← Tom Bilyeu's Impact Theory
Tom Bilyeu's Impact Theory
Alcohol vs. Weed: Which One’s Destroying Your Productivity? | Peter Attia - PT 2
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Tom Bilyeu
I'm Tom Bilyeu and this is Impact Theory. Welcome back for part two of my conversation with the one and only Dr. Peter Attia. To your point about variability of response to something feels a lot in the way of interpretation. So I was actually listening to an episode that you did with Lane Norton. He was talking about anxiety, something unfortunately I know up close and personal. And he was saying it was a big breakthrough for him to recontextualize nothing about the physiological stimulus needed to change for him to change his relationship with it. He just had to tell himself, oh, this means that I'm focused and I'm ready and this is a good thing and this is engaging my brain and making sure I take this seriously and I'm going to move forward. And he said that just completely changed his sense of what anxiety was. So that is, and it's very similar to what I do when either I feel anxiety coming on or like when I've smoked and it, I can feel it that the panic attack trying to become the, the thing that's hijacking my brain. So the way that I think of these things is this is a means of processing data. It's an interpretation of a stimulus. And the way that I will often change my psychological interpretation of the stimulus. And this is what I'm trying to get to psyche. That to me is psyche. It is my sense of what I call the overwatch mechanism or my sense of self that there feels like I know this isn't true, but it feels like there is a part of my being that exists above whatever physiological state I'm in. So there is a watcher that sees me being drunk. There is a watcher that sees me being high. Again, I know that's not accurate but that's how it feels. Now that watcher can send a signal and the signal I almost always send is don't be a pussy. And so I'll just tell myself, ah, like, knock it off. You don't. You're not gonna let yourself be paranoid. Stop that. I once had a vagal response to getting a bunch of injections in my wrist and I didn't know it was a vagal response the first time it happened. So the second time it happened and the guy was like, basically, you're just being weak. I was like, hold on. And because I now had a new context for the same thing, I just told myself, absolutely not like, you don't get. Because it felt like I was about to black out. I was like a hundred percent not like this is not a physiological thing. This is a psychological thing. That to me, that overwatch mechanism, however badly I just explained it, is psyche. It is the ability to interpret what is happening to you rather than be swept up by it. And so if you are swept away by, oh, I just smoked weed and I'm feeling paranoid and now I'm having a full blown panic attack and I cannot get above it. That's a problem. Now the one I have struggled with
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Dr. Peter Attia
is, by the way, I think that's actually a really interesting idea, Tom. I think that's pretty cool. I'd like to. I'm going to continue to think about that through the lens of how I imagine the relationship we have to mind altering substances. You know, for me, just like I never drink to the point of even remotely getting like. I mean I've had too many, if I even start to notice it. Now I also have a very high tolerance to alcohol. So if I have two glasses of wine, like I feel literally nothing, nothing, nothing. There is not even a semblance of a buzz that I would feel. But that's an interesting point, right? Is when you get to the point where that, that third eye of yours is not able to see what's going on. Yeah. I would argue that that's not a place you ever want to be.
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Tom Bilyeu
Agreed.
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Dr. Peter Attia
Regardless of substance.
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Tom Bilyeu
Agreed. The only time that I cannot extract myself from it is if my anxiety runs wild. Now there is one thing that I've managed to peg that I'm like, this causes anxiety and this makes me so sad because I love these so much. But Diet monster, now I ran this
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Dr. Peter Attia
experiment so for a long monster is taurine, caffeine. What's the substance?
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Tom Bilyeu
I. Those are the two that I could tell you offhand what all the other one, I mean, it's just long.
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Dr. Peter Attia
But is that different? I don't drink energy drinks particularly. But is that different than Red Bull? Is that different than Monster is the
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Tom Bilyeu
only one that I enjoy enough that I've drank so many of them that
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Dr. Peter Attia
the taste of it is good enough that you can drink the can and therefore hit that critical dose of whatever's in it?
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Tom Bilyeu
Yes. And I don't feel it on the day, I feel it the next day. So it's this really. It took me a long time to realize what it was, but I went through a period of time where, admittedly, I was under so much stress that I actually thought, this is just. I actually have a reason to be anxious. And then I was like. But there was one time I turned left instead of right and I had this massive spike of anxiety and it was literally just to exit a parking garage. And so I was like, like there. That's when I realized, oh, this is generalized anxiety because there's no reason I should be anxious. Um, and so that put me on the path to, okay, there's something I'm. I've either allowed my anxiety to hardwire itself so deeply in my brain that now I'm interpreting stimuli in a way that just doesn't make any sense, or because I always ask myself, what advice would you give if somebody came to you with this? And I was just like, I would tell somebody, this is your diet, just because you are helping slowly maybe break me of this, but I just come from a place of. Anything bad in your life? Your cat just died. It's your diet. I have such a knee jerk reaction, especially given my family history. And so I was like, what are you consuming a lot of? Stop consuming it and see what happens. And I was like, well, I drink a hell of a lot of monster. And I was, how many of these drinks? The big ones. The big ones. And they were amazing. I love them so much. But I just cut them out and it went away. And I was like, wow. And then I literally recently.
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Dr. Peter Attia
What's interesting to me, Tom, in that story is not that you had that response. It's that you didn't have that response on the day of, and it was the day after. That's actually kind of interesting.
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Tom Bilyeu
Interesting. And it makes it really hard to steer by, especially because I have a shockingly poor ability to recognize patterns. So that. That was hard. That took me a while. And it was really just whittling things down of like, I know what I'm consuming a lot of. And yeah. Finally cutting that one out. Because, again, I would cut it out, but nothing would change on the day. So I thought, okay, well, it wasn't that. And then once I was like, leave it out for three weeks and see what happens. And then that was when I was like, whoa, I really think this is. And then I would. I tried reintroducing it, and it came back. So I was like, wow, there's just no way around that, because I love them, so I would keep them if I could, but alas.
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Dr. Peter Attia
Can you imagine if we had our little cave friend here and we gave him some monsters?
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Tom Bilyeu
Jesus, man. So you're just.
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Dr. Peter Attia
You got to play this game sometimes. I love playing this game. You go back in time, little time machine, 10,000 years ago. You bring one of our ancestors forward, assume he can speak our language, we'll give him that. That, like, just imagine what do you
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Tom Bilyeu
give him, and how much does he stroke out over the things that he sees?
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Dr. Peter Attia
Like, think about him, like, the next time you're sitting in traffic, annoyed, just imagine he's sitting in the passenger seat. Like, how are you explaining this thing to him that he is sitting in?
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Tom Bilyeu
That's crazy. It's crazy. And that's what makes me want to save the modern world. I am absolutely here for it. I'm here for flying cars. I'm here for going to Mars. I am certainly here for virtual worlds that you can explore that have more depth than the real world. But I also want to recognize that there's a biological reality to be faced about what we do. Speaking of that, what do you think is a thing that we think of as wisdom right now for health, longevity that we're going to cringe at in five to 10 years?
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Dr. Peter Attia
We're in the process of doing this, but it's interesting. I was just talking with your wife before we started today, and we were talking a little bit about menopausal care. So I think we're in the process of making this transition. But if you asked me this question five years ago, I would have said 100%. The denial of HRT for women. Right. So this. This idea that women should suffer their way through menopause and they should never be given hormones. Like, there's still a lot of doctors who believe that. And I hope that in five years, we look back at that as just about the way we would now look back at how they did surgery in the 1880s without anesthetic.
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Whoa.
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Dr. Peter Attia
Like, Tom, how do you feel about having an amputation where I'm just going to Give you a piece of leather to bite on. Sign me up. Right. That's pretty savage. And that's. I. I hope that in five years, we're. Are we. We have that view of if you have a woman who wants HRT and you deny it to her, that's in my mind, that's. That's that level of savage.
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Tom Bilyeu
And the reason right now that they deny it is they worry it increases cancer risk.
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Dr. Peter Attia
Yeah, there's. We still have this kind of. Kind of demonization of estrogen and this belief that. That. That HRT causes breast cancer, which, again, the data are really that. That HRT does not cause breast cancer. And even if there's a tiny, tiny subset of. Of women who are going to see a slight increase in the risk of getting breast cancer, it's. There's no increase in the risk of mortality from breast cancer. And even that risk of the increase of breast cancer is almost assuredly due to a formulation of synthetic progestins that were used years ago that aren't used today. So in its. In its current form, you know, it's just. There's. There's just no. No evidence that this is. That this is happening. In fact, the evidence is probably a little bit the opposite. So that. That would be something I would change, you know, as far as, like, on the more fringe side, I don't know if in five years, I. This is one of those things. You can't prove a negative. But I'm pretty skeptical of the mass use of stem cells. So I think that. I think there's probably some utility to stem cells in certain situations. Um, but, you know, when you look at the ubiquity of which stem cells are proposed as the solution for everything, you know, intravenous stem cells, exosomes, all of these things, like, I like the total lack of data supporting any of this stuff, and I. I just have a hard time believing it. So. So there's. There's clearly indications where I think stem cells could be beneficial. My hope is that it gets studied so that we could understand how to standardize stem cells and how to, you know, use them correctly, like make a drug out of it. Right. So you have to, like, if you're. If you want to get a drug approved by the fda, you have to be able to demonstrate that you can produce the drug the same every time under GMP conditions. If you can't do that, can't have a drug. Like, what are we. You know, we're in the wild west here. So, like, we have to be able to do the same thing with stem cells. So my belief is if we did that with stem cells, we would probably find a handful of things for which it works and it would be a pretty narrow indication and a whole bunch of things for which it's total malarkey and we should just stop stealing people's money.
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Tom Bilyeu
Well, that makes me sad, Peter. I would really like to think that there is a magic cure all. Speaking of magic cures for aging. So the last time that you and I met, you said you were on the cusp of thinking maybe testosterone replacement therapy might be a thing you wanted to do. Have you done it?
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Dr. Peter Attia
Yeah. So last. So over the winter, I just continued to watch my testosterone levels go down and down and down. And so, yeah, about six months ago, I started hcg. So. So HCG is. It's a hormone that mimics luteinizing hormone. So our pituitary gland makes two hormones. Luteinizing hormone and follicle stimulating hormone. They tell the testes to make testosterone. So the first question I had, which is, again, this is a question we would ask with our patients, right? If you have really low testosterone, is it primary or is it secondary? Is it low because the testes can't make anymore, or is it low because the pituitary gland is not making the signal to. To do that? So one way to test that is to actually take hcg. And if you take HCG and your testosterone goes up, then you know that the problem wasn't that you couldn't make it. The problem is that you're getting. Not getting the right signal for whatever reason. So in my case, it turned out that it work. Worked. So when I took hcg, which is, you know, a small peptide that you take, so you do an, you know, sub Q injection a couple times a week, my testosterone got to normal. And that obviously tells me that the reason I've had a couple of years of super low testosterone is something in my pituitary. And given that virtually everything I think I'm managing well, the one thing that I would point to is probably stress. I would say probably, you know, stress is the one thing because, you know, my sleep is actually pretty good. I don't tend to struggle with sleep. I, you know, by. By all the means that I track it. It's. It's really something that I. I've optimized. Not perfect every night, of course, but on balance, it's. It's not a chronic issue. Whereas for many people, you know, poor sleep is the cause of central hypo hypogonadism which is the technical term for that. So, yeah, I'm just. No, I'm walking around with normal testosterone now.
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Tom Bilyeu
Now, is that where you would start? Any guy that has low testosterone, is that the first thing you test or.
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Dr. Peter Attia
It's not necessarily. Every case is a little bit different, but. But that would be a discussion which is, you know, where, you know, for me, again, it doesn't really matter. I could take testosterone as well because I'm not planning to have kids. And all the things that would come my way if I stop making my own testosterone, which is what would happen if you took exogenous testosterone for a few years, you would, you would stop making your own testosterone. That's not actually a concern for someone my age, but I don't know, for whatever reason, just psychologically, it was a little bit of an easier pill to swallow to start with this kind of indirect way.
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Tom Bilyeu
Now, would HCG pop you for doping?
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Dr. Peter Attia
Yep. Okay. It's. It would still be a WADA band drug. Got it.
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Tom Bilyeu
Okay, Very interesting. What do you consider normal for testosterone for guys?
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Dr. Peter Attia
Well, it's a bit complicated because, I mean, I can give you obviously the percentiles. Right. So for, you know, a guy my age. And by the way, I don't even think normal is what we want to aspire to. I think we'd want to aspire to be top quartile. Right. If you're going to bother treating somebody, you should at least take them to the, I think the, you know, sort of top quartile. So, you know, I just wanted to see my total T above 800 and my free ticket, you know, kind of above 16.
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Tom Bilyeu
Wow. You got your total T over 800 with HCG.
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Dr. Peter Attia
Yeah. Starting with a T of 300.
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Tom Bilyeu
Wow.
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Dr. Peter Attia
Yeah. Or maybe 275. I mean, pretty low total T maybe 275 with a free tea of about 5. And then went to a total tea of about 800 and a free tea of. You know, actually the first time I took it, I overcooked it a little bit. I was more sensitive to the HCG. I ended up going to like 1200 total tea with a free tea of 22. So I backed it down and now I think I walk around at probably about 800 with a free tea of 15ish.
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Tom Bilyeu
Does it feel different?
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Dr. Peter Attia
It does. I definitely feel better. I would say the two areas where I've noticed the biggest difference is I. I genuinely just feel better, like from a mood perspective. And secondly, I'm. I'm definitely stronger in the gym. What about sex drive was never an issue before, so that wasn't like, despite my low T, I didn't, I didn't really struggle for libido.
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Tom Bilyeu
It's interesting. So when I was in my, call it early to mid-20s, my poor wife, the friction burns. But as I've gotten older, I've hit a more reasonable pace. But I've always wondered, if I started doing some sort of testosterone replacement therapy, would I go back to my poor wife suffering? Or does this stay somewhat balanced? Like, how does that.
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Dr. Peter Attia
Probably depends on how high your levels go.
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Tom Bilyeu
How high the testosterone levels go.
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Dr. Peter Attia
It would depend a little bit on how high you are now. And here's the part about this that's a little bit complicated. What we can't measure is the thing that matters most. So your testosterone and your free testosterone are just proxies for what we most care about. We most care about is how many molecules of testosterone are binding to your androgen receptors. So it's androgen receptor saturation that is the variable of interest.
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Dr. Peter Attia
So if a guy has symptoms and his androgen receptors are not saturated, that's the guy you want to be replacing. H. Conversely, if a guy has no symptoms, or if a guy has symptoms but his androgen receptors are fully saturated, you need to look for something else. And we don't have a test that measures that. So the way testosterone works, of course, is testosterone comes into the cell, binds to the androgen receptor, and then that testosterone androgen receptor complex is what goes into the nucleus and it binds as a transcription factor that increases gene transcription. So all of Those things are happening in a favorable way if you have a sufficient amount of that, but if you don't, that's where you're deficient. So when people have really low T, we just kind of make the assumption that hey, they probably have not saturated their androgen receptors. Where it gets a bit complicated is when guys have like a T of 700, a free T of 10 and they have symptoms. And at the end of the day I just think sometimes you just try it empirically. You just say, well, if we boost you such that your free tea goes from 10 to 20 and you don't feel a difference, this is not a T problem, you shouldn't be on T. Now.
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Tom Bilyeu
Testosterone, from what I've read, is dropping like crazy. Men are at across averages, all time lows. What's happening? Should they be on hcg? I'm guessing the answer is no, that there are plenty of things they can do before they get there.
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Dr. Peter Attia
Well, the most common, we think that the most common reason for that trend, and it is a pretty significant trend. So for context, I think the average 30 year old today has about the same level of testosterone as the average 50 year old 30 years ago. God. Yeah, so that's, that's pretty clear. We actually look those data up and the best explanation for it honestly is increasing body fat. It's just that men are having, men have more body fat today than they did 30 or 40 years ago. And so body fat is doing two things to lower testosterone. The first is it's increasing the aromatization of testosterone. So you're making more estrogen from your testosterone. Estrogen is very important. You want to actually make estrogen, but it needs to be in the balance, right? So if you're making more estrogen than you should, you're depriving yourself of the substrate testosterone that you want. And then the second thing is more body fat is going to be accompanied by other metabolic changes that are going to lead to more like more sex hormone binding globulin, kind of like less available testosterone. So you're going to make less testosterone, you're going to utilize less testosterone because of more being aromatized. And so that's probably the single biggest driver of what is obviously happening, which is a trend towards lower and lower testosterone in men's, in men today for a given age.
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Tom Bilyeu
So the, the fat itself is sending out a signal that's causing the body to react differently to testosterone.
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Dr. Peter Attia
Well, so, so, so fat isn't fat. Fat is inflammatory. Right. So the more inflammation you have, the more metabolic disease you have, the more that process of making testosterone is going to get interrupted. So something in that hypo, hypothalamic, pituitary, gonadal access is being disrupted that's producing less testosterone. So you're going to make less testosterone. The testosterone you make, you're going to spend, you're going to put more of it into estradiol. So it's kind of like a double whammy.
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Tom Bilyeu
All right, at what number do you want to see men looking at their testosterone? Like, what, what number is too low? And is that entirely tied to age?
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Dr. Peter Attia
Well, it's highly correlated with age. So we, you know, and I, I think we've, I'm, I'm, I know we've written about this where we've got like, we kind of go through the table. So by decade, what are the percentiles? So you can, you know, somewhere on our site lives this table where you can see by decade of life, this would be bottom 25%, second quartile, third quartile, top quartile. So very predictable age response. Again, I, I think that it would always be desirable to be in the top quartile for your, for your age bracket, which by definition means three quarters of men are below that.
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Tom Bilyeu
Now why not push a 60 year old into a 25 year old top quartile?
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Dr. Peter Attia
Well, there are, there are side effects of testosterone, so you have to be kind of mindful of those side effects. Right. So one of the side effects of testosterone is you're going to make more dht. So dihydrotestosterone is a hormone that is more potent than testosterone. So it's, it's an even more potent binder of the androgen receptor and it does some really good things, but it also does some undesirable things. So one of the things it does, it's going to accelerate hair loss. So if a guy is particularly concerned with androgenic hair loss, that's going to increase. It also increases the size of the prostate gland. And so when a guy is 60, his prostate gland is already kind of getting big enough on its own. So we don't really need to put too much more fuel on that fire. Now of course there are ways around that because you can take a drug that blocks the conversion of testosterone to dht. And of course many men do this. So drugs like finasteride and fasteride, which are commonly used either for hair loss or. Yeah, so propecia would be the, the, the hair loss version of finasteride doesn't
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Tom Bilyeu
finasteride though have like potentially huge sexual consequences.
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Dr. Peter Attia
Yes. So some men have really nasty side effects to finasteride, where they have a total loss of libido and it kills their mood and stuff like that and back. Right. Well, fortunately for most men, if they stop the drug, the symp goes away. But there is a small subset of men who appear to maybe be irreversibly damaged by that. Fortunately, that number seems to be very small. It's called post Finasteride syndrome, pfs. And it, it definitely is. You know, it's a controversial topic in the urology literature, but it's, it's, it's another reason why I, I don't just recommend those drugs willy nilly. I think I, I would want to make sure that if a guy's taking one of those drugs, he really kind of understands the potential risks of it. But there are other drawbacks to taking those drugs. Right. So you can take that drug. Let's say you're in of the cases of folks who, they don't have that side effect. Right. They don't have a post finasteride syndrome or a finasteride syndrome. But now something else happens which is you've artificially suppressed your psa. So now one of the things we want to be, you know, making sure of in an older man, or basically any man above 50, basically is what's happening with respect to your risk for prostate cancer. Well now I just took away one of my best screening tools. Now it's not the end of the world if the doctor understands that. But most doctors don't know that when you put a man on finasteride or dutasteride, you have to be much more diligent about how you screen for prostate cancer and you're looking for much smaller changes in PSA to cause alarm.
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Tom Bilyeu
Very, very interesting. Going back to something that potentially is cringeworthy down the road or maybe is amazing. Do you know Brian Johnson and his Don't Die movement?
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Dr. Peter Attia
I don't know him, but I've heard of it.
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Tom Bilyeu
What do you think about that?
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Dr. Peter Attia
I don't have any thoughts on it.
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Tom Bilyeu
So it's tied to AI basically. So he's saying, hey, now is like the period you don't want to die. Because if AI comes in and does what it's going to do, then we really might be able to find patterns in biology that right now are just completely invisible to us that will allow us to radically extend human life. So the question then really becomes about AI. Do you see anything in AI that you think is promising that could have a substantive impact on the way that we do health now, even if it's not to radically extend lifespan, but maybe radically extend health span or help us overcome diseases like cancer or whatever.
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Dr. Peter Attia
I mean, I would put myself in the camp of being very excited about AI, which is not a hard camp to be in today. I think most people are. I also think we're in an AI bubble. So I think where we are for AI, right, right now is where the Internet was in the late 90s.
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Tom Bilyeu
Do you mean that as an investor, though, or as in the ultimate promise?
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Dr. Peter Attia
Both. So absolutely. As an investor, I think it's a totally overpriced bubble that's going to crash, but also in terms of expectation and timeline of expectation. Right. So if you think back and you know, you're old enough as well to remember in the mid-90s, as we were heading into the new millennium, I mean, people just thought the Internet was going to change the world in ways that it hasn't quite. And yet there are ways in which it has changed the world that nobody could have predicted at the time. Let's take two obvious examples, Uber and Airbnb. Like, nobody thought about that at the time, right? People thought about commerce, and that was a big deal. But it even took longer there for it to really become the profitable, you know, disruptive technology. So. So, look, I just think there's a parallel between how we think about AI and how we thought about the Internet. I think AI will be more important than the Internet. So I think when we're looking back in, you know, 50 years, I do believe, and I. I don't think I'm alone in believing this. I think AI will be an even bigger disruption, hopefully in a positive way, than. Than the Internet was. But I think there are certain things that will take longer than we expect. So to your question, where do I think it's going to help? I think. I think there's some really unsexy things it could do to help that, you know, this would be a good time for people to go and get a snack or go take a leak. But like, if you think about health care, for example, like adjudication and reconciliation of health care billing is arguably the stupidest, most inane, like, part of this country, right? Like, the amount of dollars that are wasted, the amount of brain damage that is inflicted on our species, trying to reconcile medical payments and stuff like that is. It's impossible. And by the way, nobody knows how to do it. Like, if I gave you an eob, an explanation of benefits and like walked you through what was in there, you'd be like, dude, why don't you just talk to me in Japanese? Like, I literally have no idea what you're talking about. Just tell me how much to pay. And oh, by the way, you're getting ripped off. So AI should solve that problem. Like we need to train AI to basically solve the entire system of how medication is adjudicated. I would love for AI to absolutely eviscerate PBMs, pharmacy benefit, benefit management entities. So these are the companies that live between the payers and the employers that are responsible for totally ripping off everybody in America. But these, this, these are the biggest cancer in the health care system today. So if we could just eradicate that and actually have a pricing optimization run by an AI that is not skimming off literally tens of billions of dollars to itself, that would be incredible.
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Tom Bilyeu
Wow.
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Dr. Peter Attia
But none of those things are really going to help you live longer. So to the question of how are we going to live longer? Probably the most exciting thing that AI has done at the moment. Again, not that sexy if you don't understand the biology. But do you know how a protein works? Like the idea of what a protein is in the body?
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Tom Bilyeu
Yes, but good lord, as a, a person at a 80,000foot view, not in any way mechanistic.
- [29:55]
Dr. Peter Attia
All right, so you eat a steak right now, right? So you're eating, and a steak is great because it has all the amino acids in it, all the essential amino acids. So you just ingested a whole bunch of protein that gets broken down into these building blocks called amino acids. There are 20 of them. When your body wants to make something, a lot of the things your body makes are proteins. They can be structural proteins like collagen, hair, muscle. They can be functional proteins like enzymes. Your DNA gets transcribed into rna. That RNA gets turned into a signal to make a protein and it strings together the amino acids. Now, by itself, that's not the protein. It has to undergo structural change and what's called post translational modification. So sometimes it gets turned into a helix, sometimes it gets turned into something that folds and that's called the secondary structure of the protein. And ultimately it gets folded over onto itself into the most complicated three dimensional structure you can ever imagine with thousands of amino acids. Okay. Until AI came along, we had absolutely no clue what the relationship was like between the string of amino acids and the final shape of the protein. And that is a big part of what made biotech really, really hard. So we could look at a receptor and Say, man, I'd really love to have a drug that fits into that receptor and turns it on. I know the shape of the receptor and I therefore know the shape of the thing that needs to fit in it. In other words, I have the keyhole. I can impute what the key is, but the key is a complicated structure and I have to from the key, impute what the 4,000amino acids were that went into it. That had to be done by trial and error.
- [31:55]
Tom Bilyeu
Woof.
- [31:56]
Dr. Peter Attia
Today, that is done with AI.
- [31:59]
Tom Bilyeu
That's actively happening right now.
- [32:01]
Dr. Peter Attia
Yep.
- [32:01]
Tom Bilyeu
Is this Alphafold or.
- [32:04]
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- [32:34]
Tom Bilyeu
Okay, how's that being used right now? Other than now we know, but how do we get that into.
- [32:42]
Dr. Peter Attia
We just completely. So it's basically changing pharma, it's basically changing drug as we speak. Yep. Now, I want to be clear. Everybody said, oh, my God, AlphaFold is going to make drug discovery take one year instead of 10. Not really, because what they're forgetting is the long piece of this can't be done yet by AI, which is the clinical trials.
- [33:00]
Tom Bilyeu
Yeah.
- [33:01]
Dr. Peter Attia
So it's totally shaving off all this time at the beginning and saving a ton of money. But the long pole in the tent of pharma is not the drug discovery, it's the clinical trial. You're still going to have to test this in humans in a very careful way that is, you know, incremental. Like, first let's make sure it's safe. Okay. Let's do a dose escalation. Okay. Now let's make sure it kind of works. Okay. And it kind of works. And it's kind of safe. Now let's do a bigger trial over a long enough period of time with enough people in it that if it really works and it's really safe, we're comfortable approving it. So all of that still has to happen. I'm sure AI will come up with ways to help make that better. But again, as nerdy as that example is, I mean, the, the folding pattern is. That's pretty freaking cool.
- [33:46]
Tom Bilyeu
Yeah, that stuff is unbelievably cool. And this is one of those things. At the risk of me dragging people into my madness, this is why I'm so obsessed with game development. When you start doing game development, you realize that all, all, all of life is simply based on a set of rules. And once you know those rules, you can actually begin to predict what will happen. But the joy of being a human is you can't predict all of the things that are going to happen. And so now, as you create a virtual world, you can set up these rules that are so complex and interact in these really fascinating ways that you effectively. And I don't think people are going to like this sentence, but you effectively get to play God. So as a developer, you get to play God because you're creating the set of rules. But as somebody exploring those worlds, imagine creating a world that is based on a set of rules, and it will spawn literally an infinite number of worlds. And you can have a world that is an entire universe unto itself that you will get to explore uniquely. Nobody else will ever encounter that world unless you want them to. And once you understand that the sophistication with which you can create these virtual worlds is tied to what the AI can predict in our world. So now you could. Now in the future, you'll be able to apply AI like AlphaFold to a virtual world where it's building up from amino acid building blocks, but creating creatures in your world that are, like, built literally down at that level.
- [35:20]
Dr. Peter Attia
Yeah.
- [35:20]
Tom Bilyeu
And so it becomes fascinating.
- [35:23]
Dr. Peter Attia
I mean, obviously this is, this is, you know, an incredible topic to explore. It's one for which. So let's take a step back so people can kind of understand the complexity of the problem. I know you understand this, but I think it's important for the listeners to understand. We're about 25 years out from the, the sequencing of the human genome, right? Yep. So Human genome project was completed, I think, about the year 2000. And that was heralded as the single most important breakthrough in all of human health. But it hasn't really panned out. In other words, that didn't come close. Didn't come close to being as helpful to human health as the discovery of insulin, penicillin, sterile technique, sanitation. Like, you know, the, the, the, the elucidation of the human human genome has saved fewer lives in the last 25 years than 10 minutes of what sanitation, antibiotics, and insulin have saved in since we've been talking. Okay, so why is that? Well, it's because of something you sort of alluded to, but I'm going to twist it and make it my words, the rule book doesn't transmit. So what we coded was the human genotype. There are 3 billion base pairs that define you and define me, by the way. The only difference between you and me is a couple percent. So it's. We're virtually identical genetically. But obviously if you look at us, we look nothing alike. I mean, we both have two eyes. You know, we stand on our feet like you can recognize that we're of the same species. We otherwise look quite different. So what we have no clue of, for the most part, is the relationship between the genotype and the phenotype. It's why we can't go and make something genetically. So as an example, let's assume that I had all the control to manipulate the genome that I wanted, which I don't, by the way. But let's assume CRISPR was so perfect that I could. And it is, by the way. CRISPR is probably at this point good enough that we can change any gene. What we can't do is insert it. So we're good at developing payloads. We still have horrible delivery systems. But let's assume all that's done. Let's assume I can make any gene of any size, edit any gene of any size, and deliver it to your entire genome if I want to. That's a big if. Not clear that's ever going to happen. But let's grant that it's going to happen. If you said, peter, I want to be smarter, can you genetically manipulate me to be smarter? We would say we don't have the foggiest clue what genesis are responsible for being smart. Okay, can you make me taller? Never mind me, my growth plates are fused. Can you make my kid taller? No, we have no clue what genes. We can't even. We wouldn't even know what genes to adjust the eye color of your offspring. Think of how trivial these things are. And we do not understand the relationship between genotype and phenotype. And so it just speaks to how complex this problem is. Now, is AI going to help us on that front? I sure as hell hope so. But if we don't have that, we don't even have a prayer of basically doing AI clinical trials. But here's the other thing. Genotype is only part of the equation. It's also adaptation. So it's the whole nurture nature problem. So why is it that you could take three genetically identical embryos and put them in three totally different environments and they're going to end up producing three pretty different people that by the way might respond different to three different drugs. And why is that? Well, it's differential gene expression. This is now getting into what's called the epigenome. And you could say, well, Peter, can't we figure out that? Okay, maybe, but like, it's getting awfully complicated. So look, the, the beauty of futurism is it makes us all look stupid because all this, all the stuff we sit here and think is going to happen, we can't imagine the things that are going to happen. But my, my intuition is that there are lots of really incredible ways that AI is going to make what I do so much better. But, but they're, they're not as like, wham, bam, super sexy as maybe people would like to believe, at least not in the foreseeable future.
- [40:04]
Tom Bilyeu
Do you use AI right now?
- [40:06]
Dr. Peter Attia
Yes. Use it quite a bit. You know, definitely. Still kind of struggling with some of it. Like, I think, honestly, it's just, you know, I would, I would describe AI right now as a really unhelpful analyst. Like, it's an analyst, it functions as an analyst, but it's like the fastest working, fastest reading, least intelligent analyst I have. Like, there's some value to that, right? Amazing at spitting out a first draft of thought. But like, you know, we have five research analysts on our team. Like, they're all here. GPT4 is like way down here, right?
- [40:49]
Tom Bilyeu
Yeah, I.
- [40:50]
Dr. Peter Attia
For the type of work we do, obviously GPT4 is way above all of us in certain areas for the type of work we do. It's borderline a moron.
- [41:00]
Tom Bilyeu
I will be very surprised if in call it three years, that for an analyst position that it's not able to match or surpass the brightest that you have. That's pure.
- [41:14]
Dr. Peter Attia
It's going to come down to the training set. So, so this is. So for certain things it already does. Like, you know, I, I could argue maybe for coding and things like that, where the training set is so high it has the real challenge of the work we do. It's very difficult to train an AI on.
- [41:29]
Tom Bilyeu
Why?
- [41:30]
Dr. Peter Attia
Because how do you. It just hasn't been done. Like, we could do it, but like, you'd have to, we'd have to quit our jobs and just work on training the AI. So nobody's out there, to my knowledge, who's trying to train an AI to do what we do, which is how do you critically read papers and, you know, how do you read 10 papers on a subject matter, go and read all the references, be critical of which studies suck, which ones are Good. What the limitations and strengths are of each paper and all of that stuff. I mean, what AI could do. If AI could do that, it could clearly write better than us, it could clearly write faster than us. It just, it's, it's going to take a while for us to train it how to think. And it's not been from a lack of trying on our end. Like I've, I've, I really push GPT4 to, to, to, to try to get smarter on stuff that I want it to do. I, I jam a lot of papers into it and it's great at summarizing. It's just not a synthesizer. It's just not smart in that regard.
- [42:29]
Tom Bilyeu
Yeah, I'll be very interested to see if as the cost of compute goes down, which, that's a huge question mark, whether we're going to run out of compute or not. But let's say that the cost of compute goes down, you get more people training models. If you're able to reduce the amount of models need to be trained, which it seems like they will be able to now all of a sudden put it in the hands of a team like yours and thousands, maybe tens of thousands of other teams out there, I think it'll be really interesting even if it only gets more efficient. At the level of model training we could see some pretty big breakthroughs because now you have a lot of people training these and depending on whether they get made proprietary or open source, there's just so much benefit to humankind obviously if we can be begin to recognize patterns, I mean that anything where it really seems obvious that this is a pattern recognition game to me, it is only a matter of time before AI will be able to do it for things that aren't pure pattern recognition. Okay. And maybe some of what you're doing isn't just pattern recognition. And so there becomes a judgment thing. I don't know, I don't know the level of data that would be required for the genome type. I forget how you said that to the phenotype that translation like is like if we were to get everybody, billions of people, would that be enough for AI to.
- [43:56]
Dr. Peter Attia
Yeah, that would be awesome. So if you had the genome, if you had the 3 billion base pairs of every one of the 8 billion of us on this planet and you could code the phenotype, that's what you have to be able to do.
- [44:09]
Tom Bilyeu
Right.
- [44:10]
Dr. Peter Attia
So what, how are you going to, how are you going to quantify and code phenotype? So let's, what would we do for you height, weight, skin tone, eye color, iq. Like what are the parameters we're going to put in there? I don't know. Like we'd want to be able to put hundreds of thousands parameters in there. We don't know how to quant. Like, how can, what can we measure and quantify to put in there? Vertical jump? Well, I don't know. How do I know your vertical jump is what it is? Because you hurt your knee 10 years ago versus what your genetic capability was. Right. So this is the problem.
- [44:45]
Tom Bilyeu
Yeah, look heard. And that for sure is going to be a limiting factor. But when i1 is, I think about this on longer timelines, a lot of this goes away. But when I also think about if
- [44:55]
Dr. Peter Attia
you could do this prospectively, right? So if, if starting today, every kid that was born, you took their genome and you could map some quantity of their phenotype. We came up with like the 50 to 100 metrics we wanted and we just tracked everybody serially over time. I mean, sure, you could produce something really remarkable, no doubt.
- [45:13]
Tom Bilyeu
And then also, I think we're kicking off so much data now. If we were aggregating all of that data to your point, you're not going to have everything that we will ever care about, but you certainly would be able to get things like sleep data. So this person, how do they respond to sleep, how do they respond to stress, heart rate variability? There, there are so many things that we kick off now. It's not going to, you know, I mean, it's going to be less than probably a percent of the things we will ultimately care. But you can really begin to zoom in on things, especially again over time. So it's like, all right, if you're tracking what a kid's doing from whatever age 13, even if you start clocking them at 18 and you collect data on them for 20 years, including things like that you would get in a census. So how much money do they end up making now all of a sudden, and I'm not even saying this doesn't lead to something dystopian, but you'll be able to figure out a lot of these things in their genotype are coded to these outcomes or we see patterns in these.
- [46:17]
Dr. Peter Attia
But then it begs the question, to what end?
- [46:21]
Tom Bilyeu
Yeah, I will answer that question. And this comes down to, I think society ends up bifurcating. This is again where we get into my personal hobby horses here. But I think society bifurcates are going to be people that don't want anything to do with this. And then they're going to be people that break on the technological side. And now all of a sudden you are quite liter literally crafting superhuman people.
- [46:43]
Dr. Peter Attia
And how do we bifurcate this society? Is it a geographic bifurcation?
- [46:48]
Tom Bilyeu
So, yes, I think this is where I break company with Balaji, who I think you know. Oh, you don't know Balaji Srinivasan? Oh my God. Two people who I think would find each other fascinating. So Balaji has a whole thesis that we're going to break into what he calls network states where you won't be geographically bound, you're going to be bound by effectively ideology and that you'll see a weakening of governments as money decentralizes. Anyway, I don't think humans are wired like that. I think ultimately we respond most strongly to the people that we're around. And I think we respond very negatively to over isolation. And it does not yet seem that the connections that you get online can replicate the things you need in your real life. So I have a feeling that unless we overcome that, you're just, you're not going to see that play out. What you will see is a further segregating by geography. Now, how big that geography will have to be. Is it city versus rural? Probably. That seems like the sort of play throughout human history is that you see people aggregating in cities and they think about the world very differently than people that aggregate out in rural areas. So my gut instinct will be that you'll get something like the Amish. And in my mind I always clock them as puritans, people who literally use the word, I am a Puritan. My body is pure. I do not put technology in my body. I do not interface with AI. And so they'll break somewhere along the 90s, effectively, is how I think about it. They'll want technology. They're not going to want to go too far backwards. But they will go to the 90s and say, okay, this is a state of technology that is useful.
- [48:28]
Dr. Peter Attia
Meaning they'll go back from here.
- [48:30]
Tom Bilyeu
They will go back from here, regress from where they correct. Just like we're gonna stop, I think stop letting kids have social media before they're 16. That'll probably end up being a little bit later. Again, these are factions. This won't be universal. But I think parents are waking up to the fact that, that it is parental malpractice to let your kid suffer the psychological consequences of having social media too early. More and more studies will come out. It'll just be impossible to ignore. It'll Start getting mandated. You'll start seeing people really embrace that. But as literally Elon Musk continues to do brain computer interfaces, it won't be long, 15 years before you've got people that legitimately are getting upgrades. There's nothing wrong with them. They just want a brain implant because it allows them to see an infrared or whatever. And so you're going to start seeing people do that and you will get people that respond violently to that. This is not what God intended. It will break in very similar ways to religion. You're already seeing a geographic segregation based on right and left, which I. I worry about that when you start, like in the next three years, probably not in the next 30 years. Yes. Like, this stuff is going to get exacerbated. So I think we have enough things with modern technology that is both outlandishly amazing and so will attract people like me and really detrimental, and people are going to respond and they're going to go down that path. So anyway, I think anything extreme like this is going to push people farther and farther into those two camps. So, yeah, I think the ultimate segregation will be geographic. But this comes down to ideology. How far people embrace AI being the most important.
- [50:18]
Dr. Peter Attia
Yeah, interesting thesis.
- [50:20]
Tom Bilyeu
It is going to get fascinating, that is for sure. All right. As you look at some of the things that are right now today in terms of positive, negative. So modern ills, overfeeding being, I think, maybe the most profound. But I have Ozempic. Why can I drug my way out of this? Can I pour more modernity on modernity and solve the problems?
- [50:47]
Dr. Peter Attia
It looks like you can. I mean, it really looks like the. And remember, Ozempic is just sort of the. The first effective group of those drugs. So the GLP1s have been around for a decade and they've been largely ineffective for weight management. In fact, they were never brought on as weight management drugs. They're brought on as drugs for improving insulin sensitivity. But something about semaglutide as OIC was the first time when it was like, oh, my God, like all these people with diabetes, their diabetes is getting better, but they're losing an unbelievable amount of weight. And so that realization happened four years ago. And now we've got a second drug that's even better than Ozempic called Tirzepatide or Wegovi, pardon me, or Manjaro. And it's even more effective, right? Fewer side effects, even more effective. And then we've got another one that's not approved yet, but it's in phase three called Retatrutide that is even more potent than both of these with no more side effects. So if, and if you actually go down the list of all of these drugs out there, there's, you know, there's 30 more of them in the pipeline. So we have no shortage of drugs coming at us that are going to help people eat less. And now a number of these drugs are also being targeted at reversing sarcopenia. So it's not just how do I eat less, it's how do I preserve more muscle. Now the challenge is we still don't know if these drugs preserve strength. And right now, the early versions of these drugs appear to increase muscle mass, but not strength. So it doesn't appear to be a functional gain.
- [52:22]
Tom Bilyeu
They actively increase muscle mass.
- [52:25]
Dr. Peter Attia
Yeah. So there's one drug called Bima that actually increases muscle mass even in the setting of using semaglutide, which, which decreases muscle mass. All things equal, because you're losing muscle mass and fat mass. You're getting leaner, by the way. So it's, it's decreasing fat mass at three times the rate. It's decreasing muscle mass. So you're, you're still, you know, you're still, you're getting, your body composition is improving. So, you know, that begs the question that you might not have a complete pharmacologic ill to training like you. You still have to train. It seems that. But at least based on what we know today, the only way to actually get stronger is to put the muscle under stress like you. It's not enough to just take a drug that increases the size of the muscle or prevents the muscle from shrinking. That shouldn't be that surprising. Right. Like, it's hard to imagine that there was going to be a hack around getting stronger, but it, it really seems that these drugs have done something that no other class of drugs have ever done before, which is to be simultaneously reasonably safe. I say reasonably because I, I don't think we know enough yet to know that they are completely safe. And I don't really know what completely safe means. I don't think there's a single drug that is completely safe. Like Tylenol, Advil and Aspirin are not completely safe. So, you know, with a, with, with any drug, there's going to be a side effect. But when I say reasonably safe, I mean it is not, it does not appear to be the case that these drugs are causing cancer or pulmonary hypertension or, you know, some sort of irreversible damage in the brain or something like that. Where we certainly had concerns with previous drugs that had really good efficacy for weight loss, like fen phen, but they were, you know, killing people eventually. So you have this drug that's safe and effective, and that's a first. We just haven't had that in the weight space. There are a lot of things that are being touted about GLP1 agonists as like, panaceas for all sorts of conditions. But, but we did a pretty thorough review on this, and most of the evidence that these things have benefit for, you know, heart disease, kidney disease, dementia, seem more related to the fact that you're losing weight and you're getting more metabolically healthy. Because these drugs are not just weight loss drugs. What they're also doing to people is really increasing their insulin sensitivity. So with those two things happening, it doesn't surprise me that people are having less sleep apnea, fewer heart attacks, less kidney disease, less hypertension, you know, less cancer. I think we'll see all of those things happen. But it begs the question, would you get those same benefits if you used sleep, nutrition and exercise to achieve the same spot? And the answer is probably. But how many people can do that without the assistance of these drugs? That says nothing of the cost of these drugs. We can get into a much lengthier discussion about, you know, if we truly wanted to put every person who's overweight on this country on one of those drugs, well, the healthcare system can't support that. And what's the trade off of the cost of doing that versus the cost of letting those chronic diseases come to roost 20 years down the line? So there's, there, there's a whole bunch of really complicated economic and, and sort of social questions around this. But I think the more important question really comes down to what's the safety profile? What's the efficacy profile?
- [55:52]
Tom Bilyeu
Wow. I did not realize that there were that many more coming out. I had a very negative view of Ozempic. I would have told people, hey, stay away from it. There are gonna be consequences that we can't anticipate. Listening to that description, maybe I heard what I wanted to hear, but it sounds like I've got something that's like a steroid that I'll have to lift. Because if I wanna get strong, and I do, I still have to put in the energy. But if I've got something that's helped me get leaner while adding muscle mass, which is the holy grail, as long as I take care of making sure the muscle mass can actually contract hard and lift heavy things and lower heavy things. I'm pretty excited about that.
- [56:27]
Dr. Peter Attia
Yeah. Although I don't see how you're going to need to take one of these drugs. I mean, you're already pretty lean.
- [56:32]
Tom Bilyeu
I think I'm probably 12% body fat, let's say.
- [56:36]
Dr. Peter Attia
Why would you want to be leaner?
- [56:38]
Tom Bilyeu
Is that a joke?
- [56:39]
Dr. Peter Attia
No.
- [56:39]
Tom Bilyeu
Have you seen Fight Club Bitter? Like, I could look better, I'll tell you that. I look good. I don't look bad. I get comments from my wife, I'll be the first to admit, but I've been leaner. And it. When you're really lean, it looks good.
- [56:54]
Dr. Peter Attia
Yeah, I. I mean, you know, there's pro. I honestly think the sweet spot is probably 10 to 14 for a male. So if you're.
- [57:02]
Tom Bilyeu
Shut your mouth.
- [57:03]
Dr. Peter Attia
Well, again, we're not optimizing for how we look. We should be optimizing for how we perform and how our body functions.
- [57:09]
Tom Bilyeu
Yes.
- [57:09]
Dr. Peter Attia
Yeah. Again, if you're. If we're talking about peak physical performance, if you're trying to win the Tour de France, by all means, you're gonna need to be leaner. If you're trying to, you know, win a bodybuilding competition, of course you're gonna need to be leaner, but there are probably consequences of walking around at 6% body fat for prolonged periods of time.
- [57:28]
Tom Bilyeu
Yeah, more attention from the opposite sex. Feeling better naked. Yes. Terrible, terrible consequences.
- [57:34]
Dr. Peter Attia
Peter.
- [57:35]
Tom Bilyeu
No, I'm sure you're right.
- [57:36]
Dr. Peter Attia
Unfortunately, a fat guy rationalizing his existence.
- [57:38]
Tom Bilyeu
There it is. That's. Yeah. I was thinking that your. Your obesity is making me very uncomfortable. Dude, tell me about David.
- [57:46]
Dr. Peter Attia
So super exciting. Basically, for folks not knowing what we're talking about. We're talking about David, the protein bar that I'm involved with. Yeah. I've just. No offense, I've never really liked protein bars.
- [57:59]
Tom Bilyeu
Shame on you.
- [58:00]
Dr. Peter Attia
I know.
- [58:00]
Tom Bilyeu
As the founder of Quest.
- [58:01]
Dr. Peter Attia
I know. I'm sorry. I've never really been able to find a protein bar that I could eat consistently. So most of my supplementary protein has had to come in two forms, shakes and jerky. And the good news is both of those things are so much better today than they were 10 years ago. I mean, you and I are OGs. Like, we were the guys drinking protein shakes 40 years ago, and they were hideous. But in the past five or six years, I think the. The ability to just get incredibly good tasting, highly dissolvable whey isolate is like, we're done. Like, that problem's been solved. It's now a commodity product. Similarly, on the salty solid side of things, you know, to be able to, like, eat my Maui Newey, venison jerky, carnivore crisps, those things like that, like, just incredible. But this. There's been this void of, how do I have something that is sweet, solid, high in protein, low in calories. Calories? And so entered this bar, which was primarily developed by a guy named Peter Rahal, who's the founder of a company called RXBar that you're probably familiar with. They made a kind of a paleo bar. He went off, sold that bar a few years ago to Kellogg's, I believe, and. And then I think after he read Outlive, kind of came to this idea that if we can maximize protein and minimize calories, that's kind of an ideal spot for snacks. Kind of realized there was a big impediment to doing that. Protein bars, I mean, you know this very well. You know this better than I do. Protein bars are hard to make.
- [59:33]
Tom Bilyeu
Yes.
- [59:34]
Dr. Peter Attia
Protein is an awful nutrient to manipulate. Carbohydrates and fat are pretty easy to manipulate. Protein is awful. It tastes horrible. It's very chalky. It's difficult to bind to. There's nothing about protein that is meant to exist in the state that we do it this way. Right? Like, protein really should just be consumed in its natural state. You should eat eggs, you should eat fish, you should eat meat. You know, you should consume dairy. Like, those are the best sources of protein. And so how do you get a PDCAS of 1, meaning a perfect protein digestibility and absorption score in something that's manufactured using things like whey. You need a really good binding system and you need a really good fat system. And so that's kind of the technology that went into making David to sort of. We wanted to have this bar that was basically going to be able to get 75% of its calories coming from. From protein. Which, to put that on perspective with other foods, like, that's what you would get in a cooked chicken breast, right? You're getting 75% of the calories from protein.
- [60:35]
Tom Bilyeu
It's an incredible.
- [60:36]
Dr. Peter Attia
Not as good as COD. I will admit COD is closer to 86%, so.
- [60:41]
Tom Bilyeu
But for something that tastes like cookie dough, yeah, it's a big leap over cod. Well, as the elder statesman in the room when it comes to protein bars, I will say move fast and build that moat, man, because whatever problem you have solved, people will come for you. But it is very exciting. I love you guys picking up the torch and running with it and creating something new.
- [61:05]
Dr. Peter Attia
I mean, you're one of the few people who probably has a better understanding of this. I mean the list of people who know this industry as well as you do is probably a one hand industry.
- [61:13]
Tom Bilyeu
Yeah, no doubt. It's exciting man. Where can people follow along with you? You?
- [61:17]
Dr. Peter Attia
Well, probably on Instagram and YouTube which are all. It's all Peter Attia MD. And on our site where they can sign up for an awesome newsletter.
- [61:24]
Tom Bilyeu
Nice. I will say subscribe to everything that you do in terms of the the Q&As and stuff that you do. The video content is amazing. Every time you sit across from me, I make sure that I spend hours and hours and hours with your content. It is extraordinary and I am not incentivized in any way, shape or form to tell people that. It's just. Just because I really believe that's true. So I hope people will do that.
- [61:46]
Dr. Peter Attia
Appreciate that very much.
- [61:47]
Tom Bilyeu
And speaking of things that I hope people do, if you haven't already, be sure to subscribe. And until next time, my friends, be legendary. Take care. Peace.