Ep 534 - Outlive (feat. Peter Attia)

Summary

Episode Summary: "Outlive (feat. Peter Attia)" – Ep 534 of Matt and Shane's Secret Podcast

In episode 534 of Matt and Shane's Secret Podcast, hosts Matt McCusker and Shane Gillis engage in an insightful and humorous conversation with renowned medical doctor and health optimization expert, Dr. Peter Attia. Released on December 5, 2024, this episode delves deep into topics ranging from personal health journeys and the evolution of medical practice to the intricacies of immune system regeneration and stress management. The dialogue is enriched with personal anecdotes, expert insights, and light-hearted exchanges, making complex health concepts accessible and engaging for listeners.

Introducing Dr. Peter Attia

The episode kicks off with Matt expressing his enthusiasm about having Dr. Attia on the show, highlighting his familiarity with Attia's work and his read “the author’s book” [00:00]. Attia shares snippets of his impressive background, including his tenure as a general surgeon with a focus on cancer [00:10]. Matt recounts Attia’s extraordinary feat of swimming 21 miles—a detail that not only underscores Attia's physical endurance but also serves as a metaphor for his relentless pursuit of health and longevity [00:19].

“I just took it back. I've been doing it when I was little and I just started it and it's weird.” – Matt on picking up skateboarding later in life [35:20]

Transition from Medicine to Health Optimization

Dr. Attia discusses his departure from traditional medicine three years prior, a move influenced by personal milestones such as the birth of his daughter and a heightened awareness of his own health vulnerabilities [01:25]. This pivotal shift marked his transition into a more holistic approach to health, emphasizing not just lifespan but healthspan—the quality of life lived in good health.

“I'm just just trying to figure out how to not die prematurely.” – Dr. Attia on his obsession with longevity [02:10]

Understanding Prediabetes and Blood Sugar Management

A significant portion of the conversation centers on prediabetes, with Matt sharing his recent discovery of an elevated A1C level despite leading an ostensibly healthy lifestyle [02:51]. Dr. Attia elaborates on the complexity of metabolic diseases, advocating for a nuanced understanding beyond the traditional binary classification of diabetes [03:05].

“Prediabetes is a step along the way... the lower your blood sugar, the better.” – Dr. Attia on viewing type 2 diabetes as a continuum [04:07]

Matt relates this to his personal experience of experiencing brain fog and discovering that reducing carbohydrate intake significantly improved his cognitive functions [08:05].

Medicine 2.0 vs. Medicine 3.0: Shifting Focus to Healthspan

Dr. Attia introduces the concept of Medicine 3.0, contrasting it with Medicine 2.0. While Medicine 2.0 focuses on treating acute problems as they arise—such as injuries or infections—Medicine 3.0 emphasizes preventive measures and optimizing long-term healthspan [06:19]. This approach involves measuring and managing various health metrics that contribute to overall well-being, including muscle mass, strength, endurance, cognitive performance, and emotional fulfillment.

“If you don't measure something, there's no chance you're going to manage to it.” – Dr. Attia on the importance of metrics in managing healthspan [15:23]

Matt expresses his frustration with traditional medical visits that often overlook these broader health indicators, reinforcing the necessity of a more comprehensive health evaluation [07:27].

Regenerating the Immune System and Aging

A focal point of the discussion is the aging immune system and the potential for regeneration. Dr. Attia delves into cutting-edge research on epigenetics, specifically how methylation patterns can influence the functionality of T cells—the cells responsible for combating infections and cancer [20:14].

“What if we took the methylation pattern of an old T cell and made it look like a young T cell would it revert into a young T cell.” – Dr. Attia on reversing immune aging [21:30]

This exploration highlights the intersection of genetic regulation and environmental factors, underscoring the profound impact of lifestyle on immune health.

Testosterone Replacement Therapy (TRT) and Hormonal Health

The conversation shifts to the topic of Testosterone Replacement Therapy (TRT), where Dr. Attia advises caution. He emphasizes the importance of addressing underlying causes of low testosterone, such as sleep deprivation and stress, before considering hormonal interventions [23:43]. Attia warns against indiscriminate use of TRT, advocating for a personalized approach that prioritizes natural hormone optimization strategies.

“If a 30 year old has testosterone that is so low that it's impacting him, I think you have to start by asking why.” – Dr. Attia on addressing the root causes of hormonal imbalance [23:55]

Supplements and Personalized Healthcare

Matt inquires about the efficacy of internet-based companies offering personalized supplements based on various biomarkers. Dr. Attia provides a critical perspective, acknowledging that while some supplement optimizations are beneficial, many are no more effective than basic blood work assessments [26:35]. He advocates for practicality, suggesting that fundamental supplements like Vitamin D, B vitamins, and fish oil can be sufficient for most individuals without the need for extensive testing.

“I think you can do a lot of supplement optimization off really basic blood work.” – Dr. Attia on the simplicity of effective supplementation [27:54]

Optimizing Physical Activity and Fitness

Physical fitness emerges as another cornerstone of health optimization. Dr. Attia outlines a pragmatic approach to exercise, recommending a blend of cardio and strength training within a limited time frame to maximize health benefits [32:01]. The hosts share personal anecdotes about incorporating activities like skateboarding and chess into their routines, emphasizing the importance of finding enjoyable and sustainable forms of physical activity.

“If you're active could probably justify taking creatine.” – Dr. Attia on common supplements for active individuals [28:05]

Matt narrates his experience with resuming skateboarding at 38, illustrating how revisiting childhood activities can provide both physical and psychological benefits [35:20].

Stress Management and Achieving Fulfillment

The latter part of the episode delves into stress management as a critical factor in longevity and quality of life. Dr. Attia identifies stress as one of the most insidious killers, discussing its pervasive impact on both mental and physical health [44:20]. Drawing from insights inspired by Bill Perkins' book "Die with Zero," he emphasizes the importance of balancing health, time, and money to achieve overall fulfillment rather than fixating solely on one aspect.

“It's about managing how one responds to stress and finding overall satisfaction and contentment in life.” – Dr. Attia on the multifaceted nature of stress management [45:35]

Matt echoes these sentiments, sharing his strategy of dedicating a day each week to focus solely on calmness and contentment, thereby enhancing his ability to navigate daily stresses effectively [43:12].

Personal Anecdotes and Light-Hearted Exchanges

Throughout the episode, Matt and Shane intersperse their discussions with humorous anecdotes and relatable stories, such as dealing with children's behavioral challenges and the absurdities of traditional medical exams. These moments serve to humanize the conversation, making complex health topics more approachable and enjoyable.

“If you're not willing to eat three servings of fish a week, right.” – Dr. Attia on practical dietary recommendations [28:18]

Conclusion: Embracing a Holistic Approach to Health

As the episode draws to a close, Dr. Attia underscores the necessity of a holistic approach to health that prioritizes preventive care, personalized interventions, and the management of stress and fulfillment. Matt and Shane express their gratitude for Attia's valuable insights, highlighting the transformation in their own health perspectives inspired by the conversation.

“Read the book. Listen to the podcast.” – Dr. Attia on his recommendations [51:27]

Notable Quotes

• Matt McCusker [00:00]: “I'm really pumped. I read your book, so I'm kind of familiar.”
• Dr. Peter Attia [02:10]: “I'm just trying to figure out how to not die prematurely.”
• Dr. Peter Attia [04:07]: “Prediabetes is a step along the way... the lower your blood sugar, the better.”
• Dr. Peter Attia [15:23]: “If you don't measure something, there's no chance you're going to manage to it.”
• Dr. Peter Attia [21:30]: “What if we took the methylation pattern of an old T cell and made it look like a young T cell would it revert into a young T cell.”
• Dr. Peter Attia [23:55]: “If a 30 year old has testosterone that is so low that it's impacting him, I think you have to start by asking why.”
• Dr. Peter Attia [26:35]: “I think you can do a lot of supplement optimization off really basic blood work.”
• Dr. Peter Attia [32:01]: “But if you've only got... two hours a week of exercise that can bring so much benefit.”
• Dr. Peter Attia [44:20]: “I think it's the most insidious killer... managing how one responds to stress.”
• Dr. Peter Attia [51:27]: “Read the book. Listen to the podcast.”

Final Thoughts

Episode 534 of Matt and Shane's Secret Podcast offers a compelling exploration of modern health optimization through the lens of Dr. Peter Attia. By blending expert knowledge with personal stories and humor, the episode provides listeners with actionable insights on enhancing their healthspan, managing stress, and achieving a balanced, fulfilling life. Whether you're well-versed in health topics or just beginning your wellness journey, this conversation is both enlightening and inspiring.

Transcript

[A]

Doctor Peter Attia. Dude, thank you for coming. Thank you for doing this. Thank you for doing this. I'm really. I'm really pumped. I read your book, so I'm kind of familiar.

[B]

Thank you so much.

[A]

I kind of like what you're about.

[B]

Thanks for having me.

[A]

Thanks for doing the podcast and I guess I'll give you an introduction and correct me if anything, if I'm wrong. You were a medical doctor and you did cancer surgery, Right?

[B]

A general surgery with a focus on cancer.

[A]

With the focus on cancer. And then you just kind of. I liked your origin story a lot. From what I remember in your book, you did this big swim, like, right. It was like a marathon swim or something. And how far did you swim?

[B]

It was about 21 miles.

[A]

That's insane. So you did a 21 mile swim and then if I remember correctly, you were eating a cheeseburger in celebration. And your wife.

[B]

Your wife kind of. That was a slightly longer swim, but yes, yes. Now I know the story you're talking about. Okay.

[A]

Yeah, that I. That. Honestly, dude, that made me laugh so hard that you did like a what?

[B]

I think that was like 25 miles or something.

[A]

25 mile swim. You go out to have a cheeseburger and I believe a Coca Cola.

[B]

Yeah.

[A]

And your wife more or less was like, you're fat. Yeah, dude, that's the best. And then you launched you. And then you just got the ultimate revenge and started like a super successful business. How do you feel?

[B]

She was very sweet. She said she know. She just. She didn't say, you're fast. She goes, you need to work on being less not thin.

[A]

That's worse, though. I'd rather someone be like, you, fat ass and be like, you need to be less not thin. But you just swam 25 miles.

[B]

Yeah.

[A]

Well, that's wonderful, though. That is good, though, to have a woman to push you to those heights, because then that's. Is that really, like the genesis of you kind of branching out into like.

[B]

I had actually already left medicine at that point. I had been out of medicine for three years. I was working at that time. God, what was I doing? I was working at an energy company, I think. Or maybe I was in finance or something. I was. But I was like, I had nothing to do with medicine. But that was right around the time my daughter was born as well. And so I think that was kind of the one, two punch. It was sort of my daughter's born. And then I'm realizing actually, like, I'm not that healthy, even though I exercise A lot. I'm actually not that healthy. And that those, those two things were what kind of got me to be pretty obsessed with just trying to figure out how to not die prematurely.

[A]

The kids do that. I, I have a two and a four year old and that really kind of. I, I actually thought you'll find this interesting. I thought I was healthy. I did all, I was doing the, you know, all these apps. Like, I did the one where you like mail your poop and all that stuff. And I, I did that. They came back like, dude, you're like six years younger biologically. I was like, this is awesome. Did I. I had the aura thing. I had that going on, telling me I'm seven years younger than my age. And then I took a blood panel. Dude, I'm like pre diabetic. I was like, what the man? It was like, I thought I was like killing it. I got it back and it was like, I literally just found out two days ago. So this timing couldn't be more perfect. My A. What is it? A1C, I think it was. My A1C is like 5.7, which was like. But I did eat two bites of a pancake before my blood work, which I'm not. You're not supposed to do.

[B]

It shouldn't impact the A1.

[A]

Damn it, dude. I was hoping that was the answer. Yeah. So that is kind of crazy because you. And again, I don't, you know, I'm not the definition of fitness, but I'm not like, I wouldn't think. I thought I had the almost type 2 diabetes.

[B]

Well, it takes a while. Like you don't. No one wakes up diabetic. But also most people don't. Kind of don't recognize that it's a 10 year journey for most people really to get there.

[A]

Yeah, so what? I have like four, like four more years of prediabetes.

[B]

I mean, I think that's impossible to predict for any one person. But, but we, we definitely know that disease is so much more complicated than people, I think, historically have thought of it. People have historically said, well, I mean, type 2 diabetes is your pancreas. Can't make enough insulin, you can't get enough glucose out of your blood into the muscles, and eventually we just cut off some arbitrary number. We just say once you reach a certain level of blood glucose, then you have type 2 diabetes. But you know, to me, that's just not a great way to think about it. I think of it as a continuum and a spectrum, and prediabetes is a step along the way. But we also know that the lower your blood sugar, the better. So 5.7 is better than 5.8 is better than 5.9. But even though we would call you, quote unquote, normal at 5.6, I would argue 5 is much better than 5.6.

[A]

Gosh. I see what you're saying.

[B]

Yeah.

[A]

Yeah. It was, like, for real joke, because I was, like, dancing in the end zone on my wife because she's. She is her biological age, and I'm not rubbing it in, but it was like, whatever. And I was like, I'm five years older than her, so I was like her peer biologically. And I. I was laughing.

[B]

You know, these biologic clocks things are such a. Such a scam. It is incredible. No, I love it. I love it. Mine was brilliant marketing. It is brilliant.

[A]

I woke up one day and I went like, I lost half a year of my biological age. I was like, what the Did I do? I, like, went into a panic. But, yeah, so the. That was, like, a real revelation for me. I was like, holy, man. Because my dad has type 2 diabetes, and I was like, yeah, that's on him. He eats ice cream all the time. I'm healthy, and I, like, got my blood work. And I was like, son of a. By the way, I'm just breaking this right now. I don't. I don't.

[B]

This is breaking.

[A]

This is breaking news.

[B]

This is. This is, like, so timely.

[A]

I have free. And I was actually. It is very timely, and I have been leveraging it emotionally in my household, which is nice. Anytime my wife bothers me, I'm like, dude, I have pre diabetes. This cortisol is going to mess up my insulin.

[B]

So I. I got a text message literally, on the way over here from a buddy who just got a vasectomy yesterday. And we had recommended the urologist to him who. Who was going to do it. So he goes, look, I just want to tell you, man, literally the best experience ever. The guy was incredible. So funny. You know, he's got me draped, like, over the table. So, like, you know, he's like, there's a drape, like, I'm laying on my back like a C section.

[A]

They do like it. They don't let you see. Yeah.

[B]

It's like, you're sterile. They want to keep you sterile. Right.

[A]

Got you.

[B]

And the guy walks in the room. First time, he hasn't seen me. He doesn't see my face. He just sees my. My. My schlong. And he goes, oh, I remember you. But he was like, but it was just all jokes and he's. So he says today he goes, you know, look, honestly, zero pain at all, but don't tell my wife. I am going to milk this as 10 out of 10 pain for another week.

[A]

So important.

[B]

Yeah, yeah, yeah.

[A]

So also, the vasectomy, you can't ejaculate for, like, what, seven days or something?

[B]

That's a good question. I don't know. How many days?

[A]

I don't know.

[B]

How many days? I don't know.

[A]

It's like seven. My friend did it.

[B]

He had to hold off.

[A]

Yeah, seven whole days. And he said he went a little prematurely and said he had a little bit of pain, so that's not good. But, yeah, dude. So that's. That was kind of crazy, man, because again, I've been doing all the services because I haven't been to a doctor in forever. Because I'm like, you know, I go to. And this is, I think was cool. In your book, you have like. Was it healthcare 2.0 versus, like, 3? What was the latest?

[B]

Yeah, medicine 2.0 versus medicine 3.0. Yeah.

[A]

So 3.0 is kind of where you're at. That's kind of more cutting edge. 2.0 is, like, what, a step up from, like, medieval humors and.

[B]

Yeah, but. But still important. I mean, we still want medicine 2.0. Medicine 2.0 will take care of a problem when it shows up. And if you, you know, if you. If you're in a car accident, you break your leg, you get pneumonia, you want. You want someone who knows how to deal with those problems. But it's a very different system from, hey, how do I take a guy whose hemoglobin A1C is 5.5, who no one. Everyone thinks is just perfect, but I think he's on the path to actually, you know, being diabetic in 10 years. And why would I wait till he's staring down the door when I could just make the changes now?

[A]

Yeah. And that was kind of my beef with doctors. I would go there and they're like, nice. I don't have anything against them, but I go there, and they're just kind of like, yeah, cholesterol is good. And I'm like, this is all we're worried about. Like, this is. And then they lowered the window to, like, blood pressure. One day I went in there and they're like, oh, by the way, high blood pressure is lower now. And I'm like, okay, I didn't have a blood pressure problem, but it's like, I just feel like you go there and it's like you're like a car. You go in and they check. Like, two things. Like, man, you're good.

[B]

But.

[A]

So I really liked your book, how you're like, you want to check for more things and try to increase the health span, not just the lifespan, which I like, because a lot of people are very unhealthy. I thought I was a poster child for health. Dude, I'm one of the suffering Americans. Just, I need Michelle Obama to come get me lunch. Dude, I'm all up right now. So what are you working on right now? Because the book. Has anything changed from the book? Because. And again, correct me if I'm wrong, but the summary was, like, the four horsemen. That's the things that the four leading causes of death. And there are what?

[B]

Heart disease, cancer. Cancer, neurodegenerative diseases and dementing diseases like Alzheimer's disease and metabolic disease.

[A]

That's me. That's diabetes. Right.

[B]

And they overlap. So when you have type 2 diabetes, your risk of those other diseases goes up by 50%. So that one sort of feeds into the other. And also, if you have cardiovascular disease, your risk of dementia goes way up, so.

[A]

Oh, really?

[B]

Oh, yeah.

[A]

Damn, that sucks. Yeah. And you know what's weird, too, because I don't want to turn this into, like, a personal doctor visit, but, like, I for real had, like, crazy brain fog. Like, I couldn't. I was, like, messing up, recalling words. And a lot of my mom's side had, like, dementia stuff when they got older. So I started being like, damn, I might be, like, getting, like, early dementia. And as soon as I learned about the high A1C and I don't know if that's, like, high enough to cause brain fog, like, I was like, forget it. I forgot the word croissant. I was, like, trying to think of that word. Couldn't think of that. But I. As soon as I got off all the carbs and now I'm, like, basically doing, like, keto, My brain just, like, came right back to life. It's pretty nuts.

[B]

Yeah. I mean, I don't know that that's related to the A1C per se, but fluctuating levels of blood glucose are. Make it just a little more difficult. And some people are more sensitive to it than others. Some people, you know, they can eat all the carbs in the world and it doesn't seem to phase them. And a lot of people are like, no, the moment I go to slower carbs or just no carbs at all. Or just more complex carbs. My energy levels normalize, and so, too, does my attention.

[A]

Yeah, dude, that's. That happened for me. And I also don't. I don't have to eat as much. Like, I was eating so much, man. It would be like four cups of rice. I was just pigging out.

[B]

Yeah.

[A]

And then as soon as I stopped eating that much carbs, I eat, like, two meals a day, and they're pretty, like, sparse.

[B]

So tell me about these pictures here. What's.

[A]

Thank you. This. I just figured it was funny because it's just a. Kind of like a. Just an ample naked lady sitting at a picnic. So I like. Solid. I literally picked the pictures very quickly. This one, I just wanted very intense imagery.

[B]

Yeah.

[A]

And so this is kind of like, you know, this is pleasant. It's a little complicated. You have.

[B]

What do you think is going on here? Why is she naked? And who are these guys?

[A]

These guys are up to no good, for sure. They. I think these guys. It looks like they just got happened upon, and someone's going, what the hell are you doing with that ample naked lady in the park? And this guy's.

[B]

But he's, like, fully dressed.

[A]

Yeah.

[B]

Who's the girl in the background?

[A]

So to answer your first question, this is a clothed male, naked female. It's a fetish that's going on. And I think she's kind of like, next. I think they're like, get over here. Strip down, so we can have a naked picnic. This caused a serious uproar back in the day when he. This guy painted this. It was a problem.

[B]

I. Bless. I mean, I can see why they.

[A]

Were like, if you had someone posed, this lady had to have been a prostitute. And they're like, that's totally scandalous.

[B]

Yeah. What year, approximately, was this?

[A]

I wish I knew. I don't know if I had a guess. I would say, like, maybe late 1800s, if I had a guess, but I could be wrong. And I don't know what that guy's hat's all about over there, but, yeah.

[B]

I mean, it's sort of. I don't want to profile him, but I have thoughts.

[A]

True. It is a hat. I don't recognize that hat. And I do have my own suspicions as well. But, yeah, I don't know. I don't know if he's like, I don't know what's going on. He seems kind of distracted. I think he's being caught. She's just kind of getting caught. There's just a lady in a pond. Maybe just Kind of floating around.

[B]

Oh, that's interesting. So I see that now. I thought she was picking up apples, but maybe she's washing her hands in the pond.

[A]

You know, one could only guess why. But the. But. Yeah. So that's. That was cool. I thought that was a fun one. This is very intense. I like this. And then I just, you know, toss a little crucifixion up there.

[B]

Yeah, it's the rainbow crucifixion. I don't know my biblical history well enough to. I would embarrass myself if I asked dumb questions, but is there a rainbow after the crucifixion?

[A]

I would hope so. God was rising back to heaven two days before, so I'd hope that.

[B]

No, I thought it was three days after this.

[A]

Three days. My bad. Three days. Three days.

[B]

Yeah. So that foreshadowed. Maybe the resurrection is.

[A]

Could be. Yeah, it could be.

[B]

Yeah.

[A]

But I honestly don't know. I. I don't have any real knowledge.

[B]

Can you imagine how brutal the world was when we crucified people?

[A]

I think about it all the time.

[B]

How lucky are we to live in this candy ass world of softness?

[A]

Dude, I try to tell it to people and I have people tell me.

[B]

I'm so grateful.

[A]

It's insane because I try to tell people. I'm like, dude, it was way different. And other people like, like those guys were thieves, right? Yeah.

[B]

Like that today you wouldn't even go to jail.

[A]

Yeah.

[B]

In most cities.

[A]

Yeah.

[B]

They'll kill you and then you get crucified.

[A]

Yeah. And it also, the procession was like a pretty nasty part of it. Just to get walked through the streets, spit upon, rocks, thrown at you. I just, I can't fathom, dude, the social anxiety.

[B]

And by the way, that's only 2,000 years ago, which in the arc of human history is yesterday.

[A]

Nothing.

[B]

That's nothing.

[A]

That's what I try to tell people, man. Because there's a lot of people are like, everything's always been the same. It's just different variations on the same themes. And I'm like, dude, it's gotten so much different from 2000 years ago. It can still get so much different.

[B]

Think about 500 years ago, right? Think about if you could be you, or you could be the king of England 500 years ago with like, you know, now it sounds great until you get like a dental abscess and you realize there's no ac, there's no heat, the food sucks.

[A]

Yeah.

[B]

Like, I. I don't think you're going to be the king of England 500 years ago.

[A]

I think the food still sucks in England now. Yeah, that's a good point because you could.

[B]

It's probably pre fish and chips.

[A]

Yeah, that would fucking. That would actually suck. I never thought about being like the king of another country, but yeah, it would be pretty terrible. There was a king in some medieval time, like longer ago than that. But they thought alcohol was like health stuff back in the day. It was like the spirit.

[B]

It kind of was because water was so contaminated. Right, yeah. So you basically had two broad cultures that emerged from either the fermentation of alcohol of water. Right. And alcohol to make, to get rid of the bacteria. Or tea.

[A]

Right.

[B]

You have sort of the, the rise of the sort of tea culture where you boiled water. But yeah, the idea that you were just going to go and drink water was like the fact that we're sitting here drinking this is, yeah, incredible.

[A]

It's pretty tight, actually. But yeah, they had a king. They, they, they were like, they rubbed him down in like brandy maybe, and then they were like, all right, we're going to like rub this all over his body. And like a candle got too close and just burnt the guy alive. And all the high priests or whatever had to be like, ah, you must have been evil.

[B]

Yeah.

[A]

Up.

[B]

No one. No one put two and two together. They didn't understand exothermic chemical reactions.

[A]

Damn, dude. So, so let me ask you this. What is your. The gist of your book is basically. And again, correct me if I'm wrong, but the gist was basically like, we can pre screen better and we can kind of promote wellness rather than waiting till somebody has like a horrible, often irreversible disease and like try to fix it through kind of like nuking the.

[B]

Yeah. And, and, and part of it is like, you know, what gets measured gets managed. And so medicine 2.0 measures lifespan as the ultimate outcome, which is. That's been productive. That's. That's a good thing to measure. I don't, I'm not suggesting we shouldn't care about lifespan because 150 years ago, lifespan was 40 years. Today it's 80. That's insane. We doubled lifespan, and that's all due to medicine 2.0, basically figuring out how to not kill women when they gave birth to children, how to keep babies alive when they were born, how to fight infections, how to wash our hands like that. And a little bit of stuff around trauma and critical care. Like, you doubled human lifespan, but we're not managing health span. And so part of the argument is okay. We've done pretty well on lifespan. We could do better, but we really have to manage health span.

[A]

Yeah.

[B]

And so if we think about things that make up health span, it's sort of like, how much muscle mass do you have? How strong are you? How much endurance do you have? How much flexibility and balance do you have? How quick is your cognitive performance? You know, how happy are you? How are your relationships? How much joy do you have in your life? These things are softer and squishier. Some of them are pretty easy to measure, like VO2 max and muscle mass and strength. Some of them are harder to measure, like cognitive performance. But if you don't measure something, there's no chance you're going to manage to it. And I would just argue we have to. We have to slightly tilt in the direction of doing more on that front.

[A]

Yeah. It also be cooler to go to the doctor and have him, like, hit the treadmill. Let's check your VO2 max. Yeah.

[B]

Let me see how long you can dead hang for. Let me see your grip strength.

[A]

I'd be so much better than sitting there and just being, like, basically getting molested and leaving. That's. That's all you do. You go there and they're like, all right, we're going to. What. What is the coughing? Why do they do that? Why do they call. Hold your.

[B]

It's funny. I thought you were going to ask me to do it to you earlier when you said, this is not an appointment. I literally thought you were going to whip your junk out and check.

[A]

I'm just going just for the A. Dude, you got to do the butt.

[B]

It's. They're checking for a hur. Hernia.

[A]

Is that what it is?

[B]

Yeah. Yeah.

[A]

But why is that, like, the Top of the Pops?

[B]

Yeah, exactly.

[A]

There's so much other things to check. It's like, we're not going to do all this other stuff that'd be useful. We're just.

[B]

We're not going to look at a bunch of things. But I do want to stick my finger in the inguinal canal.

[A]

That's what I'm saying.

[B]

Yeah. And I'm gonna. And make you cough.

[A]

I'm glad you know, they do that. But it's like, why did that get picked as opposed to all of his other stuff you're talking about? Do you think it has something to do with, like, just, like, institutional, just repressed homosexuality throughout the entire culture? And that was like.

[B]

I don't know. But I will say, like, I can't tell you how Many rectal exams I've done. And then I realized, like, I mean, technically, a good. A good urologist will tell you that their finger is good enough to truly feel a prostate cancer that would otherwise not be picked up on a PSA or some other test. And I'll take them at their word. But I think for the rest of us who don't do 20 a day. Yeah. I just, I don't think my finger is good enough, you know?

[A]

Don't say that.

[B]

I mean, I'll work harder, but.

[A]

Yeah, that's crazy. So they're saying they can just feel like it just.

[B]

They've said, like, look, man, you know, there's always that one case that slips through the crack where the guy has a normal psa. No pun intended. Yeah, she's.

[A]

So they can't tell. Yeah.

[B]

And. But they're like, yep. If you feel a certain type of super hard nodule on the prostate, that would be suspicious.

[A]

Damn.

[B]

Yeah.

[A]

Yeah. That is. I, I do. I, I think they really could if, you know, if doctors would embrace that. It'd be so much more fun. You go, you kind of run on the treadmill, dead hang, you know, they can talk to you a little bit about it. Just seems so kind of sterile.

[B]

Yeah. There's like, a bunch of basic tests. Everybody should be able to. We should be able to see the people. Completely agree.

[A]

Yeah, I don't. That's so. I, I, I did really like your book for that reason. Hopefully that kind of stuff takes. So what, what is. So if that's the scope of the book, where do you stand now? Has anything changed in that time? Or is there anything that's like, latest and greatest that's kind of like, blowing your mind right now?

[B]

I think my thinking is always evolving. I would say if I were writing that book today, I would actually kind of add a fifth Horseman, which is anything that pertains to a weakened immune system. So I'm just getting over a cold because I have three kids and two of them are young. So basically, I'm always in the. I'm always in the face of, like, some virus, right?

[A]

Yeah.

[B]

So twice a year, I always get some stupid cold, and it's no big deal, you know, I. It starts in my throat, blah, blah, blah. It gets into my lungs, I hack up a bunch of junk, and then I'm fine. But, you know, anyone who's been around older folks realizes that that's the kind of thing that can tip them over the edge when they're 80 years old, you know, A really bad infection, a flu, Covid things that us, you know, 50 year olds laugh at can become deadly. And so from a, from a, from a research perspective, this is something I'm super interested in, is how do we regenerate the immune system? So, you know, I'm in my 50s. My immune system is also in its 50s. Would it be amazing if when I'm in my 80s, I could still have an immune system that's maybe like in my 50s or 40s? The, the effect that that would have against, you know, mitigating the risk of fatal pneumonias, infections, and even cancers is huge, because the immune system is the first line of defense against cancer.

[A]

Oh, really?

[B]

Yep.

[A]

Is that it? Didn't they used to use, like, fevers for that too? They would induce fevers to try to kill certain types of cancer.

[B]

Yeah. And it wasn't very successful because it's so non specific.

[A]

Oh, okay.

[B]

Yeah. Cancer is. The only way for the immune system to eradicate cancer is it has to. You have to get the very, very, very specific T cell that recognizes exactly that cancer, and you have to figure out a way to make enough of them that it, you know, wins that war. And that rarely happens spontaneously. I mean, the cases are, you know, documented in the literature. They're so rare. But we now have drugs that can make that happen in about 10% of cases. That's huge.

[A]

Yeah. That's pretty crazy. So how, how would you, how would you. What's your research yielded? How do you think you can bolster the immune system?

[B]

Or, like, I mean, it depends how. I don't know how technical the, the audience wants to get into this stuff. But so, so stop me when this has become unbearable.

[A]

For sure.

[B]

So the, you know, we have DNA.

[A]

Okay, okay.

[B]

So everyone's heard of DNA. DNA is the code that tells every cell how to make a protein. So what tells DNA to turn on and off are something called methylations, little carbons that stick on the backbone, or something called the epigenome. So DNA is regulated through this methylation pattern. And as we age, that changes.

[A]

Gotcha.

[B]

So we can look at a T cell, which is the type of cell that fights a cancer or an infection. And we can say, that's what an old one looks like, that's what a new one looks like. Even though the DNA is the same, the epigenome above the genome, this methylation pattern looks different. And so the question is, what if we took the methylation pattern of an old T cell and made it look like a young T cell would it revert into a young T cell. So to me, that's certainly top two or three most interesting questions in aging research today.

[A]

That's pretty cool. And that makes sense because it's like the DNA, you're born with it and then the EPA layer, that's like the kind of like pattern that's affected through the environment.

[B]

That's what regulates it. Exactly.

[A]

Yeah. And then. So if you can kind of get into that. And then. So you could. And it was stress too, because I noticed that was a big thing book. So. And you can stress yourself to the point where your epigenome will just start being like.

[B]

Everything in the environment can affect that. So it's affected just naturally through aging. So the passage of time affects it, but so does anything in the environment. So whether you exercise, whether you smoke, whether you have diabetes or not, all of those things. Good sleep, bad sleep, high stress, low stress, anything can tweak that in the right or wrong direction.

[A]

Damn. Okay. That's pretty cool. So you're saying.

[B]

But the gravitational pull of age is huge. And that's the one I'm most interested in, is like, how would you. Because Even the healthiest 80 year old has nowhere near the immune system of an unhealthy 30 year old.

[A]

Yeah. Yeah. And we also, we saw that everyone was hoping against hope that Mike Tyson would just knock out Jake Paul. And that was kind of like a bitter moment for a lot of people.

[B]

Yeah. Age is not.

[A]

Just can't do it.

[B]

Yeah. As father time is undefeated, as everybody said.

[A]

Yeah. Even with the, even with like the trt. What are your thoughts on that, like, in terms of like, you know, what age to kind of smash the glass and just go full upgrade.

[B]

I don't know that there's an age. I would do it. I mean, I think the things that I would. You know, I had a long talk with a patient yesterday about this exact question. And he's pretty young. He's like 36, does not have kids, but wants to have kids. So that's a huge consideration. So in his situation, I would say like, TRT is not a good idea. I. I suggested that he bank sperm. And if he wants to go down that rabbit hole. And by the way, I don't think he needs to because I don't think his level, his levels are like kind of 50th percentile. He's not terribly symptomatic. I would kind of eke out a bit more time, but I would, I would rely on hormones that are gonna ramp up his body's production of testosterone as opposed to just giving him testosterone which will shut off his body's supply forever. No, and it also, it's not something that happens overnight. Like.

[A]

Gotcha.

[B]

You know, he, he'd have to be on testosterone for a while before he would shut down his own production.

[A]

Yeah. So what are your thoughts on that? On like that whole thing of, especially for 30 year olds, do you think it's like good to kind of have that or you think it like, should be kind of a long road?

[B]

I think you gotta, I think you gotta, you know, take every case individually. But if a 30 year old has his. Has testosterone that is so low that it's impacting him, I think you have to start by asking why.

[A]

Right?

[B]

Like how bad is his sleep, how bad is his stress? How bad is every other factor going on? I mean when I finished, God, when I was, you know, leaving my residency, my testosterone was 227, I think, which is insanely low. That's, you know, that's only two and a half times higher than a woman.

[A]

What?

[B]

Yeah.

[A]

Is that why doctors hands are so soft every time you shake?

[B]

That's for the rectal exam. So you just don't.

[A]

That's true. That's true. You wouldn't want my dad.

[B]

No, the. And, but the reason is pretty clear, right. Because I was sleep, sleeping 28 to 30 hours a week. Damn right. So, you know, horrible sleep deprivation is going to make it really difficult to make appropriate levels of testosterone.

[A]

And that makes it harder for you to sleep too when your testosterone gets lower.

[B]

I think probably a little bit. But the causality is much more in the opposite direction. Meaning the horrible sleep is destroying the production of testosterone and growth hormone. So. But of course at the time it never occurred to me to do anything about it, you know, and once I, you know, was in a job where I could actually sleep each night, Lo and behold, my testosterone kind of normalized speak.

[A]

It peaked up.

[B]

Yeah.

[A]

What do you think that's a good thing for people to actually look at? Because I, I always get the feeling that like if you even go into one of those places, they're going to hard sell you and you'll be on the T like before you know it.

[B]

I think you should not go to. I'm trying to think of the right analogy. If you, if you walk into a store that only sells hammers, everything's a nail.

[A]

Yeah.

[B]

Right. So, so I, I think if you walk into a tea shop and all they do is male hormone optimization, I would say buyer Beware.

[A]

Yeah.

[B]

Because they, Even if they internally have the best of intentions, like, I just don't think they can get out of their own way. I also think you should be very wary of going to a place for any sort of therapy where they're selling you the therapy.

[A]

True.

[B]

If, if, if my whole shtick is I'm here to, you know, give you the best hormones or supplements or whatever, and, oh, by the way, on your way out, we'll sell them to you. It's just such a conflict of interest.

[A]

Yeah. Yeah.

[B]

So.

[A]

So what do you, what do you think about the, like, even, like, the Internet companies that are, like, like, I did one. I don't know if it's nice to, like, name it or not, but, like, the ones that, like, you mail, like, stool sample, blood, saliva, and they're like, here's precision supplements for you and you alone. How do you think they're, like, how much of that is kind of generic? And do you think some of those companies are really dialed in or, like.

[B]

I don't doubt that there are ways to kind of sort of optimize supplements around biomarkers. I just, I'm not sure that it's as precise as people want to believe. I certainly don't think that. I actually think you can do a lot of supplement optimization off really basic blood work. Like, I don't think certainly, you know, a stool sample is not necessary because most probiotics can't even provide the bacteria you need to impact it. I mean, your diet has a far greater role. Your fiber content has a far greater role on your gut biome, and things that you'd be measuring in stool and obviously saliva, blood, urine can measure things that are relevant and interesting. There aren't that many things that I think are worth taking. Like, I think, yeah, if you're low in vitamin D and you're not getting enough sunlight, that makes sense. But that's a pretty simple blood test. If your homocysteine is elevated, yeah, you probably should take some methylated B vitamins. And if you drop it by more than five or six points, you're probably doing a lot. If your omega levels are low, fish oil probably helps. If you're not willing to eat three servings of fish a week. Right. But the true basics of this are really simple. And then there's other supplements that probably make sense for most people, and you don't even need to test for them. Like, anybody who's active could probably justify taking creatine.

[A]

Yeah.

[B]

And there's no blood test that's going to tell you whether or not you need it. We just know that, you know, to, to fill and saturate Total Body stores, you're going to need three to five grams per day. So, you know, really?

[A]

That's. Yeah, that was surprising. That was like something I heard like in college, like you know, years ago when I'd lift weights. It was like creatine was almost like viewed as like a serious kind of like bodybuilder supplement. Now everything I read is like, no, everyone needs a ton of creatine. Yeah.

[B]

I mean, again, it's just if you're playing the game of optimizing, you're going to get a benefit. Probably about a 10% boost in performance for intensity and like super short intensity, I. E. The creatine phosphate energy system. So kind of like high bursts of, you know, 10 second work and then anaerobic stuff. It's not going to improve much aerobically. Yeah, but. And you'll also get a little hypertrophy benefit because the muscles will get bigger. Would they bring more water?

[A]

That makes sense. Yeah. If like my kids are like seven feet away and they're not listening, I could just run at them. Easy, easy. Just hulk them down. Yeah, that, that's. And that's my thing with fitness. A lot of people, and I'm sure I don't know if you've heard this. You're, you're kind of a. I'm sure you're like, listenership is very health oriented. But a lot of people get very like, I don't know, like very kind of scoffed. They kind of scoff a lot of this stuff where they're like, who gives a shit? And it's like. And I feel bad because like, I do get it. If you're like in a job you hate, you're just totally crushed down by like your life circumstance. Having somebody be like, dude, eat a banana and do jumping jacks. You're gonna be like, dude, fuck you. I don't want to think about this. But it also will make your life better. Like I always like whenever I lose sight of that, whenever, whenever I get too into my own, like just stuff where I'm like, this isn't going well. I got it. I don't have time. If I just take like an hour, any, even a half an hour and just like run as fast as I can, it's like, I feel like amazing.

[B]

Yeah.

[A]

And I always say that's like a nice dimension you can add to your life where it's like everyone's like, you know, like, I want to get better at my job, blah, blah, blah. It's like just adding that like time yourself running 100 meters and then try to get a better time next week. It is like it gives you something you're kind of making progress in and it also, you feel like great as a result.

[B]

Yeah, I think this is where kind of social media really distorts reality and the example you give is a great one. Right. So if you're, if your health sucks and you, you know, you're trying to figure out where you're going to find an extra two hours a week to do some form of self care, the last thing you need is some idiot influencer telling you to spend more time in the sauna and cold plunging. Like I can promise you that is not the first, second, third, fourth or fifth best use of your time. If you only have two hours a.

[A]

Week, how would you break it down then?

[B]

If you've only got. So you know, I would start with what's the. Let's do the absolute basics of blocking and tackling. So first thing I want to know is, are you getting at least seven hours of sleep a night? Because if you're not getting at least seven hours of sleep a night, it's going to be very difficult for you to do anything at your best.

[A]

So I didn't know. I don't want to interrupt you. My, my question with that is say like, you know, say you are tracking your sleep and you only get like 43 hours of deep sleep every night. Even though you go to bed at like a proper time, does that matter as much of like REM versus deep.

[B]

Sleep or like assuming 43 minutes, but.

[A]

43 minutes, I wish it's fucking 43.

[B]

I only get 43 hours of deep sleep a year. I'm doing the math quickly.

[A]

Oh God.

[B]

I don't know if you feel, if a person says I feel really well and there are these, I link to them in the book. There are a whole bunch of surveys you can get for free that just have you do like, you know, these are validated surveys that kind of go through daytime drowsiness and stuff like that. If you're in bed seven to seven and a half hours a night, ideally eight, and you're, you know, your little sleep tracker says you're sleeping seven, but you're not happy with your stages. I wouldn't put a lot of stock into that unless you feel that there is a problem.

[A]

Got you.

[B]

But if you're like, no, I feel fine and I Fill out all the two surveys and they said I'm doing fine, ignore the data that makes sense and stop wearing the tracker.

[A]

I know I gotta stop.

[B]

Done with the tracker.

[A]

So I was checking every day, I'm like 43 minutes.

[B]

Yeah, like it just creates more anxiety.

[A]

It's just red. I see red numbers.

[B]

I, I, I haven't used, I haven't used one of those in a longer time than I can remember.

[A]

Yeah, yeah.

[B]

So, so just do the next bucket.

[A]

Yeah.

[B]

So then the next bucket I want to know is what are, you know, what's your physical activity level? So let's say this is a person who's got none, they're doing none. And they say, look, I've only got two extra hours. I'm putting that entire two hours into exercise. So I'm going to say we're going to do four 30 minute workouts a week. And you know, again I'd have to know more about the person, but it could easily end up being we're going to do two cardio sessions a week. We're going to do two strength sessions a week. One of those cardio sessions per week is going to be kind of aerobic base training where you're going at the same intensity the whole time. It's not that high. You can still sort of almost carry out a conversation. It's a little hard to talk, but you could. And then the other cardio session I would do, say three days off of that would be more interval, kind of like what you were describing. So let's get on a, you know, if you, if you're at a gym and they have one of those like, you know, air bikes, do something there, be on a treadmill, be outside, it doesn't really matter. Like the goal, like this person will get so much benefit from two hours a week of exercise that it almost doesn't matter what they do. And then the other two days a week I'd have them do two 30 minute whole body workouts at a gym where they never stop moving.

[A]

Okay.

[B]

So if you're doing it at home, it might be push ups, pull ups, wall sits, something like that. If you're at the luxury of being at a gym, you might just rotate machine to machine to machine and never stop. And that would, I mean that would just bring huge dividends. And then the last thing I'd do is, in addition to that is just do a quick audit of their diet. Yeah, you know, are you overweight, are you adequate weight, are you underweight? That determines whether you need to Eat more or less and then are you getting enough protein? And, and honestly, like, I wouldn't make it much more detailed than that. And so look, with, with just a little bit of that insight, you've made better use of two hours a week. You've got them to stop worrying about their sleep. You've maybe changed three little things in their diet. I promise you, that person in three months is going to feel significantly better. And then maybe, by the way, at that point they're like, you know what? I wouldn't mind doing three hours a week of this exercise thing because I'm feeling kind of good. And you know what? I kind of want to dial the diet in a little bit more. But again, the problem is too many people are consuming information that says, oh, my God, you need to be on this supplement. You need to be on this supplement. You need to be doing 30 minutes of this type of sauna and 20 minutes of this type of cold plunge. And people are like, shut up.

[A]

Yeah. Like, I can't do that. Yeah.

[B]

I mean, and to be clear, I love sauna and I love cold plunge.

[A]

Sure.

[B]

But it is like the 20th thing on my list of 21 things that is a part of my routine.

[A]

Yeah, that makes sense, man. That's, that's actually cool to hear because it is like, the solution is pretty basic and simple. And that, that's, that's the thing that gets me bummed out when, like, you know, because I do think we live and I could just be wrong, but I feel like we live in a pretty nihilistic kind of age. And it's like, it does suck when that spreads. It's like a phys nihilism. Like, what the, the point of even. It's like, dude, you'll feel so much better. If I don't work out, I get depressed. It's like A to B easily. If I don't do it for like two weeks, I'm. I'm just like depressed and sad. And it's like, if you don't do it, it's just, yeah, you feel terrible. And I always, I always like to try to, you know, like, just get up and move your body, man. There's so much, so much better.

[B]

We were meant to move.

[A]

We were.

[B]

And meant to be outside. That might be. The other thing I would add is figure out a way to do something outdoors. Like whether it's a quick walk or incorporate some of that exercise outdoors.

[A]

You know what? I started doing skateboarding at my ripe old age of 38. I saw.

[B]

Just took it up.

[A]

I just took it back. I've been doing it when I was little and I just started it and it's weird. Do it. That's a, that's a real eye opener. When you take an activity you did in childhood effortlessly, you're like, let me try this again. At 38, dude, I swear I burnt 900 something calories. I skateboarded for an hour and 20 minutes and I was, I was dying.

[B]

Awesome.

[A]

Cardio wise. I was, I was just doing like a little pump track where you kind of just like ride up on a wall. Dude, I thought I was going to die. I used to do this all day when I was younger. Now I'm like, it's like a real eye opener to be like, all right, where am I at? Because I do feel like especially I guess men and maybe women do it too, but men specifically over index, like, I'm good. And it's like, try something that you did when you're younger and you're like, holy, I'm going to. My heart rate was like 170 the whole time, just skateboarding and I wasn't even, I was barely pushing. I just had to like balance myself on this track. It was, it was amazing though. I, I agree with you. It's like find something, you know, to do and just kind of. I don't know. I feel like, I do feel like we get too tunnel visioned into like the career stuff and it's like we need to. You need to do that to survive. But it's like the sacrifice of hours of time for like the quote unquote rest time into like physical activity. Just pay dividends and all the other things you're trying to do anyway. But yeah, I always sound like a broken record, but I'm like, dude, it's so important, man. It really is. So, yeah, skateboarding is awesome. We should go one time. Do you skate?

[B]

Nope. I do. Not at all.

[A]

Have you ever?

[B]

Nope. And it's funny, I mean, growing up I was certainly of that age when a lot of, a lot of kids were skateboarding. I don't know why, it just never appealed to me. Yeah, I was sort of busy in my own little world. My daughter did for a little bit. She's 16 now, but she did probably like when she was 12, 10, 11, 12. She was pretty into it. The coolest thing I've picked up recently though, it's not a physical activity, but it's. I'm freaking obsessed with it. Is chess.

[A]

Really.

[B]

Holy cow.

[A]

How do you. How are you pretty Good.

[B]

No, I'm horrible. I mean, but. But I love it. Yeah. I can't stop playing. Yeah, I just can't stop.

[A]

Who do you. Who are you playing against?

[B]

I'm just playing my boys, really. Literally just the three of us.

[A]

Phone chess or physical on the board. That's good.

[B]

Writing down every move, studying our moves. After really like, nerding out, watching YouTube videos. I'm obsessed with this guy Magnus Carlson, who's the best chess player in the world. Actually, dude, I. I can't stop watching chess porn.

[A]

Really?

[B]

Can't stop.

[A]

That's awesome.

[B]

Can't stop. You know how YouTube figures out what you're about? Like my videographer for our podcast, he comes, he pulls me aside like three weeks ago. Are you getting into chess? I'm like, how do you know? He goes, because, like, I'm managing our YouTube channel and like, it only populates, just. It's just like pushing chess stuff all day.

[A]

That's awesome.

[B]

Yeah, dude, I can't stop.

[A]

It is good for your brain at.

[B]

Night, like watching chess videos.

[A]

Do you really?

[B]

Oh, it's awful. I'm like, it's 9:30. I should go to bed.

[A]

What's the open? What's your opening move? What do you go with?

[B]

Oh, I'm typically like E4, you know, I. But I like to. I like to castle really early. So I'm gonna try to castle within about three or within four or five moves if I. If I'm doing a kingside castle.

[A]

Really?

[B]

Yeah.

[A]

I like the, the first move, the horse. Just over your pawns. Be like, what's up?

[B]

Yeah, it's called.

[A]

There's a name for it. I forget what it's called. It's like the English or something. But I like the horse. I just bang, here's my horse.

[B]

Yeah, no, the night's cool because again, he can, he can, he can. He can hop over people.

[A]

You move in that fucked up L shaped pattern. Oh, yeah. I love chest too. That is fun. I just say, yeah, I don't have anyone to play it with. That's the thing. It's like, I don't. And how long does a chess game take?

[B]

One of my boys is super aggressive, so the games are quick because he just comes out swinging.

[A]

Does he really?

[B]

Oh, he swings.

[A]

I like that.

[B]

He goes for the fences. And then the other one is so conservative and so thoughtful that the games take like so long. And I got us a little time too, so I'm like, buddy, that's nice.

[A]

Yeah.

[B]

Two hours to make the first 40 moves. Or you're disqualified.

[A]

That's good. Yeah, yeah, yeah. That's good. Yeah. You got to think on your feet.

[B]

And the younger one, the one who's super aggressive is so competitive. Like, if anyone in our family ever makes it and becomes like, great, it's him. Because the you can't, like, hit the fire is insane.

[A]

Really.

[B]

When he loses, he tears up his sheets, and I'm like, buddy, you shake my hand and we had a good game. He's like, he's just losing his mind that he lost a game of chess.

[A]

It's war. Yeah, it's war. Is it true that the possibilities of the chessboard are kind of infinite?

[B]

They are truly infinite.

[A]

That's crazy.

[B]

Yeah, it's a computationally infinite problem.

[A]

Damn.

[B]

Or as close to. I mean, I shouldn't say infinite, right? In that AI can. Yeah, but. But it's from a. From a practical perspective, I think it's infinite.

[A]

Damn. That's awesome. That is cool. How. I'm going to try it. My kids are too young for that. Me and my daughter did a.

[B]

Like, your oldest is six.

[A]

Four.

[B]

Oh, four. Okay.

[A]

Four. Six could be. Six is doable.

[B]

Four.

[A]

I did chess. We did one of those big ones. We're on vacation. We did one of those, like, you know, those like, huge outdoor chess boards. The big pieces. Yeah, yeah, we did it. And I tried with my 4 year old, and by the end of it, it was like the mommy and daddy were the queen and king were mommy and daddy, and the pawns are all of our babies. And I was like, all right. Man. Sucks. Oh, yeah, man, that is amazing.

[B]

I once made the mistake of in a game, like one of. One of my older one, the one who's more conservative, like, he had, you know, he had a rook, knight, bishop in the back that hadn't moved, and it was like 25 moves in. And I'm like, buddy, those guys over there are standing there like they got their thumbs up their butts. And now those two boys cannot stop saying that. They just walk around every. Anytime someone's not moving. Why do you have your thumb up your butt? And my wife's like, why do you say this stuff to them? Like, you can't say anything like that. They're just gonna say whatever you say.

[A]

I know, it's weird. It's weird because my 4 year old is like language police in our house. She, like, will learn that something's bad, and then she's just, like, horrified of the idea of saying it, and she's like, if we. If she hears us saying anything. Like. Like we even say the word hate. I don't know where we didn't. This wasn't a rule for us. Like, oh, I hate that. She'll be like, don't say that. She, like, polices our language if we say like that. We said. My wife said freaking the other day. She's like, mom, that's a bad word word. Like, no, it's not. And she's like. And I was like. I was arguing. My wife's like, no, just. Just give her that one. She's like, it's. It's pretty nuts. But, yeah, that is true. They do parrot everything. You really do got to watch what you say because you can say whatever you want around them for the longest time, and eventually you're like, oh, you can. Talking on my neighbors. You can hear this. You can hear this right now.

[B]

Our youngest one, when he would. This is the super aggressive one. So it's not surprising. I think even he was like, three. We get a call from the preschool and they're like, yeah, you got to come and get them. My wife's like, what's going on? They're like, he said the F word.

[A]

Whoa.

[B]

My wife's like, oh, I. I'll be right there. But I.

[A]

They made you get him for that?

[B]

I'm like, this is a misunderstanding. And my wife's like, first of all, the kid is obsessed with rhyming. So he almost assuredly was like, truck, truck. Or something like that. And the woman is like, no, no. He's actually the first kid we've ever heard use it properly.

[A]

Oh, no.

[B]

They're like, what was the situation? And they're like, well, he was in circle time, and we were telling all the kids they had to be quiet, and he wasn't being quiet. And we're like, hey, if you're not quiet, you're gonna have to get up and leave. And he wouldn't be quiet. So we got up and made him leave, and he stood up, apparently, and just goes, fuck it. And then walked and got out of the corner.

[A]

That's a coincidence. Yeah.

[B]

I'm like, I think he learned that from his mom.

[A]

Yeah. My daughter nailed a. She dropped something one time when she was really little, and she was like. I was like, ah, damn it. That's. That was right on.

[B]

That's on me.

[A]

Yeah. So they made you. What are you. It was like a one day suspension.

[B]

Yeah. Was like, he's on probation now. I mean, like, we ended up finding another preschool for him that he did Great in.

[A]

Oh, that's cool. Yeah. That's insane to, like, be like, you got to come get this kid.

[B]

Yeah.

[A]

Although that could spread like wildfire amongst other people. This is all.

[B]

Yeah, I guess I can see it from your point as well.

[A]

No, that. That's lame. That. That's crazy to be like, he leave right now. But I think they got to let that kind of stuff go. That is. That is tricky, though, man, because especially that age, it's like kids hit other kids and like, you know, some people are like, this is. This is like, you can't. It's like. But I don't know. I treat it like the dog park. It's like, they'll figure it out, man. If. If it's really bad, there's got to.

[B]

Be enough discomfort in the situation for the kids to evolve.

[A]

Yeah, exactly what I'm saying. Yeah. Because it's like, dude, you got to let. They're going to do that, man. It's like, you know, me and my cousin got separated in. We were in kindergarten together, and then we went to the same school the next year, and they were like, like, AM class. BM class. They can't be. They can't be with each other at all. But I thought I turned out all right. So before you get out here as we are, we're coming up on what are we. Where are we at right now? Josh, I don't want to keep you too long. Huh? Perfect. The. The one thing that I feel like was in the book a lot you talked about how. And again, always correct me if I'm wrong because I'm always have stuff in my head. Stress was something you was really on the back burner that you kind of put to kind of like the forefront of your thinking from like a day to day and a health perspective. How. Where do you kind of stand on that? And like, what's. Like. Do you have any. Give any thoughts on that at all?

[B]

When I think about, like, what is the. What is the thing that's going to kill me fastest? I think it's undoubtedly stress. I just think it's, you know, I think it's the most insidious killer in a way, because it's the hardest thing to measure directly. You can sort of measure some of its indirect actions, like on blood pressure and blood sugar, which both go in the wrong direction when stress is high. But I think there's even components of it that just. Even when blood sugar and blood pressure are normal, I still think it's just doing something to your brain. Probably and to your heart. And again, I don't think anybody would feel good living in a zero stress environment. So it's mostly just about kind of managing how one responds to it. And I think it goes beyond just stress. I think it's sort of like just overall, like, satisfaction in life and contentment and, you know, enjoying your relationships with people. You know, I interviewed this guy on my podcast, Bill Perkins, who wrote this incredible book. It's one of my favorite books. It's called Die with Zero. And he writes about how you have basically, like, you know, you have time, you have money, and you have experiences and. Sorry. He talks about through health. So health, time, and money.

[A]

Okay.

[B]

And you're not optimizing for the most of any one of those. You're optimizing for the net of fulfillment.

[A]

Okay.

[B]

So too many people miss that. Right. They're just, like, working. Working really, really hard to get as much money as possible or as much fame as possible. Or they're, like, maniacally focused on their health. That's the only thing they think about.

[A]

Right.

[B]

Or they're just trying to, you know, live as long as possible or make as much time for certain things. But it's kind of like how you put all those things together to optimize around fulfillment. So in this book, he writes about this idea of. Of, like, people aren't doing the equation correctly. They're deferring too many experiences when they're young to do when they're old. But then they don't realize when they're old, their health is actually not. They're not actually able to do it when they have all the money in the world.

[A]

Yeah.

[B]

They can't go and take the incredible vacation or if they can, their kids aren't with them or their kids aren't young. So I think it's just kind of reframed a lot in my mind and made me realize that, you know, when our kids are young and we are incredibly healthy, that should be the time that we invest more in fulfillment and experiences as a family, which has just been a, you know, a completely different mindset for me from where I was most of my life.

[A]

Yeah. Just going kind of like full blast.

[B]

Yeah.

[A]

Make as much money as possible.

[B]

Sleep when I'm dead.

[A]

Yeah. Yeah. That's a big one. Sorry about that bug, dude. That bug won't leave you alone. It hasn't even come over to me at all.

[B]

I mean, I must stink.

[A]

Yeah, that is. That is kind of a cool thing too, man, because you don't really it's also something you don't really learn. Like, nobody really tells you how to manage your stress. You kind of. Mostly, from what I gather, you kind of just like, watch your parents deal with stress, and you're like, all right. And you just kind of, like, take those patterns and just apply them to your life. And it's like, it really does. Like, I don't. What I've been trying to do recently is, like, just take one day out of the week. Usually it's Sunday because, like, we're all off, everyone's hanging out, and I just try to focus on, like, being as calm and at ease. That's, like, top priority of my day. Usually it's like, I gotta get this done. I got this done. And on one day a week, I'll be like, I'm only focused today. My number one goal. Goal is to try to, like, stay in a state of, like, ease and kind of contentment. If I get out of it, I. Like, before, I'm like, you know, like, I just try to zero in on that. That's been kind of, like, for me, that's been, like, a bit of a revelation to be like, oh, I can move through, like, multiple days without completely spinning myself the out. And, you know, it's been. I don't know, it's been kind of nice.

[B]

And what do you think spins you out? Is it just busy? It's too much.

[A]

Yeah, it's too much.

[B]

Particular thing.

[A]

Yeah. I mean, it could be anything. My kids not listening kind of spins me out. If I'm, like, trying to get up the steps, and it takes 40 minutes, and I'm kind of like, all right, let's. Let's go. Could be anything. Could be, like, overwhelmed. Like, just, like, situations at work I got to deal with that are just completely overwhelming stuff in the house. You know, it's just, like, lack of sleep because our kids are still so little that, like, our sleep gets fucked up. But, yeah, it is. It's that. It's usually, like, relational stress or just, like, work stuff. Those are two. The two main things, like, that kind of, like, can really spin me out.

[B]

And I would argue that most work stress is relational as well. So I. Yeah, I kind of agree. I think relationships are both the best part of life and the most stressful part of life.

[A]

Yeah, I agree. So that's been kind of. That's been my.

[B]

That's what's going on here, by the way. A lot of relational stress in that. I can tell you right now.

[A]

That is true. But, yeah, that. That is. That's kind of the thing, man. It's like. Well, this is. My whole point is, like, you do have some say in how much a thing can. Like. Like, you can. It could. Everything can floor you. Things come out of nowhere, and you're like. You get caught in it. But it's learning how to be like, all right, something got me. It's like laser tag. Like, my thing's beeping. I can kind of walk myself through this without, like, going on, like, a Godzilla path. You know what I mean?

[B]

Yeah.

[A]

It's like, I don't know. That's been pretty helpful for me. Before I get caught. That's. That's my ultimate fate. It's like, babe, babe. I'm having a naked victory for the prostitute. She's right there, and they're coming out of the water just hawking me.

[B]

It's not what it looks like, but.

[A]

Yeah, that is the number one, man. It's like, dude, it's, you know, like, managing stress, keeping yourself physically fit because you can't, like, otherwise. Like, what the are we doing, man? It's like, you know, it's like, unless you. I mean, some people are just surviving, which is. Which is kind of. That sucks. But I don't know. I feel like you can even. I feel like people. There's other countries where people are just surviving. They still do cool stuff, like big, ornate jugs of water and they carried around. They, like, dance and stuff. I don't know. It's kind of sick. I'm just trying to make people happy. I don't know how to do it. Well, dude, I mean, is there anything else that's kicking in your mind?

[B]

I don't think so.

[A]

Well, I think you did it. Thank you for coming and doing this. I apologize for the strange format, but how do you feel about standing in podcasts?

[B]

I think it's hilarious. I think it is. This is the first standing podcast I've ever done, bro.

[A]

It's not bad. I. How do you feel about it? Honestly? You can. You can hurt my feelings.

[B]

Honestly, I think I have better posture than I normally do.

[A]

That's what I'm saying. When you're sitting on a podcast, you like it. Kind of like, yeah, slouching forward, standing keeps you on your feet. It keeps the mind sharper.

[B]

Like, I feel like we're doing a political debate, the way they're angled at each other, too. You know what I mean? Like, I feel like I need a moderator to ask me a question. That's the only thing that it would have been a little better if it was moderated.

[A]

Moderate.

[B]

Discussion was moderated. I'm more heated.

[A]

That true? That is true. I. I gotta. I want to work on being.

[B]

I wouldn't mind a teleprompter next time if you wouldn't mind.

[A]

Teleprompter is nice.

[B]

So I want a teleprompter there. Moderator there.

[A]

Right. More for sure.

[B]

Yeah.

[A]

I mean, we could bring some heat. We could bring some heat.

[B]

If you want the heat.

[A]

I could. I have some burning hot questions. I didn't ask them. They're about a lawsuit. So I was like, why can't everyone. You can't talk about lawsuits. No one can ever talk about them.

[B]

I know the lawyers say no.

[A]

Yeah. You. Why?

[B]

Yeah.

[A]

What's the point? Bring awareness.

[B]

Bring awareness.

[A]

Yeah, I did. I actually, I was researching just, you know, when you have someone on the same. I saw you're embroiled in a lawsuit and I said, hell yeah, dude, that's what's up. So. But we won't. The lawyers won't like that. That is. You can't talk. I mean, dude, don't. Don't do it. But that is, like, why. What the problem here? It's. I don't know, Whatever. Anyway. Well, dude, thank you. I. Dude, is there anything you want to plug? Is there any. The book, obviously. Read the book, dude.

[B]

Read the book. Listen to the podcast.

[A]

Peter, to you. Thank you so much.

[B]

Thanks for having me.

[A]

The man.