Peter Attia and the Long Game of Healthspan: Transcript

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my sense is a lot of folks they hang on every word that you guys say that's got to be a little surreal for you I don't try to represent myself as the the guy who's got it all figured out or the guy who's doing it all you're better off being good most of the time than wobbling between exceptional and off the rails [Music] yeah today's show brought to you by Roka Roa has invented a completely new class of eyewear glasses optimized for performance no other iare brand can keep up with what these guys are doing they just keep making their stuff better and better also their prescription glasses have the exact same technology as their performance sunglasses I have a pair of their readers actually I have many pairs and uh in every room at my house every car every backpack I don't go anywhere without them they are absolutely the best damn reading glasses I've ever had and you folks um when you get about 40 you know what I mean uh unbelievably lightweight you'll literally forget you're wearing them the best Optics on the market never slip no matter how sweaty you get the forward listeners get 20% off just go to Roa r. com that's roka. com use the code forward a checkout for 20% off roka. com now let's talk about ag1 morning routines are critical to me and one of the most important parts of my routine is drinking my ag1 I drink it before working out right

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ag1 I drink it before working out right before making my coffee and it makes me feel ready to take on my day like I'm doing something good for my body like I'm taking control of my health ag1 is a foundational nutritional supplement that delivers daily nutrients and gut health support and is backed by multiple research studies so you can trust what you're putting in your body I trust ag1 because unlike so many other products out there their entire formula is backed by research studies not just the ingredients over 14 years ag1 has been focused on Innovation with a trusted nutrient-dense blend that's the perfect complement to my diet if there is one product I trust to support with my whole body Health it is ag1 and that's why I've partnered with them for so long it's easy and satisfying to start your journey with ag1 try ag1 and get a free one-year supply of vitamin D3 K2 and five free ag1 travel packs with your first purchase all you got to do is head on over to drink a1. com forward that's drink a1. com forward petera ladies and gentlemen Peter thanks for doing this I was just before we jump in I was telling people uh I told people you were coming on of course everybody's so excited and I but I I found myself just saying you know um Peter and I are very good friends so that's sometimes for these conversations that can

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that can be a good thing or a not so good thing it's like you we we talk so much that sometimes it feels like or you might fear that you're like wait a minute we just talked told we've already talked about this are you asking me to say this again Lance so there may there full disclaimer people there might be some of that so I should act like any question I've heard I've never heard before yeah hey it's great to meet you yeah it's good to meet you too I want to kick it off cuz I I know we and this has been a really special week for me and um Yan ol has been in town um and I think most listeners know uh my relationship with him and my history with him and as as Sportsmen and Rivals um and the people who really didn't know each other and he's become such a an interesting part of my life the last handful of years and I I do remember and this you will remember this too of of us talking about his sort of the early stages of his issues we'll call it um and and so it's just been great he's never been to Austin and we've been training and riding and uh you took him out uh what it drifting drifting I'm like what what is drifting um but you've been a without knowing him you've just been such a you obviously been a fan of

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been such a you obviously been a fan of his but or supporter but such a friend that he didn't know he had no idea I mean I had to explain to him yeah who you were and well you kind of brought I I remember it might have been July of 2018 we you and I actually really bonded over kind of the crisis he was in you because you knew him me being your friend um and that's you went out the first time to my Orca to see him and he was in pretty rough shape which I know you've talked about um and it's hard to believe that was six years ago but you know yesterday we had a lot of time to to it's weird because you know I feel like I know him better than I should because of that that's always the case with someone whose life has been public but also through you um but it was just amazing to to sort of realize like how someone could be so close to kind of you know not making it and then to see them thriving and and obviously you know as as I'm sure you've alluded to elsewhere I mean Mike is probably a really big part of that as well and having true friends which is a lot of people don't get to that level and still have their real friends around them well I think and for those listening we're talking about Yan's he he Mike Being Mike baldinger kind of manages Yan's Affairs now and I I think and I think this is common for a lot of athletes right there's people involved in your life that that

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people involved in your life that that have their own agenda and and then you have friends yeah and Mike is just this guy that's who first called me six years ago and and I didn't know Mike baldinger at all um and I've just gotten to know him I mean he's just he's a complete sweetheart I love being around him um very playful and he has Yan's best interest at heart which has been I mean you spent the day with him so you I he's just a he's a Minch yeah as they say and so without him but I mean they had look I mean and I often times I will see Yan at least this week and I'm like I know where Yan came from I watched the Amazon documentary which you did as well which was was only in German so far but we watched it in subtitles and so you get a sense and his the the biography of him is fantastic yeah I mean he's it's a great book both you know tell you the same story he a very complicated life so I've just sort of stood back and and watched him you know we've been on Lake Austin a couple times we were out two nights ago beautiful sunset we were wake surfing I'm thinking wow this guy's probably going holy C like this what world is this right what this is we were talking about this yesterday which is like it's still hard for me to wrap my head around the world that 20 35 years ago you were in the G DDR and you didn't you you had to sneak around with the antennas to

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had to sneak around with the antennas to actually see what was on TV in the west right right fast forward to right you know this week and I try to be also sensitive to that right I I think a guy like him um in the position he's been in the last decade really um you know you don't want to throw too much at them right and and it's it's cuz it's it's fun and sexy in a way but you you also it's also like hey let's just sit at home and have dinner tonight like stay at home so it's but the the drifting thing I missed and the whole I didn't even understand drifting but they brought back a lot of videos you know this of course you're you're going to have to come I understand listen I know and and you're obsessed with cars both owning them driving them watching other people race them you race them um sitting on simulators uh which but it never disappoints see you don't trust me but when when you finally trust me and you come and you get in the car you have fun but I do you just you're right I know but I also you should have come yesterday I'm working and you got the simulator I want I do want to put Yan on the simulator tonight I think you would lose his [__] mind all right that's awesome I that'll make me so happy um I wanted to give you something I know we've chatted a little bit about it and and but Yan I I mentioned this to him before he came over and and um but he

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before he came over and and um but he brought for you and I'll take it out of the bag and of course if you're listening you're not seeing this but this is very special so um and if you're watching you'll see it obviously um so this is a n and of course for those who don't know Yan won the Tour in 1997 he has a couple of more a couple more yellows from 98 but this is of course the year he won 1997 which one of the days I was actually on the roadside when they went by and I thought um I was that was the year I took off and I thought when he came by I said well that's one sport I should not be doing yeah this I think we should all maybe find something else to do I mean he was in his early 20s but um tour issued what's interesting about the jerseys from that day and age and you saw my jerseys downstairs and if they weren't behind glass you would feel it so the the jersey and this is how you always know if something's from this generation if it's real was the yellow Jersey which of course was made by Nike issued from the tour this was this would just be white yeah so you didn't know who was and they just made a whole bunch of they made a whole lot of yellow jerseys with a big white box in the middle and if uh you know some back then some team from you know if chiellini got the Jersey well they would laminate his team inside this white box so and you can actually feel it and so that's all and those ones down

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it and so that's all and those ones down there behind the which doesn't by the way doesn't feel great to RAC writing yeah yeah it's kind of like you know it's got a little bit of a trash this is just such a meaningful significant thing um yeah thank thank you I I mean and I can't wait to give Yan a big hug yeah I mean he's he's he was uh they were you I'm gonna have him sign it though well I didn't want to yeah I didn't want to I don't know I didn't know what you want so this is yours you can do what you may but it's it's this is I always just love because I get a lot you know people will bring these you I know this was one of year I said well if you don't feel this sort of that plastic rubbery feel then it didn't come from the tour and today cuz I've seen a modern mayun totally different totally no no totally no they go I haven't felt one but and the other interesting thing is this is long sleeve like I would never race in a long sleeve he would like you can this is yeah you're burning up in this thing right but he this has been worn I mean this is yeah which I think is just so cool yeah this is gorgeous can we leave this out here for now you can leave it there let's leave it right yeah he would but they were obsessed last night when you gave them your book out live in German which I I thought it was interesting because it was and we had this whole debate last night the book looks like it's 50% thicker in German the pages are smaller in English it's a 9 by7 got you the German every it's really funny the

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German every it's really funny the things I've learned because it's in it's been translated to 45 languages good and I've asked them to send me a copy in each language so I can see it and it's it it's really interesting to see how every Market has a totally different shtick you know some countries are like nope our books must be this size versus this size uh we have to do this way versus this way and I stopped managing that like for the first five of them I tried to micromanage it and say oh I really don't like that and then I was like Peter just shut up let them run their Market I know you well enough to know that you probably did micromanage that how many weeks or months was that uh at the top of the bestsellers it was a while yeah um I mean it still is so um okay well that's a long time yeah we're probably at 80 some odd weeks wow I mean I think you know and I get asked and and as you know we invest a lot in this not a lot I shouldn't say we invest a lot in this space and we being um next Ventures my investment firm um but we invest plenty and it's just been fascinating to watch people's Obsession passion interest whatever you want to call it in this space the last really five years right and what has it done right your book is still on the best seller list 80 weeks later but that's a data point your shows your following is one thing then you layer in

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following is one thing then you layer in the Andrew huberman and the Heyman and the Sinclair's and all of these folks like this is a thing right this is and and I also think Co accelerated that interesting yeah and I I really do I think people were already starting to pay attention to their health and their longevity whatever you want to Define it as K came along like oh no wait we're not going to live forever then they doubled down and so I'm just so it as I watched it unfold and and really lived it in my own life I see people um I listen to your shows I I don't listen to a lot of these shows but I dip in and out and there's a lot of information there's a lot of it's very technical sometimes my sense is a lot of folks in just watching this Army of people they hang on every word that you guys say you guys and gals and there's plenty of ladies talking about female health or Women's Health um and uh that's got to be a little surreal for you or a little um yeah I mean I think it's look I think um I feel fortunate in that I I don't try to represent myself as the the guy who's got it all figured out or the guy who's doing it all right because otherwise you're just under a microscope and you

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you're just under a microscope and you feel like you're a fraud I mean at least that's how I would feel if I was trying to pretend to the world that do exactly what I do I'm a messiah and that's what it is so instead by taking the approach of like look man I struggle with I struggle just as much as anybody else on this stuff and there are some things that come easier to me than others uh exercise comes easy me I love it so I'm like you in that regard it's not hard for me to get my workout in every day but you know what is hard it's hard for me to not eat everything that I want to eat it's hard for me to regulate my emotions it's hard for me to sometimes pass on a drink if I actually you know don't really want to have it but I'm just having it out of habit right how can I minimize you know you I know you've been not drinking at all for how many months now uh it's been nine months geez now is this something you just plan to do indefinitely Or you is there a point in time which you just wanted to prove to yourself I can go without a sip of alcohol for a year no no I um and I do think I mean this is uh it brings up a good point because I think we all need to look at our lives and Lifestyles and and just make calls right and um I didn't set this wasn't I've done that before I mean I've done all right you know what I need to put the bottle down for 3 months yeah and boy 3 months in a day comes you're like honey let's go out tonight like that didn't work for me and it wasn't working for me and so it was no this is a long-term commitment for me and and it just wasn't working and but you've I

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just wasn't working and but you've I mean I've known you a long time I've been with you I've seen you drink you've never I've never witnessed you ever have a problem drinking so is there you might have missed some nights okay but but did you ever feel like it was maladaptive for you what I felt yeah yeah and with just in terms of how you feel I can appreciate that the next day's workout could be compromised with age it just and I've alluded to this and in other comments I've made there's just this voice like hey man it might be time just to you had a good run just acknowledge that and and make a change and so I I set out to do that and and when I did I was like wow this is I feel like this was the right change I'm not saying this was the change but this this is good for me and I'm going to commit to that and now am I going to sit here and sign a document that that says I'll never have another Margarita for the rest of my life of course not um would I be surprised if I did yeah really yep um and it's I've got some really good non-alcoholic beverages cuz I'm coming to your house tonight for a Formula 1 party so you know what uh it's funny I mean I'll I'll uh I love NA beer is so good it is exceptional it's are they going to be able to do this with tequila and other things CU I have to be honest with you every other na product I've tried is unbearably bad it's it's tough and so but you find these are just little hacks

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but you find these are just little hacks I mean look I love Diet Coke I know that I mean we're talking about health I know my wife kills me every time she sees me drinking a diet coke I love it um I like a Sprite sometimes a little sugar you know I love water you know so there's all that to say like it's yeah I'm going to introduce you to one of my favorite alcohol-free uh appara THS this evening yeah yeah I'm happy to to try anything I just decided and as I got into it and I really that didn't D I mean I sort of quadrupled down on my own uh Fitness and and especially in the gym which I want to talk to you about just this canest to yeah strength and and any kind of resistance training I just it just fed on itself and I was like yeah this is right for me and um I always stop short of um you asked me the question so I'm talking about it uh I never offer that up this is my journey and it feels right to me and if if somebody asks I'm happy to answer it but um yeah I think uh do you feel fitter now than you have in the last 10 years last 20 100% last 20 years and I were talking yesterday um and we decided he and I are going to go and do some rides in France but not with you yeah we're like yeah we're not doing that and I don't ride very much I mean I spend most of my time in the gym um it it's how

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of my time in the gym um it it's how many hours a week are you on the bike uh it would depend on the time of year summertime we ride more yes we say summer 15 tops that's that's not that that's two hours a day I know but that's that's those are good miles yeah it's mostly mountain biking it's more fun um that's fit yeah and but that would be also those would be double days so there'd be an hour in the gym at least do the show do the do do the move for the tour and then George and I would go out for a couple hours after so you it's kind of a two a day um but I do man I feel better I'm 3 now I overall I feel better now than I have in 20 years which I think is cool that's insane it is because you retired about 20 years ago that's right y that's right and it really does though it gets to this place of where I was it it gets to this place of where I was going because I I do think look I think I don't think I know people I mean you guys have created this following and when I say guys I'm the the folks I mentioned where it's it's almost like people are like hang on a second like this is the show this is the one he's going to tell me everything this is the hack this is and there isn't right right so

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is and there isn't right right so unfortunately people there's your answer there's not a hack but it's just finding like I did right these little um changes to make in in your life and lifestyle that that's the hack and and certainly one of the hack is compounding right the hack is um you're better to be eight out of 10 every day than vacillate between five out of 10 and 10 out of 10 yeah um and that's I mean that's incredibly true in exercise but it's true in nutrition it's true in sleep it's true in all of those things um you're better off being good most of the time than wobbling between exceptional and off the rails yeah the the neutal Christian peace is as I really started this journey and it's been a year now um cu the Journey of Fitness or recommitting myself to Fitness started before you know I put the bottle down um which that that wasn't a great combo you talk about either zero or 10 that doesn't equal five I mean it was that's not the right combo but the nutrition piece I've just I have and I think I've almost intentionally let me just say it very simply I just eat like [__] it and I'm sort of leaving it out there like you know that's I am going to get to that but right now I'm focused on do you think about do you pay attention to for example like I'm going to at least eat a certain amount of protein every day you don't you literally don't

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every day you don't you literally you eat what you eat what's in front of you that's right you eat when you're hungry I don't eat a lot are you making a conscious effort to not eat a lot I uh no I just don't eat a lot I uh do you just to dig into that further cuz there's different strategies some people when I'm doing well MH what I'm doing is I'm never eating to the point of being full so I'll always leave it with I could eat another half a plate but I won't are you taking that conscious step I I do but only because I know that uh I've got a one of those things of talent ice cream in the freezer and I'm going to get it you know so I I leave that's that's what you're saving for buddy I save it for that I'm like and it's almost nightly and at some point I know I'm going to be like all right no talente tonight but your weight is great right now like you wouldn't wait it's it's great for somebody that doesn't watch their diet well well and I mean yeah you I mean unless you're trying to ride up mountains anymore I don't know that you need to no no I know that if I go do a fast group ride I'm going to pay for sure first of all I'm 53 and you're on the the group ride with 21y olds or 25y olds how often do you still show up on a group ride you know the last time I it's good question the last time I did one was here in Austin it's a ride called The Breakfast Club they do it once a month it's a big ride there a bunch of fast kids on it

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ride there a bunch of fast kids on it and that was several months ago and how did that feel um uh it felt good I was out of position when the kind of the hard climb started so that's my excuse it won't happen again I will be in position the next time we do that ride um but I at lbs and not having and not never doing any specific intense work on especially on the climbs you can only fake it so much I can fake a lot of things on a bike ride or even in a bike race you when the road goes uphill you cannot fake that like power wait best man wins do you still have a power meter on your bike no so you're just riding on heart rate heart no no heart rate I have nothing you just ride on exert you know do you know when you're about to break and to back off uh well I know when I'm about to break but I don't necessarily back off I just like well [__] it let's just give it see how long no I don't it no power no heart rate I have a bike computer that's it speaking of bike computers remember the old cat ey bik computer two little buttons on it yeah my first bik computer yeah it holds both of them down to reset yes the little had those like little rubber buttons yes exactly yeah they were great they were awesome little wire running down the fork to pick up the Y they had the little and then the um it was like

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little and then the um it was like magnet you just clipped it on the front hub and then the magnet mounted on the fork God yeah technology wow we're really dating ourselves but that's it right there' s not folks I mean uh I know a lot of people are going to listen to this um but it's it there's a lot of layers to this and it's and and everybody's answer is different so I would love for you to tell us you know all the here's the cliff notes or here's the cheat sheet but maybe not you know the other thing I've done and you know all of this stuff because we talk all the time um I've done I've I've really try over the years but even more in the last nine months it's like okay what what all do I need to know right so you'll remember three or four years ago you sent me to biograph in San Francisco to do a full body MRI uh I never would have done that but did it primarily because you told me to do it I like knowing those things um recently did how did you get the calcium scan as well you had me get a calcium scan and then recently did the clearly test another heart uh scan y tons of uh blood work um dexa scans obviously uh um uh Gallery test yep so just knowing just gather I would say to people like hey first know what you're dealing with

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hey first know what you're dealing with like are you like let's start ruling out some [__] yeah I mean there's some things that you don't need to get a test to tell you right so if you're 50 pounds overweight um you you don't a scale isn't even necessary right if you are winded walking up a flight of stairs if you can't carry your groceries up two flights of stairs to get into your apartment I don't you don't need to do a VO2 max test we know the answer um this is what you have to go and do to fix it but we know the answer but what's amazing is um how many silent killers there are out there and honestly when it comes to heart disease and cancer which are the number one and number two Killer by a country mile right like I mean it's nothing's like the the third ranked killer is so far down the line that you just have to think about those two diseases um both of those diseases can kind of strike without warning if you don't know what to look for so when you consider heart disease um I think one of the most remarkable statistics is that about 50% of people's first brush with the knowledge that they have heart disease is sudden death right it's not chest pain right it's not uh you know shoulder pain I mean it's chest and shoulder pain that leads to immediate death of course right but the point is they don't get a second chance um so and these can be people that look otherwise incredible this is not a disease that is just confined to somebody who's got type 2 diabetes or somebody who's overweight or somebody who smokes yeah all of those things increase your risk dramatically but um

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increase your risk dramatically but um the youngest healthiest person can still get heart disease because ultimately there's a strong genetic component to it and um a person's lipids lipoproteins cholesterol don't necessarily correlate with the other elements of their health um so that's that's why I just think everybody really needs to know their APO their LP little a um it's genetically determined the lp little a apob is heavily genetically determined not entirely um and so yeah I just heard of somebody the other day you know sort of not somebody I know but somebody who I know knows and and it's just this the classic story of a guy who's like super fit and healthy and drops down at 62 right and in in the year 2024 it is absolutely unacceptable to die at 62 from a from something that we could have known about ahead of time and then similarly like you I mean think about your experience with cancer right it actually doesn't matter uh cancer at the end of the day yes smoking and obesity are the two largest determinant but the majority of cancer still comes down to bad luck it's still a stochastic process there still has to be a genetic mutation that occurs and can strike the youngest healthiest person and you know um so so that's why I think screening really matters um because our only chance for the most part you're an exception but for the most part the only chance you're going to beat cancer is with an early diagnosis right and how confidence should let's just say full body MRIs and

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should let's just say full body MRIs and a gallery test I mean you're starting to rule out you're not ruling out so with cancer you got you're dealing with this tradeoff of sensitivity specificity so sensitivity says How likely am I to find the cancer if it's there specificity says How likely am I to not find a cancer if it's not there so in an ideal world you would want something that's very sensitive and very specific but in the real world that such a test does not exist you will trade off between those two so MRIs tend to be very sensitive but they lack specificity so what that means in English is they're going to find most cancers if they're there depending on the type so there's MRIs have huge blind spots to certain types of cancers which we could talk about if you want but for the most part if you narrow it to the subset of cancers that are diagnosable on an MRI it will be good at finding them but it's also going to find a lot of things that aren't cancer and so I I don't really love the idea of people going to get an MRI without some counseling up ahead of time and I don't mean like hours of counseling I just mean an understanding of yeah like there is a decent chance they're going to find something that's not cancer and and as a result of that we're going to need to do another scan and maybe even a biopsy and that's a lot of emotional distress and I don't think it's worth going down that pathway unless you can appreciate that and and accept that that's a risk you're worth taking um similarly other tests like the gallery test uh it's the

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tests like the gallery test uh it's the opposite right it's a very very highly specific test but quite low in sensitivity so here you have the opposite problem right which is you can actually to get into false negatives um so all of these tests are going to be subject to false positives and false negatives and in that sense I think the more things like you go to whatever your level of Tolerance is in terms of testing and then the more ways you can look at something the more likely you are to find it so as you said if you paired a blood a liquid biopsy with an MRI you're going to do better than if you did one or the other right and then even just on the when you were talking about somebody walking up a flight of stairs or carrying their groceries or maybe trying to pick up their grandkid or their kid yeah um I always and I tell people the story all the time it's one of my favorite things that we've talked about that you do to folks in your assessments is just the static hang yeah like I it sounds so crazy I just get up there and hang on that bar well I mean most people like why why that thing a static hang tells you like five different things things yeah it is for um by the way I can static hang a lot longer now than I could when we first met yeah what what are you up to now I I haven't tried but now now you get what were you what did you do the first time I had you try that oh it was certainly less than a minute oh yeah I bet you you probably over two minutes now I bet I think I could uh now

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minutes now I bet I think I could uh now well I haven't tried it okay but I will try it tomorrow cuz now I'm super curious but it it's it's significant but it's it's a great test it's it just as V2 Max is an amazing way to assess your total you know cardiorespiratory Fitness um a dead hang for Max time is a great way to assess your grip strength your forearm strength your scapular stability and your body weight yeah yeah strength to weight I mean all of this stuff is is you know if that's out of whack you're just you're you're 20 second person yeah I was at a fair once with my son and there was a game where it was like if you can hang for one minute you get this prize if you can hang for two minutes you get this prize and and my son of course knowing how long I can hang he's like Dad we got to play this game like we're g to get the biggest prize which was literally a stuffed animal bigger than he and I put together and I was like buddy yeah just because I can win it doesn't mean I want it what are we going to do with that thing oh you had you please tell me you did it no I was like first of all I don't even think we could put this in our car it was Lance the thing was bigger than you and I put together like a stuffed bear oh this this is where you and me are different I would you would have strapped it to the car you would have found a way I would have been sprinting to to the bar and I don't know say I'll be back tonight with the U-haul I don't know I mean really because you want to prove that you could do the max hang or

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prove that you could do the max hang or because you actually want the big bear I it's a great question I would be competitive on the Hang but you know if a kid look um if if that were my son right now you're going to make me feel like a bad dad no no that's why I'm hedging you're like but it's kind of cool like I told him I wanted him to do it well he'd probably do it for a long time yeah I don't think he would have done it for four minutes which is I think where you needed to be to get the be okay so I mean but the kids like hey my dad can do this better than anybody here like I I that's the way I would hear that and I'm like [__] a son you're right let's I wouldn't say it like that to my son or my child but you you would be like yeah where's where's the bar here's my guy he's he's it's literally the only time I've been at a fair where I knew I could win the hardest thing because most of the other things you're like I don't know if I could do like you know because a lot of the other things it's not like how hard can you hit the hammer it's can you hit the hammer at the right level to hit the you know I remember they must do that at kids things we were at one of these jumpy house not a jumpy house but like a trampoline park once where it had bars and that had a lot of gymnastics stuff and they had the very same thing but they would have everybody get on the bar at the same time so you're looking around and you're just seeing people drop that's cool see that is it's a whole new level and then all of a sudden it gets down to five people and then three and next next thing you know it's just a hang off between two people it was I was not one of them the very very first time I had my wife do a

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very very first time I had my wife do a dead hang she went for 3 minutes and 5 Seconds yeah I was by the way I mean we could spend the whole podcast talking about Jill I mean I buddy I don't know what you did to deserve her I I don't know either I'm very fortunate yeah she's she's uh as are you no I know yeah yeah they're very similar I mean we're complicated guy you're a very complicated guy and as am I yeah let me ask you he's funny I we we didn't plan on talking about this but I just acknowledge that we are both complicated but I'll walk through my day and be fully convinced that I'm super chill and I'll tell people like yo man it's all good man I'm chill do you ever say that like it's no big deal I'm really chill and I've had people call me like bro you actually no you you are not chill yeah I don't think anyone's ever accused me of that but do you do no I I don't I think deep down I know that this is I see I do which is weird yeah I don't I who was I talking to the other day I was talking to a friend and and somehow it came up like how great he looks for his age and he does he's 6 he's 64 and he looks younger than me right and uh we were like dude what is your secret and he goes no stress and I'm like yeah I think there's something to it man I I agree with that yeah um well I don't know how he has it

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yeah um well I don't know how he has it set up but there are people that have gotten to that some place in their life where that's the setup right they've either generated some sort of wealth or they've just generated some sort of happiness or they're retired and and they've checked all the boxes and they're just cruising it's interesting I have not been able to appreciate the pattern yet um so I've met no me Nei as as if you you we meet people from all walks of life and so that's everything from the most successful by pick your metric right so by Fame by wealth by achievement by whatever and yeah I I can't figure out the pattern I've met people across the the Spectrum and and it it suggests to me that there's there has to be a strong genetic component to how a person is wired like you know is is a person just kind of innately a little more anxious a little more on edge a little more critical um we certainly know that happiness and and disposition is quite genetic actually um so I think that this is also a part of the piece now happiness as an example and Arthur Brooks has written a lot about this and and spoken about it um it's also a skill right so it's not happiness is really less of a destination more of a process um and even though people might have more of what's viewed as a happy veilance to them and that part is sort of genetic um when you think about the the core ingredients of Happiness the the

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ingredients of Happiness the the strength of relationships uh Joy uh sense of purpose those things actually you can work on so um I don't know I take stock in just sort of like let me modify what I can modify Y and Dan buter has talked a lot about this and and I I buy into that I mean the Blue Zone stuff and just as people in those parts of the world as they age the life is different for them and they have Community they're revered they've been active like I I see that I'm like I yeah yeah I like that I'd sign up for that minus the nutrition part um I got to ask and the not exercising part listen you you said it earlier like exercising is is easy for us and you're right but what would be hard for us is not exercising that's the difference like you and I are wired the same where it's like in and everybody around us can attest to this right your our our close friends our family people we work with a day that we don't exercise that's not just it is hard for us but it's hard for everybody like it's just I have really become a lot better at this in the last two years so so I that used to be 100% the case if I didn't work out everybody knew it right I would make every I wasn't trying to but everybody's life would be miserable as a result of it and I have really worked hard on being

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being being flexible and so so for me it means I never schedule off days right there's no off day in my workout I exercise seven days a week but I now accept the fact that probably twice a month there's going to be something in the schedule that becomes so disruptive it's usually travel it's never like a day when I'm just sitting around um and I had one last weekend right like we went you know my father's pretty sick we went back up to Toronto to see my family and you know it was a short trip it was a Saturday to Monday trip so Saturday I did a hard ride first thing in the morning we flew up there well Sunday should have been a workout day for me but I was kind of like you know what I'm here for one reason and one reason alone is to see my family and I'm I'm just not going to make the hassle to do the workout and I'm just going to get this thing but here's the point it didn't nobody knew it there was no you didn't there wasn't the Sparks or the steam as a result of it happening and and that's something I couldn't do 5 years ago yeah five years ago there was no off switch Yeah Today's Show brought to you by Ketone IQ hvmn launched the world's first drinkable Ketone in 2017 Ketone IQ is their latest Innovation on ketones with improved Effectiveness taste and cost Ketone IQ delivers clean fuel that can cross the blood brain barrier Supply in your brain and body sustained energy focus and sharpness putting you in flow lasting

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just take my word for it they've got over 4, 000 fstar reviews for their full line of Face Body sun and travel size products one SK is the world's first skin longevity Company by focusing on the cellular aspects of Aging one skin keeps your skin looking and acting younger for longer get started today with 15% off using the code forward at on skin. co that's on skin. co it gets you 15% off and again the code is forward I'm so F we we and we actually really haven't ever talked about this but this and I I can't remember if you've done it once or twice but this swim from Los Angeles or wherever the coast of California to Catalina Island did you do that once or twice twice you did do once in each direction oh okay yep was it out and back no it I didn't do a double cross Al although people have done double cross okay so the best the I'm assuming they're probably two totally different times because of tides and current and so Catalina Channel 20 hours uh no the first one took me 10 and a half the second one took 14 and change and the four the second one um was one of the rare occasions when there was a really bad current against me uh so normally it's kind of most of the current is just a little bit sideways and it's not super strong it's not like the English Channel the reason the English Channel which is the same

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the English Channel which is the same distance is a has this element harder is that it's going through such a narrow area whereas in the Catalina Channel you're basically swimming out in the Pacific and so the currents are not it's not as much of a choke point the thing that makes the Catalina Channel harder than the English Channel is the the marine life is much freakier like you've got great whites out there no that part is the scarier part this is on my list um because this and and just so I'm clear whether it's 10 hours or 14 hours starting at midnight and that's to minimize I know that's hard it's hard this makes it's hard this is crazy it is it's one of the more difficult things to wrap your mind around is that for the first six hours that's can't see yeah versus 5: a. what's wrong with 5: 00 a. so um if you start at 500 a. m yeah if you start at 6: 00 a. m. you are going to be on the water at 2 p. m. and you do not want to be out on the Pacific Ocean at 2 p. m. that time of year the Santa Ana winds kick up and you are going to have so much chop you're just you know you're going to be drowning in chop now it's not that you can't do it mean I've done it but it sucks you actually are optimizing on the smoothest water so you suck it up on the Fear Factor to just give yourself the best shot at smooth water and so everybody's clear you're just swimming because you could imagine a world where you swim in some sort of a net or cage that people have

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sort of a net or cage that people have tried never works out you end up breaking your hands on the cage CU a big cage okay yeah yeah they've tried it and and you put a huge C first of all technically it's cheating because you're drafting right the cage gives you a draft but if you put that aside for a moment it's logistically really tough for the boat to perfectly match the speed of the swimmer and the boat's going to get hit by waves that the swimmer is not and so every time I've I've read about accounts of them trying this because they were trying to do this to to get someone to swim from the Faline to San Francisco which is kind of the sharkiest water in North America now when I did swim the Maui channel I wanted to start that in the middle of the night because it was same reason it was like Hey you know Maui is really bad when during the daytime that's a true choke hold there so that rips through there brutal and and there the boat pilot would not let me start at night cuz he said there are so many tiger sharks out here that when we stick a glow stick on your bathing suit at the middle of the night like I might as well just Chum the water so I actually had to wait until 6: 00 in the morning and I paid a very heavy price because I did not finish that swim for 12 plus hours the first 75% of it meaning all the way to Maui and halfway back took 6 hours mhm the last half took 6

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took 6 hours mhm the last half took 6 and a half hours cuz the wind was insane macking yeah but go back to the Cataline any of these things doesn't matter I mean although the English Channel I mean I don't know how Sharky that is but let's just know English Channel isn't Sharky but the it's you've got jellyfish in there I think the bigger issue is English channel is colder and the currents are much stronger it doesn't nobody thinks that people like ah okay it's cold but I mean the shark thing is freaky I'm not Li hold on like it's in the middle of the night it's Pitch Black I'm assuming you don't have recourse the water is you just don't you can't see it's actually can you see your hands um here's what's the coolest part you have you ever swam in the ocean in the middle of the night no I not but these questions we should do it sometime next time you're in Hawaii you should do it when your hand is coming through the water you are tearing through this bioluminescent thing and so you see streaks under the water wow it is that's actually nobody told me that part going in so I was just kind of trippy yeah and the first first time I swam it I was living in Baltimore I was in residency I did all of my training in a pool and a lake so I had no cold water training and I had no Night Swimming training and so I show up to Long Beach to do this thing and I get in the water at Catalina and it I I couldn't believe it I couldn't believe how beautiful it was to see this bioluminescent thing going and it like kind of looks like stars and I was fortunate the night I first swam

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I was fortunate the night I first swam it it was a clear sky so you could actually see all the stars so you see stars there's no light from La cuz you're so far from LA you don't even have the glow of La yet so you're seeing underwater the St what looks like stars and B medicines and then you breathe and you see stars and you can't see where the water line is that's how dark it is so it looks like it's I mean I will say that part is really pretty awesome and and follow boat safety boat you know I'm so big couple boats you have one boat that's that's following like that's that's setting the direction cuz you can't as a swimmer navigate so you're yeah you're setting the direction and then um so the boat's in front of you beside you yeah right so you're just siding off a boat I just I couldn't do that I couldn't I I wouldn't do that for um I wouldn't do it for 20 minutes in the middle of the night knowing the guys with the gray suits are out there I can't see them they can certainly see me I I could not I don't think most people no no I'm out and but you had to did you see anything not on oh I did I saw lots of cool things I saw by the time sun came up I had I got Dolphins so I I spent 30 minutes being surrounded by a pot of dolphins that was incredible saw huge tuna cuz by the time you're in the middle of that channel it's 2500 ft deep and the visibility is 150 ft it's a lot

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and the visibility is 150 ft it's a lot picture that that means a lot it's like a clear swimming pool that's how and it's so it's and it's so you're seeing 150 fet down into dark dark blue and then you're watching dolphins swim up to you and I remember at one point I'm swimming and I see a dolphin coming up to me and I naively thought he was going to hit me but of course you know he just immediately went around me and jumped out of the water so that kind of stuff was pretty cool the only time I've ever been really re there two times in my life I've been scared swimming the first was in um May of 2008 so I was getting ready for a training I was getting ready for a swim this is when I lived in the Bay Area so at this point I was like I always would go down to San Diego for my really long training swims because the the bay is kind of crap for a lot of these if you know so so I'd go down to San Diego and the Saturday I did my swim we supposed to go do my swim that Thursday uh swimmer got killed in salana Beach mhm 200 yards offshore right attacked by great white y you probably remember this I mean yeah I do so two days later I was swimming where that guy got killed and I was and it's and it was a it's a murky part of salana beach like and you just knew that this was a shark that obviously thought he was a seal kind of went up took a bite right well that's not he was wearing W he was wearing a wet suit so I came up with all the rationalization which is well I don't wear a wet suit blah BL but this let me tell you that still pretty scary you swim in there and then the other time was

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other time was um actually the other time was a year earlier and this was when we did a relay swim in one of the northern Channel Islands so there's there's eight Channel Islands Catalina is one of them but there's you get these four Northern ones and one of them is called San Miguel and one is Santa Rosa they're the two northernmost islands and they're the two sharkiest and we were doing a swim a 60m relay swim from that and I happen to be the swimmer in the water water as it's about 30 minutes before Sunrise is the first moment you can start to see anything and I'm looking down and I am seeing a fish moving this way beneath me now we know that Dolphins move like this if people are listening to us I'm moving up and down and sharks move this way side to side and I'm watching the side to side and I am in that moment thinking I have a choice if I touch the we're disqualified I screw the whole team here like if I am I tapping out am I freaking out and I convinced myself this is a dolphin on its side but I'll never know okay I was waiting for the answer NOP don't know just kept swimming but I was I mean I almost hyperventilated for a second I freaked out well you know I love swimming but and I'm excited to get back into it yeah more than you're building a great pool yeah I cannot wait to come out there and completely whoop your ass

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out there and completely whoop your ass whatever set you want to lay out first of all like I mean doc I will give you you will give me a two to one advantage you'll still smoke me this is not there's not going to be a compar I haven't swam in 12 years I just liked saying it I just thought it sounded cool brenn's gonna come out too he wants to Christen the pool I mean swimming just it's such it's a great sport for folks I mean we're talking about people that most people listening this are interested in living longer and stronger and and Etc I mean swimming is one of those things you can do forever I think it's and that's why I'm excited to get back into it you know I think it's been whatever 10 12 years since I've been in a pool and um look I have no aspirations to to go and spend 20 hours a week swimming anymore or Swim some Channel again I mean the only one that I kind of think I wouldn't mind swimming is the straight of Gibralter um that would be kind of a cool one to do it's actually not that that long it's I think it's only 8 or 10 miles which again I mean you have you got to get in shape for that but it's that's that's manageable that would be that would rip that's a bottleneck right there yeah yeah oh yeah no no these are swims you can't just do whenever you want you just as the English Channel there are very very specific Windows almost down to the minute when you have to start um otherwise it's unswimmable um but but uh the idea of just kind of getting you know putting swimming back in the exercise portfolio y um a great low impact sport um there's just you need chlorine in that pool we are yeah

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need chlorine in that pool we are yeah I'm getting a lot of crap from it from my buddy Rick Rubin who yeah I don't know if you know Rick but I don't know him but know certainly but he's close to L and you know so L's already tried to talk me into not doing chlorine but it's just too complicated for me I don't want to weigh in on the impacts of whatever it's just I just don't like chlorine I mean if there is one thing in this world that stops me from swimming every single day it is chlorine and I'm I'm you can minimize it by doing Ultra yeah you can have UV and so so like we we have a separate system that'll do like UV and um um and ozone yep so you can minimize the amount of and you own the pool so you can certainly minimize it but like if I you know if I goes to a masters at Rollingwood I mean you got the kid out there like he's doing the chlorine and he's measuring it with the little thing I mean it's and you get out and you smell for a day day I mean I literally feel like I'm going to have to go for a 2hour run to sweat all of this chlorine it's disgusting like that is the number one reason I don't swim every day yeah it's been oh it's been so long since I've swam in a pool I don't honestly remember but and I'm sure it's worse in indoor pools too MH oh yeah for sure yeah um let's of all the things that are out there and and I by the way I love the this is these are things right these are things that people talk about um cold plunges U

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plunges U saunas um infrared um all I mean you're tracking all this stuff and and I've also been a skeptic of as much as I love it I've I've been doing sports for 35 years so I've seen a lot of things come and go um which of these things like if you're just in fact you are telling me I was going to say if you're telling the listener but I'm the Listener at this point like what are the ones people should really think about I know you love you're talking about just like little hacks cold plunge or hot cold cont I think it depends on what you're optimizing for if you're saying which one of these has the highest probability of um impacting how long I live MH which means which one of these has the greatest chance of lowering my risk of disease sauna would stand out by far okay um so I think that SAA I think if you really look at the data we've we've written a we sorted write these premium newsletters once a month for our subscribers with they super deep dives into these topics so we did a super deep dive on this topic a few months ago and I think the takeaway was pretty clear right I think your risk of Alzheimer's disease and your risk of cardiovascular disease go down significantly and I mean like not as much as they do from exercise but a lot right noticeable yeah a meaningful reduction and even if

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yeah a meaningful reduction and even if you cut the epidemiologic response by half it's still absolutely worth the time in my view not at the expense of exercise so I get this you get the biohacker who's like yeah I just want to sauna all day it's like well yeah but are you working out if you're not working out don't don't sa this is an add-on this is exactly right but if you could justify four 20 minute sessions a week in a sauna from a time and money perspective I think you're does it matter the the hot dry the temperature the mo most of the data are in dry sauna um the finished dryas and the temperature seems like it needs to be above 180 Fahrenheit so this is real you know today I was in 20 minutes at 190 um so you feel it like that's it's not subtle um but but if you do it with infrared or steam it's harder we don't have as much data on it it appears that it comes down to can you increase the skin temperature tempure by about 5 Dees okay um I love steam rooms as well we don't have one but I every time I'm at a a hotel or something that has it I'll just mix it up and do the steam room and I actually find it's easier on my lungs a little bit you know the dry Sonic can kind of burn you cold plunge is great for um for muscle soreness and inflammation but it's there's just no evidence that it's going to make you live longer it does feel better and it it can also improve your mood quite a bit I was just going to say you because you I get a lot of mood benefit out of it yeah you started by saying what is going to help me live longer what does the data suggest there's a lot of people that and I have plenty of friends that

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that and I have plenty of friends that do this like they just their day is day not life their day is different because of cold exposure and I and and I'm one of those people so not everybody is that's a big deal yep so so there's a subset of people for whom uh and actually just released a podcast this week with a woman from Stanford named Anna lmka who studies dopamine and we were talking this on the podcast which is that um the body can produce dopamine right so you know it's a good thing obviously and if the body is producing relatively low amounts of dopamine in response to something painful it tends to persist even after the painful stimulus goes away this is why for many people exercise is so pleasurable it's one of the reasons because exercise is actually quite painful because it hurt but but it's a natural pain it's not an I I should work out harder so so you you actually produce this little bit of dopamine to keep the brain in in a homeostasis and then once you're done exercising you still have that lingering bit of dopamine and the same is true for cold now not everybody experiences that for some people the pain is just so unbearable it's not worth it I'm one of them oh really yeah I struggle what what have you tried you you haven't been in my cold plunge have you no you've asked me every every time I go over there and we work out you ask me and I say no every time but have you tried listen this show is not about this this the answer is yes I have tried no have you I'm just trying to think I haven't tried yours I've you know I've tried friends of mine and they keep them

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tried friends of mine and they keep them super low uh but maybe you just start maybe you just started a slightly less cold one thank you right I had this whole idea that I was going to start at like 655 or something 6 no it's part of the story you started I started 72 you know just kind of work every week you go down one degree that's the story right you start at I wouldn't start at 72 but let's just say start at 60 for sure and every week you drop it I mean that feels like a a good plan yep I would do that and are you struggling because your hands and feet okay so what I would say and I get maybe this is what everybody gets but maybe not I get extremely nauseous wow that's interesting it's it's just like a and I I do have I say I think I have RADS um either from well either or both you know high dose chemo therapy Andor just years of getting cold exposure on my toes and fingers so what I would do all kidding aside because I think that's legit and I wouldn't I think you were on some toxic [__] yeah um I would get uh Surfer it's like surfing booties and gloves okay and just take that off the table Yeah cuz remember the benefit that doesn't no it doesn't negate any of the benefit it doesn't matter you don't need to you should not be tortured by the fact that your ankles toes fingers and wrists are suffering oh yeah we're trying to get your core temperature

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trying to get your core temperature lower right I love this this is the best part of the show so far so and but I just you know I was going to actually document these things and as I drop the temp and um you know make have a little fun with it on social media but if you're wearing Surfers gloves and booties it's hard then you I'm I can't can't show that but I would I mean that's that's my No but that's a point right like I tell I say the same thing to my wife I don't do it yeah because she's the same like her hands and her feet hurt so much and I'm like well stop toughing it out for that reason like you know let it cool your body let it cool your torso where you're really losing temperature okay what about the other stuff that's out there I there's there's you know I forget the name of it there's a new Clinic here in town that's got just got all the bells and wh yeah so I'll tell you one thing that I I can't find a use case for Beyond a few narrow ones which is uh U hyperbaric oxygen okay so very popular um absolutely proven benefits for wound healing so if a person you know had a burn or a wound that really had a lot of surface area concussion some sort of brain well we'll come to that in a sec so for any wound healing hyperbaric oxygen is remarkable and absolutely worth the investment of time concussion is one for which there is no formal indication and the data are kind of mixed but when I reviewed the data with my team we came to the conclusion that the data were mixed because the studies weren't great and as a result of that I think if I had a concussion I

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that I think if I had a concussion I would probably do hyperbaric oxygen in addition to all of the other things that one should do for a concussion I would not assume that that's the only thing but I would add it to the lck but when it comes to you know is hyperbaric oxygen you know going to make you live longer the answer to that is I mean the probability of that is so low that I wouldn't waste a minute of my time on it if I had the time to drive to a hyperbaric oxygen chamber get in it and drive home the you know I would much rather put that time into meditating journaling sitting there with my thumb up my ass talking to friends like I could think of a thousand things that would do more for my lifespan in that okay uh what are the other red light okay red light also very good for the skin true proven benefit for skin um depending and when we say red light we can also include laser in there so if you just talk about the whole Suite of these products uh proven benefits for for uh skin proven benefits for Hair Restoration both for men and women um probably believe it or not some metabolic benefits there's one pretty interesting well done trial that did huge you know boluses of red light on people's backs and demonstrated that the people who had red light shining on them were disposing of glucose better now again you have to put this in context right it's like with it better than if they had exercised for the same length of time no so I just put this in the category of it's like one of those things where like you know I would rather use exercise as the tool to

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rather use exercise as the tool to increase my muscle capacity to take glucose out of my circulation not just because I like exercise but because it's doing so many other things so I just don't think relying on red light to you know REM you know increase glucose disposal there might be Niche cases where you have a hospitalized patient where that might be advantageous but I would say for the most part red light's going to mostly come down to um and there's a little bit of data that it might help with sleep but I think that's less clear I think the the two big ones are hair growth and skin Health cryo whole body cryo is just as effective for the most part as cold therapy for delayed onset muscle soreness right so that's easier to tolerate if you've done whole body cryo it's a lot easier a lot less pain I've never done it but it yeah it's super easy because the these PL you know but then there's a hassle of having to go to the place the clinics I mean they got them all you know these optimizations but you don't get the mood benefits right cuz you're not actually feeling that cold NAD drips no which I've done you know I've done many NAD drips and have hated for those who've never done an NAD drip um and for those that have you'll understand what I'm talking I've hated every second of it CU it's for whatever whatever is going on I think you're feeling an niin flush it h it feels like you're getting backed up over your chest is getting backed over by an 18-wheeler there's something so why how many times you done this I mean probably done 20 why everybody kept talking about because I I'll try

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talking about because I I'll try anything and I never but why the next 19 well you know I don't know but I kept trying and I I never felt anything yeah there's no evidence that an NAD drip is doing anything for you other than maybe transiently increasing your NAD levels which it is um but again this is one of those areas where if you and I I was on Andrew huberman's podcast a few months ago and we did the entire episode just on NAD NR and nmn which are the you know the oral supplements that do that so if anybody's listening to us and they want like the super deep dive on that yes I covered the entire topic the entire history of it where the story came from um how it relates to these things called cerin how RIS veratrol tries into you know ties into that story um but the the tldr is no need thank you yeah I was well it's and I have done probably 20 but I I bet the last one has been four or five years ago I'm not going back that's good yeah and there's all you know every 6 to 12 months there's something else something you know somebody comes along with something and these clinics will move one unit out and put some unit in and so keep us posted if you find something that actually works speaking of these I've been fascinated I haven't tracked that closely but I follow him on Twitter and I actually met him two weeks ago in San Francisco is this fell Brian Johnson I mean you've paid attention to

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Johnson I mean you've paid attention to this this Tech entrepreneur who's trying not really really I mean this okay well we'll talk offline I I don't know what all he's doing but it's it's pretty extreme you can see extreme change in him by the way too perfectly nice guy like super cool guy to just chat with but it's extreme I mean a lot of I was hoping you had tracked this closely because I don't know what to make of it no haven't haven't tracked man speak another thing I have been tracking and and I I've um we've touched on this just in our personal conversations before and I'm still forming an opinion on this we have to talk about gp1s OIC Etc I don't I struggle with this phenomenon um but maybe I shouldn't have heard and is that kind of a moral struggle you think look I don't um uh no well it's it's moral struggle in the sense that the people that early days needed the medicine the most couldn't get it because people that just kind of want no no do you think you have a moral struggle with it because you feel like hey man isn't the way to weight just to eat less and exercise more and should we have a drug that helps people do that which again I don't think that's a conscious struggle for many people but I do think all anyone it would be understandable to have that subconsciously as part of the struggle I

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subconsciously as part of the struggle I mean maybe some of that but not that's not my Foundation um my my question is is where does this lead right 10 20 30 years down the road do we know maybe we know uh is this sustainable is is um well I think um look you know we've been I've been following these drugs since 2014 right and people think that this is a new drug it is not yeah right so the first version of this drug that we began to Tinker with was at least the first version I began to Tinker with was called l glutide in 2014 it was a drug that was only approved for type 2 diabetes but we noticed that patients were also losing more weight on this drug than other diabetic drugs so I began experimenting with it in a couple of patients 10 years ago for weight loss so non-diabetic patients who were overweight and needed help and my impression at the time was it was no better than any other drug at available at the time and the best drug at the time was called fenine fenine is a stimulant comes with all of its own problems also I'm not you know sort of an obesity medicine doctor so this is really not a world I play in um and I just kind of dropped it I never really paid attention to it again until 2020 so now four years ago almost exactly um I started paying attention to semaglutide when it was only in the form of OIC so this was still it had not yet been approved for obesity so you did not have

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approved for obesity so you did not have the wovi version we didn't have tepati yet but the diabetic data on OIC were mindboggling I mean it wasn't just oh yeah this lowers your hemoglobin A1c and makes you less diabetic it was like this is insane what it's doing to people's weight um and again we tinkered with a little bit impatience and uh the results were out of this world this was totally different this was a very different uh era from anything we'd seen before and um we you know we had enough reason to believe that the safety profile here was much better than you know fenfen or something like that that where you know we where we saw that no you could you know lose weight but the but there was a price you paid down the line um so fast forward to today what do we know I think we have even more reason to believe that these drugs are really safe um and part of that is not just that we have more time on drug but we have so many more people on drug right so when you to understand safety profile you want to understand something called patient years how many patients are on it times the number of years that are on it and that number is huge right so um now that doesn't rule out that there's some long-term complication that if you've been on one of these drug for 20 years you know you have a higher risk of X that that's always going be that Matthew just did doesn't doesn't equal that that's correct that's right right so so um what it means is if there's anything that's going to go wrong in the first four years we've the probability we're missing it is super low but if

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we're missing it is super low but if there's a 20-year increase in the risk of you know breast cancer or something well that's going to take 20 years to show up um now is that likely I don't think it is right it's possible though like you know and that's why I think for anybody who's going to make the choice to take one of these drugs I actually think you have to come at it through the lens of I'm willing to be on this drug indefinitely that's my that that's if there is that was my next question like is this is there some world where this is a six-month cycle of therapy or dose we've seen both but most of the time so the data this is a lifelong commitment yeah what the data suggest is when you come off the drug the weight comes back now it takes longer to come back depending on if you the more weight you lose the longer it takes to come back that's should be selfe even with the lifestyle changes that perh so that's the question I mean we have seen patients who and this this so this is my hypothesis which would be I don't have any data to support this my hypothesis is depending on the root cause of why a person's overeating there's a chance in which this drug can be transient and helpful so if a person transformative yeah clearly transformative but there's a chance where look you got a person who just has to cut 10 PBS and they're kind of struggling but they they have really good food awareness they go on the drug low dose of the drug they lose the 10 pounds all the while maintaining tons of food awareness they come off the drug I've seen these people maintain that

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I've seen these people maintain that that weight loss conversely if a person's eating maybe is more emotional they don't have a lot of food awareness around it they're reactionary they go on the drug they lose it 20 25 PBS they come off the drug but they haven't addressed the underlying issue which is what is my attachment to food those patients tend to regain the weight and here's the part that I don't again I don't have data for this is anecdotal but it's from talking with a lot of other Physicians and seeing it as well when people are yo-yoing on the drug it tends to become less effective um yo-yoing meaning going on and off on and cycling their weight the drug seems to lose its its efficacy so what we do when we put patients on these drugs is try to put them on the minimum effective dose with the idea that what what do what's the lowest dose we could keep you on if we had to keep you on forever now no one's going to be on the drug they're on today forever even if they're going to stay the course because the pipeline of these drugs is out of this world right of course um so right now you've got two but very soon there's a third one coming out that looks even more potent than tepati um and so my guess is there'll be a day when nobody's even on semaglutide anymore unless it's an economic issue and the drug you know and you know Lily drops the price and it just becomes um you know basically Dirt Cheap my you know I had this but I didn't there's another part of your question that I didn't answer if you have a minute for one more idea which is I don't think this target is going anywhere in other words I don't think

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anywhere in other words I don't think the idea of targeting GI incron is going anywhere unless there is some major safety thing that that emerges that is so mind-numbing but truthfully even if this drug increases the rates of thyroid cancer by 2% the net net of it is probably still beneficial um and therefore I don't think it's going anywhere and the really interesting question is in 20 years will we be using genetic uh tools to address this in other words I think so yeah will we just say to hell with the drugs like we're just going to come up with a genetic switch that changes the regulation of gp1 and Gip um in people so that it's a oneandone drug yeah I asked Sanjay gupa this question it's been it's probably been six months because I was curious his take on on gp1s and I expected a different answer from sanj he I've known Sanjay a long time he tends to be pretty conservative and he said look I support you know I'm he didn't say he was a fan but he said listen he's he summed it up like this if um um it's not an if but obesity and all of the things associated with obesity it's the number one killer in America right all as you define them The Four Horsemen right they can all kind of Y it contributes to all of those so acknowledging that that is such a significant issue and just take another one of the horsemen just take cancer if somebody

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horsemen just take cancer if somebody came up with a drug that that was so beneficial for this disease obesity nobody would say anything whether it's cancer heart disease dementia any of these things people like I'm in this comes with this social stigma and I you know I'm asking these questions because I guess I'm also admitting that there's part of me as like wait a minute what are we doing but the way he laid it out and it's right I mean that that's I never had that view and so yeah the genetic piece is interesting yeah I mean again at some point if you can just if you can manipulate Gene Express in an individual and they make more gp1 and you don't have to give them a super expensive drug every two weeks um but by the way I mean this is always this has been the discussion in sports for a long time and I I get the question probably more than anybody and and I'm sure you get it as well um if you're going to do that with gop1 well then you're going to be able to manipulate other things right on the performance side oh I I've posed this question already I've never heard a great answer one way or the other which is uh like take take your sport um it's it's actually a two variable sport it's power and weight now we've made it really clear you cannot take a substance a performance-enhancing substance that improves the top of that equation or that ratio yep but what's what's our point of view going to be on

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what's our point of view going to be on the bottom because well I don't know there yeah but but you see my point right which is those numbers are equal now is water for example testing for gop1 yeah and I was on a podcast many months ago and I asked the question knowing that there might not be an answer but it was like I wonder how many athletes going into the Olympics that we just came out of uh in France were using a gp1 Agonist because you know not all athletes but there are a number of athletes whose lives are made better when they are lighter from an athletic perspective and anything that can Aid in that and take you know you read you know I'm sure you didn't read the book but one of the things I remember was was um Tyler Hamilton's book I forget what it was called the inside race or something like that one of the things that was most remarkable to me about that book was he probably more than any other thing I'd read about cycling explained the starvation like he spent a lot of time explaining how hungry he was and how miserable his life was and even the drugs that he used to try to like I mean it was horrible like he'd put himself into a coma to fall asleep while hungry um now imagine you could take that was pretty common back in the day when guys would truly starve themselves then they would um they would take you know uh super strong sleeping pills just just to knock themselves out because they were so miserable um so it's hard to say right like where do wew

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it's hard to say right like where do wew glad I didn't I mean we cut back and and minimized calories and got on the scale every morning like well I got to guess we got to eat less but uh but imagine if that variable wasn't there and you think about a runner or a cyclist I mean the the weight penalty those guys pay yeah yeah so I mean these are again all going to be very interesting ethical questions if they're not being asked I'm sure they are but y all right before I let you go uh this week in Formula we've talked a lot about formula one too uh you know My Views look I'm going to the race I like I mean but you must be happy this year this is what I'm getting at because we've talked about this years doc this is [__] boring and then you would remind well you what do you think it was like for all those years and you it was boring watching the tour and I'm like yeah they got a good point but it seems to be more interesting they're they're you know verstappen and Red Bull are not the same and I don't know if it's because uh the guy left the yep um mcclaren's seemed to found their groove mhm the race is tied I think that's good for the sport oh it is I mean um the ticket sales for Kota spiked once Red Bull started tanking yeah I believe that yeah I totally believe that um then you got Lewis you know then you the way this sport the sport evolves so fast not just

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sport the sport evolves so fast not just the technology obviously but um we're we're guys you know the team's guys drive you know so he's going to for I know you're big Lewis guy big Ferrari guy but that could be interesting yeah it's interesting I mean if I had to bet I think Lewis's departure to Ferrari means he won't win another championship I think he's kissing his eighth Championship Goodbye by not staying at Mercedes um I think he had a but but then there was no guarantee he could win it at Mercedes like it's not like beating George wasn't going to be easy and knew he went to uh he went to um Str team yeah to Aston Martin is he that good I think they paid I mean I saw some numbers they paid him I mean the deal I don't I heard 40 million a year yeah I think it was yeah I mean come on that's a lot of money I think that Adrian newie is exceptional it's not entirely clear to me what how much he's going to be doing on the on he won't I don't think he'll have any direction on the car next year that that die is past so I would assume he's working mostly on the 2026 car cuz that's when the regulation change kicks in um but I also don't know how much he's working on their hypercars and other cars as well because remember Adrien was not doing a lot on the Formula 1 like the rb20 which is this year's Formula 1 car for Red Bull that's not doing very well Adrian didn't work on this car he was even while still at Red Bull mostly working on you know

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Red Bull mostly working on you know their other hyper projects like the guy who jumped out of space with a hotter no no other cars yeah yeah no other cars yeah um but no Adrien is I mean he is a he's the best that that ever lived in that role for sure B stappen I still believe that veren is is you've always said that I mean no I think that veren I mean current crop I think Max is the best driver on the grid um no that doesn't mean that on any given day that someone else can't can't have a better day but in terms of like so so how do you think about what makes a great driver a great I was a discussion yesterday with one of the team principles about this a great driver is someone who spends exactly zero cognitive energy thinking about how to drive the car to the Limit and all of their cognitive energy on strategy and race tactics right very few drivers can do that right uh Max can do it y Fernando Alonzo can do it Lewis Hamilton can do it so I would say at this point in time there are only three out of 20 drivers on the phoning in the driving and and then they're they're just trying to play the game think about the day you came driving with me at the racetrack now I don't know no no never forget itet but think still sweating but think about and I'm in this boat myself like 98% of my resources are going to driving when I'm driving I'm sensing the limit I'm realizing oh I'm losing the rear what do I need to okay correct this

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rear what do I need to okay correct this okay boom Oh there's my Apex there's my exit back to thrott like I mean my CPU is at total m capacity 98% of it on driving and maybe 2% of my CPU I can actually talk to my coach and get feedback from him or if I'm in the simulator or if I'm in one of my formula cars like do some of the higher order manipulations like you know use my DRS or something like that when you're talking about Max and I think also probably Fernando and Lewis they are so good that they they do what nobody can do from a driving perspective which means they are at the the limit every moment in the car but it's an extension of their body they're just moving through the day it's like you riding with a beautiful CAD of 90 RPM yeah 100 110 yeah and then but what but then every bit of their CPU is now dedicated to where is everybody on the track and oh by the way like I mean you know like here's the example like oh in turn three I exited and the wind gust and the rear slipped a little bit and I caught it and so what does that mean at the next corner is what direction is the wind going to be at corner 4 if that's what it did to me at corner 3 can you imagine having the processing speed to be able to do that no um a great example of this was watching what Fernando Alonso did to czecho Perez at inter logos two years ago where it was like some of the most amazing racecraft you've ever seen where the guy in the inferior car beat the guy in the better car because of racecraft and it's because it's Fernando wow

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yeah yeah I mean just being a been in your simulator like that's that I can't imagine like that that that's no extension of my body like that's terrifying yeah and it's kind of weird like I'll spend the rest of my life doing this and I'll never be and Alonzo is no longer a kid but nor is Hamilton but I mean they were born to D race cars yeah like it's just but I guess you're right like if I think of um I've never I was just sort of think well who's the best guy like if you gave him a crappy C would he still win and most would because they're so well in this day and age no that was true 30 and 40 years ago you could take like you look at aan Senna in his rookie year 1984 he's driving a Tolman that's like a garbage truck mhm he still came within an inch of winning a race in his rookie year at Monaco why because it was pissing rain and when it rains like crazy back then they would let them Drive in much worse conditions than today but when it rains all of sudden the advantage of the car becomes less relevant and the driver's skill matters and so even as a 24 year-old rookie he was still the best driver in the rain even with three or four world champions on the grid and so he was able to to shine in that way and so back in the 80s and certainly before it you know the expression for football Any Given Sunday any team could win any game in the NFL um it was that way in F1 I think today it's probably not that there are certain

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it's probably not that there are certain cars that are just never going to be able to win a race it's you know I get asked all the time about that stage into Gap in 2003 where beloki crashed and I ended up in the field I've never thought about it but you hearing you talk about it in that way and me trying to relate that to cycling I mean I what do you exactly remember not a whole lot but I it that did you see him go down no no but did you like before he went down did you realize when he hit that patch of uh well I mean this goes to your point earlier of if the wind was this in turn three then it must be doing that in turn four I mean this descent was already like that as we were getting down it was you could tell it was hot it was a lot of tar you could tell that it was sticky and boiling you're like well this isn't good yeah so when it happened was I surprised I was like oh no he were you expecting something bad to happen either to you or to him or like were you on happened to me I was saying away can see you know you're supposed to see the patchy section so I was I knew you can hit those if you're going straight y any turn involved especially on those tires but you know when I I guess now that it's fun fun to think about and it's not fun for boki who I think is a he's never recovered he's a great guy I get asked about this all the time I could have got off and walked in that field is just I mean the same like the way I just went I was like well I

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well I I just wonder if there was something subconscious that tipped you off that he was going to go down before he went down cuz I think that you might have seen something in his body position I wouldn't have been behind him if IID seen that because of most of but I wonder if that's what got you already processing I need an Exit Plan yeah yeah but it it was just like well cuz good driver you'll hear them say that as well like it's kind of amazing when you listen to the radio and you'll hear Max say hey so and so is losing his left front like he'll he can see in his mirror the way the guy exited that corner his left front tire didn't have as much grip as it did on the last lap again talk about a CPU by the way he's looking backwards when he's most people are thinking I have to look forwards because I'm going 150 miles an hour like it's I'm glad it's close it's going to be a good race I think it's exciting yeah and then we have what three or four or five where we go um Austin Mexico Brazil Vegas uh is it Bahrain no it's um Qatar and and then UAE and this will come down to the last race I think for both because you have the individual the constructor's championship is already no no one's going to take that from mlar my view I think the drivers Championship will come down at the last race if I had to guess at least mathematically wow yeah doc thanks for doing this enjoy this is very special special gift and so

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this is very special special gift and so cool and I'll I'll see you tonight man thank you for having me finally got you on here I don't know why it's like I the other day I was like you want to come on my podcast here like sure I'm like I should have asked that a long time ago thanks do all right [Music]