00:00
[Music] hi everybody thanks for joining us today thank you so much Peter for being here thank you so much Peter for being here I'm going to read your bio and then I'm going to read your bio and then we'll kind of dive in cringe um all we'll kind of dive in cringe um all right Peter AA MD is the founder of right Peter AA MD is the founder of early medical a medical practice that early medical a medical practice that applies the principles of medicine 3.0 applies the principles of medicine 3.0 to patients with the goal of to patients with the goal of simultaneously lengthening their simultaneously lengthening their lifespan and increasing their health lifespan and increasing their health span Dr Atia received his medal degree span Dr Atia received his medal degree medical degree from the Stanford medical degree from the Stanford University School of Medicine and University School of Medicine and trained for 5 years at the Johns Hopkins trained for 5 years at the Johns Hopkins Hospital and general surgery he's the Hospital and general surgery he's the host of the drive one of the most host of the drive one of the most popular podcasts covering the topics of popular podcasts covering the topics of health and medicine and he's also the health and medicine and he's also the author of the number one New York Times author of the number one New York Times bestseller outlive the science and art bestseller outlive the science and art of longevity which will be the topic of of longevity which will be the topic of our discussion today Peter thanks for our discussion today Peter thanks for joining us thank for having me joining us thank for having me yeah um so personally speaking uh as I yeah um so personally speaking uh as I shared with you before we got here your
01:00
shared with you before we got here your book changed my life and I'm really you book changed my life and I'm really you know grateful for the opportunity uh for know grateful for the opportunity uh for you to to be here today and share your you to to be here today and share your work with a broader audience so before work with a broader audience so before we dive into the book I want to learn a we dive into the book I want to learn a little bit more about you uh many of us little bit more about you uh many of us know you as physician author podcaster know you as physician author podcaster Etc specializing in longevity but can Etc specializing in longevity but can you tell us a little bit about just your you tell us a little bit about just your path to get path to get here um yeah it's not I mean what's the here um yeah it's not I mean what's the there's an expression about how things there's an expression about how things always make sense in retrospect but always make sense in retrospect but maybe not at the time they don't seem maybe not at the time they don't seem that logical there's a more eloquent way that logical there's a more eloquent way to describe that um I uh you know to describe that um I uh you know growing up didn't didn't particularly growing up didn't didn't particularly care for school um was really enamored care for school um was really enamored with boxing and that's I wanted to be a with boxing and that's I wanted to be a professional fighter um and that was professional fighter um and that was that was essentially my life until my that was essentially my life until my final year of high school when an final year of high school when an amazing guy who was my one of my amazing guy who was my one of my teachers um I think you know probably teachers um I think you know probably one of the first pivotal uh moments in one of the first pivotal uh moments in my life was when this this teacher
02:00
my life was when this this teacher called me in early one morning and um called me in early one morning and um interestingly rather than sort of brow interestingly rather than sort of brow beating me for not applying to college beating me for not applying to college you know he just said look I think you you know he just said look I think you really have a talent for math I think really have a talent for math I think you'd be crazy he didn't even say it you'd be crazy he didn't even say it that way he goes I think you would be that way he goes I think you would be depriving the world of something if you depriving the world of something if you didn't pursue your talents in didn't pursue your talents in mathematics and I just even though I mathematics and I just even though I didn't like school I loved this teacher didn't like school I loved this teacher um and something about that just really um and something about that just really got me thinking and uh ultimately I got me thinking and uh ultimately I ended up needing another year to apply ended up needing another year to apply to college uh but but I ended up going to college uh but but I ended up going and following in his footsteps doing and following in his footsteps doing engineering and math together engineering and math together um and uh and then I had another change um and uh and then I had another change of heart which is a long story that I of heart which is a long story that I won't get into and after I completed all won't get into and after I completed all of that and was just about ready to of that and was just about ready to start my PhD in aerospace engineering start my PhD in aerospace engineering realized I actually wanted to do realized I actually wanted to do medicine instead and then I needed to medicine instead and then I needed to spend another year screwing around to spend another year screwing around to take Premed courses which i' never taken
03:00
take Premed courses which i' never taken I've never taken a biology course a I've never taken a biology course a funny story when I took the MCAT I funny story when I took the MCAT I hadn't actually taken Biology yet and it hadn't actually taken Biology yet and it was only the night before the MCAT that was only the night before the MCAT that I realized meiosis and mitosis were I realized meiosis and mitosis were different and it wasn't a typo the different and it wasn't a typo the entire time I was going through the entire time I was going through the practice test I was like how sloppy of practice test I was like how sloppy of these books that they can't even spell these books that they can't even spell check them for heaven's sakes and then check them for heaven's sakes and then then luckily the night before I figured then luckily the night before I figured that out um so uh so then I you know I I that out um so uh so then I you know I I went to med school and uh uh you know went to med school and uh uh you know thought I was like everybody you sort of thought I was like everybody you sort of go into Medical School thinking you're go into Medical School thinking you're going to do one thing I thought I would going to do one thing I thought I would do pediatric oncology but then decided I do pediatric oncology but then decided I really wanted to do surgery um and then really wanted to do surgery um and then interestingly when I was still two years interestingly when I was still two years shy of completing my seven-year shy of completing my seven-year residency I just had another change of residency I just had another change of heart and heart and realized I'm not happy doing this I'm realized I'm not happy doing this I'm going to leave um decided I would go and going to leave um decided I would go and get an MBA um and then met somebody who get an MBA um and then met somebody who told me about this company called told me about this company called McKenzie where you basically get an MBA McKenzie where you basically get an MBA but get paid I was like well that sounds
04:00
but get paid I was like well that sounds like a better idea cuz I have so much like a better idea cuz I have so much debt at this point in time um so then I debt at this point in time um so then I went off to Mackenzie for a couple years went off to Mackenzie for a couple years didn't do Healthcare did uh credit risk didn't do Healthcare did uh credit risk which was um the most amazing time to be which was um the most amazing time to be there 2006 2007 2008 in the leadup to there 2006 2007 2008 in the leadup to the mortgage meltdown was um like being the mortgage meltdown was um like being a kid in a candy store if you enjoy a kid in a candy store if you enjoy quantitative stuff which I do and did quantitative stuff which I do and did um and then to make a long story short I um and then to make a long story short I just sort of became interested in my own just sort of became interested in my own health and that was actually the journey health and that was actually the journey that kind of led me to doing what I do that kind of led me to doing what I do now and have done for the past 10 years now and have done for the past 10 years which is sort of really think about this which is sort of really think about this idea that at the time I wasn't calling idea that at the time I wasn't calling medicine 3.0 but that I now call medicine 3.0 but that I now call medicine 3.0 yeah great thank you that's medicine 3.0 yeah great thank you that's actually a good uh sort of onboarding actually a good uh sort of onboarding into some of the concepts of the book so into some of the concepts of the book so um you describe outlive as an actionable um you describe outlive as an actionable operating manual for the practice of operating manual for the practice of longevity and that's a term that gets longevity and that's a term that gets used really you know Loosely and thrown used really you know Loosely and thrown around a lot can you sort of describe around a lot can you sort of describe how you think about longevity and maybe
05:00
how you think about longevity and maybe share a little bit about the terms that share a little bit about the terms that you use lifespan versus Health span yeah you use lifespan versus Health span yeah um I do make a point in the book of um I do make a point in the book of saying how much I don't like the word saying how much I don't like the word longevity but it's not because the word longevity but it's not because the word doesn't have meaning it's because it's doesn't have meaning it's because it's been I think uh hijacked to mean a lot been I think uh hijacked to mean a lot of things that I don't necessarily think of things that I don't necessarily think are are relevant and and in many cases I are are relevant and and in many cases I think are actually just kind of harmful think are actually just kind of harmful or silly um but for whatever it's worth or silly um but for whatever it's worth the word is here and it's clearly a the word is here and it's clearly a heuristic for something um but I do heuristic for something um but I do think it is important to differentiate think it is important to differentiate between lifespan and health span as they between lifespan and health span as they are two different components so for are two different components so for example when we talk about the increase example when we talk about the increase in in lifespan um of for example people in the lifespan um of for example people in the United States over the past 100 years United States over the past 100 years it's profound there's been a doubling of it's profound there's been a doubling of lifespan um and that's obviously a part lifespan um and that's obviously a part of longevity but it's not the only part of longevity but it's not the only part um and and so there must be this other um and and so there must be this other part that's not as obvious and and I part that's not as obvious and and I think think Health span is less obvious
06:00
think think Health span is less obvious because it's harder to Define harder to because it's harder to Define harder to measure and frankly it's not binary measure and frankly it's not binary right you guys are Engineers so we love right you guys are Engineers so we love digital things right it's zero or it's digital things right it's zero or it's one and that's it and that's what one and that's it and that's what lifespan is but Health span is not so I lifespan is but Health span is not so I think in part you know the expression think in part you know the expression what's get what gets measured gets what's get what gets measured gets managed is very true here and I think managed is very true here and I think that historically the medical system that historically the medical system measures measures lifespan and we've managed it pretty lifespan and we've managed it pretty well well but um but Health span is more but um but Health span is more complicated because it has components complicated because it has components that are somewhat subjective and even that are somewhat subjective and even the things that are objective are a the things that are objective are a little squishier right so cognitive little squishier right so cognitive Health you can measure certain elements Health you can measure certain elements of that you can measure processing speed of that you can measure processing speed you can measure memory shortterm memory you can measure memory shortterm memory long-term memory visual spatial memory long-term memory visual spatial memory um but we don't typically do these um but we don't typically do these things and therefore I think it's harder things and therefore I think it's harder for people to kind of wrap their mind for people to kind of wrap their mind around what is health span um so for me around what is health span um so for me it has three pieces it has a physical it has three pieces it has a physical piece it has a a cognitive piece and it
07:00
piece it has a a cognitive piece and it has an emotional piece and those are has an emotional piece and those are broad terms so you might say well how broad terms so you might say well how can it only include those three things can it only include those three things but if you unpack what each of them is but if you unpack what each of them is you'll you'll see that there's quite a you'll you'll see that there's quite a lot there so I would say in summary lot there so I would say in summary lifespan uh pardon me longevity is about lifespan uh pardon me longevity is about the pursuit of in increasing both of the pursuit of in increasing both of these yeah great um so so building on these yeah great um so so building on the concept of Health Span in the book the concept of Health Span in the book you talk about you know the four you talk about you know the four horsemen and uh describing the toll that horsemen and uh describing the toll that chronic disease has taken on our Our chronic disease has taken on our Our Lives can you talk a little bit about Lives can you talk a little bit about the four horsemen uh and just share your the four horsemen uh and just share your perspective on you know maybe methods perspective on you know maybe methods that we can sort of Stave them that we can sort of Stave them off yeah so for you know humans have off yeah so for you know humans have been around for about 250,000 years so been around for about 250,000 years so there's uh it's kind of interesting I there's uh it's kind of interesting I was meeting with a friend yesterday and was meeting with a friend yesterday and he was commenting on how remarkable it he was commenting on how remarkable it is that in 1950 there were only a is that in 1950 there were only a billion people on the planet today uh on billion people on the planet today uh on the planet in 1950 and today of course the planet in 1950 and today of course we're at 8 and you know relatively we're at 8 and you know relatively shorter will be at 10 and I said that's shorter will be at 10 and I said that's interesting but what's more interesting interesting but what's more interesting to to me is that there have been 110
08:00
to to me is that there have been 110 billion people on this Earth in the past billion people on this Earth in the past 250,000 years like you don't realize the 250,000 years like you don't realize the value of all that time also very value of all that time also very interesting and totally on a side interesting and totally on a side there's a paper that came out in science there's a paper that came out in science last year that talked about a few choke last year that talked about a few choke points in human civilization I don't points in human civilization I don't know if any of you saw this but there know if any of you saw this but there were at least two or three points when were at least two or three points when they believe the human population was they believe the human population was down to as little as four to 8,000 down to as little as four to 8,000 people meaning we came really close to people meaning we came really close to extinction many many times over the last extinction many many times over the last uh 250,000 years so uh 250,000 years so um this idea that up until very recently um this idea that up until very recently across that huge time frame of you know across that huge time frame of you know 250,000 years virtually all death was 250,000 years virtually all death was pretty quick you died of infections you pretty quick you died of infections you died from trauma and uh women and their died from trauma and uh women and their babies died during childbirth that babies died during childbirth that basically accounted for why uh life basically accounted for why uh life expectancy didn't really exceed expectancy didn't really exceed 40 now in a very short period of time 40 now in a very short period of time because if you're drawing this on on a because if you're drawing this on on a graph and you're looking at it in linear
09:00
graph and you're looking at it in linear time it looks like this life time it looks like this life expectancy right it's a total step expectancy right it's a total step function over a 100 years um but we function over a 100 years um but we traded what I call fast death for slow traded what I call fast death for slow death death so the Advent of medicine 2.0 made those so the Advent of medicine 2.0 made those causes of death much less common causes of death much less common infections communicable diseases uh infections communicable diseases uh infant mortality and Trauma have fallen infant mortality and Trauma have fallen dramatically because the tools of dramatically because the tools of medicine 2.0 are really good at treating medicine 2.0 are really good at treating those things and so now that the tide those things and so now that the tide has gone out and you can see who's not has gone out and you can see who's not wearing their shorts you realize that wearing their shorts you realize that what's really going on now that we've what's really going on now that we've survived those fast causes of death is survived those fast causes of death is we die from slow things um and I term we die from slow things um and I term them The Four Horsemen but uh you know them The Four Horsemen but uh you know it's basically the things that everyone it's basically the things that everyone knows right so it's cardiovascular and knows right so it's cardiovascular and cerebrovascular disease at number one cerebrovascular disease at number one cancer at number two uh cancer at number two uh neurodegenerative diseases and dementing neurodegenerative diseases and dementing diseases uh at number three and I say diseases uh at number three and I say that because remember there's a lot in that because remember there's a lot in there right it's not just Alzheimer's
10:00
there right it's not just Alzheimer's disease it's Parkinson's disease Louis disease it's Parkinson's disease Louis body dementia vascular dementia Etc and body dementia vascular dementia Etc and then the fourth Horseman you know then the fourth Horseman you know doesn't kill nearly as many people as doesn't kill nearly as many people as the others but I would argue it is the the others but I would argue it is the foundation upon which all of those foundation upon which all of those diseases are Amplified and that's that's diseases are Amplified and that's that's the Continuum of metabolic diseases that the Continuum of metabolic diseases that that spans the gamut from insulin that spans the gamut from insulin resistance to fatty liver disease uh to resistance to fatty liver disease uh to type two diabetes um and that is at from type two diabetes um and that is at from a growth rate perspective increasing a growth rate perspective increasing more rapidly than the other three and it more rapidly than the other three and it is by extension accelerating the other is by extension accelerating the other three yeah I have a question about that three yeah I have a question about that a little bit later so we'll we'll dive a little bit later so we'll we'll dive in there um but just to sort of finish in there um but just to sort of finish out on defining some of the concepts out on defining some of the concepts that you introduce in the book you talk that you introduce in the book you talk about this notion of the centenarian about this notion of the centenarian decathlon and the marginal decade uh can decathlon and the marginal decade uh can you you know share a little bit about you you know share a little bit about what those things are and why they what those things are and why they matter to us as we matter to us as we age so so I'm going to try to do this
11:00
age so so I'm going to try to do this I've never been successfully able to do I've never been successfully able to do this every time I try to explain I'm this every time I try to explain I'm about to explain everyone goes what are about to explain everyone goes what are you talking about so I'm not going to be you talking about so I'm not going to be offended if you guys are like this offended if you guys are like this doesn't make any doesn't make any sense um in oil markets the oil price is sense um in oil markets the oil price is set by the marginal Barrel price right set by the marginal Barrel price right so if the worldwide demand for oil is 87 so if the worldwide demand for oil is 87 million barrels of oil a day I don't million barrels of oil a day I don't even know what it is anymore by the way even know what it is anymore by the way but that's probably directionally where but that's probably directionally where it is it is the price is not set by the lowcost the price is not set by the lowcost barrel the ones that are re really easy barrel the ones that are re really easy to pull out of the guar oil field the to pull out of the guar oil field the price is set by the marginal Barrel the price is set by the marginal Barrel the last one that comes out of the ground is last one that comes out of the ground is the one that's setting the price and the one that's setting the price and sort of occurred to me that when I was sort of occurred to me that when I was looking at the longevity curve that looking at the longevity curve that there was a parallel here which is the there was a parallel here which is the quality of our life is not determined by quality of our life is not determined by the first decade or second decade of our the first decade or second decade of our life in many ways it might be determined life in many ways it might be determined by this marginal decade in other words by this marginal decade in other words when I see people whose final decade is
12:00
when I see people whose final decade is filled with suffering in some capacity filled with suffering in some capacity it could be physical suffering it could it could be physical suffering it could be cognitive suffering it could be be cognitive suffering it could be emotional suffering so you could take emotional suffering so you could take somebody who's in perfectly great health somebody who's in perfectly great health but they've lived such a miserable life but they've lived such a miserable life that they spend the last decade of their that they spend the last decade of their life alone because they don't have life alone because they don't have anybody that they love and nobody wants anybody that they love and nobody wants to be around them to me that's that's a to be around them to me that's that's a bad marginal decade um you take an bad marginal decade um you take an individual who's never looked after individual who's never looked after themselves physically maybe they have themselves physically maybe they have their cognition all about them but you their cognition all about them but you know they can't do anything they can't know they can't do anything they can't they're in so much pain or they can't be they're in so much pain or they can't be mob to me that's a suboptimal marginal mob to me that's a suboptimal marginal decade and so it occurred to me that if decade and so it occurred to me that if we could Target making the marginal we could Target making the marginal decade better all the decades that come decade better all the decades that come before it by necessity have to be good before it by necessity have to be good you can't just wake up one day at 86 and you can't just wake up one day at 86 and say the next 10 years are going to be say the next 10 years are going to be amazing if they're not already really amazing if they're not already really amazing at 86 which means they were very amazing at 86 which means they were very good at 76 and 66 Etc and so if I good at 76 and 66 Etc and so if I haven't lost you yet with this idea that haven't lost you yet with this idea that the marginal is the last decade of your
13:00
the marginal is the last decade of your life you don't know the day you enter it life you don't know the day you enter it but you will all have one hopefully no but you will all have one hopefully no one in this room is in their marginal one in this room is in their marginal decade um but we're all going to be decade um but we're all going to be there uh and we want that decade to be there uh and we want that decade to be as far away as possible the next idea is as far away as possible the next idea is uh one that comes really from my love of uh one that comes really from my love of sports which is that um no matter what sports which is that um no matter what athlete you're talking about none of athlete you're talking about none of them are exercising you might say what them are exercising you might say what are you talking about athletes exercise are you talking about athletes exercise all the time no athletes train there's a all the time no athletes train there's a fundamental difference exercise is just fundamental difference exercise is just kinetic it's just movement right going kinetic it's just movement right going for a run jumping up and down great for a run jumping up and down great that's exercise training is specificity that's exercise training is specificity and this is why if you pick the best and this is why if you pick the best athlete in every athlete in every sport they look nothing alike their sport they look nothing alike their training looks nothing alike and they training looks nothing alike and they are not Shuffle right you could not put are not Shuffle right you could not put Max for stappen on a basketball court Max for stappen on a basketball court you cannot put Steph Curry in a car you
14:00
you cannot put Steph Curry in a car you cannot put Patrick Mahomes in you know cannot put Patrick Mahomes in you know uh in a different position let alone a uh in a different position let alone a different sport that's different sport that's specificity and I realized that well specificity and I realized that well that must be the way we think about the that must be the way we think about the marginal decade we have to make life our marginal decade we have to make life our sport because we know that exercise is sport because we know that exercise is beneficial and if you did nothing but beneficial and if you did nothing but mindlessly exercise run and lift weights mindlessly exercise run and lift weights and do all these things that's great and do all these things that's great you will get many of the lifespan you will get many of the lifespan benefits of exercise which is to say benefits of exercise which is to say your risk of heart disease and cancer your risk of heart disease and cancer dementia metabolic disease will go down dementia metabolic disease will go down you won't necessarily get the health you won't necessarily get the health span benefits because for example you span benefits because for example you could injure yourself well that's very could injure yourself well that's very counterproductive if you're running to counterproductive if you're running to the point where you're grinding your the point where you're grinding your knees into the ground you're going to knees into the ground you're going to have a hard time being Mobile in the have a hard time being Mobile in the final decade of your life and so if final decade of your life and so if instead we focus on this idea that I instead we focus on this idea that I called the centenarian de cathlon which called the centenarian de cathlon which just means you pick the 10 most just means you pick the 10 most important things you want to physically
15:00
important things you want to physically be able to do in the last decade of your be able to do in the last decade of your life and these can be both recreational life and these can be both recreational activities but also just activities of activities but also just activities of daily living I get asked all the time daily living I get asked all the time like tell me some of the things your like tell me some of the things your patients say I mean on the activities of patients say I mean on the activities of daily living side it's have sex uh care daily living side it's have sex uh care for myself be able to cook like it's for myself be able to cook like it's things that we would all just take for things that we would all just take for granted today and then of course people granted today and then of course people also think about what they want to be also think about what they want to be able to do recreationally a lot of able to do recreationally a lot of people say look I really enjoy playing people say look I really enjoy playing golf if I'm 90 could I play 18 hle and golf if I'm 90 could I play 18 hle and actually walk all 18 uh could I pick a actually walk all 18 uh could I pick a kid up a grandchild out of a crib uh can kid up a grandchild out of a crib uh can I sit on the floor and get up on my own I sit on the floor and get up on my own again all of us could do these things again all of us could do these things today without any effort but if you've today without any effort but if you've been around people in the final decade been around people in the final decade of their life very few of them can do of their life very few of them can do these things well I would argue it's these things well I would argue it's because none of that will happen because none of that will happen automatically and the only way it will automatically and the only way it will happen is if you train for those things happen is if you train for those things as though they are the sport and it's as though they are the sport and it's just weird because we don't think of just weird because we don't think of people in their s competing in the people in their s competing in the Olympics but that's effectively what it
16:00
Olympics but that's effectively what it is great thanks for that um so so let's is great thanks for that um so so let's move a little bit into how people can move a little bit into how people can put this into practice in their lives uh put this into practice in their lives uh in the book you uh quote sunu saying in the book you uh quote sunu saying that tactics without strategy is noise that tactics without strategy is noise before the defeat could you talk a before the defeat could you talk a little bit about that and then maybe little bit about that and then maybe expand on what are some of the tactics expand on what are some of the tactics that can help people to sort of achieve that can help people to sort of achieve their centinary to their centinary to cathlon well you know we sort of Break cathlon well you know we sort of Break um we we break the tactics down into um we we break the tactics down into kind of five areas domains pillars kind of five areas domains pillars whatever you want to call them um so I whatever you want to call them um so I think and and there you you could argue think and and there you you could argue there's a sixth one that is all else there's a sixth one that is all else just to make it sort of mutually just to make it sort of mutually exclusive and collectively exhaustive exclusive and collectively exhaustive but uh nutrition would clearly be but uh nutrition would clearly be something that fits in like it's a it's something that fits in like it's a it's a clear input that matters in this a clear input that matters in this equation and that's your favorite topic equation and that's your favorite topic yeah that's the one I want to talk about yeah that's the one I want to talk about exclusively um then we have exclusively um then we have exercise which actually is my favorite exercise which actually is my favorite topic um
17:00
topic um sleep uh all the tools that we would sleep uh all the tools that we would think of bringing towards emotional think of bringing towards emotional health and happiness and then uh the health and happiness and then uh the fifth one that I talk about is fifth one that I talk about is molecules exogenous molecules meaning molecules exogenous molecules meaning anything that you take from the outside anything that you take from the outside they put in that's not food so drugs or they put in that's not food so drugs or supplements or hormones and and like I supplements or hormones and and like I said I guess if you really want it to be said I guess if you really want it to be Mei you would add a sixth bucket and Mei you would add a sixth bucket and just call it the waist bin of everything just call it the waist bin of everything else some of which is probably valuable else some of which is probably valuable like saunas some of which is probably like saunas some of which is probably useless like Hyperbaric o oxygen sorry useless like Hyperbaric o oxygen sorry if people love H baric oxygen Chambers if people love H baric oxygen Chambers um but but you could just say and every um but but you could just say and every other thing that anybody thinks of okay other thing that anybody thinks of okay great um so maybe I'll go to nutrition great um so maybe I'll go to nutrition first since you don't like it so it's a first since you don't like it so it's a topic you often joke about not uh loving topic you often joke about not uh loving to speak about but what are just some to speak about but what are just some common misconceptions that people have common misconceptions that people have about nutrition and what do you think about nutrition and what do you think are sort of the No Regret are sort of the No Regret moves I think the biggest misconception moves I think the biggest misconception about nutrition is that it's more about nutrition is that it's more complicated than it is is and that complicated than it is is and that there's one true diet and that and this
18:00
there's one true diet and that and this by the way this isn't this is kind of an by the way this isn't this is kind of an elitist view of nutrition I don't think elitist view of nutrition I don't think the average person out there is is the average person out there is is thinking this way but but I think that thinking this way but but I think that in the circle of you know influencers in the circle of you know influencers and personalities and things there's and personalities and things there's this view that like my diet is the diet this view that like my diet is the diet and those of you that are eating seed and those of you that are eating seed oils or eating this or eating that I oils or eating this or eating that I mean you're you're I mean gosh you might mean you're you're I mean gosh you might as well be smoking so so the truth of it as well be smoking so so the truth of it is the human body is remarkably is the human body is remarkably resilient at basically turning chemical resilient at basically turning chemical energy into electrical energy back to energy into electrical energy back to chemical energy that's all we're doing chemical energy that's all we're doing we're just taking hydrocarbons we're we're just taking hydrocarbons we're breaking them down stealing the breaking them down stealing the electrons putting them into the electrons putting them into the mitochondria generating ATP from ADP and mitochondria generating ATP from ADP and recycling re recycling the whole thing recycling re recycling the whole thing and um so there's a little bit of kind and um so there's a little bit of kind of religion that flows into this because
19:00
of religion that flows into this because it is so cultural because it is so it is so cultural because it is so relevant we just really want to believe relevant we just really want to believe that what we're doing is the right thing that what we're doing is the right thing but the truth of it is the the things but the truth of it is the the things that are capital T true are that energy that are capital T true are that energy balance matters a lot meaning can't eat balance matters a lot meaning can't eat too much and you can't eat too little too much and you can't eat too little now the body has way more protections now the body has way more protections against the eating too little part this against the eating too little part this is and obvious if you reflect on our is and obvious if you reflect on our evolutionary history right too little evolutionary history right too little food was historically a way way bigger food was historically a way way bigger problem than too much food too much food problem than too much food too much food has only been a problem for 50 years and has only been a problem for 50 years and 50 years out of 250,000 as Homo sapiens 50 years out of 250,000 as Homo sapiens is nothing 50 years out of billions of is nothing 50 years out of billions of years as going back to single cell years as going back to single cell organism is also nothing so so we have organism is also nothing so so we have zero evolutionary adaptations for too zero evolutionary adaptations for too much food but we have lots for too much food but we have lots for too little food so neither is good but little food so neither is good but they're bad for different reasons and they're bad for different reasons and our system is skewed to tolerate uh
20:00
our system is skewed to tolerate uh excess more than excess more than deficiency um another important deficiency um another important principle is that of the three principle is that of the three macronutrients the one that you ought to macronutrients the one that you ought to pay most attention to is protein not pay most attention to is protein not carbs not fat carbs and fat can be quite carbs not fat carbs and fat can be quite fungible they're both great sources of fungible they're both great sources of energy fats are more essential because energy fats are more essential because you need them for structural purposes so you need them for structural purposes so you can't be too restrictive on fats but you can't be too restrictive on fats but there's actually quite a bit of flex in there's actually quite a bit of flex in the system how much you want to toggle the system how much you want to toggle between your fat and your carb buttons between your fat and your carb buttons but where you don't want to get two out but where you don't want to get two out of whack is on protein and the reason is of whack is on protein and the reason is protein is purely structural so it is protein is purely structural so it is the building block for muscles it's the the building block for muscles it's the building block for enzymes it's the building block for enzymes it's the building block for many of the very building block for many of the very important things in our body so protein important things in our body so protein deficiency is really bad and we know deficiency is really bad and we know this for example like the body will go this for example like the body will go to such amazing lengths during to such amazing lengths during starvation to preserve muscle mass until
21:00
starvation to preserve muscle mass until the very end and um and obviously once a the very end and um and obviously once a person is in Starvation and they're person is in Starvation and they're starting to consume muscle mass the end starting to consume muscle mass the end is very is very close so beyond those things of how much close so beyond those things of how much you're eating in total calories which you're eating in total calories which will be reflected I'm sure if we talk will be reflected I'm sure if we talk about metabolic health and what are the about metabolic health and what are the consequences of excess calories um and consequences of excess calories um and getting sufficient getting sufficient protein if you if if there's truly an protein if you if if there's truly an 8020 rule that's the 80 yeah got it 8020 rule that's the 80 yeah got it thanks thanks um so let's talk about exercise since um so let's talk about exercise since you do love that uh explain sort of just you do love that uh explain sort of just the importance of cardiovascular the importance of cardiovascular strength Mobility you touch on all these strength Mobility you touch on all these things uh in the book and just how do things uh in the book and just how do they contribute to staving off the four they contribute to staving off the four horsemen and just contributing to health horsemen and just contributing to health span so I think it's important to just span so I think it's important to just sort of acknowledge that the I don't sort of acknowledge that the I don't harp on exercise just because I enjoy it harp on exercise just because I enjoy it although I do I think the data make it although I do I think the data make it pretty clear that exercise has a bigger pretty clear that exercise has a bigger impact on length and quality of life
22:00
impact on length and quality of life than any of the other metrics and the than any of the other metrics and the easiest way I think to look at this is easiest way I think to look at this is to look at what happens when a person is to look at what happens when a person is in the off state for a given input right in the off state for a given input right so what's the off state for nutrition so what's the off state for nutrition what would be a good place we could look what would be a good place we could look for the off State of Nutrition it would for the off State of Nutrition it would probably be either um uh significant probably be either um uh significant obesity or type 2 diabetes those would obesity or type 2 diabetes those would be the two most extreme states you could be the two most extreme states you could could say malnutrition but I'm putting could say malnutrition but I'm putting that aside it's not really a problem that aside it's not really a problem today would have been a problem before today would have been a problem before and and obviously it's a problem in and and obviously it's a problem in certain part of the worlds but let's certain part of the worlds but let's just for the purpose of this just for the purpose of this illustration say what is the increase in illustration say what is the increase in all cause mortality for a person with all cause mortality for a person with type 2 diabetes uh and it's significant type 2 diabetes uh and it's significant um so how significant it's about 40% um so how significant it's about 40% that's a big number that means that at that's a big number that means that at any given point in time a person with any given point in time a person with type 2 diabetes has an increase in all type 2 diabetes has an increase in all cause mortality for the coming year of cause mortality for the coming year of 40% more than the similar person age sex
23:00
40% more than the similar person age sex education smoking status Etc that the education smoking status Etc that the non diabetic person does so it's a very non diabetic person does so it's a very big deal um so we put that number aside big deal um so we put that number aside and now we go and do the same analysis and now we go and do the same analysis with other variables that are congruent with other variables that are congruent with exercise notice not with exercise with exercise notice not with exercise because that becomes it's irrelevant to because that becomes it's irrelevant to look at inputs and subjective look at inputs and subjective assessments of like what I do in other assessments of like what I do in other words I don't care what people tell me words I don't care what people tell me they eat I care about the end State I they eat I care about the end State I don't care what people say about how don't care what people say about how much they exercise I care about the end much they exercise I care about the end State how strong are you and what's your State how strong are you and what's your V2 Max those are the two most objective V2 Max those are the two most objective ways that we can measure the output as ways that we can measure the output as opposed to the input does that make opposed to the input does that make sense I don't care about the inputs sense I don't care about the inputs because there's no reliability in because there's no reliability in reporting that stuff I just care about reporting that stuff I just care about objective measurements on the output so objective measurements on the output so I can measure your V2 Max I can measure I can measure your V2 Max I can measure how strong you are those are very how strong you are those are very objective and the data there is objective and the data there is overwhelming if you compare top quartile overwhelming if you compare top quartile V2 Max to bottom quartile V2 Max it's
24:00
V2 Max to bottom quartile V2 Max it's 175% difference and all cause mortality 175% difference and all cause mortality if you measure top desile strength or if you measure top desile strength or even top uh quintile strength to bottom even top uh quintile strength to bottom quintile strength you're talking about a quintile strength you're talking about a 100 to 125% difference in all cause 100 to 125% difference in all cause mortality so we have to Discount all of mortality so we have to Discount all of these things because they're associative these things because they're associative and they're not randomized data so and they're not randomized data so there's a healthy user bias embedded there's a healthy user bias embedded within them but when you're starting to within them but when you're starting to talk about um Hazard ratios that are talk about um Hazard ratios that are that large you know that there's that large you know that there's actually a signal there and it's not actually a signal there and it's not just a bunch of random noise like oh you just a bunch of random noise like oh you know people who eat pepperoni have a 6% know people who eat pepperoni have a 6% greater chance of colon cancer that's greater chance of colon cancer that's the noise you can totally tune out yeah the noise you can totally tune out yeah thanks for that um I think we'll skip thanks for that um I think we'll skip over sleep you've got a lot of great over sleep you've got a lot of great podcasts and things like that on on that podcasts and things like that on on that subject but on supplements um I think subject but on supplements um I think people are kind of confused right people are kind of confused right there's industry and influencers that there's industry and influencers that are constantly pedaling quick fixes and are constantly pedaling quick fixes and whatnot how do people sort through the
25:00
whatnot how do people sort through the noise and understand a do they even need noise and understand a do they even need supplements and B which ones are right supplements and B which ones are right for for them so I really like Frameworks because them so I really like Frameworks because um people always want me to give an um people always want me to give an answer but I feel like if you you know answer but I feel like if you you know it's such a stupid cliche but like if it's such a stupid cliche but like if you just give a person the answer you're you just give a person the answer you're kind of giving them the fish but if you kind of giving them the fish but if you give them the framework you're teaching give them the framework you're teaching them how to fish kind of thing so I them how to fish kind of thing so I would say given that there is no would say given that there is no shortage of supplements on the market shortage of supplements on the market today and there will never be a shortage today and there will never be a shortage of them in the in perpetuity it's better of them in the in perpetuity it's better to think of it this way so when I'm to think of it this way so when I'm anytime someone asks me about a anytime someone asks me about a supplement and again let's just say a supplement and again let's just say a patient coming into the practice what am patient coming into the practice what am I what am I asking I'm saying okay I what am I asking I'm saying okay question one is this a supplement you question one is this a supplement you were taking to repete replace correct a were taking to repete replace correct a deficit or are we talking about deficit or are we talking about something that is independent of that something that is independent of that and we're dealing with supernormal and we're dealing with supernormal physiologic levels so an example would physiologic levels so an example would be vitamin D some says should I be be vitamin D some says should I be taking vitamin D well again are you
26:00
taking vitamin D well again are you taking it because your vitamin D levels taking it because your vitamin D levels which we can objectively measure are low which we can objectively measure are low and you're replacing it yes or no um but and you're replacing it yes or no um but for many supplements the answer to that for many supplements the answer to that question is no we're we're not repleting question is no we're we're not repleting uh replacing something physiologic we're uh replacing something physiologic we're we're we're taking something that is uh we're we're taking something that is uh you know outside of the Realms of that you know outside of the Realms of that creatine would be an example right creatine would be an example right should you be taking creatine every day should you be taking creatine every day well again you're clearly taking more well again you're clearly taking more than the body normally would take in than the body normally would take in second question then is second question then is are you taking this because you believe are you taking this because you believe it will positively impact lifespan or it will positively impact lifespan or health health span if lifespan is it doing it through span if lifespan is it doing it through a specific mechanism that targets a a specific mechanism that targets a specific disease for example I'm taking specific disease for example I'm taking this supplement because I believe it this supplement because I believe it will lower my risk of cardiovascular will lower my risk of cardiovascular disease which is a cause of mortality so disease which is a cause of mortality so that should increase lifespan um or are that should increase lifespan um or are you taking this because say me it might you taking this because say me it might not have
27:00
not have any uh bearing on any disease but it any uh bearing on any disease but it might improve my quality of life to might improve my quality of life to which I then say Okay bracket it as which I then say Okay bracket it as physical cognitive physical cognitive emotional the next question is do we emotional the next question is do we know the mechanism of action again you know the mechanism of action again you don't have to get the quote unquote don't have to get the quote unquote right answer to each of these questions right answer to each of these questions but if you go through this it becomes but if you go through this it becomes really easy at the end to go this is really easy at the end to go this is probably probably nonsense the next question is what are nonsense the next question is what are the safety data what do I know about the the safety data what do I know about the production of this actual molecule and production of this actual molecule and how has it tested in animals and in how has it tested in animals and in humans uh and how sure can I be about humans uh and how sure can I be about its Purity because again the problem its Purity because again the problem with supplements is they're not with supplements is they're not regulated regulated so there can be anything in a bottle so there can be anything in a bottle there is no regulatory oversight so you there is no regulatory oversight so you are putting an unbelievable amount of are putting an unbelievable amount of faith in a company that has no reason to faith in a company that has no reason to even if they're not trying to harm you
28:00
even if they're not trying to harm you they have no reason um to to sort of tow they have no reason um to to sort of tow the line that for example a drug company the line that for example a drug company does and then lastly how do you put this does and then lastly how do you put this all together in a risk reward Matrix of all together in a risk reward Matrix of tradeoff Right Where You assess the tradeoff Right Where You assess the certainty by which you think the certainty by which you think the efficacy is there the safety is there efficacy is there the safety is there and honestly I think when you go through and honestly I think when you go through this logic you realize there aren't the this logic you realize there aren't the list of supplements that a person should list of supplements that a person should noodle taking is pretty pretty low great noodle taking is pretty pretty low great thanks um so as you think about these thanks um so as you think about these tactics and the fact that you talked tactics and the fact that you talked about output being important a lot of about output being important a lot of this is very measurable blood tests you this is very measurable blood tests you know devices that we wear things like know devices that we wear things like that um so in this field that's like that um so in this field that's like sort of increasingly dominated by data sort of increasingly dominated by data how do you balance taking in all this how do you balance taking in all this data with just intuition and how you data with just intuition and how you feel yeah that's a great question and feel yeah that's a great question and and it's I think it's different for and it's I think it's different for different people different people like I guess because I'm an engineer I
29:00
like I guess because I'm an engineer I actually like data yeah um I don't mind actually like data yeah um I don't mind it I don't get overwhelmed by it I I it it I don't get overwhelmed by it I I it sounds silly but I I would bet that half sounds silly but I I would bet that half this room can appreciate this like it's this room can appreciate this like it's just fun like I like spreadsheets I like just fun like I like spreadsheets I like Excel more than I like PowerPoint and Excel more than I like PowerPoint and word that's just the way it is it's word that's just the way it is it's always going to be that way and um and always going to be that way and um and therefore I I really therefore I I really enjoy modeling things enjoy modeling things I love coming home from a ride and I love coming home from a ride and downloading the data and looking at it downloading the data and looking at it but if there's someone in this room but if there's someone in this room who's listening who says what the hell who's listening who says what the hell are you talking about that's totally are you talking about that's totally fine you don't need to do any of that fine you don't need to do any of that nonsense sometimes there are certain nonsense sometimes there are certain things where if you once in a while pay things where if you once in a while pay attention to it it will help guide you attention to it it will help guide you so for example there's a type of so for example there's a type of exercise that I talk about is being very exercise that I talk about is being very important it's called Zone to cardio important it's called Zone to cardio training so when you're we all training so when you're we all understand I think that cardio training understand I think that cardio training is important but it has to be done at
30:00
is important but it has to be done at different intensity levels and there's a different intensity levels and there's a low energy system um that we describe a low energy system um that we describe a Zone to and there's a very technical Zone to and there's a very technical definition to explain what it means and definition to explain what it means and it has to do with the way the it has to do with the way the mitochondria is working but most people mitochondria is working but most people don't care they just want to know how don't care they just want to know how intense should I be exercising to hit intense should I be exercising to hit that level well if you're me you that level well if you're me you actually every single day check your actually every single day check your lactate levels while you're doing the lactate levels while you're doing the workouts by poking yourself in the workouts by poking yourself in the finger to get that number but very few finger to get that number but very few of my patients do that and nor do I care of my patients do that and nor do I care that they do it or want them to do it that they do it or want them to do it but I do care that they know if they're but I do care that they know if they're in zone too so at the other end of the in zone too so at the other end of the spectrum if you're not willing to use spectrum if you're not willing to use the gold standard which is measuring the gold standard which is measuring lactate and you don't even really want lactate and you don't even really want to get crazy about wearing a heart rate to get crazy about wearing a heart rate monitor which would be sort of the next monitor which would be sort of the next way to help do it you can just rely on way to help do it you can just rely on What's called the rate of perceived What's called the rate of perceived exertion and if you don't want to learn exertion and if you don't want to learn the Borg scale which is fine you you can the Borg scale which is fine you you can just do something very simple which is
31:00
just do something very simple which is am I able to speak while I'm doing this am I able to speak while I'm doing this albeit difficulty y great if the answer albeit difficulty y great if the answer is you can talk you just don't want to is you can talk you just don't want to talk but you can talk in a complete talk but you can talk in a complete sentence you're in zone two if you can't sentence you're in zone two if you can't talk in a complete sentence you're in talk in a complete sentence you're in zone three or four if you can talk and zone three or four if you can talk and it's quite easy you're in zone one so it's quite easy you're in zone one so that becomes a really simple way and that becomes a really simple way and honestly I think you can do this for so honestly I think you can do this for so many things um and I I think that um you many things um and I I think that um you know like for example wearables for know like for example wearables for sleep are very popular are they sleep are very popular are they necessary no I don't think they're necessary no I don't think they're necessary at all and I think frankly necessary at all and I think frankly they can cause a lot of anxiety for they can cause a lot of anxiety for people especially when the data are people especially when the data are wrong which depending on the wearable wrong which depending on the wearable they're wrong quite a bit um and so they're wrong quite a bit um and so people will wake up and they'll be like people will wake up and they'll be like I feel fine and then they'll look at I feel fine and then they'll look at their sleep date and they'll be like oh their sleep date and they'll be like oh my God I didn't get good sleep last my God I didn't get good sleep last night and um you know I mean I I night and um you know I mean I I interviewed a guy by the name of tday interviewed a guy by the name of tday pogacha I don't know if any of you know pogacha I don't know if any of you know who tday is so um he made a great point who tday is so um he made a great point on the podcast which is his coaches will
32:00
on the podcast which is his coaches will not let him see those Data before he not let him see those Data before he goes out in races or trains because they goes out in races or trains because they don't even want the suggestion to him if don't even want the suggestion to him if something looks negative that he's off something looks negative that he's off because one he might not even be off and because one he might not even be off and even if he is who cares like that's you even if he is who cares like that's you know so so I I think one has to be know so so I I think one has to be mindful of the interpretation of data mindful of the interpretation of data like like today my Readiness data were very today my Readiness data were very high Sunday it was very high Sunday it was very I had a killer workout crushed it today I had a killer workout crushed it today on the bike today my Readiness data was on the bike today my Readiness data was amazing I had worst ride I've had in amazing I had worst ride I've had in three months wow yeah like just three months wow yeah like just something was totally off so I see something was totally off so I see enough of that to realize that the data enough of that to realize that the data can be right 80% of the time that's not can be right 80% of the time that's not a high enough Precision that I should a high enough Precision that I should live my life by it it's more just a live my life by it it's more just a curiosity got it thanks so um you're a curiosity got it thanks so um you're a busy guy you're a you know a husband busy guy you're a you know a husband father physician podcaster writer father physician podcaster writer entrepreneur all these things um and and
33:00
entrepreneur all these things um and and lots of people watching and here in the lots of people watching and here in the room today go through seasons of life so room today go through seasons of life so what are the elements that are sort of what are the elements that are sort of the non-negotiables and when can you you the non-negotiables and when can you you know Flex to allow for That season of know Flex to allow for That season of life to prioritize other things that may life to prioritize other things that may you know arise new baby new job new you know arise new baby new job new health diagnosis health diagnosis Etc I would really like another baby but Etc I would really like another baby but my wife has said no so unfortunately my wife has said no so unfortunately we're down to our we have three but we're down to our we have three but um I think um I think this is difficult um I think um I think this is difficult I don't pretend to have a great Insight I don't pretend to have a great Insight here honestly I think this is kind of here honestly I think this is kind of the eternal struggle um I think the eternal struggle um I think the I think the cruestv treat money in the future as less valuable than money
34:00
less valuable than money today we can't do the following exercise today we can't do the following exercise I can't say I'm 51 today from now until I can't say I'm 51 today from now until I'm 61 two things are simultaneously I'm 61 two things are simultaneously true and I wish I could switch them so true and I wish I could switch them so unfortunately the next decade of my life unfortunately the next decade of my life is the most productive decade of my life is the most productive decade of my life to work that's just the nature of the to work that's just the nature of the fact that you know my brain still works fact that you know my brain still works uh my work is relevant you know all the uh my work is relevant you know all the reasons that anybody would feel that reasons that anybody would feel that like this is still a a good time to be like this is still a a good time to be in my career uh it's also the most in my career uh it's also the most important decade when my kids are in the important decade when my kids are in the house I have three kids in the house and house I have three kids in the house and for the next 10 years at least one of for the next 10 years at least one of them will be in the them will be in the house so I really wish I could work 30 house so I really wish I could work 30 or 40 hours a week for the next 10 years or 40 hours a week for the next 10 years and then when they all leave go back to and then when they all leave go back to working 60 hours a working 60 hours a week but it doesn't really work that way week but it doesn't really work that way because in 10 years nobody's going to because in 10 years nobody's going to know who I am and I'm going to be know who I am and I'm going to be irrelevant and I could do all the work irrelevant and I could do all the work in the world I want it's not going to in the world I want it's not going to matter like I this is the only matter like I this is the only opportunity I have to do this and I'm opportunity I have to do this and I'm sure many people can kind of relate to sure many people can kind of relate to that but I don't just want to kill
35:00
that but I don't just want to kill myself and do 80 hours a week even myself and do 80 hours a week even though I'm physically capable of it though I'm physically capable of it because when my kids are gone as you because when my kids are gone as you probably all know there's a statistic probably all know there's a statistic that uh children will spend 19 years on that uh children will spend 19 years on average in the company of their parents average in the company of their parents and the first 18 of those 19 years are and the first 18 of those 19 years are the first 18 years of their life so once the first 18 years of their life so once they go to college you get a grand total they go to college you get a grand total of 365 days with your kids as adults of 365 days with your kids as adults that statistic terrifies the hell out of that statistic terrifies the hell out of me and honestly it's the greatest in my me and honestly it's the greatest in my life which is there's a part of me that life which is there's a part of me that literally wants to do nothing but play literally wants to do nothing but play baseball and chess with my boys and ride baseball and chess with my boys and ride bikes and play soccer and goof off like bikes and play soccer and goof off like I I could literally just do that all day I I could literally just do that all day but I can't so how do I balance it and I but I can't so how do I balance it and I I don't I don't know the answer other I don't I don't know the answer other than I feel like at least by knowing than I feel like at least by knowing that and being aware of it I'm doing a that and being aware of it I'm doing a better job than I used to five years ago better job than I used to five years ago yeah that's great and maybe we'll pull yeah that's great and maybe we'll pull on that thread a little bit and talk on that thread a little bit and talk about emotional health so um in the book about emotional health so um in the book you share a personal story about you you share a personal story about you know the importance of emotional health
36:00
know the importance of emotional health and how while we age physical and and how while we age physical and cognitive abilities are just Destin to cognitive abilities are just Destin to decline but uh as we get older we can decline but uh as we get older we can actually improve our emotional health actually improve our emotional health can you talk a little bit about just the can you talk a little bit about just the subject yeah I mean I think it's a subject yeah I mean I think it's a difficult subject to talk about because difficult subject to talk about because you know it it now we get so far outside you know it it now we get so far outside of my I have no professional experience of my I have no professional experience right so I can talk about exercise I right so I can talk about exercise I talk about cardiovascular disease talk talk about cardiovascular disease talk about these things about these things and I I can speak to them and I I can speak to them outside my sphere of of experience but outside my sphere of of experience but when I talk about this I'm I'm mostly when I talk about this I'm I'm mostly just talking about myself and and just talking about myself and and obviously what I've learned from my obviously what I've learned from my patients um but it is true and I think patients um but it is true and I think that's that's that's even for people that's that's that's even for people like myself who struggle with mortality like myself who struggle with mortality which I do I if if I think about it a which I do I if if I think about it a lot it's still a struggle it's still lot it's still a struggle it's still hard to wrap my mind around the finitude hard to wrap my mind around the finitude of life um and it's of life um and it's on the one hand I feel like how lucky
37:00
on the one hand I feel like how lucky are any of us to exist right just are any of us to exist right just statistically speaking no one should be statistically speaking no one should be here and then the fact that we actually here and then the fact that we actually exist now as opposed to 500 years ago exist now as opposed to 500 years ago 5,000 years ago 50,000 years ago I mean 5,000 years ago 50,000 years ago I mean that's insane oh and then the fact that that's insane oh and then the fact that we exist in the United States or in the we exist in the United States or in the developed world as opposed to subsaharan developed world as opposed to subsaharan Africa like I mean that's insane so you Africa like I mean that's insane so you have you have all of these things that have you have all of these things that are inredible and yet somehow we still are inredible and yet somehow we still feel robbed by the fact that we don't feel robbed by the fact that we don't get to live forever and this is you can get to live forever and this is you can appreciate this in the Zeitgeist right appreciate this in the Zeitgeist right this do not die we cannot die we must be this do not die we cannot die we must be immortal I mean we all of us struggle immortal I mean we all of us struggle with this one way or the other but if with this one way or the other but if you then come back to reality you you then come back to reality you realize well you know barring some realize well you know barring some miracle and maybe we can talk about what miracle and maybe we can talk about what some of those Miracles might be um our some of those Miracles might be um our health span physically and cognitively health span physically and cognitively slows I mean I it's they've already slows I mean I it's they've already slowed so much for me that it's
38:00
slowed so much for me that it's frustrating um but to think that this frustrating um but to think that this other one area doesn't have to where other one area doesn't have to where your relationships with others your your relationships with others your relationship with yourself can actually relationship with yourself can actually get better as you age kind of like wine get better as you age kind of like wine that to me is both hopeful but also that to me is both hopeful but also gives motivation to work on that thing gives motivation to work on that thing just as we would work on delaying the just as we would work on delaying the decline of the other things yeah so can decline of the other things yeah so can you share a little bit more about you you share a little bit more about you know you've you've been studying the know you've you've been studying the field of longevity for quite some time field of longevity for quite some time can you just share a little bit about can you just share a little bit about like wisdom and aging and how you think like wisdom and aging and how you think you know age enriches one's you know age enriches one's life life well I don't think that's necessarily or well I don't think that's necessarily or automatically the case right I mean I automatically the case right I mean I think that for some people it probably think that for some people it probably is but I think for other people it has is but I think for other people it has to be somewhat deliberate and I guess to be somewhat deliberate and I guess that's sort of my argument with the that's sort of my argument with the centenarian de cathlon which is every centenarian de cathlon which is every once in a while you'll come across the once in a while you'll come across the story of a person who's 100 years old
39:00
story of a person who's 100 years old and there is spry as a 75-year-old and and there is spry as a 75-year-old and we're like what's your secret what's we're like what's your secret what's your secret and but a lot of the times your secret and but a lot of the times is there's no secret it's luck like is there's no secret it's luck like there's going to be outliers out there there's going to be outliers out there um so so so luck is not a strategy um so um so so so luck is not a strategy um so preparation is the strategy and preparation is the strategy and therefore I don't draw a lot of therefore I don't draw a lot of inspiration from the people who just got inspiration from the people who just got there by luck I I kind of look at the there by luck I I kind of look at the people who had to overcome something to people who had to overcome something to get there physically get there physically whatever whatever um look I think the single most um look I think the single most important thing is just introspection important thing is just introspection like if you cannot be honest with like if you cannot be honest with yourself about your yourself about your shortcomings you you're never going to shortcomings you you're never going to grow I mean that's that's just full stop grow I mean that's that's just full stop all day when I you know if I think about all day when I you know if I think about the single biggest impediment to the single biggest impediment to happiness in a person's life it's when happiness in a person's life it's when they can't acknowledge their own they can't acknowledge their own mistakes they can't acknowledge how mistakes they can't acknowledge how they're actions are impacting other
40:00
they're actions are impacting other people there's until that changes you people there's until that changes you you you can't begin to kind of um create you you can't begin to kind of um create a new pattern of behavior yeah there's a a new pattern of behavior yeah there's a phrase that we use that you know the phrase that we use that you know the best leader is the self-aware leader so best leader is the self-aware leader so it's just an element of self-awareness it's just an element of self-awareness it sounds like an it sounds like an introspection um kind of building on introspection um kind of building on that one of the things that I think that one of the things that I think people really admire about you is that people really admire about you is that you're not afraid to sort of change your you're not afraid to sort of change your mind on subjects that you've studied and mind on subjects that you've studied and maybe held an opinion about and then maybe held an opinion about and then then you you go back on it um I know the then you you go back on it um I know the book took you quite some time to it book took you quite some time to it almost didn't even come to to life we're almost didn't even come to to life we're glad that it did but are there any glad that it did but are there any practices or insights that you didn't practices or insights that you didn't include in the book or that have changed include in the book or that have changed since you've written since you've written it yes many um where to begin how long it yes many um where to begin how long do we have um I would say I mean just do we have um I would say I mean just just on the on the Pharma side um I just on the on the Pharma side um I think two think two two things that um I've changed my mind
41:00
two things that um I've changed my mind on quite a bit um I used to have a on quite a bit um I used to have a pretty negative view on Metformin in um pretty negative view on Metformin in um modestly healthy people who were modestly healthy people who were exercising so someone with a little bit exercising so someone with a little bit of insulin resistance usually measured of insulin resistance usually measured by you know higher levels of fasting by you know higher levels of fasting glucose so high if your glucose is high glucose so high if your glucose is high in the morning the only place it came in the morning the only place it came from is the liver right you haven't from is the liver right you haven't eaten in 10 hours your muscles can't put eaten in 10 hours your muscles can't put any in the Circ ation so if your glucose any in the Circ ation so if your glucose in the morning is 110 Mig per Deiter in the morning is 110 Mig per Deiter that is a hepatic glucose output problem that is a hepatic glucose output problem and there's one drug that treats that and there's one drug that treats that really well and it's called metformin really well and it's called metformin but I've always had the view that well but I've always had the view that well metformin because it it um it inhibits metformin because it it um it inhibits part of the mitochondria and that's how part of the mitochondria and that's how it activates uh well and we don't to get it activates uh well and we don't to get into all that but I've always thought into all that but I've always thought well not a great idea I also know that well not a great idea I also know that we see a slight increase in serum we see a slight increase in serum lactate levels in people taking lactate levels in people taking metformin even when they're not
42:00
metformin even when they're not exercising I just thought that you know exercising I just thought that you know it was doing something in the muscle it was doing something in the muscle that I didn't like and actually I that I didn't like and actually I recently learned that no that's not true recently learned that no that's not true I looked at a tracer study and realized I looked at a tracer study and realized that um that metformin can only get that um that metformin can only get taken up into cells through something taken up into cells through something called an organic cation transporter and called an organic cation transporter and it only exists in the liver so all of it only exists in the liver so all of that lactate elevation we're seeing is that lactate elevation we're seeing is in the liver not in the muscle not it's in the liver not in the muscle not it's not from muscle production of lactate not from muscle production of lactate and so that's a silly and small example and so that's a silly and small example but it is an example of where I am more but it is an example of where I am more liberal now with the use of Metformin um liberal now with the use of Metformin um a more topical discussion might be a more topical discussion might be around the use of glip 1A so again when around the use of glip 1A so again when these drugs came out 10 years ago these drugs came out 10 years ago actually um the second generation one actually um the second generation one came out 10 years ago that was when I came out 10 years ago that was when I first learned about them um I didn't first learned about them um I didn't think much of them and they quite think much of them and they quite frankly didn't have much efficacy for frankly didn't have much efficacy for weight loss it wasn't until four years weight loss it wasn't until four years ago that the diabet data for semaglutide ago that the diabet data for semaglutide showed how effective they were for showed how effective they were for weight loss um and we began to start
43:00
weight loss um and we began to start using them sparingly in patients and I using them sparingly in patients and I was still a little bit skeptical uh was still a little bit skeptical uh which I don't think is a problem I think which I don't think is a problem I think it's good to be skeptical but it's good to be skeptical but um I really just felt like one it wasn't um I really just felt like one it wasn't possible to maintain muscle mass while possible to maintain muscle mass while you were on these things and two there you were on these things and two there were a bunch of other things that I were a bunch of other things that I thought would be negative side effects thought would be negative side effects but I I just think with the emergence of but I I just think with the emergence of more and more data and now that we're more and more data and now that we're seeing generation uh generation five seeing generation uh generation five data so the fifth version of this that's data so the fifth version of this that's not out yet um the data look better and not out yet um the data look better and better and better and I'm really better and better and I'm really believing we are this is a major turning believing we are this is a major turning point in um in how we think about point in um in how we think about metabolic disease and now frankly to me metabolic disease and now frankly to me it's not even a qu now it's just a it's not even a qu now it's just a question of Economics now it's just a question of Economics now it's just a question of can we tear down the pbms question of can we tear down the pbms and get rid of them all together so that and get rid of them all together so that Americans don't have to get gouged on Americans don't have to get gouged on the price because the truth of it is the price because the truth of it is guys a monthly Supply of tepati is 300 guys a monthly Supply of tepati is 300 bucks so when a patient pays a, 700 of
44:00
bucks so when a patient pays a, 700 of that is going to their employer through that is going to their employer through the PBM and a cash rebate I want every the PBM and a cash rebate I want every American to understand that this if if American to understand that this if if I'm going to die on a cross one day it's I'm going to die on a cross one day it's that cross I want the American public to that cross I want the American public to understand how corrupt the pbms are and understand how corrupt the pbms are and how they are literally stealing money how they are literally stealing money from American workers to cross- from American workers to cross- subsidize back to drug companies and to subsidize back to drug companies and to their employers so um people say well their employers so um people say well these drugs are so expensive we're never these drugs are so expensive we're never going to be able to manage the 42% going to be able to manage the 42% obesity rate at that price point and obesity rate at that price point and you're right at that price point we you're right at that price point we can't but if we actually paid what can't but if we actually paid what everyone else in the world pays for them everyone else in the world pays for them without our without our um bureaucracy around um this system I I um bureaucracy around um this system I I think we start to have better think we start to have better opportunity yeah um I promised a opportunity yeah um I promised a question on just metabolic health and I question on just metabolic health and I think that's a good sort of entrance think that's a good sort of entrance into it so there was a study published into it so there was a study published last week I know we always have to take last week I know we always have to take these things with a grain of salt but it these things with a grain of salt but it effectively suggested that obesity is effectively suggested that obesity is just at a crisis Point uh in the US and
45:00
just at a crisis Point uh in the US and that the disease burden associated with that the disease burden associated with that is just massive on our society what that is just massive on our society what sort of like cultural or societal shifts sort of like cultural or societal shifts do you think need to take place to help do you think need to take place to help address this well you could you could sort of think about that question in many ways think about that question in many ways right the right the the the the first way you can think the the the first way you can think about that is the why like what changed about that is the why like what changed so much in the last 50 years that the so much in the last 50 years that the rate of obesity has gone from roughly rate of obesity has gone from roughly 10% to 40% and type 2 diabetes has gone 10% to 40% and type 2 diabetes has gone from 1% to 10% by the way that's a more from 1% to 10% by the way that's a more startling statistic is the log fold startling statistic is the log fold increase in type 2 diabetes in the last increase in type 2 diabetes in the last decade um and I suspect the reason that decade um and I suspect the reason that there's so much debate around this is there's so much debate around this is that it's not one thing and that when we that it's not one thing and that when we when you when you have many things that when you when you have many things that are conspiring against you um you're
46:00
are conspiring against you um you're always going to have different Arguments always going to have different Arguments for well it's it's all uh big egg like for well it's it's all uh big egg like it's you know it's the glyphosate in the it's you know it's the glyphosate in the in the wheat or it's the sugar or it's in the wheat or it's the sugar or it's the uh electronics or it's you know the the uh electronics or it's you know the hyper palatability of food or the fat or hyper palatability of food or the fat or the the salt um the inactivity the stress the salt um the inactivity the stress the reduction in sleep and the truth of it reduction in sleep and the truth of it is it's probably all of the above and is it's probably all of the above and you need three of the eight to sort of you need three of the eight to sort of kick you off on the wrong path like I'm kick you off on the wrong path like I'm making this up right but you can imagine making this up right but you can imagine a model where okay there were 10 a model where okay there were 10 potential things out there that trigger potential things out there that trigger obesity and diabetes and once you obesity and diabetes and once you accumulate three or four of them you're accumulate three or four of them you're 80% of people are on the way there 80% of people are on the way there genetically and um and in a system like genetically and um and in a system like that it's very difficult to identify and that it's very difficult to identify and then Target from a policy perspective then Target from a policy perspective what you're going to do about it um but
47:00
what you're going to do about it um but like I it's not clear to me that even if like I it's not clear to me that even if you took some of the most egregious you took some of the most egregious offenders like if you just taxed sugar offenders like if you just taxed sugar would this get better I think the answer would this get better I think the answer is no it wouldn't like I just don't I'm is no it wouldn't like I just don't I'm not I'm not convinced that any sort of not I'm not convinced that any sort of uh solution like that's going to work so uh solution like that's going to work so um I I can certainly um I I can certainly imagine scenarios where if you had imagine scenarios where if you had perfect control over a population in an perfect control over a population in an autocratic world you could you could autocratic world you could you could make Draconian changes that would impact make Draconian changes that would impact it but that's just not even a trade-off it but that's just not even a trade-off that's even worth talking about because that's even worth talking about because nobody wants to deal with what the other nobody wants to deal with what the other consequences of that are so one of the consequences of that are so one of the most remarkable things about being in most remarkable things about being in the United States is that we're a the United States is that we're a consumerist society like we we we we consumerist society like we we we we want it bigger we want it faster we want want it bigger we want it faster we want it now we want the best we want well it now we want the best we want well okay that comes at a cost yeah um and okay that comes at a cost yeah um and anybody who's been to other parts of the anybody who's been to other parts of the world where we don't see the same world where we don't see the same obesity rates realize it's totally obesity rates realize it's totally different culture different culture totally different culture so it sounds
48:00
totally different culture so it sounds like a like a copout answer but it's the same reason copout answer but it's the same reason why us Healthcare is twice as expensive why us Healthcare is twice as expensive as everyone else is it really comes down as everyone else is it really comes down to the fact that we are the greatest to the fact that we are the greatest consumers on earth now again the consumers on earth now again the question is what can we do about it or question is what can we do about it or what should we do about it and I think what should we do about it and I think the answer is we should do something the answer is we should do something about it because it's if you're not about it because it's if you're not swayed by the economic cost of it which swayed by the economic cost of it which is significant you should be swayed is significant you should be swayed maybe by the personal cost of it um and maybe by the personal cost of it um and I think the personal cost is high I I think the personal cost is high I think the suffering is is real uh and I think the suffering is is real uh and I kind of reject this idea that obese kind of reject this idea that obese people are just gluttons and Slots like people are just gluttons and Slots like I I think that's just such a dumb I I think that's just such a dumb argument um and I I just don't think argument um and I I just don't think anybody wakes up and says what can I do anybody wakes up and says what can I do today to be more overweight like I I'd today to be more overweight like I I'd really like to double down on my type really like to double down on my type two diabetes how can I do it um and two diabetes how can I do it um and maybe this is getting a little too maybe this is getting a little too philosophical but I also kind reject the philosophical but I also kind reject the willpower argument a little bit I also
49:00
willpower argument a little bit I also think that's a little bit genetic I mean think that's a little bit genetic I mean that's a very unpopular thing to say that's a very unpopular thing to say among High achieving individuals but among High achieving individuals but like everybody says God Peter you have like everybody says God Peter you have insane willpower and it's like yeah but insane willpower and it's like yeah but I don't think I did anything to get it I don't think I did anything to get it like it it was it's carved into my chip like it it was it's carved into my chip like that that's the chip was built that like that that's the chip was built that way so uh it's very difficult for way so uh it's very difficult for someone who's got that chip set to look someone who's got that chip set to look at the other person and sort of say why at the other person and sort of say why aren't you like this um so so all of aren't you like this um so so all of this is to say I'm very excited about this is to say I'm very excited about these pharmacologic options and I think these pharmacologic options and I think they should be a part of a solution but they should be a part of a solution but I also think people should be exercising I also think people should be exercising more and eating better because I think more and eating better because I think they will feel better and I think they they will feel better and I think they will perform better and I think they will perform better and I think they will enjoy their lives more so I'd like will enjoy their lives more so I'd like to kind of see the whole thing done um to kind of see the whole thing done um but it's it's that's not a that's not an but it's it's that's not a that's not an easy thing to do because it's part easy thing to do because it's part policy part culture uh part structure policy part culture uh part structure yeah thanks um okay we're going to move yeah thanks um okay we're going to move to Q&A because we have about 10 minutes to Q&A because we have about 10 minutes left and uh we had some uh questions
50:00
left and uh we had some uh questions submitted from online so I'm going to submitted from online so I'm going to read one of those first and then we'll read one of those first and then we'll move to live questions in the room so move to live questions in the room so Brent from Dallas asks uh given ai's Brent from Dallas asks uh given ai's potential to transform Health Care in potential to transform Health Care in many ways from drug Discovery to Patient many ways from drug Discovery to Patient Care and access what do you see as ai's Care and access what do you see as ai's biggest potential to change the way that biggest potential to change the way that practitioners transition to Medicine 3.0 practitioners transition to Medicine 3.0 and what can companies like Google do to and what can companies like Google do to accelerate this process accelerate this process oh that's a that's a tougher question oh that's a that's a tougher question than the one I hope you were going to than the one I hope you were going to ask which is where where is AI going to ask which is where where is AI going to help medicine um but that said you know what the way to help practitioners transition to 3.0 to help practitioners transition to 3.0 is get a bunch of the 2.0 stuff off is get a bunch of the 2.0 stuff off their plate so I think there were um their plate so I think there were um there are a couple of big areas where there are a couple of big areas where where AI can and should help where AI can and should help practitioners today so the administ any practitioners today so the administ any of you married to Physicians and listen
51:00
of you married to Physicians and listen have to listen to them gripe about it have to listen to them gripe about it over yeah and again this is not over yeah and again this is not something I deal with because we're in a something I deal with because we're in a private practice we don't take insurance private practice we don't take insurance we're not dealing with but but if you're we're not dealing with but but if you're in the system that most doctors are in in the system that most doctors are in the administrative burden of your job the administrative burden of your job is generally regarded as the most is generally regarded as the most unrewarding aspect of the unrewarding aspect of the profession and the the something that profession and the the something that started out as hey this is good the EMR started out as hey this is good the EMR like this is going to make medicine like this is going to make medicine better um has become so onerous and so better um has become so onerous and so user hostile that most doctors who are user hostile that most doctors who are still in this system of hey this is what still in this system of hey this is what I do I I have 11 minutes to see 40 I do I I have 11 minutes to see 40 patients each you know um they're patients each you know um they're getting mired down in in sort of the getting mired down in in sort of the charting aspect of this then you layer charting aspect of this then you layer on top of that the the Recon ilation and on top of that the the Recon ilation and adjudication of charges remember there's adjudication of charges remember there's something in the United States
52:00
something in the United States Healthcare System that is just hard to Healthcare System that is just hard to Fathom it's not just that it's a 4 half Fathom it's not just that it's a 4 half trillion dollar system if you can just trillion dollar system if you can just wrap your head around that for a moment wrap your head around that for a moment it's that 15% of that 4 and a half it's that 15% of that 4 and a half trillion is purely administrative trillion is purely administrative friction there's no other Health Care friction there's no other Health Care system in the world because they're all system in the world because they're all single-payer systems that has to have a single-payer systems that has to have a 15% friction tax that's the first thing 15% friction tax that's the first thing AI should be solving there's no value AI should be solving there's no value being created there there's no patient being created there there's no patient life that's being made better physician life that's being made better physician experience that's being made better um experience that's being made better um so even though that's not sexy we love so even though that's not sexy we love to talk about folding proteins and that to talk about folding proteins and that is super cool um and that will shorten is super cool um and that will shorten the path to drug Discovery but take the path to drug Discovery but take 15% of the cost of Health Care Away by 15% of the cost of Health Care Away by taking the friction and brain damage taking the friction and brain damage away of reconciliation adjudication away of reconciliation adjudication charting that would be huge I think charting that would be huge I think another place where I hope AI can be another place where I hope AI can be really helpful and this isn't
53:00
really helpful and this isn't necessarily going to impact Physicians necessarily going to impact Physicians is um we do have to come up with a is um we do have to come up with a better way to do not just drug Discovery better way to do not just drug Discovery but drug testing um we have to come up but drug testing um we have to come up with better biomarkers that can predict with better biomarkers that can predict success in late stage drugs because if success in late stage drugs because if you if you look at Alpha fold right it's you if you look at Alpha fold right it's pretty amazing in that you're going to pretty amazing in that you're going to get to an IND quicker than you would get to an IND quicker than you would have before have before but then guess what you still have to do but then guess what you still have to do phase one phase 2 phase three that's phase one phase 2 phase three that's still more than a billion dollars in 10 still more than a billion dollars in 10 years so to short cut that and increase years so to short cut that and increase the probability of success there you the probability of success there you have to be able to predict in Phase One have to be able to predict in Phase One success in phase three better and and we success in phase three better and and we we right now are have such poor we right now are have such poor biomarkers for nuanced things right we biomarkers for nuanced things right we we cannot measure syence we can't we cannot measure syence we can't measure M Tor activity there's a whole measure M Tor activity there's a whole bunch of stuff we just have no clue bunch of stuff we just have no clue what's going on and therefore we're not what's going on and therefore we're not even trying to develop drugs that would even trying to develop drugs that would Target those systems I could go on but I
54:00
Target those systems I could go on but I think those are just two opposite end think those are just two opposite end examples from the totally benal to the examples from the totally benal to the totally sci-fi right thanks for that all totally sci-fi right thanks for that all right so we will take a few questions right so we will take a few questions from the room um and for purposes of the from the room um and for purposes of the recording I'll repeat the question recording I'll repeat the question before you answer thanks thank you for before you answer thanks thank you for the book I think you have us all eating the book I think you have us all eating more protein and working on strength more protein and working on strength training um my question was not to get training um my question was not to get too political but obviously we have a um too political but obviously we have a um someone who's been nominated for the someone who's been nominated for the health secretary uh has some interesting health secretary uh has some interesting ideas and more controversial if you were ideas and more controversial if you were to be nominated like what were like the to be nominated like what were like the two or three things that you would want two or three things that you would want to focus on to help make this country um to focus on to help make this country um healthier again can I repeat the question sure okay great thanks so the question is uh okay great thanks so the question is uh if Peter were to be nominated to u a if Peter were to be nominated to u a government position where he could sort government position where he could sort of wave a wand and uh make change happen of wave a wand and uh make change happen and make us all healthier what would and make us all healthier what would that look
55:00
that look like well I think the wand waving would like well I think the wand waving would be putting me in that position that's I be putting me in that position that's I mean if you said we put you in that mean if you said we put you in that position and you get a wand it's too position and you get a wand it's too easy a question I can do of course um easy a question I can do of course um look the truth of it is I've never given look the truth of it is I've never given that any thought so I don't I I don't that any thought so I don't I I don't want to answer with something stupid um want to answer with something stupid um if if I were in that role I'd literally if if I were in that role I'd literally put my head down for the first six put my head down for the first six months and interview a million people CU months and interview a million people CU I it's I just I think that's a super I it's I just I think that's a super hard problem the problem I have spent hard problem the problem I have spent more time thinking about is how do you more time thinking about is how do you fix health care cost that's a problem I fix health care cost that's a problem I think a lot about I don't know how much think a lot about I don't know how much of that falls under the uh authority of of that falls under the uh authority of of HSS um HHS human health HHS of HSS um HHS human health HHS um but I've already alluded to what I um but I've already alluded to what I would love to see happen structurally would love to see happen structurally right I think um you know more AI on the right I think um you know more AI on the service side more AI on the um service side more AI on the um administrative side eliminating the pbms
56:00
administrative side eliminating the pbms cuz remember 1ir of that 4.2 billion is cuz remember 1ir of that 4.2 billion is drug and device and the devices don't drug and device and the devices don't cost much compared to the drugs so so cost much compared to the drugs so so like our our goal with with healthc care like our our goal with with healthc care should be U we just have to reduce should be U we just have to reduce Healthcare cost inflation so Healthcare Healthcare cost inflation so Healthcare used to be 5% of GDP it's now 18% of GDP used to be 5% of GDP it's now 18% of GDP and it's Rising 2 to 3% faster than GDP and it's Rising 2 to 3% faster than GDP growth so it's going to be 20% growth so it's going to be 20% then it's going to be 30% and at some then it's going to be 30% and at some point we just go bankrupt so um if we point we just go bankrupt so um if we could get healthare cost growth to be could get healthare cost growth to be lower than GDP growth there'll be a day lower than GDP growth there'll be a day where healthc care could only be 10% of where healthc care could only be 10% of GDP we're actually in line with the rest GDP we're actually in line with the rest of the world um so anyway that's where I of the world um so anyway that's where I would probably put all my effort and would probably put all my effort and that's at least that would be the first that's at least that would be the first place I would go uh and then of course I place I would go uh and then of course I would you know have to come back to you would you know have to come back to you in six months with some other ideas as in six months with some other ideas as in regards to autoimmunity I feel like in regards to autoimmunity I feel like there's been a lot of data about it there's been a lot of data about it increasing thousands of percentage increasing thousands of percentage points over the last 5 years what are
57:00
points over the last 5 years what are your opinions on low do alen and other your opinions on low do alen and other peptides such as thos alpha 1 and thos peptides such as thos alpha 1 and thos beta 4 on reversing beta 4 on reversing autoimmunity autoimmunity wow really putting me to the test um wow really putting me to the test um okay so the question is about the rise okay so the question is about the rise uh exponentially in autoimmune disorder uh exponentially in autoimmune disorder and very specific drugs that have been and very specific drugs that have been prescribed to help reverse that trend prescribed to help reverse that trend there so you know as far as nxone goes there so you know as far as nxone goes uh obviously that's a that's a that's a uh obviously that's a that's a that's a drug that exists on the market today so drug that exists on the market today so this is kind of an off Lael use of it if this is kind of an off Lael use of it if it's used in lowd dose and um you know it's used in lowd dose and um you know just to be clear not my specialty but we just to be clear not my specialty but we have patients who have you know been on have patients who have you know been on protocols where it seems to have been protocols where it seems to have been somewhat successful so I think there's somewhat successful so I think there's some evidence to suggest that lowd do n some evidence to suggest that lowd do n trone is um um potentially something trone is um um potentially something viable that a rheumatologist should be viable that a rheumatologist should be considering in the treatment of autoim considering in the treatment of autoim your second part of your question really your second part of your question really is about peptides right so you mentioned
58:00
is about peptides right so you mentioned a couple um and one of the challenges we a couple um and one of the challenges we have is that uh last September so like a have is that uh last September so like a year and a bit ago um the FDA basically year and a bit ago um the FDA basically struck down the sale and distribution of struck down the sale and distribution of peptides in the United States and um so peptides in the United States and um so that created a little bit of a problem that created a little bit of a problem which is that now they're still being which is that now they're still being sold but done with a a wink sold but done with a a wink which means the companies that sell which means the companies that sell peptides are selling them for research peptides are selling them for research purposes only and the people who buy purposes only and the people who buy peptides are buying them for research peptides are buying them for research purposes only to use on themselves but purposes only to use on themselves but there's no regulation so we're back in there's no regulation so we're back in that same problem we were in with the that same problem we were in with the supplements where I would just have a supplements where I would just have a really hard time telling a patient with really hard time telling a patient with a straight face like that's a good a straight face like that's a good peptide to take because if I can't vouch peptide to take because if I can't vouch for it right like if I can't do the lcms for it right like if I can't do the lcms on the molecule and make sure that two on the molecule and make sure that two things are true what it says is in there things are true what it says is in there is in there and nothing that's not
59:00
is in there and nothing that's not supposed to be in there is not in there supposed to be in there is not in there it's very dangerous um I do believe that it's very dangerous um I do believe that there are a handful of peptides out there are a handful of peptides out there that really have biological there that really have biological efficacy um I'm not sure that thymosin efficacy um I'm not sure that thymosin is the I mean again I'm just not close is the I mean again I'm just not close enough to it to to to to weigh in on the enough to it to to to to weigh in on the specifics of one peptide versus another specifics of one peptide versus another but I certainly know that like for but I certainly know that like for example bpc 157 look it's a VF analog I example bpc 157 look it's a VF analog I can I can see a case where that would can I can see a case where that would really be a valuable peptide when really be a valuable peptide when someone's recovering from a certain type someone's recovering from a certain type of injury but again and maybe this goes of injury but again and maybe this goes back to your question like I'd like to back to your question like I'd like to create a better regulatory framework create a better regulatory framework where we can actually study these things where we can actually study these things because the one thing that really because the one thing that really bothers me is a morass of uncertainty bothers me is a morass of uncertainty that allows people to profit at the that allows people to profit at the confusion of others and that is the confusion of others and that is the current regulatory environment for current regulatory environment for peptides it is just a boondoggle for peptides it is just a boondoggle for people to to rip people off and some people to to rip people off and some people might get something good and some people might get something good and some people might not and some people get
1:00:00
people might not and some people get hurt and I find that very hurt and I find that very frustrating I think uh actually we have frustrating I think uh actually we have to close we're at the end of the hour um to close we're at the end of the hour um sorry we we're uh out of time here but sorry we we're uh out of time here but Peter thank you so much uh for joining Peter thank you so much uh for joining us today for sharing your work uh for us today for sharing your work uh for the book and just for all the knowledge the book and just for all the knowledge that uh that you shareed I'm sure it's that uh that you shareed I'm sure it's been extremely helpful to everybody here been extremely helpful to everybody here today and will continue to be so well today and will continue to be so well thank you so much for having me thanks thank you so much for having me thanks [Music]
