The Truth About Ozempic, Sugar and Big Food - Dr. Peter Attia
Episode Stats
Length
1 hour and 3 minutes
Words per Minute
182.14037
Summary
In this episode, Dr. Peter Kogan joins us to talk about his new book, "How to be Healthy in a World Where Medicine Hasn't Covered It." Dr. Kogan talks about the history of medicine, the role of food, and why we should all be eating more of it.
Transcript
00:00:00.640
You mentioned, you know, the hamburger that you eat today is not the hamburger you had 50 years ago.
00:00:11.940
The standard American diet that we have is nothing more than a solution to a business problem.
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Crop subsidies led to basically the total destruction of soil in the United States.
00:00:25.540
And if nutrient density goes down, you have to eat more of something.
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All of this is probably not the end of the world if we didn't consume it in excess.
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Peter, it's great to finally have you on the show, man.
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Last time we were here, you very kindly gave us a couple of copies of your book.
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And I was not someone who actually paid too much attention to my health prior to that.
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And so I was like, you know, I'm really healthy.
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And then on the plane back, I started reading the book and I couldn't put it down.
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And by the time we landed, I'd finished the book.
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And then started actually looking into a lot of the stuff that you're talking about, which is all about how to be healthy in a world in which medicine hasn't caught up to many other things that are going on.
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Like, you have this concept of medicine 2.0 and 3.0, which is really interesting.
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As you know, because we've talked about it over many meals, I mean, I'm just such a huge fan of your podcast.
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So it's an honor to be here and talk about my pet topic.
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So, yeah, so medicine 2.0, I think to understand it, you sort of have to understand a little bit of what medicine 1.0 was.
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So this is basically an evolution of how we think about medicine.
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And for most of human history, you know, dating back thousands of years, there was no scientific basis for medicine.
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So we didn't, without a scientific method, you can't really practice the process of science.
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And therefore, anything that was imputed about illness was really, you know, thought to be based on the gods or bad humors or things of that nature.
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So when a person was ill, you didn't really know what to attribute it to, right?
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So medicine 1.0 sort of evolved into medicine 2.0 in the latter part of the 19th century.
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Again, it wasn't just at the advent of the scientific method, which came along 300 years earlier, but it was really other tools that enabled it.
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And one of the most important was the light microscope.
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So the moment we as a species could appreciate microscopic entities, bacteria namely, and also eventually come to understand that there were things like viruses, it created a whole new infrastructure in the way we thought and the way we treated disease.
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And then when you add to that the advent of antimicrobial therapy and antibiotics, really medicine changed.
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And it sounds like overnight, because in the grand timescale of human civilization, it was almost an overnight change.
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And it produced an almost overnight, although in reality four or five generations, doubling of human lifespan.
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So we went from basically living to a life expectancy of the late 30s and early 40s to now late 70s, early 80s.
00:03:07.240
And that's largely been due to kind of the amelioration of the following.
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We are much better at infant mortality and maternal mortality.
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And we are much better at treating acute conditions, primarily those that involve infections.
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So it's largely been those three things that have doubled human lifespan.
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And so Medicine 2.0 is humming along, and it's the thing that we're swimming in, right?
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We collectively wouldn't be sitting here without Medicine 2.0.
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What I argue in the book is that unlike where Medicine 2.0 completely displaced Medicine 1.0,
00:03:55.100
But what we need to do is sort of allocate part of the portfolio to this thing called Medicine 3.0,
00:04:02.300
Instead of trying to apply the hammer of treat something when it arrives,
00:04:06.700
which is the Medicine 2.0 strategy, that doesn't seem to work with chronic diseases.
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And it's now chronic diseases that are killing most people in the developed world.
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We instead have to prevent these things decades before they show up.
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So you don't treat heart disease when a person has coronary plaque, right?
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That's a process that's been going on for 50 years.
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Sorry, Peter, to stop you there, because there's going to be a lot of people listening to this
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So can you just explain it to them and then move on?
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So if somebody has a heart attack, why is that, right?
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So cardiovascular disease is the leading cause of death globally.
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19 million people per year die from cardiovascular disease.
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Number two, by comparison, is cancer at 13 million.
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So cardiovascular disease occurs when plaque accumulates in the arteries of the heart.
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And the heart is very sensitive to anything that reduces its blood flow and subsequent oxygen
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And so these plaques accumulate very, very slowly on the order of decades, not years.
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And we know that these plaques are accumulating in teenagers.
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And we know this because when you look at cases of young men and women who die in trauma
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for reasons that have no relation to heart disease, you still see on autopsy small amounts
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And so the idea that we should wait until those coronary plaques become significant enough
00:05:35.200
that either A, somebody has their first heart attack, or B, you do a study on them, like
00:05:40.320
a CT scan of the heart, where you can visibly see the coronary plaque.
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And then we decide to treat them, which would kind of be part of the way that most people
00:05:49.680
would think about this, probably doesn't make sense, right?
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When instead, you might want to be treating that decades before it shows up.
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In other words, using that as an example, you want to treat the causal agents of the disease
00:06:06.120
So an example of where Medicine 2.0 does this very well is with smoking, right?
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So with smoking, there's nobody out there saying, we should get people to stop smoking once they
00:06:18.660
start to develop nodules in their lung that look suspicious for cancer.
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Because we know that smoking is causally related to lung cancer.
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And when you know that, you tell people to never smoke.
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And the minute they start smoking, you get them to stop regardless of risk.
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And meaning regardless of age or any other risk factor.
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Similarly, we know what the causal drivers are of cardiovascular disease, right?
00:06:44.860
So it's, the technical term is hyperbeta lipoproteinemia.
00:06:48.340
That's just a very fancy way of saying the types of cholesterol-carrying molecules that
00:06:55.680
So that's the LDL, the VLDL, the IDL, LP little a.
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All of those little particles are causally related.
00:07:07.080
So what we want to be able to do is treat those things the second they emerge.
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Even if a person is young, otherwise healthy, or otherwise low risk.
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Another very important tenet of Medicine 3.0 is not just the early and aggressive primordial
00:07:22.780
prevention, but it's also this emphasis on health span as being equal to lifespan.
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So lifespan, I think, is a pretty obvious concept.
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It's how long you live, and it's quite binary, which makes it easier to understand you're
00:07:37.160
Health span is a little more subjective, and what one person deems exceptional health span
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But regardless, I think people intuitively understand what quality of life means.
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And it has a sort of physical, cognitive, emotional component.
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And Medicine 3.0 would treat the optimization of that at the same level.
00:08:01.000
And that's important because what gets measured gets managed, right?
00:08:04.400
And so Medicine 2.0 really optimizes around lifespan, and therefore that's the metric that
00:08:11.500
Well, that was really the thing that shook me kind of awake when I was reading the book,
00:08:17.140
because you have this, I think it's a graph and also an explanation to basically show,
00:08:22.460
I mean, this may be overstating it slightly, but the way we currently manage health is essentially
00:08:26.380
we live, then we get sick, and then medicine comes in and extends as much as possible the
00:08:33.940
period of our life when we are sick so that we can live longer.
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But you're living longer while really actually having some real issues, right?
00:08:42.780
And what you were talking about in the book very powerfully is how do you extend the period
00:08:47.360
of life when you're not sick so that you kind of have a very short period of the end of your
00:08:51.800
life when you are maybe dealing with issues, and then you die.
00:08:54.960
So you're kind of extending your actual high quality life.
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And that seems to me like a pretty good thing to be doing.
00:09:02.940
I think that's honestly what anybody who puts a lot of thought into it will come to the conclusion.
00:09:09.420
And I say that because I spend time with lots of people where I'm asking them to really make
00:09:18.620
So I'm sort of saying, like, what do you want the last decade of your life to look like?
00:09:25.720
It's called the marginal decade exercise because we refer to that last decade of life as the
00:09:31.180
And what I can tell you is I have yet to meet an individual.
00:09:34.640
Now, maybe my sample size is, you know, only, you know, hundreds instead of millions.
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But I have yet to meet a person who, when contemplating their marginal decade, i.e., the last decade
00:09:45.220
of their life, something all of us will have as sure as God made little green apples, everybody
00:09:51.240
is focused far more on what they will be able to do in that decade than how old they will
00:09:57.820
Now, obviously, nobody would view a marginal decade from the ages of 51 to 61 as ideal.
00:10:03.880
In other words, anybody would argue that, hey, to die at 61 would be premature and awful.
00:10:09.280
So we have to take the steps to address lifespan, which means delaying the onset of chronic disease.
00:10:15.080
But I don't see anybody saying that, you know, 85 to 95 at very good health is demonstrably
00:10:25.100
worse than 100 to 110 at, you know, marginal health.
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Even though you live 15 years longer, something to that effect.
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So I think quality of life is actually what most people really focus on when you force
00:10:41.600
them to kind of go through the exercise of what will it tangibly look like in the end
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And by living alone, I don't mean necessarily without others, but living without assistance.
00:11:01.860
Do you want to be able to live with your spouse?
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Or if you are living alone, do you want to be able to care for yourself?
00:11:08.200
These are things that when people are asked to stop and reflect on them become far more
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important than the how many years am I going to be?
00:11:18.100
And one of the things that I found very interesting in your book, Peter, is when you were talking
00:11:22.520
about type 2 diabetes and how we're not actually talking about what a serious condition this
00:11:30.860
And then I started looking at the stats about obesity and the proportion of people that are
00:11:39.580
Something like 74% of Americans are overweight.
00:11:42.660
I think it's something like 40% of Americans are obese.
00:11:54.240
I mean, I think there's so many different ways to look at it.
00:11:57.860
And obviously, we need to caveat all of that by saying that there is this now new class of
00:12:03.840
drugs that more than any other drugs in the history of as long as we've been dealing with
00:12:10.560
this problem appear to be more efficacious and with fewer side effects than anything we've
00:12:17.540
So if we bracket that for a moment and say, let's come back to it, the obvious question
00:12:25.440
And what is the implication of it from the health of the population and economically?
00:12:33.960
So we could talk about any of those that you like.
00:12:36.960
I think what's causing it would be a good start.
00:12:43.320
And if you could tell the story, because I found it incredibly powerful about the story
00:12:50.300
I think it's the technical term as a surgeon's assistant.
00:12:52.780
And you were talking and you were interacting with the patient just before they went to have
00:12:59.460
a surgery and they told you they weren't an alcoholic.
00:13:02.620
So I was in my, and I go, we have a different system here than probably some of the, the
00:13:10.640
So I was, it was the first year of my surgical residencies.
00:13:13.640
I mean, it's the first year I was an actual doctor.
00:13:15.420
So you'd finished medical school, you've chosen your specialty.
00:13:18.340
And yes, for that, in that particular case, I was doing what was called pre-opping.
00:13:24.620
This was a gentleman who needed part of his colon removed for, because he had colon cancer.
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And so there's a, there's just a checklist of questions you ask these patients, any patient
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And one of the questions is about how much alcohol they drink.
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And the reason for that is not to be judgmental.
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It's because it really matters in terms of both the anesthesia they receive and also how
00:13:49.800
you manage potential withdrawal from alcohol following surgery when they can't actually eat
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So in a manner of normal discussion, this gentleman mentioned that he barely drank alcohol at all,
00:14:04.080
And the next day when we are operating on him, and of course, because I was only the intern,
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So my job is to hold him open while the chief resident and the attending surgeon are operating.
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And sure enough, his liver was malted with fat.
00:14:20.980
Now that's something you only saw historically in people who were severe drinkers.
00:14:27.160
At the time, it was very poor, this is 25, yeah, almost 25 years ago, it was very poorly
00:14:34.640
acknowledged that there was a condition called non-alcoholic fatty liver disease, right?
00:14:40.140
Where you had the same appearing liver, but it wasn't occurring because of excess alcohol.
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It was excess calories that were being shunted into that very unfavorable storage location.
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Now today we recognize this as an epidemic actually.
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And today this is the leading indication for liver transplantation in the United States.
00:15:03.300
And, you know, that's kind of a remarkable statistic when you stop to think about it,
00:15:08.420
that there are people who are literally receiving liver transplants today because their livers have
00:15:13.540
become so cirrhotic due to the scarring and inflammation associated with excess accumulation of fat.
00:15:19.000
And again, that's both from alcohol, but also a significant portion of that is not from alcohol.
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And when we say not from alcohol, what do we mean?
00:15:29.380
Well, the best of our belief system is this is really caloric excess.
00:15:33.420
So this is people who are not consuming alcohol.
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And if they are, they're consuming it minimally.
00:15:38.280
But this accumulation of fat in the liver along with its concomitant metabolic derangement is
00:15:43.700
the result of excess calories being taken on relative to the level of exertion of an individual.
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And is that why Americans and Westerners more broadly, because it's a big problem in the
00:15:58.180
Or is there something else going on in terms of the food system and all the rest of it?
00:16:03.480
So you have to think about it through the lens of like, what's the proximate physiologic
00:16:09.900
And then you can peel back the layers of, well, why is that happening?
00:16:14.460
So at the simplest level of physics, it's clearly a caloric imbalance.
00:16:19.500
Now, that's not the most helpful explanation, right?
00:16:22.300
That's sort of like saying, we're sitting in a room with 20 people.
00:16:28.980
Well, the physics answer is 20 more people entered this room than left the room.
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Is there an interesting person in the room that they're all coming to listen to?
00:16:44.400
That's the sort of the real why that we want to get at.
00:16:47.260
So the real why as to why are people consuming more calories than they expend today relative to
00:16:55.240
any time in the past has to do with, I believe, so many factors.
00:17:02.300
And I've done this myself, so I can take responsibility for this in some way.
00:17:06.400
It's very tempting to isolate one factor and say, it's because there is more processed food.
00:17:13.060
It's because of social media that keeps us glued to our phones instead of being active.
00:17:19.920
And the truth of it is, it's a bit of everything.
00:17:23.280
There's no doubt that food is today more hyperpalatable and more calorically dense than at any time
00:17:30.540
This is an undeniable fact over the past two decades.
00:17:33.740
It is also absolutely clear that people are, on average, less active today than they were
00:17:42.840
It is also a fact today that people generally consume lower quality food.
00:17:51.320
Even, you know, the same type of thing that they might have consumed, like whether it was a hamburger
00:17:55.100
that you ate 50 years ago or a hamburger today, it's not just that the portion size is larger today.
00:17:59.980
It's that the actual quality of the food is lower.
00:18:02.660
Now, we don't necessarily know what the impact of each of these things is individually,
00:18:06.680
but it's very hard to deny that something in the way we eat is probably playing the most
00:18:15.220
Because when you were telling that story about the patient's incredibly fatty liver, you
00:18:21.860
mentioned that the guy was drinking a lot of fizzy drinks, soda.
00:18:26.580
And it made me think, number one, that's a huge problem.
00:18:29.060
But number two, it's something that I noticed here, and Constantine's mentioned it as well.
00:18:34.540
Yeah, like even coming over from the UK where people are hardly all slim and healthy, it's
00:18:40.480
like you get a coffee, it feels like it's got way more sugar in it than the exact...
00:18:46.160
If you go to a Starbucks, basically what I'm saying, and get a latte, that tastes way sweeter
00:18:53.700
Well, that's interesting because in theory, the latte shouldn't be much different.
00:18:57.380
If it's a true latte, it's literally like, are you putting milk in it or half and half
00:19:02.700
But no doubt, when you go to Starbucks, just to pick on Starbucks for the moment, it is
00:19:09.280
unbelievable the amount of calories and sugar that are flowing out of their Frappuccinos
00:19:22.640
I say this probably, like not definitively, there's probably something to be said for drinking
00:19:30.420
calories in excess, being even a little more damning than eating calories in excess.
00:19:36.280
And I think there's decent evidence for that when it comes to sugar.
00:19:39.320
In other words, if a person is going to eat 50 grams of sugar versus drink 50 grams of sugar,
00:19:46.440
sugar, I think there's, in the animals, very compelling evidence that the latter is more
00:19:53.340
The reason for it gets into a bit of technical biochemistry, but sugar is half fructose and
00:20:02.400
It's also a molecule that has a very unique metabolism.
00:20:05.480
Both of them are metabolized quite readily by cells, but the speed at which fructose is
00:20:14.080
And in the process of metabolizing fructose, cells have to use the currency of energy called
00:20:21.620
So the rate of ATP depletion in cells within the gut and ultimately the liver as they metabolize
00:20:29.500
fructose requires that more energy is put into the system.
00:20:34.860
It means that if you're drinking a lot of sugar, even though you're getting energy and you
00:20:40.360
should be satiated, it can actually have the reverse effect, which is, I need more energy.
00:20:45.160
It signals to the brain, I need more energy because there's a depletion of ATP required
00:20:49.440
to increase the speed of metabolism of it relative to glucose, right?
00:20:53.400
So this would be the difference between eating 100 calories that is half fructose, half glucose
00:21:01.020
And you were talking about the decline in the quality of food.
00:21:03.640
This has been a big part, you know, by the time this video has gone out, the election
00:21:06.640
has already happened and America is over, whichever side wins.
00:21:10.320
Just so people know, we're having this discussion not knowing who's going to win the election.
00:21:15.300
But it has been made into a conversation, which I think is a good thing, that the quality
00:21:23.500
And you mentioned, you know, the hamburger that you eat today is not the hamburger you
00:21:29.880
I mean, in a word, it's scale and economics, right?
00:21:34.380
And I, you know, I think it's very tempting to just demonize big food.
00:21:39.140
And to be clear, I don't have a dog in this fight.
00:21:42.040
Like, I don't, I don't know anybody that works for big food.
00:21:44.840
I have no, you know, I don't own Monsanto stock.
00:21:48.000
Like, I truly think about this from purely a scientific and policy perspective.
00:21:52.940
But what I don't think people understand is the complexity that has been involved in the
00:21:59.100
agricultural revolution and what it takes to feed billions of people.
00:22:04.800
So the way I think about it is there's a problem statement, right?
00:22:08.380
What the problem statement is, so we could go back in time a hundred years and I'm going
00:22:12.380
to anoint you to the food czars of the universe.
00:22:19.260
I say to you, listen, guys, here's the problem you have to solve.
00:22:21.780
I want you to figure out a way to feed eight at the time, whatever it was, you know, four
00:22:25.780
billion people or whatever the number would have been.
00:22:28.140
But I want you to feed it, figure out a few billions of people.
00:22:36.720
It used to be you had farmers that would sort of farm locally and they would sort of feed
00:22:42.360
a certain area and that would be the end of it, right?
00:22:44.200
So you have to be able to, if you build, feed a lot of people, you have to be able to transport
00:22:59.440
It's hard to imagine that people would come up with a very different system from the
00:23:05.720
So what I've referred to, and I'm sure I took this term from somebody else because there's
00:23:10.680
no way I was the person that came up with this, but what I've referred to as the default
00:23:16.760
The standard American diet that we have is nothing more than a solution to a business
00:23:24.120
Now, a lot of times the solution to a business problem ends up having collateral damage.
00:23:29.980
So if you were a tobacco farmer and I said to you, what are you going to do with all this
00:23:37.820
Well, what if we roll these things up and give them to people and let them light it and
00:23:41.380
I mean, it's got, it seems to produce great qualities.
00:23:44.260
Have you noticed when people smoke that thing that I have on my field, they don't eat as
00:23:48.240
much, they lose weight, their mental alertness goes up and they feel better.
00:23:56.800
Well, it turned out there was a nasty side effect of that that didn't show up for 20 years,
00:24:03.800
Does that mean that people set out to do that, to kill people?
00:24:10.520
It just makes the point that people apply morality to these things when in reality, what's really
00:24:16.080
happening is these are just people trying to solve a business problem and there are unintended
00:24:28.000
I think there's ample evidence to suggest, and this really goes back 100 years, right?
00:24:34.120
So if you go back to the Dust Bowl, which was 90 years ago in the middle of this country,
00:24:38.740
was really when agriculture took a turn for the worse.
00:24:41.980
So call it the 1920s into the 1930s when crop subsidies led to basically the total destruction
00:24:52.900
So instead of saying, hey, we'll grow wheat this year, we'll grow soy the next year, we'll
00:24:59.720
grow a different crop the next year and rotate these crops and let the soil actually dictate
00:25:06.980
It turned into we're going to add more nitrogen in the form of fertilizer.
00:25:11.060
We're going to drive crop yields as much as possible.
00:25:13.500
And then, of course, you had a subsidy that came in that enabled that flywheel.
00:25:17.260
And then what happened is we've kind of eroded soil to the point where we're now completely
00:25:21.000
dependent on not just genetically modified crops, which people hear that and they get
00:25:29.140
What that really means is crops that are now dependent on pesticides.
00:25:34.520
And we run these monocrops and we just do all of these things that produce basically
00:25:40.460
suboptimal plants that are grown in suboptimal soil that feed animals that become suboptimal
00:25:47.500
And again, all of this is probably not the end of the world if we didn't consume it in
00:25:53.020
So I think it just becomes like another thing that gets layered on the problem is, well,
00:25:58.200
on top of that, and some have argued, by the way, that that's another factor driving
00:26:02.040
our excess consumption, which is we have sort of a governor in us that is selecting for nutrient
00:26:08.260
And if nutrient density goes down, you have to eat more of something, right?
00:26:13.980
Like if you have sort of a central mechanism for seeking out how much micronutrient you
00:26:20.560
want and you're used to getting it in a certain amount of rice and a certain amount of wheat
00:26:25.620
and a certain amount of meat, but now the actual density of those things is 30% less,
00:26:32.080
would you eat 30% more to compensate without realizing it?
00:26:35.020
So this is one of the theories of overconsumption.
00:26:38.560
Again, I don't think any one theory is entirely correct, but I suspect many theories play a
00:26:44.580
And so we now have this population that is a lot of significant percentage or obese, morbidly
00:26:54.940
That's a ticking time bomb, isn't it, Peter, for a country?
00:27:00.760
And then the question becomes what part of the system breaks first?
00:27:05.440
So we could talk about different parts of the system.
00:27:08.000
So let's talk about one that doesn't get that much attention, but which is sort of preparedness
00:27:13.580
So we're currently in the last, I would say, 10 to 15 years for the first time in U.S.
00:27:18.440
history when most people who show up at a recruiting station are failing a physical.
00:27:23.200
They aren't actually physically capable to meet the standards of the U.S. military.
00:27:29.620
Well, again, maybe the implication of that is, and maybe the implication of that is irrelevant,
00:27:34.940
It might be that we're never going to fight wars again that require hundreds of thousands
00:27:39.000
But what we can say with some confidence today is if we had to, we would have a problem.
00:27:45.380
Another obvious, I think more obvious implication is the economic one.
00:27:49.800
So as you guys probably know, the U.S. spends more on health care than any other country
00:27:53.620
in the world, both in absolute terms and relative terms.
00:27:55.820
In relative terms, we're spending about 18% of our GDP in health.
00:28:00.100
And that's problematic in many levels, but perhaps the most problematic aspect of that
00:28:05.700
is that the rate of health care expenditure as a function of GDP is outpacing inflation
00:28:11.440
by 3-4%, and it's been doing that without abating.
00:28:17.660
In other words, there was a day when health care spending as a function of GDP was 5%, it's
00:28:22.200
now 18%, and that it's growing because health care spending is growing faster than GDP.
00:28:28.480
Now, I've spent a lot of time on this problem, so this might be the problem I spend the most
00:28:34.500
And what's driving that cost is many things, but a piece of what's driving it is our health.
00:28:40.960
To be clear, anybody who says you are going to solve health care economics by getting everybody
00:28:49.940
No, I mean, believe it or not, the biggest thing that's driving the U.S. health care
00:28:54.460
spending is the consumerism mindset of an American.
00:28:58.700
So technically, the single biggest driver, because U.S. health care spending is one, well,
00:29:05.580
85% of it is divided as one-third drugs, one-third facilities, and one-third personnel.
00:29:13.500
And then 15% is administrative cost that's associated with a multi-payer system.
00:29:20.080
So which of those three buckets are being driven?
00:29:23.780
Because this administrative piece is not being driven by how sick people are.
00:29:27.300
That's simply the infrastructure of our system.
00:29:29.740
Technically, the cost of personnel is really more a function of the U.S. economy and salaries
00:29:36.240
So it really comes down to facilities and medications.
00:29:39.760
And so it's really the medication bucket that is pushing hard, that you could reduce the most
00:29:49.200
But again, every dollar matters when you're at 18% and trying to avoid being 19% and 20%,
00:29:56.040
which we probably will at some point if we don't fix this problem.
00:29:59.040
Um, and then I think there's sort of just the personal toll it takes, which is, you know,
00:30:04.900
it's harder to put a dollar amount on that, but there's a ton of stigma associated with
00:30:09.660
I don't think there's anybody out there who's walking around who's overweight, who's oblivious
00:30:13.340
to the fact, or who wants to be in that situation.
00:30:15.560
And I think many of these people are quite frustrated.
00:30:17.620
And I think it's, look, I think it's very easy to kind of demonize people who are unhealthy
00:30:20.940
and say, oh, you know, why don't you just buck her up and eat less and exercise more?
00:30:24.720
But, but I think that's, I think that's, I don't, I don't favor that approach.
00:30:28.160
And I think that, um, I think we need to have more empathy for people.
00:30:31.520
Like I think, sure, there's always the edge case of the person who just truly says, fuck
00:30:36.140
Like, I just want to eat Big Macs all day and I don't care.
00:30:39.420
But I think the truth of it is for many people who are in that situation where they're, you
00:30:44.800
know, they have type two diabetes, they're overweight.
00:30:46.960
Um, I think they go through bouts and spurts of really trying and not necessarily achieving
00:30:52.640
We also have to sort of bake in this idea that people, I think have different amounts
00:30:56.680
of willpower and I don't know that you can take much credit for it.
00:31:06.020
Like, isn't that kind of just like why I have brown eyes too?
00:31:11.080
I, all of the characteristics about me are largely innate and I view kind of willpower
00:31:17.060
Do you not think it's, I'm sure there's an element of it that's genetic.
00:31:19.860
Do you not think it's also a muscle that you train?
00:31:29.160
What gives me the desire to, I agree that you practice this stuff.
00:31:32.920
And I put it into practice in many things I do, but I, I, this is one of those areas
00:31:38.700
Like I'm, I mean, yeah, yes, yes, yes, I, I have, I have, I could spend hours talking
00:31:47.400
Um, but, but when I examine things in myself, I tend to appreciate that I can't take credit
00:31:56.860
Luck has sort of given me, you know, maybe genes that are less susceptible, a stronger desire
00:32:05.380
Anyway, all of this is a long winded way of saying, I think there's an enormous personal
00:32:10.860
Um, I think there's, you know, a lot of denigration of, of self-worth and things of that nature.
00:32:15.580
And, and I think, look, you see this, you see this bubbling to the surface in the discussion
00:32:21.240
around GLP one agonists and their derivative drugs, right?
00:32:24.680
Which is the morality associated with using them, right?
00:32:31.080
These are drugs like, um, I don't know if they have the same names in the UK.
00:32:36.560
Um, there are newer versions of these drugs that are not even yet approved that look even
00:32:43.080
So, so semaglutide, which is the drug that, um, is Ozempic or Wegovi is actually the third
00:32:53.900
And then the next one coming out is called Retitrutide looks even better than the fourth
00:32:59.320
one, which is better than the third one, which was a log form better than the second
00:33:03.760
Point is these drugs aren't going anywhere in the pipeline of these, there's 20 of these
00:33:08.980
Um, but I think as a society, there's a lot to wrestle with because the cost of these drugs
00:33:14.880
But I also think deep down, a lot of people think, is it, you know, you know, there's a
00:33:22.300
judgment that comes with from some, I think when it comes to their use case, of course,
00:33:28.460
I was just going to say that there's the economic consideration of them as well, which
00:33:33.220
How much of this is because I've noticed something.
00:33:36.820
So I can't drink alcohol because I just can't, I can't control myself when I'm on my alcohol.
00:33:49.340
Because I've noticed as somebody who has a personality which is obsessive and can, if
00:33:56.400
I've noticed that when I eat things here, I get a little kick that I don't get back at
00:34:04.020
And in particular, when you look at fast food, when you look at sugar, how much of this
00:34:08.880
accompanies putting things in their products, which they know will mean people will get
00:34:16.000
addicted to them and will come back again and again and again.
00:34:22.260
I think it's them just trying to boost profits.
00:34:26.640
I think that I try to not use the word addiction because it has such technical meanings and I
00:34:32.300
don't want to get into the nuances of what constitutes a true addiction because there's
00:34:38.000
a very clear clinical definition, but the point is what's important, not the terminology.
00:34:44.020
So if we bracket that the word addiction may or may not apply to food for the average person,
00:34:52.940
And I would argue that any American who has spent any time in Europe, and I love being in
00:35:00.040
Europe, will explain exactly what you've just said, which is we have the reverse experience,
00:35:05.460
right? When we go to Europe, whether we're in Italy, it doesn't matter. You could be in
00:35:09.560
the food central of Europe. You just don't tend to overeat the same way that you can in
00:35:14.740
America. And I have spent untold hours asking people, why do you think that is? What is it
00:35:23.780
in the food in Europe that seems to be different? I have never been able to find empirical evidence
00:35:28.780
to support my assertion. It's all anecdotal, but you are yet one more person to kind of ring that
00:35:35.000
anecdote true. I think there's a lot of things, right? I do agree that in Europe, the portion sizes
00:35:40.320
are so much smaller. And I think that there is, this has been an observed phenomenon that's been
00:35:45.460
done in studies. When you give a person a portion size, they will often eat past their limits. So there
00:35:51.560
was the experiments done many years ago where they gave people these drinks, right? So it was kind of
00:35:56.600
like a milkshake sort of thing. And they had one group drinking one drink and another group drinking
00:36:01.920
another, but the one group was drinking it where it was being refilled at a level that allowed it
00:36:07.900
to constantly stay higher than it would have been if they were just drinking it. And of course,
00:36:11.780
the question is, are people stopping when they're full or are they stopping when they finish? And of
00:36:17.580
course, these people were drinking more than the other people, meaning that the people who had a
00:36:21.440
refilling drink. So that would suggest that if you put more food on a person's plate,
00:36:26.020
they're going to eat more. So portion sizes matter. Most people have talked a lot about the
00:36:30.780
differences in wheat quality between Europe and the UK, pardon me, between Europe and between
00:36:35.600
North America. And obviously a big difference here is we use glyphosate on our wheat. In Europe,
00:36:40.920
it is not used. And so it's really not to me about the GMO distinction, but it is clear that there
00:36:46.580
might be a difference in the use of glyphosate. For example, people talk about how they just
00:36:50.940
don't feel as bloated when they eat things there. You've already alluded to the fact that less sugar
00:36:56.020
tends to be used, but also it's like, think of how smaller the cans and bottles are and stuff like
00:37:01.120
that. Right. So. Oh yeah, man. We went for a meal with somebody the other day and you just go to the
00:37:07.120
fridge and there's a liter bottle of Coke, a liter. And that's like, that's the minimum size you can get.
00:37:14.920
Yeah. That's fucking crazy. Yeah. So I just, I think, I think there are just so many differences
00:37:20.840
and, um, yeah, part of it is just, it's our culture here. It's everything is bigger. Everything is
00:37:29.100
better. I mean, but it's everything, right? It's like, it's, it's, our cities are bigger. They're
00:37:33.540
more spread out. Uh, our lane, I think, look at the difference in the, I'm sure you've thought of this
00:37:38.640
if you've driven here, when you drive in Europe versus when you drive in the United States, like when you
00:37:44.020
drive in the United States, you can shut your eyes half the time. The lanes are so big. When you are
00:37:48.840
driving in Europe, you have to be switched on. There is no futzing around. There's no drifting in
00:37:54.040
and out of lanes. Like everything is compact. So I just think there's a lot of this going on. Um, but
00:38:02.060
to your question, I agree completely that food science is all about engineering a product that
00:38:10.820
tastes as good as possible and gets you to buy as much as possible. And moving on to type two diabetes.
00:38:19.380
Let me just stick with this quickly on. Do you think you, it's very clear from the way you're
00:38:27.340
talking about it, Peter, the, the, the, you know, we all, I think would agree that capitalism is
00:38:32.960
a great system, but it comes with externalities. It comes with trade-offs. And I guess the question
00:38:40.580
is, do you think this can be solved by the market? Because like when we're in LA, you can get very
00:38:47.660
good food in LA. It's very expensive, but if you want to eat very clean, you can eat very clean. It is
00:38:53.120
available. Do you think this can be solved simply by the fact that, look, there's very cheap food and
00:38:59.620
if, and it's filling and whatever. And if that's what you want, you can have that. Or if you choose
00:39:05.120
to allocate a different portion of your family budget to food, because you care about health,
00:39:10.760
there's a supermarket that only sells really good stuff. That's all organic and all this and that.
00:39:14.860
Do you think this gets sold by the market or not?
00:39:16.800
So this is complicated because you can't disentangle politics from this. And I think it's,
00:39:28.540
it's very counterintuitive to people, to myself included, how non-linear the effects of agricultural
00:39:36.520
subsidies are on what we ultimately consume. Now, if, if I were czar, what I would, but I also had
00:39:47.560
infinite time where I could do multiple experiments. So I had kind of like a parallel universe.
00:39:52.020
The first thing I would do is just see what happened when I removed all crop subsidies.
00:39:58.500
I don't believe that's the answer, by the way. In fact, I don't think that will get us where we want,
00:40:02.720
but it will perturb the system enough. And I would really like to see what would happen,
00:40:06.780
right? So right now in the U S corn and soy are the dominant crops and they are heavily subsidized.
00:40:14.540
Of course, corn is the backdrop for most sugar, right? Most sugar in the United States is not
00:40:20.860
cane sugar. It's high fructose corn syrup, obviously derived from corn. I would be very curious to just see
00:40:27.780
what the economic ramifications would be of a complete elimination of subsidies.
00:40:34.220
Then what I'd want to do is perturb the system further in the direction that I would want things
00:40:39.520
to go, right? Everybody knows, you know, show me how a person gets paid and I will show you how they act.
00:40:47.080
And so if we wanted to create a state where fruits and vegetables, whole foods,
00:40:53.820
you know, regenerative agriculture as a concept, which we didn't talk about, but we could
00:40:59.240
became the norm, which meant it wasn't just available to rich people in Beverly Hills,
00:41:04.400
but it was available to everybody, right? Anybody who was trying to put food on their table could
00:41:09.980
acquire this food. What would have to be true? And I would basically work backwards from that desired
00:41:16.900
state to what are the economic incentives that need to be in place? So in this sense, even though
00:41:23.240
I don't, I think many people don't like the idea of the government putting their finger on the scale.
00:41:28.940
I think this is one of those examples that, as you said, if you just let capitalism run amok,
00:41:34.200
it's going to purely maximize profits and it has no consideration for the externality of human health.
00:41:40.000
What I think instead we want is modified capitalism. We want all the tools of capitalism
00:41:45.440
and the innovation, but the government probably needs to have their thumb on the scale in a way
00:41:49.880
that puts a guidance system on that missile. And currently that guidance system is broken.
00:41:57.400
And I believe it's in large part due to how food is subsidized today. I would just want to do the
00:42:04.540
experiments of changing those subsidies in a way that would produce a different desired outcome.
00:42:10.300
So, and that's not a satisfying answer because I'm not telling you what those changes need to be,
00:42:14.820
but it's a, because I'm quite ignorant of it at this point. Uh, and B, I'm not sure anybody fully knows.
00:42:21.600
And so if we look at, for instance, type two diabetes and you talk about it in the book. Now,
00:42:28.240
when I think about type two diabetes, I go, Oh, someone's just quite big that it needs to be dealt
00:42:33.680
with and blah, blah, blah. It's not a big deal. But you argue something else in the book that this
00:42:38.400
is a very, and it actually opened my eyes to the dangers of being obese and morbidly obese.
00:42:45.080
And there is a whole host of issues that come with this particular condition.
00:42:49.600
Yeah. So in the book, I talk about the four horsemen of death. Um, and the reason I talk
00:42:54.540
about them is that anybody who's listening to this podcast, like they're probably going to die from
00:42:59.480
one of the four horsemen. There's about an 80% chance. If you're listening to us right now,
00:43:03.120
you're about to die. And so, um, and part of that is due to the success of medicine 2.0,
00:43:11.400
right? Like you're not likely to die giving birth to a child anymore. You're not likely to die of
00:43:18.380
an infection. You're not likely to die of cholera. You're not likely to die of influenza. Like the
00:43:23.820
things that killed our ancestors 200 years ago are not the things that kill us. So now we die of
00:43:29.020
cardiovascular disease and cerebrovascular disease, heart attacks and strokes, cancer,
00:43:34.180
dementia, and neurodegenerative diseases, and these cluster or spectrum of metabolic diseases
00:43:41.140
that include everything from hyperinsulinemia, uh, insulin resistance, obesity, fatty liver disease,
00:43:49.260
and type two diabetes. Now, what's interesting is that that fourth horseman by itself doesn't kill
00:43:54.780
that many people. So if you, if you actually just look at death certificates and say how many people
00:44:00.780
on it has, when you, it's really funny filling out a death certificate is a complicated, it's much more
00:44:05.100
complicated than you would think. You have to list the primary cause of death and then all the
00:44:09.420
contributing factors. Uh, and it's very, you have to be very, very technically correct when you do this.
00:44:14.020
So if you were to just look at the 2.6 million death certificates that were filled out last year in the
00:44:18.540
United States, very few of them would have type two diabetes as the number one proximate cause of death.
00:44:24.780
It's when you look at how many of them have cardiovascular disease, cancer, dementia,
00:44:30.280
all these other diseases where a contributing factor is indeed type two diabetes. And the reason
00:44:35.400
is type two diabetes contributes so much to each of those diseases by effectively doubling your risk
00:44:42.860
of each of the other three horsemen. In fact, if you have type two diabetes, your risk of all cause
00:44:49.140
mortality goes up about 40 or 50%. That means if you take an individual with type two
00:44:54.640
diabetes, their risk of dying in the subsequent year from any cause is 50% higher than someone
00:45:01.900
without type two diabetes. And do we know the reasons for that?
00:45:06.620
Yeah. We think that the majority of it comes down to what happens when glucose is dysregulated because,
00:45:14.060
you know, that's what type two diabetes is. It's a disease of glucose dysregulation.
00:45:18.100
It's a mismatch between how much glucose is in the bloodstream and how much that person is able to
00:45:25.120
dispose of it, which is just a technical word for put that glucose into their muscles and into their
00:45:30.420
liver and keep their blood glucose levels normal. And if the blood glucose levels are elevated and they
00:45:36.200
don't have to be elevated very much, I mean, to put this in perspective, the three of us are sitting
00:45:40.540
here right now talking. We probably have a grand total of five teaspoons of glucose in our entire
00:45:47.620
circulation. That would be normal. If that number were increased to seven from five, we have type two
00:45:55.560
diabetes. Wow. I mean, it's a subtle difference. In other words, the body's capacity to maintain
00:46:02.060
homeostasis in this regard is incredible. But what are the consequences of that? Well, the more glucose you
00:46:07.680
have in your bloodstream, the more glucose sticks to various proteins in the body. And that leads to
00:46:13.240
certain issues that result in microvascular damage. So that you've probably heard of people with type
00:46:18.580
two diabetes, they're more likely to have impaired vision. They're more likely to require amputations,
00:46:24.340
get kidney disease, cardiovascular disease, small vessel disease in the brain. And then the other thing
00:46:29.620
that happens is you have higher levels of insulin because you have more insulin trying to put
00:46:33.980
that glucose away. And then higher levels of insulin tend to be more damaging to larger blood vessels.
00:46:40.020
So it's a complicated cascade that involves the elevated levels of glucose, the elevated levels of
00:46:46.160
insulin that initially are made by the body, but ultimately usually supplied by the exogenous insulin
00:46:51.260
that they have to give themselves. And then you have a whole host of other factors, including the
00:46:55.440
inflammatory cascade that comes from the excess adipose tissue, meaning excess fat cells produce excess
00:47:03.340
inflammation, cytokines that also lead to damage of organs. And there was something in the book that
00:47:09.220
I found incredibly fascinating where you were talking about tumors, cancerous tumors, and the effect
00:47:14.860
that glucose had on them. And if you've got excess glucose in your body, I was there thinking, well,
00:47:20.880
what's your tumors are growing basically quicker than normal? Yeah, I think the bigger issue for the
00:47:26.300
cancer cells is probably not even the glucose. Although yes, cancer tumors rely almost exclusively
00:47:32.760
on glucose. It's the other growth signals that come with high glucose, namely insulin. So I would argue
00:47:40.240
that it's the hyperinsulinemia more than the hyperglycemia that is probably the more important
00:47:47.560
relationship link between type 2 diabetes and the increase in the prevalence of cancer.
00:47:54.040
Peter, I want to talk about before, you know, in this interview at the end about some of the answers
00:48:00.020
to these things at an individual level. But before we do, one thing we really want to talk about that
00:48:04.520
you don't talk about in the book is testosterone. We know that men's testosterone is going down
00:48:10.000
generation by generation. First of all, do we know why that is?
00:48:15.920
There's probably a couple of reasons, but the data would suggest that the most dominant explanation for
00:48:22.200
why basically a 30-year-old man today has the same testosterone as a 50-year-old man did about 40
00:48:32.640
So that's a demonstrable fact. The best explanation for that is probably the increase in body fat that
00:48:42.360
has come along for the ride in that period of time. And with that increase in body fat comes an increase
00:48:47.920
in inflammation. And with that increase in inflammation, you basically are going to make
00:48:52.920
less testosterone. So it's impairing the body's ability to make testosterone. And then also the
00:48:57.980
other thing that happens with more body fat is more of the testosterone that is made is shunted into
00:49:02.940
estrogen. So the what's called aromatization of testosterone into estrogen is a natural process.
00:49:11.280
But the balance, the more adipose tissue, the more fat tissue you have, the balance of that shifts
00:49:16.300
more that way. There are probably other factors as well, though. For example, we only make testosterone
00:49:21.560
when we sleep. I mean, that's where we have the biggest pulsatile amount of luteinizing hormone and
00:49:27.280
follicle stimulating hormone, which tell the body to make testosterone. So you could argue, although I
00:49:31.940
don't think I have great data for this, that anything that's going to disrupt sleep or degrade quality of
00:49:37.960
sleep, especially deep sleep, might have a negative impact as well. So that could be stress. That could
00:49:43.840
be, you know, phones, things that kind of get in the way of people's lives. But I think that most of
00:49:51.800
this effect is probably explained by the increase in body fat. Really interesting. And the question that
00:49:57.240
I was wondering about with all of that, we know testosterone affects behavior. And you're not a
00:50:05.420
political guy. You don't get involved in this stuff. But I do think it's an interesting question
00:50:08.600
to think about. This must be affecting how people vote, what policies they support, and therefore
00:50:19.460
I honestly have never thought about it that way. So are you arguing that lower, on aggregate,
00:50:25.760
lower testosterone would lead to a shift in one way or the other politically?
00:50:30.860
Well, when people have less testosterone, they show up differently in the world. They respond
00:50:37.460
to threats differently. They care about different things. They feel more powerful or less powerful.
00:50:42.800
They have a different locus of control, all of these things, right? So forgive me for kind
00:50:48.320
of being as blunt about it as I am, but a culture in which sensitivity and, you know, being extra
00:50:54.760
careful and not offending people, et cetera, seems to be taking off, frankly, or has at least done over
00:51:01.260
time. It doesn't seem like much of a leap to go, well, if we all have less testosterone, wouldn't
00:51:09.040
Yeah, super interesting thought. I never gave it thought. I don't know. You'd have to put it in
00:51:15.620
the context of all the things that change. The other thing is, even though testosterone levels are
00:51:20.920
lower than they've ever been, testosterone replacement is also higher than it's ever
00:51:25.400
been. So what we don't really know is what is the realized level of testosterone today in the
00:51:32.220
population relative to a decade ago or two decades ago when some of these behaviors, you know, started
00:51:39.580
to take hold. Because if natural testosterone is lower, which it undeniably is, but it's being
00:51:45.740
supplemented and corrected, then maybe it's a wash and there are other...
00:51:50.620
But I'm guessing college students aren't taking testosterone replacement, right?
00:51:56.400
I do believe some are, but I don't know how prevalent it is.
00:52:02.960
Yeah. And the other thing I was going to ask you is, this is a question from my wife who wants
00:52:08.440
me to eat less red meat. It's something that kind of is the universal meme that red meat is bad for
00:52:16.140
you. When I went for dinner at your house, there was quite a lot of red meat on the table from my...
00:52:20.840
Now, Jordan was there, to be fair, so you kind of had to do that. What's your take on that as
00:52:27.000
Yeah, this is one of those enduring examples of really, really bad science that just never dies.
00:52:35.900
So this idea that red meat is somehow harmful really began its hold during the 1980s when people
00:52:50.840
began to be aware of cholesterol and the role cholesterol played in heart disease. And of
00:52:57.480
course, red meat at the time was being compared to white meat. And so back in the early to mid-1980s,
00:53:04.180
there was really a push to move people away from beef to chicken. And the idea was, well,
00:53:09.980
chicken contains less saturated fat and therefore, on balance, you would have a lower level of
00:53:16.660
cholesterol. And that's true depending on how much of it you eat. What has given that idea more legs
00:53:25.060
is some of the epidemiology that has demonstrated, though not consistently, that people who eat
00:53:31.720
red meat have higher risks of, you know, type 2 diabetes or cardiovascular disease than people who
00:53:38.080
avoid red meat. So on the surface, you might be listening to this and thinking, well, that seems like
00:53:42.740
a case closed, no-brainer. But the problem is epidemiology, especially when the hazard ratios are
00:53:49.100
relatively small, is so fraught with errors, right? Epidemiology only identifies associations,
00:53:55.360
but it can never identify causation. And so one of the biggest challenges with the red meat
00:54:01.280
epidemiology stuff is that people consuming red meat and people not consuming red meat tend to be
00:54:08.420
proxies on average for very different behaviors. So for example, people who consume red meat on average
00:54:15.920
will tend to consume more processed foods. In fact, much of the red meat that they consume is in the
00:54:20.760
form of processed red meat, like, you know, gas station jerky sticks and things like that.
00:54:25.300
People who go out of their way to avoid red meat tend to engage in many behaviors that are pro-health.
00:54:32.560
They tend to exercise a lot more. They smoke a lot less. They engage in other food behaviors,
00:54:39.520
such as the consumption of fruits and vegetables, to a much higher extent. Now, what's interesting is when
00:54:45.040
you strip all of those things away and you normalize for, say, vegetable consumption,
00:54:50.480
that cancer-causing effect of red meat completely vanishes, right? So in other words, when you just
00:54:56.840
say, let's compare people who eat red meat to people who don't, you're going to get that difference in
00:55:01.580
risk. But yet when you start to correct for everything, including servings of vegetables in a day,
00:55:07.780
all of a sudden the harm, the supposed harm of red meat goes away. I think there's more nuance to it
00:55:13.480
than that, frankly. And I think it also comes down to the type of red meat you're going to consume.
00:55:17.620
And I don't think all red meat is created equal, just as I don't think all plants. We've already
00:55:21.460
talked about how in Europe, there's clearly something different between the bread and pasta
00:55:26.560
in Europe and the bread and pasta in the United States. And it's not a stretch to assume then
00:55:31.420
that not all meat is the same. And I don't, you know, I mean, so much has been said about it.
00:55:35.380
I don't need to harp upon it, but I think there's a fundamental difference between consuming
00:55:39.140
farmed red meat and consuming, you know, grass-fed red meat that is free of antibiotics and hormones.
00:55:46.220
Now, again, this gets back to a problem you raised earlier, which is that's a great thing to say when
00:55:51.040
you're, you know, well-to-do enough that you can afford to buy those things and not everybody can.
00:55:56.280
So that said, I still think that the majority of the literature condemning red meat is highly flawed.
00:56:05.480
I would say that if a person consumes red meat, they should probably make an effort to
00:56:10.140
invest a little bit more and get the red meat that's probably of the highest quality.
00:56:14.140
And this may be an incredibly stupid and factually incorrect question, but I have
00:56:18.520
heard a lot of talk and read a lot of talk about the fact, the idea that actually there are several
00:56:24.920
types of human beings and some are supposed to eat meat and others are not. Is there any truth to
00:56:31.520
any of this? I have a really hard time kind of accepting that. I mean, I think the basis for
00:56:37.380
that line of reasoning stems from the fact that, you know, you can trace our ancestors to different
00:56:44.580
parts of the globe, right? So my ancestors all came from Africa. Yours came from Northern Europe.
00:56:50.660
You know, there's someone whose ancestors came from Asia. And the idea was, well, my ancestors would
00:56:55.340
have ate more of this and less of it. And therefore, would I be more naturally suited to that?
00:57:01.660
Again, I've just never seen compelling evidence to support what is otherwise a very lovely story.
00:57:07.740
And so before we move on to our final question, there's the average person who's sitting there
00:57:13.460
watching this or listening to this and they're thinking, right, this is really interesting and
00:57:17.260
this is great, but how do I become healthier as a person? What can I do to improve my health and to
00:57:24.140
live a longer and most importantly, not just longer, but as you said in the book, healthier life?
00:57:30.400
Well, it's actually interesting. It's the one thing we didn't talk about today. I mean,
00:57:33.140
we did a lot of things we didn't talk about, but I think the most important thing that we didn't
00:57:36.420
talk about, but it's okay because there are three of the 17 chapters in that book are about it,
00:57:40.320
is exercise. And I think that... Yeah, let's not focus on that. What else can I do? No,
00:57:46.380
I'm joking. Carry on. Honestly... Well, I have to make an effort. God, no, no.
00:57:51.240
Well, but for some people, myself included, food requires more effort than exercise. So
00:57:57.260
everybody has their own cross to bear in this regard. And for me, food is the biggest cross
00:58:02.500
to bear by far. Sleep comes naturally to me if I do the right steps, meaning it comes naturally to me
00:58:08.460
to be disciplined about sleep hygiene. It comes very naturally to me to want to exercise. I get the
00:58:14.260
reward in the short term of actually feeling good. And for whatever reason, it connects with my
00:58:19.600
cognition where I can tie my ability to do something now to what I did in the gym yesterday.
00:58:26.240
But food is very difficult. Food is a never ending struggle for me. If left to my own devices,
00:58:31.380
I would eat French fries, Kentucky fried chicken and pizza all day, every day. I love it so, so much.
00:58:39.160
Yeah, we do. You know, you should come around one time, Peter. Let's just go.
00:58:42.840
Do you know, the last time I was in the UK, I made a point to have fish and chips every single day.
00:58:49.380
I was like, you know what? I'm only here for a week. Like, I'm just going to go to hell.
00:58:57.480
You couldn't stop eating fish and chips. Couldn't stop. But I think that the majority of the health
00:59:06.560
span benefits that we speak of, both mind and body are going to come from exercise. So if I could,
00:59:12.300
if someone said, look, Peter, just direct me to one thing, I would direct them to, hey, read the
00:59:17.640
chapters on exercise and figure out a way to sort of balance your exercise portfolio around the right
00:59:24.300
amount of strength training, the right amount of cardio training, the right amount of movement
00:59:29.600
training. And I think that that's, on a singular level, going to pay higher dividends.
00:59:35.620
It's been a fantastic interview. Thank you so much for coming on the show, Peter. Final question
00:59:39.840
is always the same. What's the one thing that we're not talking about that we really should be?
00:59:44.720
Yeah. Even knowing you're going to ask that question, I still can't come up with a great
00:59:47.860
answer. So I would say, what's the opposite side of the AI bet when it comes to health, right? So
00:59:55.060
most people that are talking about AI as it pertains to health are taking, I would say,
01:00:02.680
the most optimistic view, right? Which is, and let's give them reason for saying that, right? So
01:00:09.460
at the time of our recording, a Nobel Prize was just awarded. The Nobel Prize in Chemistry was just
01:00:15.640
awarded to the folks at Google that developed AlphaFold, right? So this was a remarkable AI
01:00:21.880
technology that did something, I don't know, if you told me this was possible two years ago, I would
01:00:26.940
have said, I don't think so. And I would have been wrong, which is, and this is nuanced, but it's an AI
01:00:34.220
that was able to predict the folding structure of a protein only knowing the primary sequence of amino
01:00:39.880
acids. And you might say, well, why is that interesting? Well, that's interesting in that it's a much,
01:00:44.120
much quicker way to help scientists predict what type of molecule would fit into a receptor, and
01:00:52.140
that's effectively what pharmacology is. So that now takes the first step of drug discovery and makes
01:00:57.980
it really, really fast. So based on that, I think many people are now saying, in 10 years, we are going
01:01:04.620
to be immortal. Because when you have an AI that can solve that problem today, and you look at the pace
01:01:11.340
at which AI is growing, what is it going to be solving in 10 years? It's going to solve aging. So I've met with
01:01:17.920
many people, some of whom I think are incredibly intelligent, who say, look, in 10 years, it doesn't
01:01:23.120
matter. Just don't die for the next 10 years, and it's all going to be okay. Because in 10 years, AI will have
01:01:28.020
solved death. And I think while that might be a slightly extreme view, virtually everybody I talk with in
01:01:35.700
healthcare says, AI is going to completely change our lives for the better with respect to health.
01:01:43.180
And I just think it would be interesting to hear the bear case on that. And what's the less optimistic
01:01:48.060
case? Not that AI is necessarily harmful, but that aging is a much more complicated problem than some
01:01:53.480
of these standard engineering problems. And while what AlphaFold did is incredible at the chemical level,
01:01:59.260
it still doesn't solve, like, how do you unfold proteins in my body that have folded irreversibly?
01:02:07.860
So we should keep drinking our own urine for the meantime.
01:02:14.040
Just take the hedge, assume that, yeah. Keep exercising, yeah.
01:02:18.060
I literally can't think of anything worse. I actually would rather die than drink my own urine
01:02:23.200
for the rest of my life. Peter, I don't know why we ended on that. Thank you so much for coming on the
01:02:27.680
show. It's been absolutely awesome. I would, not only would, I actually do recommend your book to
01:02:32.260
everybody because it was so transformational for me. It's really, really, I really hope more people
01:02:37.640
read it because, as I said, I was somebody who was not paying too much attention to my health. I was
01:02:42.820
busy with work. I sort of thought I was very healthy anyway. It's been genuinely eye-opening
01:02:47.260
and transformational. I think if more people read it, the world will be healthier. So all power to you.
01:02:53.140
I hope people buy Outlive and read it. It's a fantastic book and keep up the great work.
01:02:58.600
All right. Head on over to Substack where we ask Peter your questions.
01:03:03.480
Do you have any suggestions for legislators or educators who are trying to break the insatiable
01:03:08.860
appetite for sugar, fat, and salt, especially in lower-income groups?