because I was given this advice by Sam Harris a couple of years ago and I didn't follow it because

00:55:20.580 I never had the time. But Sam said to me, do not do your edits silently. When you are editing this

00:55:28.520 book, read it out loud. Yeah. That's good writer's advice.

00:55:31.220 And I was like, I mean, I acknowledged what he said and I never had the time to do it because

00:55:36.240 when push came to shove, this is like nights and weekends. And if I got to get through a 5,000

00:55:42.160 word section, I don't have the fricking time to sit there and read that out loud. And so as we got

00:55:47.340 closer and closer to that reading, my anxiety was peaking because I was like, I haven't actually sat

00:55:53.080 here and done this exercise. And there were a lot of last minute edits that came out of that.

00:55:58.780 Probably many more than anybody would have been comfortable. I mean, I think you said 400.

00:56:03.460 You pushed it to the very end. And also not only like line edits, but also like,

00:56:09.720 hey, we just saw the study about tau deposition and women. Yeah. Women are like, can we put this

00:56:16.280 in? Bill's like, oh my God, we're going crazy. But I think just kind of going back to something you

00:56:21.560 said, like a lot of times you'd come up with something or some idea or there'd be some new

00:56:26.760 study about tau, can we put this in? And it's like, well, we'd find a way to do it that worked

00:56:31.720 and kind of weave it in, massage it in. But a lot of times it would be, you realize like

00:56:37.480 something so significant might only warrant a sentence in a book of this nature. And I think

00:56:43.800 that was just a general process of getting comfortable, but it is the way these things

00:56:48.180 need to be done. And I'm really glad with the way this turned out, because if this had been

00:56:52.600 written in the voice that the first version had been written in, it would have been accessible

00:56:57.760 to so many fewer people. The feedback again, from that first version was not just that it's so

00:57:03.580 technical, but there is no story in here. There's no protagonists. There are no journeys. There's

00:57:09.780 nothing to follow.

00:57:11.560 And that was one of Diana's insights. Like what's the thread that pulls the reader? That was her big

00:57:16.180 thing. What's the thread that pulls the reader through the book? And they were there. We just had to

00:57:21.220 kind of expose them, let them kind of shine.

00:57:24.820 One of the questions we get asked a lot, which is, you often said, this is the only book you're

00:57:29.060 ever going to write. And a lot of people are like, there's no way. And I think even Bill

00:57:33.600 joked that he doesn't think this is the only book you're going to write. And whenever people would

00:57:37.980 ask, I'd always be like, oh, there's not a chance Peter writes another book. There's no way. But as

00:57:42.360 I'm hearing you talk now, kind of thinking to myself, how do you not write another book in 10 years

00:57:48.060 on an update to all this? You went into this being like, look, I want to write one book.

00:57:53.520 I want it to contain everything, which is why you did the objective strategy tactics. Like we talked,

00:57:59.400 what makes you think that you'll actually never write another book?

00:58:03.140 Again, I think if we're being reasonable people, we could never say never, right?

00:58:07.100 I just think a couple of things would have to be true for me to write another book. I say that

00:58:11.320 one thing that would have to be true is I would have to have something to say.

00:58:15.340 I think this process is so difficult. I mean, I see these people that write a book a year. I don't

00:58:20.460 understand how they're doing it. Again, let's just put those people aside. But for someone like me to

00:58:25.180 do this with the unbelievable inertia that's required to do it, the desire, the drive to need

00:58:32.960 to say something must be so great that you have to be able to overcome that pain. So that's condition

00:58:38.600 number one. I would have to have something so overwhelming to talk about. Second condition is I

00:58:44.920 would have to be at a different place in my life than I am today. I would not want to repeat what I

00:58:50.000 have done for the past five years, which is work on something so difficult on nights and weekends.

00:58:56.740 This has been, I've paid a price for it that is probably higher than I would like to have paid.

00:59:01.480 And I don't want to do that again. So I think the second equally important condition is I will need

00:59:06.100 to be at a point in my life where I'm not working 24 seven and writing this will not kill me.

00:59:10.880 Meaning it's not something I have to do nights and weekends. I can write it during the daytime.

00:59:15.120 That just means my life looks different than it looks today, right? That means my kids are a lot

00:59:18.820 older. That means I'm not working as hard on my practice or other things as I am today,

00:59:25.000 where those are my jobs and this is my hobby. So I think if those two conditions were met,

00:59:29.680 if I had something really amazing to write about or update or tweak, and I could do it in a civilized

00:59:37.440 manner, I would be open to it. One of the questions that we got came through,

00:59:41.320 which I thought was really interesting and fits well with the thread you just went on is,

00:59:44.600 did you want or need to write this book? Because you mentioned it there. There's obviously no shortage

00:59:50.600 of books on health, books on longevity, whatever you want to call it. And so going back to the

00:59:57.320 framework you just laid out, what do you think to you was so important to say that you were like,

01:00:02.900 I need to get this out there and I need people to have these insights.

01:00:06.940 I think it's hard to speak to the motivation at the outset. When I started this in 2016, it was

01:00:11.620 two years before having a podcast. So it never occurred to me at that time to have a podcast,

01:00:16.920 or I probably would have had a podcast. And maybe if I did have a podcast, I wouldn't have thought to

01:00:21.340 write a book because in some ways a podcast is an easier way to communicate. It's less formal,

01:00:27.280 but it's easier and you can communicate much more through a podcast.

01:00:30.020 So I think the more interesting question for me to think about is let's go back to where we were

01:00:36.220 in December of 2020, Bill. So basically in February of 2020, this project is nuked. It's

01:00:43.500 dead. We're done. Publishers fired me. And nobody wants a book about longevity in the

01:00:48.220 pandemic anyway. Yeah. It's like, it's over and I'm over it. Like I'm so frustrated and I feel bad

01:00:55.760 that I've wasted so much of Bill's time because he's put in two full years at that point and he's

01:01:03.780 going to have nothing to show for it. Like he's not going to have a book to show for it. For me

01:01:07.820 personally, I don't care. Like I don't need a book, whatever. And I don't know, Bill and I probably

01:01:12.700 didn't talk for nine months. It was sort of done. I felt bad and Bill didn't make me feel bad or

01:01:17.600 anything like that. That was just the nature of things. So that was the end of it until late,

01:01:22.600 late, late 2020 when Michael Ovitz somehow asked me about it. And I don't know what brought it up.

01:01:29.160 We were talking about his book, which I love. And somehow it came up that, oh, I had kind of

01:01:33.380 written a book too, but sort of got scrapped. And he was like, oh, send it to me. And so I called Bill

01:01:38.740 and I was like, hey, Bill, do we still have the G doc that has like whatever the last version was of

01:01:44.360 that thing before it died? And he's like, yeah, I could probably find it. And I was like, do you mind

01:01:49.180 sending it to me? So he did. And I sent it to Michael. And I remember this was around Christmas

01:01:53.420 of 2020. He read it in two weeks, which is saying something because it was a pretty long ass

01:01:59.100 thing. And he said, look, man, this has got to be published. And I was like, well, we don't have a

01:02:04.840 publisher. And I explained all the, you know, how much hair was on this dog. And then the rest is kind

01:02:09.660 of history. He just said, well, yeah, no, no. He goes like, we'll get this published. The question

01:02:14.240 then becomes why at that moment in time did I go back in the ring? Because I was clearly out of the

01:02:19.840 ring. And by that point we had a podcast. I wasn't looking for things to do. And honestly, I think it

01:02:25.260 kind of comes down to some of the stuff I write about in the very last chapter of the book. I think

01:02:30.440 there was a coming to peace with some of my demons and a realization that I wanted to do it. I really had

01:02:40.280 a strong desire to put this material out there in basically the form it's in now, which turned out

01:02:46.740 to be such a blessing. Had it not been for getting fired by the old publisher, had it not been for

01:02:52.180 COVID, had it not been for all of the crises that emerged, this book looks a lot different. And

01:02:58.000 truthfully, I think it's not as good. But to answer your question, I think it was want more than need,

01:03:02.920 but I don't think that want really found its why until the end of 2020, the beginning of 21.

01:03:09.540 Yeah. And Bill, so hearing that, I mean, what are your thoughts on that process? And also

01:03:14.620 during that nine months of silence, to you, did you ever think the book would see the light of day?

01:03:20.280 I think deep down, I knew that it would because there had been so much work that went into it.

01:03:24.980 And there was so much that's original and interesting and amazing. I felt like it would be a tragedy

01:03:30.840 if it wasn't published. And I was kind of depressed and sad for a while.

01:03:35.380 Well, so I was very glad to get your call about your friend, Michael Ovitz,

01:03:40.460 wanting to see it. I was like, yes, this is going to happen. It was kind of interesting watching

01:03:45.140 Peter kind of like become a writer in certain ways. You're talking about like working on nights

01:03:49.720 and weekends, and you're just kind of tortured by this thing that's like hanging over your head

01:03:53.240 and it won't go away. And it has to be good. It has to be perfect. And so one of the stages of

01:03:59.380 that process is deciding that the whole thing sucks. And, you know, there's all kinds of stories

01:04:05.080 about writers throwing all their manuscripts in the fire. And it's a process you have to go through.

01:04:12.380 And especially in science writing, right? There's like a first draft that we call it like the shitty

01:04:17.600 first draft and you have to write it. And it doesn't mean you're a shitty writer or a shitty

01:04:22.640 thinker. You're just getting it all out there. And then it's like, what do we got? And then the

01:04:28.300 process, you think you're done. Because I remember finishing the first draft. It's like, okay, sweet,

01:04:32.760 I'm done. And I think at about that point, you had sent me an espresso machine. I was like,

01:04:38.280 this was nice of Peter to send me this espresso machine now that we're done, but we weren't done.

01:04:43.680 Weren't even close.

01:04:44.400 You've got the first draft. It's like you've run the first half of the marathon.

01:04:48.140 Don't put the sticker on your car. You got to run the other half of the marathon

01:04:51.220 before you're done. So it was a marathon.

01:04:55.260 And like a marathon, anybody who's run one or swum one or done these things, you know that the

01:05:00.500 physiologic halfway point is not the actual halfway point. I mean, my wife just ran a marathon

01:05:06.180 recently and, you know, in training for this, I mean, it was all about the training for the

01:05:11.120 physiologic hits. And in that 26 miles, you don't physiologically hit the half point till

01:05:16.820 20. So you'll hurt as much in the last 6.2 miles. It will be as difficult metabolically and

01:05:23.260 physiologically in the last six miles as the first 20 were. And I think the same is exactly the same

01:05:28.200 for this writing process, right? What we did in the last nine months was more valuable than the

01:05:35.860 previous five years. Right. I kept telling you that through the process. You got to trust this

01:05:41.460 process. Yeah. You got to trust it. And it's going to get a lot better in the last six months

01:05:45.860 than in the first however many years. And that's just the nature of the beast.

01:05:51.680 I remember this summer, sorry, last summer. So it was July of 2022. We were on a pretty tight

01:05:59.580 deadline at this point. So this was when Penguin said, this book has to come out in March.

01:06:04.780 And if you reverse engineer that, the manuscript needed to be final by the first week of September.

01:06:12.360 And we were six weeks away from that. And there were gaping holes in this thing. Like you could

01:06:18.100 drive a tractor truck through some of the holes in this thing. And I had a feeling that I have not had

01:06:26.880 since I was on a very difficult swim in 2008, 2009, where I was in the water and nothing was going

01:06:36.100 well. This was actually early on after I tore my labrum and I was in so much pain and the current

01:06:42.420 was moving in the wrong direction. Everything was going wrong. And you know, these things are very

01:06:46.860 psychological. It's just like running. It's like cycling. I mean, once your brain is hurting,

01:06:51.780 nothing goes right. And I remember at one point realizing I still had seven hours to swim and

01:06:58.480 every stroke, I felt like someone was sticking a dagger into my shoulder. And there was just a part

01:07:03.340 of me that was like, I don't want to do this anymore. I just don't want to do this. And I remember

01:07:09.360 thinking for at least an hour, all I thought about was quitting. All I thought about was just getting

01:07:14.400 out of the water. All I had to do was put my hand up and touch the boat and I was disqualified and the

01:07:19.080 swim was over. And I didn't for better or worse. I kept swimming. I don't think it changed anything

01:07:23.600 in my shoulder. I'm still going to need shoulder surgery regardless. But I came back to this in

01:07:28.400 July of 2022. And I remember talking about this with Jill. And I remember thinking in the next six

01:07:35.140 weeks, we will have to work so hard to get this thing submitted. And we don't have a choice now,

01:07:42.780 meaning we can't stretch that out for six months. It's you have six weeks to finish,

01:07:48.200 do what you can in six weeks. And I remember saying to Jill, I'm so torn right now because I

01:07:54.340 am so tired. I don't want to do any more. I know that our publisher would accept this right now as

01:07:59.960 is because it's good enough. But in my mind, it's not good enough. And the only way this thing is going

01:08:06.840 to be good enough to what we think it deserves is I'm going to have to kill myself for the next six

01:08:14.920 weeks. Everything I do will revolve around this. And I will have to rewrite and rewrite

01:08:20.040 and chop out and do all these things. I just remember saying to Jill, I want to quit right now.

01:08:26.520 I've never wanted to quit so bad. And quitting, this is a soft quit. It's just a saying, I'm going

01:08:32.320 to back off. It's not that I'm not going to finish. I'm just going to back off. And I'm glad that I

01:08:38.920 didn't. I don't know how you felt at that point. But I really was like, I'm done with this. I don't

01:08:44.840 even know if I care anymore. Most people won't notice the difference between this version and

01:08:51.180 the version we might be able to get to in six weeks. One thing we share in common is maybe

01:08:56.740 you're more than me, but like a perfectionism. And to me, that goes to the level of the writing.

01:09:02.780 I would be going through every single sentence like, is this the best way that this sentence can be

01:09:07.420 cast? Or are these in the right order? How are we structuring this? I was doing that constantly.

01:09:14.140 And spent most of that summer doing just that. Yeah, it felt like in a pretty deep hole and the

01:09:20.320 deadline's looming. But deadlines are good because nothing would be finished without a deadline.

01:09:26.300 So at a certain point, you have to take your hands off it and say, all right, this is what it is.

01:09:32.980 It did get a lot better. Even between then and when they finally yanked it out of our cold dead hands,

01:09:39.040 it got better. It got a lot better. More readable.

01:09:42.340 That was the proverbial darkness before light was that August, September was really hard. And

01:09:49.920 that's what I think every person was trying to tell me before, which is you have to trust how

01:09:55.040 much this is going to converge at the end. Yeah. It's kind of funny hearing that timeline

01:09:59.460 because by the time this comes out, well, I've released a podcast with Ethan Weiss and you guys

01:10:04.240 were talking about blood pressure on it. You were like, you know, Ethan, my blood pressure has

01:10:07.600 always been normal. But in August, I started taking a reading and it just was higher, but I could calm

01:10:13.600 down. And he was like, well, did anything change during that time? You were like, yeah, I had a book

01:10:18.100 deadline. So it's kind of funny to just see how much this book is trying to kill you along the way of

01:10:24.020 not only the blood pressure, the voice, just every little bit of stress. Let's talk about the

01:10:29.780 audio book. You kind of mentioned it there. I know you struggled a lot with, should I read this or

01:10:36.300 should I not? And part of it was, you've said yourself sometimes like reading that much you'll

01:10:42.240 struggle with. It was not only that, it was the time aspect, the commitment. What made you ultimately

01:10:47.980 decide to read it? Because the overwhelming feedback we got from the audience was they didn't

01:10:53.520 want to hear someone else read this book if it wasn't you. And I think this is where kind of having

01:10:58.760 your own podcast probably hurt you as everyone knew your voice and knew what it sounded like. You

01:11:03.660 weren't a voiceless figure who was just a writer. So what made you ultimately decide, all right,

01:11:08.920 I'm going to go do this audio book? Well, I mean, first I should explain why I didn't want to do it.

01:11:13.700 And I think I had some pretty good reasons for not wanting to do it. First of all, I'm not a great

01:11:17.940 out loud reader. I think I do have mild dyslexia. I certainly do when it comes to spelling. So I can't

01:11:24.980 spell if my life depends on it. And when you hear me read even to my kids, you know, Reese is eight,

01:11:31.160 so he can read. So if I'm reading to him, he's catching mistakes that I'm, he's catching words

01:11:36.580 that I'm flipping back and forth. So that was one reason there was just, this is going to be very

01:11:41.320 hard for me to do. The second is I did the math pretty quickly, meaning I had figured out how long

01:11:47.100 it took me to read a page. I multiplied it by how many pages that were in the book. And I knew that I was

01:11:52.060 going to basically be in a recording studio for two weeks. I also knew that that meant that that was

01:11:57.760 the one week a year that I kind of wind down is between Christmas and new year's. I was going to

01:12:03.580 be in a recording studio all day, every day. And I just knew how I felt, which was I'm exhausted.

01:12:08.000 I'm exhausted. I actually need a week to recharge. I don't need two more extra weeks of work.

01:12:13.780 The third thing was when Rick Rubin was in town visiting over the summer, he was beginning the

01:12:20.240 process of recording for his audio book. And he had a sound engineer set up a studio in our basement.

01:12:26.600 So he was beginning to do his read that he and his family stayed with us for a couple of weeks.

01:12:31.880 And one day he was like, Hey, why don't you go in the studio with my engineer and just read a bit

01:12:37.220 and see how it goes? And I was like, all right, that's not a bad idea. So I did. And I read it and

01:12:42.140 I sent it to you guys and you guys finally acknowledged what I was saying, which was, yeah,

01:12:47.280 that's pretty rough. Like, dude, there's no intonation in your voice. You sound like a robot

01:12:52.400 reading that. So now we've got confirmation on my worst fear, which is I'm a lousy reader

01:12:57.360 coupled with all these other things. So those were all the reasons I didn't want to do it.

01:13:02.440 And I think those were all very compelling. On the flip side of that, I don't remember who suggested

01:13:07.360 it. If it was you or somebody suggested that I at least meet with this woman named Stacy Snell,

01:13:13.400 who I guess is a kind of a freelancer, but works for Penguin. And she would be the producer director

01:13:19.260 of my audio book. Maybe Stacy had just said, let me go and spend an afternoon with Peter and do some

01:13:24.280 coaching. So sure enough, one day, and this is probably like November, she comes over here and

01:13:30.560 we do some reading. And for two hours we read, but she coached me on reading and she gave me some really

01:13:37.240 amazing tips that seem so self-evident, but they made a difference. So for example, first is read

01:13:44.480 slower. And I should have known this because I consume virtually all of my books in audio first,

01:13:49.700 and then certain ones I go back and read in paper. But I listen at about 1.8 to 2x, depending on the

01:13:57.100 author. And so in my mind, that's the cadence of an audio book. But if you ever actually go and listen

01:14:02.340 to an audio book on 1x, I mean, it sounds like this. So what she reminded me was it needs to sound

01:14:12.980 pretty slow at 1x speed. The other thing she said is, and she could tell right away, she's like,

01:14:17.860 you're not present when you're reading. It's clear to me how bored you are of this book,

01:14:22.780 and I can't blame you for it. You've read every word a thousand times, but your boredom is showing

01:14:28.660 in your reading. She's like, a good reader reads this like it's the first time they've seen these

01:14:35.920 words. You have to get there. And I was like, wow. And she's like, oh, and by the way, reading slow

01:14:41.700 makes that easier. The slower you read, the easier it is for you to be present with every word.

01:14:49.700 So armed with Stacey's feedback, I decided I'm going to do this. And so a couple of days before starting

01:14:58.100 it, I had a session with one of my therapists. And obviously one of the things you talk about

01:15:02.160 in therapy is like, what are you worried about? What's going on in your life? And I said, well,

01:15:05.440 you know, I'm really worried. In a couple of days, I start this reading process. And so

01:15:08.520 Katie said, well, what's your why? Why are you doing this? And let's write those down. So I had

01:15:14.100 three reasons why I was writing this. And I wrote those three reasons down on a piece of paper.

01:15:18.780 And those were with me in the recording studio. And the three reasons were very simply,

01:15:23.660 one, the listeners of the podcast will expect this and deserve it. In other words,

01:15:30.560 we feel really grateful. Obviously, I don't need to just say this, but we have a very loyal group of

01:15:35.420 listeners to this podcast. And to your point, there is an expectation that the person whose voice they

01:15:41.300 listen to is the one that reads it. I think it's a correct expectation. I think they deserve that.

01:15:44.720 The second is a pet peeve of mine when I'm listening to technical books that are not read by the

01:15:51.720 author is how many mistakes there are when things are read incorrectly. It bothers me to no end. I

01:15:58.820 mean, I remember listening to one book where the author had written the word causal multiple times.

01:16:04.820 And every time the word causal was misread as casual. I mean, it's like how that got missed,

01:16:11.340 I don't know. But you know, I thought about how many technical words are in this book. And I was like,

01:16:15.700 I'm going to lose my mind if a person, and I basically said, I'm going to end up having to be in

01:16:20.460 the recording studio anyway, just to make sure everything is said correctly. And then the third

01:16:24.720 reason was just a very personal one, which was, you know, right now, none of my kids are old enough

01:16:29.300 to appreciate this book. None of them are going to read this book anytime soon. But one day they will,

01:16:35.100 and one day they might listen to it. And in fact, I thought further, and this is kind of a weird thing

01:16:39.780 to think about, because we don't normally think this way. But imagine Hemingway had read some of his

01:16:46.160 audio books and now distant relatives of him could listen to it and listen to him reading it. And I

01:16:51.600 thought long after I'm dead, my great grandkids could still listen to this, but they'll hear me

01:16:57.400 reading it. And I think that will be more valuable than hearing someone else read it. So it was really

01:17:01.800 more of like something for kids and grandkids to one day have. It's also, there are a lot of stories

01:17:07.860 in there about your early life and your medical career and some fairly dramatic ER stories. And

01:17:16.600 you know, your story is kind of like embedded throughout the book and especially in the last

01:17:21.900 chapter. So I think it would have, like you had to read it. You just didn't realize it.

01:17:27.080 Yeah. I think that's true.

01:17:28.020 But it is a daunting and kind of terrifying task at the same time. But I don't know. Are you glad you did

01:17:33.920 it? Oh, I'm a hundred percent. I'm a hundred percent glad I did. Zero regret on that. And

01:17:38.280 just glad with the way it turned out. Having Stacey there in my ear for the whole thing was

01:17:42.620 incredible. I couldn't imagine if I had to do it with somebody else.

01:17:45.600 It's funny is there'll be a lot of times we'll be like, Peter, you got to do this. And I'll be like,

01:17:49.220 no, I suck at this. Like, I can't do it. And it's like, okay, yeah, yeah. Just go ahead and do it.

01:17:54.340 And you're like, okay. And you send it. It's like, yeah, this is totally fine. And I think that's

01:17:57.940 what we all expected when you sent over the sample from the studio in the basement. I remember listening to it.

01:18:03.580 And you're like, he's right. And I was like, this is bad. Like there is no sugar coating it. And I

01:18:10.400 remember talking to Lacey and I was like, I honestly think it's so bad because people hear

01:18:15.640 him talk on the podcast and clearly you can speak, but you sounded like you'd never read anything in

01:18:21.680 your life. You were a caveman dropped in and you were just like, what is all this stuff around me?

01:18:26.200 You've got these phonetic symbols and like, go.

01:18:28.620 Yeah. And it was, it was just a conversation of, we can't let them do this. This is going to be

01:18:34.780 embarrassing. But then Stacey came in and really cleaned it up. And I listened to some of the audio

01:18:40.320 and it does sound really good. So to see that progression, maybe down the road, we'll release

01:18:45.180 a snippet of the initial, just so people can hear the difference of it because it's blackmail material.

01:18:51.140 It's strong.

01:18:52.300 Actually, really, we got to make sure Stacey does a before after on her website or something.

01:18:57.080 Working with me will get you from here to here.

01:19:00.060 Before and after.

01:19:01.900 That's funny.

01:19:02.980 And you kind of talked about it earlier where, you know, reading the book caused you to make some edits.

01:19:08.140 Some.

01:19:08.640 Some edits.

01:19:11.380 563 or was it 863?

01:19:13.560 I think that's the closest Bill and Diana came to wanting to kill me. I think if they could have,

01:19:20.020 if they could have killed me and nobody would have found out about it, they probably would have

01:19:22.860 and been like, oh, God, so tragic that something happened to Peter this week. Well, you know,

01:19:28.400 anyway, posthumously, we published this book with your name on it.

01:19:31.820 We'll release it as is. I think there is a little Easter egg in the audio version as well.

01:19:37.300 That's a little different too, which probably also led to some of Diana's stress. Do you kind of

01:19:42.920 want to talk about that piece of it?

01:19:45.740 Sure. So before we turn the book over to Penguin, so back when it was in the old version that died,

01:19:53.080 you know, it was a very similar structure to the way it is now, just a much longer,

01:19:56.660 less elegant version. So the end of the book, the 17th and final chapter had an ending.

01:20:03.020 And I loved it. Bill was sort of ambivalent. When Diana saw it, she hated it. She was like,

01:20:09.920 I don't get it. This sucks. And I was like, what do you mean you don't get it? I even like sent her

01:20:14.080 YouTube videos to help her understand it, to get the reference. She's like, I don't get it. It's

01:20:18.600 the dumbest thing I've ever seen. This is awful. At this point, Bill was like, I kind of see Diana's

01:20:23.480 point. I don't think it's good. And I was like, all right, fine. So they took it out. So we took it

01:20:28.060 out. This is months ago. It's long been forgotten. So I'm in the studio finishing and I finished the

01:20:33.860 whole book. And I said to Stacey, I said, Hey, Stacey, do you want to see the alternative ending?

01:20:41.280 She's like, what do you mean? And I was like, this book ended with a totally different thing.

01:20:45.600 Where you see it ending now, there used to be a whole page after this. And she's like,

01:20:50.280 oh, really? Let me see it. I was like, let me see if I can even find it. So I'm like rummaging

01:20:53.480 through my computer and I find it. I give it to her and I'm like, read it. And she reads it and

01:21:00.260 she's in tears. And I was like, what do you think of that ending? She goes, I think it's

01:21:04.180 beautiful. And I was like, well, do you want me to read that? And we can decide if maybe that goes

01:21:09.600 in. And she's like, yeah, I'd go. So I went back in the booth and I read it and I go home that day

01:21:14.620 and I emailed Bill and Diana and I'm like, all right guys. And by the way, you got to put this

01:21:19.140 in context. They are at the point of wanting to kill me for changing words at this point. Literally,

01:21:25.020 I'm like, can we get rid of the the here? And this word needs to be like this versus this. Like,

01:21:31.100 and I'm saying, I want to add another page and a half to this manuscript. Like it's going to screw

01:21:36.320 up everything. I won't get into the details of those conversations. They were not pleasant,

01:21:40.980 but suffice it to say, the answer was, oh, hell no. So I accepted the fact that it would never make

01:21:45.280 its way into the written version of the book. But I said, but would you at least entertain this being

01:21:49.100 in the audio version? And they were like, of course not. Like you can't have the audio version

01:21:53.640 and different from the written version. And we kind of left it at that, I think. But then

01:21:57.940 I asked Stacey to send it once it was edited and I just forwarded it on to Bill.

01:22:05.140 So it sounds good the way you read it. So I was like, this is good. This is moving.

01:22:11.600 Tried to find a place to kind of massage it in or put it in someplace, maybe not as the ending,

01:22:17.360 but someplace in the manuscript that kind of didn't work without going into detail. Like that last chapter

01:22:22.460 probably evolved the most of any chapter in the book. And we'd gotten to a place where

01:22:29.380 it was working and that part had dropped out. So decided as a compromise to leave it in the audio

01:22:35.700 as the Stanley Kubrick director's cut.

01:22:38.480 I think it's great. But honestly, like I feel like as far as print, the last few paragraphs

01:22:45.900 of the book and especially like the last line is something that like sticks with me. I think about

01:22:51.860 that every day, that line, and I won't say what it is, but every day when I walk the dogs, I think

01:22:57.740 about that when I'm thinking about like, what am I going to do today? Like, how am I thinking about

01:23:01.600 this day and the week to come? And that line sings in my head. So I'm glad it's there.

01:23:07.660 I think we captured the best of both worlds. I think even if we thought it could have been

01:23:11.700 shoved in at the end, I think it would have been logistically impossible because of how it changes

01:23:15.720 the pages of the book and stuff like that. So I think it's an elegant way to do it. And I know that

01:23:19.920 also if people are anything like me, a lot of times you want an audio book and you want the paper book.

01:23:25.480 You want to fold your pages. You want to mark it over. You want to do that kind of stuff. So I think it

01:23:30.760 worked out just fine. Frankly, I was glad on some level that you were making like little line edits

01:23:35.540 and stuff like, cause it makes it better. There's always stuff you can find that, you know, I did a

01:23:40.420 lot of things that you probably didn't even notice, but it got so much better. There is like a huge

01:23:45.640 sprint at the end to just make this thing sound right. You're getting these like PDFs from the

01:23:52.260 publisher, like, okay, your book's done. Here's your PDF. Just proofread it and see if there's any

01:23:58.060 spelling mistakes. And of course, I think we kind of both went to town on it.

01:24:02.400 I guess the industry standard is you would do three passes on the PDF final copy. Once you are

01:24:07.300 out of working in Word doc, you're into a fully typeset PDF copy. And it's expected that like the

01:24:13.060 first round of passes on that, you might find some mistakes. The second, by the third round,

01:24:17.280 there's none. We got up to six or seven passes on a PDF. I mean, these people, they were incredibly

01:24:25.040 patient with us. The lovely people at Penguin Random House who worked very hard to accommodate

01:24:30.800 all of our last minute changes. And they also now understand why we say with you, the only thing you

01:24:36.500 do in moderation is moderation. That's right. And also it's just really funny to just think about

01:24:41.060 the aspect of, they probably thought of you like a child. Like we left Peter unsupervised to record

01:24:45.940 this book and he just totally went off script. And speaking of things that you joke, like what could

01:24:52.800 go wrong, did go wrong, voice, everything else. You want to talk about the first day

01:24:57.860 in the recording studio? What happened?

01:25:00.020 God. So we had two recording studios to choose from in Austin and Stacy's like, it's totally up

01:25:07.300 to you. Which one do you want to do? And I was like, well, this one seems a little closer to my

01:25:10.900 house than that one. And given that I'm going to be over there every day, let's minimize the commute.

01:25:14.880 So we went to the closer one. So first day we go in there and I sit down and I, we just jump right

01:25:21.240 into it. And I'm reading the book in chronological order. Of course, I just hear like a weird little

01:25:26.440 hissing sound and I call out to the engineer and I say, Hey, do you hear that? And he says, yeah,

01:25:33.900 but that's not being picked up on the recording. I said, okay, I can get over it. Like it's annoying,

01:25:40.540 but it's, I can work through it. So I keep reading, get through the introduction, get through chapter one.

01:25:46.680 And I'm like, yeah, it's getting louder. You're sure it's not being picked up on the mic. He goes,

01:25:52.280 no, I can tell you it's not being picked up on the mic. And I'm like, yeah, this can't be right

01:25:55.920 because I can hear it with my ears. You're wearing a headset in there and it's not coming through the

01:26:02.360 headset. It's what I'm hearing in the room. And I know how sensitive the mics are in those studios.

01:26:06.520 I mean, they're insanely, they're so sensitive that if you're moving your feet on the floor,

01:26:11.460 it's being picked up. So we keep having this back and forth where he keeps insisting

01:26:15.560 that this is not being picked up. I just finally said, like, I'm not going to tell you,

01:26:19.660 I know your world, but I know how recording works. And if I can hear this with my ears off sound in

01:26:28.020 the recording studio, it must be picked up. And then he kind of pivots and says, well,

01:26:32.560 we'll be able to strip it out in post. Okay. So it is being picked up. So finally I'm one paragraph

01:26:38.900 away from finishing the third chapter, which was all we were going to get through that day.

01:26:43.240 That's a big day to get through the intro and then three chapters, but they were short chapters.

01:26:46.940 So it was a full day of reading. And I remember this, I had literally one paragraph to go and we

01:26:51.100 were done for the day. And he goes, you know what? I think we are picking it up. I'm like, what? He goes,

01:26:57.220 I think there's a, it's a grounding issue. So to make a long story short, we ended up having to go

01:27:02.060 to the other studio anyway, because we couldn't record there. And they assured me that they would be

01:27:07.220 able to fix that in post and they could not. So when I finished the book, they were like,

01:27:12.580 you got to come back and reread that first day again. I think that also was a good thing in a

01:27:17.640 weird way, because I think I was a better reader by the end than I was at the beginning. And so in a

01:27:23.460 way I got a day to practice where it didn't count. It's funny how it ended up, you ended up getting a

01:27:28.480 free practice run, which at the time, I don't know if we thought of it that positively, like wasting day

01:27:34.120 on something you were dreading doing. But I think the audio version ended up really well.

01:27:40.220 One of the last questions that we got, which I think is a really interesting question based on

01:27:43.620 the whole conversation we had. And I think we can start with you, Bill, because I'm curious what

01:27:47.740 you think as it relates to this, which is looking back at everything that ended up in the book,

01:27:52.700 did you have a favorite chapter that you guys wrote? Is there anything that stands out where

01:27:58.080 for whatever reason, you really look back fondly at that chapter?

01:28:01.640 It's sort of like picking favorite child. So there are these four chapters, kind of core chapters

01:28:08.860 about the Horstman diseases, metabolic disorders, atherosclerosis, heart disease, cancer, and

01:28:15.840 Alzheimer's disease. And those, they were not in the original plan. And kind of the way those all came

01:28:21.500 together, it was a huge heavy lift to try and understand each one of these disease processes,

01:28:27.620 really. And it took a huge amount of research and me spending time with Bob Kaplan, who was kind of

01:28:34.640 our research guru for the book project, and just kind of hammering these things out. That was pretty

01:28:40.800 intense, pretty intense experience. And I feel a real sense of accomplishment about how those chapters

01:28:47.220 all came out. I feel really good about them. As far as like the chapter that progressed the most from

01:28:54.000 like most improved, I think, is the final chapter. And just from where that started to where that

01:29:00.020 ended up, I think that has to be probably my favorite chapter.

01:29:03.840 It's interesting because you didn't like that chapter initially. I know that you and Diana both,

01:29:07.820 that was probably your least favorite.

01:29:09.360 And Michael, in the early discussions we had, Michael was like,

01:29:12.440 It should be a separate book.

01:29:13.260 Is this part of this book or is this part of a different book, the second book you're going to

01:29:17.220 write? And I didn't agree with that either, but it had to change. And I'm always thinking about,

01:29:23.400 like Nick said, where the reader is coming from, like you said. So that chapter ended up being one

01:29:29.520 of my favorites, probably my favorite.

01:29:31.440 I think there were sections of various chapters that I really liked. I think that the insights that

01:29:36.200 come out of the atherosclerosis chapter are so important and probably have the potential to save more

01:29:42.140 lives than anything else. I really think that I don't pull any punches in my views on how we are

01:29:49.040 mistreating this condition and why it does not need to be the leading cause of death. No chance of that.

01:29:55.600 I do think that, and that's also one of those things where earlier versions of it didn't get to

01:30:00.620 the point quick enough. They had too much in it that didn't matter enough. And it was really a very

01:30:06.740 late, late addition was that the really clear pivot to the causality stuff at the end that I think is

01:30:12.720 a much more insightful way to talk about it. So I'm very proud with how that turned out.

01:30:16.880 I think for me, the exercise chapters, there are three chapters on exercise, which speaks to the

01:30:23.740 importance that that plays in this book. And that was probably the one where even as recently as

01:30:31.080 like July or August of last year, I was like, I don't see how we get this to the finish line.

01:30:36.740 I don't see how this gets done. And we were trying at that time to do too much. When we instead focused

01:30:45.360 on what we could do in a book, because again, it's not a picture book. This is not a how to exercise

01:30:50.220 book where you're going to have like a picture of every single step of like, here's how to deadlift.

01:30:55.880 Here's how to do this. Here's how to do that. And we were trying to do all of that in writing

01:30:58.920 at one point. It had an incredible level of detail just wasn't, wasn't happening.

01:31:03.920 Couldn't make sense. Like you can't explain these things in writing. So I think a big aha moment we

01:31:10.840 had was a, let's restructure this, which we did be let's simply make a page of videos that explain

01:31:18.040 some of these things so that we don't drown the reader in anatomic kinesthetic lingo that won't

01:31:28.780 actually serve the purpose. And so when I look at how those three chapters form together and coalesce

01:31:37.740 around the centenarian decathlon in the marginal decade, I'm really proud of that.

01:31:42.780 You mentioned Bob's name a few times, kind of both of you, but I know this was a beyond just the two

01:31:48.160 of you. There was a lot of people involved in the research, the writing, the science piece,

01:31:53.340 because one of the questions that we got was, you know, how many people do you think were

01:31:57.100 involved in the writing of this book? Well, Bob did the heaviest lifting in terms of,

01:32:02.620 because, you know, Bob was working on kind of the research full-time. So basically the way it would

01:32:07.660 work is I would be writing and I would be saying, Bob, I remember there was a study that sort of

01:32:12.860 had this, like, I mean, the end notes on this book are probably 500, probably more than that.

01:32:17.700 I would say, Bob, can you go and find me the citation of this study? I kind of vaguely remember

01:32:22.400 reading it a year ago, blah, blah, blah, blah, blah, blah. Or it would be, I want to write about

01:32:26.440 this. Is the answer this or this? Bob, can you go figure it out? So this was really important

01:32:31.700 research that was being done. But then the other thing that had to be done was all the fact-checking.

01:32:36.420 And one of the things that I took as wise advice from other authors who had written scientific books

01:32:42.300 is you can't just rely on a publisher to fact-check your book. They can fact-check some things,

01:32:47.680 but you have to have an independent person to come in and do scientific fact-checking.

01:32:52.240 So we had one analyst named Vin Miller who did a lot of that work because Bob was too close to it

01:32:59.280 at the time. If Bob's the guy pulling the citations, can't have Bob fact-check it. So had to have a

01:33:04.980 separate analyst that was working on fact-checking. And then once we got into a much, much later version,

01:33:12.000 then we had Bob go back and do specific certain fact-checks on certain things, which also meant,

01:33:20.160 and God bless Bob, because this was long after Bob had left, he came back and did a night weekend.

01:33:26.860 He was the guy that organized the end notes. And that was another thing that just gave me chest pain.

01:33:31.320 Yeah, me too.

01:33:32.220 The unbelievable thought of what it would take to organize the end notes to this book

01:33:37.520 and the version control problems that we had with multiple different documents. I mean,

01:33:41.900 it was so stressful. And by the way, it should go without saying, people are going to find mistakes

01:33:46.480 in this. It's impossible that we got it all right. It's impossible that we got every end note perfectly.

01:33:53.200 I guarantee you, we have a citation in there that we got wrong. That's why you have second and third

01:33:58.940 editions to books. So folks should let us know when they see those things and we'll do that. But

01:34:03.580 I think we did as good a job as one could do in this regard and having a lot of people to shoulder

01:34:08.880 some of those lifts.

01:34:10.580 I spent a lot of time putting my head together and on Zooms and going back and forth with Diana

01:34:15.720 when you were off doing things and kind of trying to work out the literary side of the book and how

01:34:22.120 to structure it and how to make these different chapters move better, basically, is a better way

01:34:29.220 of putting it. So I worked very closely with Diana and Bob, actually. Bob would give me the

01:34:33.560 full research download on, literally, I'd say like, hey, Bob, I'm trying to understand how APOE

01:34:39.900 works. And boom, a G-Doc would appear the next day with tons of sites and studies. I'd just go down

01:34:46.840 the rabbit hole with Bob about that. So he was great with that.

01:34:50.920 Yeah, Bob has an endless number of G-Docs. I would love to know how he stores all of them

01:34:57.100 because you asked Bob a question, you are getting a G-Doc in response.

01:35:02.380 I spent like weeks, we probably all spent weeks talking about the monkeys,

01:35:06.940 the caloric restriction monkey studies.

01:35:08.940 I'm glad that they stayed in the book.

01:35:10.800 Oh, yeah.

01:35:10.940 I was really worried that the Bethesda, Wisconsin monkeys were going to get chopped,

01:35:15.380 but in the end, we found a great place for them. And it's a fantastic story to tell.

01:35:20.240 There are a lot of folks in here that I put in my acknowledgements.

01:35:23.500 And in fact, it's pretty unusual, I think, that an author will read the acknowledgements

01:35:28.160 in the audio book. But there was no hesitation in my mind. When we finished the book and I said,

01:35:33.040 look, I'm going to not just read the epilogue, but the acknowledgements, they were like, oh,

01:35:36.500 that's unusual. A lot of authors don't. But it's a very sincere, heartfelt thank you to a lot of

01:35:40.560 people who have played an enormous role in my broad education on this topic, which has been going

01:35:46.840 on for more than a decade. And also some of the real specifics, broad education, the podcast guests,

01:35:53.940 again, the podcast started basically as a research tool for the book. And then of course,

01:35:59.340 one of the things I do mention in the acknowledgement section, which is true and interesting,

01:36:03.160 every single person that I ever sent a chapter out to for technical feedback and review did so.

01:36:09.900 There's not one person that I sent a chapter to. And every chapter of this book,

01:36:14.380 every technical chapter has been reviewed by a technical expert in that field.

01:36:17.640 At least one.

01:36:18.300 At least one. That's right. And oftentimes at least more than one. There is not one example

01:36:23.460 where I said, hey, dear so-and-so, can you read this cancer chapter? Can you read this

01:36:27.900 athro chapter? Can you read this? Where that person didn't come back with incredible feedback.

01:36:34.640 The word is overused, but I'm humbled by that. It means a lot to me. I think it makes this book a

01:36:39.980 better book.

01:36:40.640 When you decided to read the acknowledgements, did they try and get you to read the footnotes as well?

01:36:44.640 Or is that, did that not make the audio book?

01:36:47.340 You know, it's funny. And Bill, you probably don't even realize this, but I took a hit or

01:36:50.960 miss approach on footnotes. Some of them I read and some of them I actually didn't.

01:36:54.620 Oh, the ones at the bottom of the page.

01:36:56.020 The true footnotes in the bottom of the page. Now, which obviously we took 98% of them out.

01:37:00.180 You were delighted, I'm sure. And of the remaining ones, some of them I just felt

01:37:04.940 they don't flow with the text. I'm trying to put myself in the mindset of the reader or the listener

01:37:12.380 rather. And if the footnote was so tangential that it would be difficult to get back into the book,

01:37:17.900 I didn't read it.

01:37:18.780 There were some funny tangents that maybe didn't need to be read.

01:37:21.720 Yeah, exactly.

01:37:22.460 I think there was one about making all your dates read Richard Feynman.

01:37:26.000 I definitely didn't read that in the audio book. I don't even know if that one stayed in the book.

01:37:29.540 And Steven Rosenberg. You made them read The Transformed Cell also about immunotherapy.

01:37:34.180 Well, Peter, Bill, anything either of you want to end with as we kind of end the podcast? And again,

01:37:41.900 the hope going into this wasn't to answer specific questions about the book. I'm sure we'll do a

01:37:47.500 podcast down the road, which is once people have had time to dive into it, like answer specific

01:37:52.960 questions.

01:37:53.640 We should do a book AMA at some point. And obviously, I've been on a few podcasts already

01:37:58.700 for the book. And the coming months, I will be on many podcasts. We have a number scheduled where

01:38:04.000 we'll get into the book, into the subject matter. But I think this was a unique opportunity to

01:38:08.700 talk about something we'll probably otherwise never really talk about.

01:38:12.300 A little behind the scenes. It was an honor and a pleasure to work with you. And I learned a lot,

01:38:18.800 obviously, but as far as like thinking and rethinking about these issues was exciting adventure

01:38:24.660 and a little tough to get it on the page sometimes and get it just right. But I'm proud. I hope you

01:38:29.700 are too proud of what we have come up with.

01:38:33.200 I really am, Bill. It's hard to imagine this having worked out any other way. So I'm glad that

01:38:38.200 all the way back in 2017, they said, Peter, this will be a better book if you write it with someone.

01:38:44.000 And that, you know, they even back then trusted me to go and find who that person was. And I think

01:38:48.760 this is the best book I could have ever been a part of. So thank you, Bill.

01:38:51.560 All right.

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The Peter Attia Drive - March 28, 2023

#248 ‒ OUTLIVE book： A behind-the-scenes look into the writing of this book, motivation, main themes, and more

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