What Medicine is Getting WRONG, with Dr. Peter Attia! | Mayim Bialik's Breakdown

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Where most people are dying today is of chronic diseases.

And where most people are suffering today is from an erosion of health span.

So even if we are incrementally eking out a few more years of lifespan, which...

Technically, we're not.

Actually, lifespan is retreating a little bit in the United States.

I think we're down to about 76 and a half years or so.

So we've had a significant retreat in large part on the back, unfortunately, of opioid epidemics.

Medicine would be better served. if it changed the metrics of interest.

So if you go to your doctor, they might simply be putting out fires that are right in front of them.

If you only have seven minutes or 10 minutes or 14 minutes with a patient, it's very difficult to do anything proactive, let alone to take an interest in real health span related issues.

The single most important resource that an individual needs take control of their life and improve their longevity is knowledge and time.

It doesn't mean that money doesn't matter.

It just doesn't rank in the top two.

So it's really important that people understand that race wealth, celebrity status don't rank very highly in that hierarchy.

Here's the good news.

The knowledge is at this point free.

Literally, it is free.

We have these things called podcasts.

They are free.

Knowledge at this point is not the bottleneck.

The bottleneck is truly time.

It's Mayim Bialik's breakdown.

She's gonna break it down for you.

Because you know she knows a thing or two.

So now she's gonna break down.

It's a breakdown.

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Healthcare just got less painful.

Hi, I'm Mayim Bialik.

And I'm Jonathan Cohen.

And welcome to our breakdown.

This is a place where we break things down so you don't have to.

Today we have an exceptional guest who is the ultimate breakdowner of all breakdowners.

Today we're talking to Dr Peter Attia, who you may know from the Drive podcast and from his book Outlive, which he got to talk to Oprah for.

And it's just become a just enormous success.

It's such a fascinating book.

He's also the founder of Early Medical, which is a medical practice that applies the principles of what he calls Medicine 30, with the goal of lengthening lifespan and improving healthspan.

He's going to talk about that with us today.

The book is Outlive the Science and Art of Longevity.

But I have to say, don't think I've heard...

Dr Atiyah go this deep as to his motivation for wanting to help people outlive and also his personal reasons for embarking on this line of work, which has impacted millions and millions of people.

He got his medical degree from Stanford.

He's actually Canadian.

Shout out to all you Canadians.

This guy is yours.

He got his medical degree from Stanford.

He trained for five years at Johns Hopkins in general surgery.

And... at the end of his residency, decided to walk away and start a new path.

And he's going to talk to us all about that.

He's going to talk about psychedelics.

He's going to talk about trauma.

He's going to talk about his personal experience with a mental health journey that almost led to this book not coming out, as well as what to eat, how much of it and why we should care about moving our bodies.

It's really an honor to welcome Dr. Peter Attia to The Breakdown.

Break it down.

We're exceptionally excited to talk to you.

As many people in the podcast universe are.

We're enormous fans of what you've done, what you've built and how you communicate.

And so we're just really thrilled and honored that you agreed to speak with us.

We've been wanting to speak to you for a long time.

And Jonathan basically lives your book.

And that has made me both excited and frustrated with him over the years that we've been doing what we do here.

But we're just really excited to talk to you.

So thank you.

Yeah, thanks very much for your interest.

There's many places that we could start, but I have your book right here and I've dog-eared certain things that I hope to get to.

But I wonder if you can talk to us a little bit about where your path diverged from that of a Stanford-trained medical doctor who could have spent his life, you know, seeing patients every seven minutes.

Where did your path kind of... diverge from what could have been kind of a standard medical journey?

Um, probably, uh, during my fifth year of residency.

Um, so this is you know.

After you finish medical school, you then go off and specialize in something.

And for that part of the it was really, you know, there were moments in there where, you know, and I talk about a couple in the book where I became quite frustrated, but you know, the rubber sort of met the road when at the end of that fifth year I decided not to return and frankly decided to not just, you know, go and do something different, but rather to leave medicine altogether.

And So I went and joined a consulting firm and had nothing to do with medicine for very many years.

What did you discover in those years that you kind of stepped away?

Well, I mean, I think truthfully, I couldn't have been happier.

I think a lot of people said to me, boy, you're really going to regret this.

You know you've already invested 10 years into this, between medical school and your training to date.

You know, you're just, sort of miserable because of residency and it's not really about medicine.

And, you know, there were just a lot of people saying that this would be a mistake.

And I never felt that way at all.

I mean, I couldn't have been happier when I was gone and I felt much more intellectually stimulated.

And I was, you know, I felt like a kid in a candy store again.

I was just, like you know, insatiable learning from day one, in part because I went to do something that wasn't healthcare related right,

So I had to basically start from scratch and learn an entire new industry and play catch up with all the Stanford Harvard MBAs.

And I just, I don't know, it was just pure bliss to me.

So I just learned, I think, and one thing I learned right away was how much I missed learning in a sort of problem solving way.

That wasn't just kind of a rote algorithmic way.

What are we getting wrong about how we practice medicine?

And obviously health 30 and this revolution that you, you know, have been a pioneer in, and that's exactly what your book, you know, is kind of outlining.

But I wonder if you can explain in kind of lay person's terms what are we getting wrong about the way we're training people to become doctors?

Well, I think there are probably many things in there that are somewhat related, but not the same.

Um, But I start with probably the more important question, which is what's wrong with the current system?

And maybe it's worth starting with what's right with the current system, right?

Because the current system, the Medicine 20 system, was obviously an evolution to the first one, Medicine 10.

And without kind of explaining all of that, I'll give folks a reason to read the book.

But what medicine 20 did really well and still does very well is take care of acute problems.

Um, and if you, you know, think about how we were dying 150 years ago.

Um, those means of dying don't happen anymore, right?

I mean, infant mortality is vanishingly small, if not non-existent in the developed world.

Um, you know immunizations vaccinations antibiotics, critical care, these things have fundamentally changed human life expectancy to the tune of 2x right.

So we've literally doubled human life expectancy.

I mean even hygiene, like wash your hands before you stick them inside a body when you're operating on it.

Right.

Semmelweis, be damned.

Okay, so it did all of that stuff right.

But now let's talk about what is it doing wrong.

And I think what it's doing wrong stems from what it measures.

And you know the saying, what gets measured gets managed.

And medicine 20, either rightly or wrongly, when it chose to make its step function, leap forward was focusing on lifespan.

That was the metric of interest.

And when lifespan was being truncated due to infectious and communicable diseases.

The problems that it was solving were geared towards addressing those issues.

But the problem is, here we are today, 100 years later, and we've largely solved those problems.

You know, to a first order approximation.

But where most people are dying today is of chronic diseases.

And where most people are suffering today is from an erosion of health span.

So even if we are incrementally eking out a few more years of lifespan which you know, technically we're not actually lifespan is retreating a little bit in the United States.

I think we're down to about 76 and a half years or so.

So we've had a significant retreat in large part on the back, unfortunately, of opioid epidemics.

I was just going to say, I think actually women, I think, are still about four years ahead.

We just pulled ahead a little bit more because of opioid, which is just a devastating statistic as well.

Yeah.

But... our health span is deteriorating all the while.

And so this is a long-winded way of saying I think medicine would be better served if it changed the metrics of interest.

So if you go to your doctor, I'm pretty sure they're not asking you.

I'm sure they're not measuring your grip strength, your VO2 max, other modes of cognitive performance and things like that.

Instead, they're looking out for risks of hopefully, chronic disease at best.

But they might not even be doing that right.

They might simply be putting out fires that are right in front of them.

You alluded to the sort of seven minute repertoire earlier.

And the truth of it is, if you only have seven minutes or 10 minutes or 14 minutes with a patient, it's very difficult to do anything proactive, let alone to take an interest in real health span related issues.

Well, and I think one of the things... And also, I grew up... I'm a Kaiser kid.

My parents were public school teachers.

So you know, I had the best health care that could be offered to literally the people educating the future of America, which was really, really challenging.

You know, it was a very large, you know, very kind of scary bureaucratic system.

And you know I managed to find, you know, doctors that you know, I liked and like.

Some were actually like members of our synagogue who happened to be doctors there.

So like, at least it was like a familiar face.

But you know, when I talk to a lot of people who are part of the medical system that many of us have to participate in, many people don't want to go and they don't want to hear what the doctor has to say.

And a lot of it centers around what your book and your platform are exactly tackling, which are the things such as how tall you are versus how much you weigh, the kind of diet you're eating, the amount of exercise, or lack thereof, that you are encouraging yourself to get your sleep patterns like some really basic stuff that I think many doctors want to talk about.

Why don't people want, and I know you can't fix everything, but I kind of think you can.

Why don't people want to hear the kind of answers that you are providing?

Well, that's an interesting question.

I thought you were going to go somewhere else with that question.

I thought you were going to go in the direction of why aren't doctors able to help their patients in those capacities?

That was my follow-up question.

Okay.

Let's answer that one first, because it's the first thing that came to my mind, which is, I think actually a lot of doctors do want to, but there are two impediments to it.

The first is a knowledge impediment.

All this stuff that I've learned about nutrition and exercise and sleep, emotional health and frankly, much more different uses of pharmacology and disease prevention.

None of those things were taught in medical school or postgraduate training.

So people like me and there are many doctors who know the same sort of things.

I know we had to learn that stuff on our own outside of formal training.

And to do that, you have to make some sacrifices, which I don't think everybody is able to make.

Um, just just from a practical standpoint vis-a-vis, you know, the time away from actual work to learn these things.

Um, and also my personality, I'm just a bull in a China shop.

Like I'm constantly, I don't believe that.

I think you're just a big softy.

That's right.

Yeah.

No, I mean, I never hesitate to reach out to somebody if I need to know something.

And I'm just a, you know, I'm a walking sponge, but not everybody has that personality.

And not everybody is willing to be as aggressive in the acquisition of knowledge.

The second point is insurance doesn't reimburse for those things.

And ultimately, that is the real issue, right?

If you want something to be managed, not only do you have to measure it, you have to reimburse for it.

So that's the fundamental and structural problem that needs to be addressed if we're going to flip from medicine 20 to 30.

Now to your question.

Look, I think we're also kind of conditioned and need to take some personal responsibility for this.

In the world of ultra comfort, which is, you know frankly, we've just become accustomed to not having to do hard things.

And medicine has enabled that, right?

Because we've got a pill for everything now.

And I think pills are really valuable.

I think pills solve a lot of problems.

But if you consider something you alluded to a second ago, like depression and psychiatry, I think the evidence is pretty clear that pills alone don't work that well.

And that if you want a pill to work and some of those pills really have the potential to work it has to be combined with some other form of psychotherapy and really hard work.

And, you know, that's just kind of one example.

But, you know, look, MindBalance Breakdown is supported by Odoo.

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A lot of people.

People are happy to take a testosterone shot, but they're not necessarily happy to work out.

People want Ozempic, but they're not necessarily happy to, you know, exercise more and change their dietary patterns.

So I think that's part of the problem is the most important things that we can do.

Don't fit in a pill.

Exercise being, I think, the foremost example of that.

It really has the potential to do more to lengthen life and improve quality of life, which is the good news.

The bad news is you can't just take a pill for it.

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Healthcare just got less painful.

You just said something that really kind of made my ears perk up.

The first thing you said is that you know there's a certain amount of sacrifice involved for physicians to leave the system to try and better the system.

And you know one of the things that You know.

I'll be honest, you know, as a person who seeks the support of a functional medicine doctor, you know utilizes all of the privilege that I have simply because Western medicine in the classic allopathic sense failed me.

It failed my autoimmune condition.

It failed trauma.

It failed depression, anxiety.

Like it failed everything, all the places, and I'm grateful you know, in the most painful way to be able to, you know, try and engage with other components of the medical world to try and heal.

But one of the things that happens is an elitist, you know kind of cloud floats over this kind of approach.

And I don't mean you in particular, but this is part of especially like I live in Los Angeles, where everybody assumes that the things we do are only for white, rich celebrities, which is not the case,

You know, plenty of non-rich, non-white, non-celebrities do the crazy things that I do.

But I wonder if you can speak a little bit to how we start dispelling that kind of resistance that a lot of people have to this notion of medicine as something different from either punch the clock, do your seven minutes with a doctor you don't like and don't know who doesn't really know you, or just kind of like eat whatever you want, do your best, like drink and do drugs because it numbs you out, and then get mad if you get sick.

Yeah.

Sorry, but can you tackle that first?

Yeah, no, and I understand your question.

I think it's a bit, because I don't think that you're arguing that that's the way it is.

So what I would say is I think that people who argue that that's the way it is are thinking very superficially and they don't understand the nuance.

So the nuanced answer is the single most important resource that an individual needs to take control of their life and improve their longevity is knowledge and time.

It doesn't mean that money doesn't matter.

It just doesn't rank in the top two.

So it's really important that people understand that race wealth, celebrity status don't rank very highly in that hierarchy.

So in other words, I'm conceding that you need knowledge.

Nobody comes out of the womb knowing what to do on this front.

So somehow one needs to acquire the knowledge.

Well, here's the good news.

The knowledge is at this point free.

Literally, it is free.

We have these things called podcasts.

They are free.

You can listen to Peter Attia and 10 other people that are out there kind of talking about these things right?

I've got a newsletter.

It is free.

Yes, the book probably cost 20 bucks, but in the grand scheme of things, knowledge at this point is not the bottleneck.

The bottleneck is truly time.

Now one could argue and I think there's a fair argument to be made that there is some socioeconomic difference in time.

But I'll tell you, looking at my patients who are on the top end of the socioeconomic curve, They seem just as busy, if not more busy, than the people I meet at the lower end of the curve.

Now, a lot of that's self-imposed.

I'm not saying that they need to be working.

There's a lot of spin classes to go to and smoothies to purchase.

Well, no, no.

I'm saying like they were working 80 hours a week, not because they need to, but because they've chosen to.

And we still have the same discussion, is my point, which is you're telling me that you're running two companies and you're too busy to exercise.

And I'm telling you, This is your window to do something about it, because at some point it won't be voluntary anymore.

So this is kind of a long-winded way of saying the single most important resource that an individual needs, once you take into account the free acquisition of knowledge, is time.

And that's the one that I probably spend the majority of my interaction with patients talking about, which is, You know.

OK, tell me how much time you are willing to spend on your health in a week.

How do we make use of that?

How do we best make use of that?

What's the minimum effective dose within your constraints?

And this is where I think you see the greatest variability between people.

I think there are people who are willing to say look, I'm willing to put 15 hours a week of my time into my health.

And there are other people who say, look, it's going to be four hours a week.

What can you do?

And you can do something with either of those.

But obviously, you can do more with 15 hours.

So I think it's important for people to understand that nobody should be listening to this discussion and thinking well, you know, if I'm not rich or famous, like you know, I'm hosed because it's just categorically untrue.

I really I appreciate that clarification.

And I also wonder if you have any sort of insight, you know, not necessarily from your practice, but just sort of as a observer of humans.

Many people will only be motivated by something devastating.

Like, that's just like a thing, right?

Like, I'm not making this up, right?

Like, my father of blessed memory had multisystem atrophy, which is a horrible way to die.

And indeed, it's a horrible way to die.

But you know, a lot of the tools that would have been helpful for him in his dying were things that he was never motivated to pursue.

And by that I mean lowering anxiety depression, like you know, like all of the mental health blah blah, blah.

But one of the things that I find so powerful about your book, your platform and also this notion in particular of like, move your effing body, is why we feel the need to wait until it is literally too late.

And then it is too late is sort of what you are trying to prevent, correct?

Because this is what you believe as a human being you can bring to the human race.

I mean, I'm not overstating it.

Yeah look, there's probably some really.

You know strong evolutionary basis for why we tend to focus on immediate gratification at the expense of long term.

You know solution.

Right.

That's.

I think we see that in the way that you know.

People do or don't save for retirement choices that are made in the short term.

We also know, by the way, that there's variability in that, right?

So not everybody is the same.

There are some people for whom it's just easier to think long term.

It's also easier in some areas than others, right?

For me, it's infinitely easier for me to think long term in terms of my physical body.

I mean I probably spend two and a half to three hours a week just working on corrective, preemptive movement strategies.

That to make my life easier when I'm 80.

I mean, again, for most people, that would be an absurd use of time.

For me, it's a perfectly reasonable use of time given my physical demands.

Conversely, I don't think I've ever said no to a chocolate in the now term, if it's a good chocolate, even though I know you know really that's not doing me any favors tomorrow.

So, you know, where I struggle with food, I have no struggle with exercise.

One of the things I do recommend that people do, especially as it comes down to the physical component of this, is spend as much time as possible with people in the last decade of their life.

I think this is a practice that would serve young people, middle-aged people very well, because there's probably a whole sociologic reason why that's valuable in terms of wisdom and accrual of information and things like that.

Yes.

I'm putting all of that aside for a moment.

I think it would be helpful to and I've done so much of this to to actually see what people are giving up in the last decade of their life and asking the question is that inevitable?

Or how much of that is inevitable?

You know, um, does it need to be that way for a decade or could it be that way for just a year?

Um, and For me and for people who I think are willing to engage in that type of activity, all of a sudden there is motivation to do some of this seemingly boring stuff that is, base building, foundation building, to make sure that when I'm 80 I'd really like to be able to sit on the floor to play blocks with a grandchild and stand up on my own.

That would be nice.

Even though, again, you can do that when you're 50 blindfolded.

But you have to watch a few 80-year-olds who can't even get up off a chair on their own, let alone get up off the floor on their own.

Do you feel like that's Well?

Okay, I'm going to drag Jonathan into this aspect of the conversation because Jonathan does like I said.

I think Jonathan is Peter Itzia, just in a very different skin.

I just wear a hat, though.

That's right.

I feel that a lot of this breeds a certain kind of anxiety.

And I'm wondering if you can help us, literally us, balance out this reckoning that you're talking about with how not to make that all you obsess about.

And I'm not saying, Jonathan, that you obsess.

Heaven forbid I accuse you of that.

But I think for a lot of people I mean even me kind of going through the book it's like I felt it rising in my chest.

You know, this like, I have to do that.

OK, I got to do that.

Like will I ever go out socially again?

If you know I'm working and coming home and feeding my kids and doing homework and helping them apply to college?

And then I'm like trying to do something for myself and then I have to eat.

And then like maybe I want to watch just like a documentary on Netflix like that.

It's making me anxious.

And I'd like you to make me not feel anxious.

This might take a little longer because it's not really my area of expertise.

If I had a nickel for every MD who said that to me.

We only have seven minutes, so we're going to see how far we can get.

I think I hear you.

I think I understand what you're saying, and I think it makes sense.

But I suppose it kind of comes down to how do you balance two opposing sides? views.

One view is I'm so myopically focused on the future that it's creating anxiety versus I'm going to completely ignore the future and just show up and rely on the force to get me through it.

Um, And I think we would both appreciate that neither strategy at the extreme makes sense, right?

So if the squirrel can't think about saving nuts for the winter, like if the squirrel is only able to focus on the nuts in front of them, the squirrel dies.

I am that squirrel.

Yeah, presumably.

If the squirrel only thinks about saving as many nuts as possible, he doesn't even have the chance to procreate in the present.

He basically also dies effectively.

Jonathan is that squirrel.

I was that person who started to be like, oh my God, there's all this free information.

And before I discovered The Drive, I discovered the Huberman Lab podcast and I started learning everything I could.

And I didn't realize there was Cliff Notes versions of these things.

And so I'm like taking notes and then I'm bringing them back to Mayim and I'm like we have to know this, and she's like i don't have a research team to like dive into all of this information.

Um, and then i discovered the drive and uh it's, it's awesome to speak to you, not only for the information, but also your voice is very calming.

I don't know if you've gotten that note zero people in my life will say that but i mean, maybe not outside the drive, but while you're listening to the drive.

You know the way that you're dissecting information.

I find very meditative um, And so then, all of a sudden, there's this wealth of information and I began to be like well, what do I prioritize?

You know how do what?

What are the like?

Oh, now I'm learning about um APO4 and genetic conditions.

And over here, I'm learning about testosterone production.

And over here, I'm learning about all the different metabolic things I need to know.

So I think you actually do a fantastic job.

And for our listeners, it may be helpful.

And I know you've done this on a ton of pods but, like the top, you know five things that we begin to prioritize before we, because it can be overwhelming, you know, and when we talk about the time and the balance between future forward and the immediate um.

As people dive into this and I've been an example of that I had to be like okay well, what am I going to do today?

And then what am I going to build into my routine?

And you know, especially as I'm watching your Instagram, and I think it was a couple days ago you were on your bike talking about VO2 max.

And I'm like, I'm not doing my VO2 max properly.

So I'm like adding to the list.

But I think that's where the overwhelm can come in.

One way to think about that, though.

I mean, and maybe this is just different people have different personalities.

I tend to look at something like that with a bit of glee, which is oh cool, I get to learn a whole new thing.

And I actually think I'm a bit envious of the situation you're in, which is you're still at the drinking from a fire hose stage of all this stuff and, like i miss those days, right like i'm, i'm getting drops under the faucet here, and they're valuable drops, um.

But you know, the rate at which i'm learning relative to a knowledge base has slowed.

That's just the nature of you know your maturity within, within a field.

So in some ways, your challenge is how do you prioritize all of this information you're being overrun with so that you can sort of say look, I literally listened to three podcasts today.

And especially if you're listening to Huberman and me, these are dense podcasts, right?

You're not listening to And then he has to listen to me after hours, like you can imagine.

So in that sense, I think that developing a framework makes it really easy, right?

The framework is what allows you, or at least it's what allows me, to always have a scaffolding for what I'm learning.

And I think that that's kind of what I tried to offer in the book, right?

And it's much more explicit in the book than in any podcast.

But the framework is what is our objective?

Our objective is to optimize longevity.

That means simultaneously doing two things, elongating lifespan and improving healthspan.

Okay, you can double click on both of those.

What does that mean?

To elongate lifespan means to delay the onset of chronic disease.

What are they?

Here they are.

There are a finite few number of those things.

And all we're trying to do is delay their onset.

We can't prevent them.

Let's be clear.

We are all going to die and we're going to die of diseases that we already know what they are.

Our goal is to delay the onset of those things.

Then you can start to think of okay, when someone says to you Hey Jonathan, I've got this new supplement.

You, you, rub this little Beetlejuice on your testes.

Like it's, it's really great.

You can think back to wait, sign me up.

How, how does that fit into the framework, right?

Is this something that is going to reduce the risk of a disease?

And if so, what's the mechanism by which it's doing it?

Or is it just nonsense that's, you know, typically being peddled, right?

Then you get into the health span side.

What are the three dimensions of health span, physical, cognitive, emotional, right?

So anyway.

So once you have kind of a framework in mind, you realize that all of this information you're being bombarded to can either fit into one of the bins or be discarded altogether.

And I think that makes it a little easier to stratify.

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Healthcare just got less painful.

You want to major in the major and minor in the minor.

So going back to what you said a second ago, what do you have to do today, right?

Like what are the most important things you have to do today?

Move, right?

That's a very high priority.

And even if it's a day of travel and it's, you know, or it's not your perfect day, or something is wrong, or your kid was sick overnight.

Yeah, great.

Those are all things in life that are going to happen.

Can't stop them.

But like, what's my accommodation today?

How am I going to prioritize moving, being active, being outside, even for a brief moment?

I couldn't agree more.

And just one point to add in here, which is, you know, when we spoke to Huberman, We said there's a playbook for the human body.

There's an owner's manual that most people don't know exists.

And so even moving somewhat, going outside somewhat, have these huge impacts on us to help regulate ourselves?

And a lot of what we think of as normal is not necessarily normal or inevitable.

And I just appreciate that message in all the different ways that it comes through to people.

And so to kind of get into some of these, you know the nuts and bolts, not to depress people, but physiologically speaking, most of us will die from some combination of you list them, but some combination of heart disease, the heart being clogged with things it ought not be clogged with.

We will die from basically eating too much of the kind of food that disrupts our ability to process sugar molecules.

Correct?

Diabetes type 2, those sorts of things.

And what am I missing?

We will die of neurodegenerative things, which is some sort of inevitable time bomb that will go off for a variety of reasons.

Yeah, I mean, the big three in order is atherosclerotic diseases.

So heart disease, stroke, rank number one by far.

That's followed by cancer.

And then the third big bucket is the neurodegenerative diseases and the dementing diseases.

So there's some overlap there, but there's some not.

So for example, Alzheimer's disease is the most common form of dementia.

It's also a neurodegenerative disease.

Whereas vascular disease, dementia is not a neurodegenerative disease, but it's still a very common form of dementia.

But if you just sort of put those diseases of the nervous system in a bucket, those become kind of your big three.

And then the fourth one, so I call these the four horsemen are the metabolic diseases.

And while they don't directly kill that many people right?

There's not many people in 2023 that are dying directly from type two diabetes, meaning on their death certificate it says died from type two diabetes.

That's very rare today.

Was more common before.

Today, it's very rare.

But most of the way we see metabolic disease amplified is through the others.

So if you have type two diabetes, your risk of Alzheimer's disease cancer, cardiovascular disease is 50 to 100 higher.

So that's the way in which metabolic disease is really killing people.

Is that it's just making them far more susceptible to the other three horsemen?

But, you know, that's what it comes down to, unfortunately.

And so you know, one of the things that I want to make clear is that you know you talk a lot about diet and nutrition without also saying that you have the definitive way that everybody needs to eat, and here's the Peter Atiyah meal plan, and you can order it online right now.

Do you know how many people have asked me when the Outlive cookbook is coming out?

I'm surprised that like I can't pay to have you cook for me on Zoom.

Like, you know, I'm sure people would love that.

But the kind of take home messages that I got you know from your book and from the research that you present in the book.

You know processed food is not something we should be eating a lot of.

And by and large, we eat too much.

Like our portions are killing us.

We eat too much and we eat too much of the wrong things.

Like that's legit the take-home message.

And that is no matter whether you're eating vegan keto paleo, like name, another thing, octo lacto, like whatever.

We are eating too much, and we are eating too much of the wrong things.

Like, does that feel like a safe take-home message in terms of diet and nutrition?

Yeah, and I think to help people understand why that might be the case, like why is it that a diet that's high in processed food, that's low in fiber, is more likely to be obesogenic?

It's frankly because it's not that satiating.

It's also because it contains and it's been engineered to make you want to eat more of it.

So, you know...

Look, I used to spend so much time in the nutrition world.

Unfortunately, I'm not anymore.

But I'm well versed in kind of the important discussions around isocaloric substitution of macronutrients, right.

Because that's just the fancy way of saying at the level of the calorie, does it matter where the calorie comes from?

Is a calorie just a calorie or not?

And the answer is it's complicated.

From an energy balance perspective, a calorie is indeed a calorie.

It's true that a thousand calories of broccoli and a thousand calories of Snickers bars have the same directionally, the same energetic property.

Now, technically that's not true because of the fiber in the broccoli, et cetera.

But that's a negligible difference that you're talking about.

Yeah, the bigger point is that, well, let's use something more realistic.

A thousand calories of French fries versus a thousand calories of baked potatoes.

Now, there's a fundamental difference.

And what is it?

The fundamental difference is when you eat that thousand calories of French fries, and for the purposes of research only, not for any enjoyment.

I've done this many times.

When you eat that thousand calories of French fries.

Your system of appetite regulation is completely hijacked, completely hijacked.

When you eat that thousand calories of plain baked potato, it's not hijacked.

And you know this flies in the face of what every kind of you know, I think diet guru would want you to believe, which is it's their diet.

Like, and by the way, I used to be on a very, very strict diet myself.

Now I'd like to think I had the belief system that it wasn't necessarily the best diet for everyone.

But the truth of it is, like, there are many ways to get the job done.

And, in some ways, the least satisfying thing you can hear turns out to be true.

Which is the best diet for you?

Is probably the one that most easily allows you to adhere to energy balance.

What does that mean?

Meaning you will eat it not to excess.

Now there's nuance and I go into it, right?

So we need to talk about protein.

We need to talk about the fats and all that stuff.

All of those things matter.

But your point is correct, which is the first order term in this equation is energy balance.

And it is the thing that is being most violated in the world today.

And that, by the way, is now a global problem.

It's not just kind of a US problem, obviously.

I like to say we've exported all of our favorite things.

Everyone in the world can have all the diseases we have now through our food.

I want to pivot a little bit to the latter part of your book, which I found very moving and very significant.

I'm going to read to you from your book, because that's something I like to do when I have people on, but it won't be long, so don't worry.

Not all suicides jump from bridges.

Many more people sort of slow roll into misery and early death via various roundabout routes, letting stress and anger erode their health, or falling into self-medicating addictions to alcohol and drugs, or engaging in other reckless life-endangering behaviors that mental health professionals call parasuicide.

This part of the book, as you described, is where you are not the physician, but you are the patient.

And you speak very candidly and in you know, really elegant terms about kind of a series of confrontations you had with yourself about how to tackle this aspect of health.

And I wonder if you can share a little bit about what you see as the significance of mental health in terms of overall health.

Look, I think it varies by individual.

So there are some people for whom it's just not playing that much of a role, right?

It's neither directly nor indirectly, even through you know, preventing them from doing what's in their own best interest.

I call that more of the indirect approach.

It's neither direct nor indirectly really impeding them.

And yet there are, for others, it's the primary issue, right?

And it could be directly.

So you've given some extreme examples of that, but it could be very indirect.

It could be, and I you know, A lot of this thinking or realization just comes from taking care of patients and having lots of time to get to know people and realizing wow, you know, you're constantly putting everyone ahead of yourself, right?

This is the typical phenotype for the overachieving mom.

You know, everyone comes ahead of you.

And boy.

On the one hand, that's really noble, but your own health is of such little concern to you that it's become pathologic.

And there's usually a reason for that.

And so that's an example of where you know emotional health, mental health, is impeding physical health at the individual level.

And then, of course, you know, there are these places, including my own example, where it gets to a level where it's even more significant.

And it's impairing your relationships, impairing your happiness.

And you know, I think, as I quote Esther Perel in the book, I mean it's sort of making the whole thing an ironic joke that you're.

You know, you're sort of doing all, you're checking all the other boxes of not dying as quickly.

And yet you're just basically prolonging misery.

You talk about two instances in your personal life where you do a very specific kind of dive into the world of mental health and your own kind of mental wellness.

Where do you see the integration of mind and body?

We're big fans of sort of mind-body syndrome features.

And by big fans, I mean I live almost every mind-body syndrome feature that there is.

You know I baffle many Western doctors, but when you speak to holistic practitioners or you speak to people who treat mind-body syndrome, they understand and they, you know, have different modalities that I believe have helped.

Where do you see that?

I mean because I'm just picturing also.

You spend so much time on your body and your physical wellness and all these things.

Where does your mind fit in?

Do you see them as connected?

Do you keep them separate?

No, they're certainly connected.

For whatever reason, I didn't really seem to experience any measurable or quantifiable negative impact physically from all of my mental health issues, probably with one exception, because it's too difficult to measure.

But I suspect it had to have been an issue.

And by the way, will remain an issue for the rest of my life.

It's.

I don't ever want anybody to come away from reading the last chapter of my book thinking like oh, now I'm like perfect.

I mean, I'm, you know, I'm an addict who struggles every single day.

And I make mistakes that not fortunately, not nearly the frequency I once did.

But I still really screw things up and have to fix things.

But point is, I suspect that the impact of cortisol you know, just a lifetime of hypercortisolemia probably has ravaged me.

And, by the way, it's probably still.

When I think of all of the endocrine disruptions in my body, I'm positive that cortisol is still the one that is least in an optimal state.

It's just, you know, unlike thyroid and sex hormones and things like that, it's just it's a much harder one to measure and truly quantify the damage it's doing.

But you know, as far as somatic things, which I think is what you're asking about, I think there's no doubt that these things exist.

You know I personally have no medical experience with it and therefore I kind of defer to experts on it.

But clearly I've seen it.

You know examples that are very profound to me.

Are you know, seeing patients who suffer from debilitating lower back pain that clearly waxes and wanes with their mental health?

So, you know, that's just one example, but it's probably a very common one.

Well, that's the classic Dr Sarno.

You know who was the first one to say like oh, some people have herniated discs and report zero pain.

And then some people have herniated discs and we operate on them and they're still in pain.

Can you speak?

I mean, I'm you know, there is this cortisol assay that my doctor had me do.

You know where you have to like spit you know into a little tube and you have to do it.

And you know, the diagnosis was that I am constantly operating in in fight or flight like, like it doesn't stop when I sleep and it kind of goes like.

That's just, I live in cortisol.

Can.

Can you speak about like if people don't know your story?

What does addiction look like for Peter Atiyah?

Yeah, I think, look, there were probably just two addictions whose seeds were sown very young.

And they both, you know, produced some reinforcements and some collateral damage.

And for whatever reason, my combinations of addictions which were, you know, kind of workaholism and perfectionism, being one.

And then, I think, anger being the other um, the balance was just such that I was able to kind of skate through life without, not only without consequence, but with like, a lot of reinforcement, because most of it was on the perfectionism and workaholism side.

Um, and yeah, Those are very well-rewarded phenotypes in the world we live in.

And, you know, it's really funny.

Have you watched that recent Netflix series on the Sacklers?

I think it's called Painkillers or something.

No, I've been nervous too, but no, I have not.

Yeah, it's very interesting.

I mean, look, it's a story that gets... It's hard to watch.

I'm not going to sit here and make a commercial for why you have to watch it.

No, I did Dope Sick and had to fast forward through a lot of the really painful addict stuff, but yes.

Yeah, so I was really struck by it because you know I when I had my first and second debilitating back surgeries back in 2000, they were botched.

You know, the surgeon operated on the wrong side.

It was a total disaster, right?

Um, not surprisingly, like I was put on Oxycontin like everybody else.

And not surprisingly, I mean, you develop a tolerance to that stuff and I was up to 80 milligrams three times a day, maybe more.

I mean, it might have been like 120 milligrams three times a day.

What does that feel like?

Can you describe what it feels like to need that?

You know, Oxycontin or opiates in general produce a remarkable high, right?

It is truly the greatest feeling I've ever experienced.

It's hard to describe what that euphoria feels like.

But what I distinctly remember was I knew the day that I realized I was taking it more for my emotional pain than my physical pain.

I knew because at the time I couldn't walk still.

And I was basically assuming I would never be able to do anything again and never wouldn't graduate on time from medical school.

I mean, all of this other stuff.

And I was just taking it to numb that emotional pain.

And that sort of freaked me out.

And I decided to stop cold turkey, much to the chagrin of my my girlfriend at the time, who was an anesthesiologist, who said you need to go on like an IV drip of nortriptyline.

If we're going to take you off is you're going to need a methadone taper.

And I was like, Nope, I'm just going to stop cold turkey, which I did.

And that had cataclysmic, ridiculous ramifications physiologically.

You mean you had to detox?

Oh, I went through the full withdrawal on my own, yeah.

But here's what kind of struck me when I went back and watched this movie, which was I watched all these people who didn't die or who did die right, who couldn't detox.

And I realized and you would probably appreciate this, I think as a neuroscientist, I'm not a morally superior person to them.

I'm just very fortunate that I never truly became addicted to narcotics.

So I had a physical dependency and I paid a price for that.

But it never got its hooks into me the way perfectionism and workaholism got their hooks into me.

And so I'm just a different kind of addict.

But it's just as bad as what those people in that movie are going through.

The difference is their addiction kills you much faster.

Their addiction is not socially acceptable.

It's really easy to see when somebody's spiraling out of control with a needle in their arm or snorting.

You know, broken oxy tablets.

Um, but you know, that, that just gave me, that just gave me, um, a sense of gratitude.

I suppose that I managed to escape.

Um, but but a realization that I think it was David Foster Wallace who said I mean, we're all addicts.

I was just, I literally was just going to say, I believe we are all addicts.

And, you know, this is where I'm really not the fun person at a party.

And you know, when I started studying neuroscience, I was the person who everybody would come to me with their CAG repeats and be like am I going to die of Parkinson's?

Like, am I going to get Alzheimer's?

You know, I was that person at parties and even in grad school when people would hear like oh, you're studying neuroscience.

Like, My, you know, my uncle had this and like my mom's dying of like I was that person.

Right.

And, you know, cut to like I had two kids.

I left the industry.

You know, I left academia.

I like started acting like whatever.

My life is insane.

And here we are.

But through my journey on a personal level and also kind of a scientific lens, I really believe that, like when I go to a party and I look around, it is hard for me to even watch people who think they're enjoying themselves, because I think they're just numbing out, because I know what's going on with them.

I know what they're dealing with.

I know what their parents are going through.

Like that's become a lens and it doesn't make it fun.

My kids are like, we're doomed.

They're like, the gene is in our family.

And mom talks about this all the time.

Right.

But that when I think about how you talk about food, you know when I think about how you talk about also.

You know our propensity to lethargy.

It's often being filled with something else.

You know how do you approach people kind of in your practice in your life with with that kind of lens.

I think it's exactly what you're talking about.

It's just saying, can you observe the areas in which you were numbing pain?

Like, let's not judge it.

Let's just identify it.

Can you figure it out?

I do it with food.

I don't do it with alcohol.

That's just a fact.

Like it's never once occurred to me to drink because I'm upset, but watch me tear through the pantry when I'm upset and you'd think the world was about to end.

So like, can you watch me shop on Amazon?

Like my life depends on it, right?

Like I know the things that I do to distract myself and to numb myself.

What do you buy on Amazon?

I want to know what Peter Atiyah buys.

Oh my God.

Well, first of all, as a true addict, I'm going to justify every one of them.

Just do it.

This is your time to do it.

Go.

All right.

You want to know this week?

Yeah, I do. all right, I bought six packs of lit nox.

So nox are the things that go on the end of arrows.

But I noticed that I'm running low on them and there is a sale.

So it's like, I mean, these things are normally 30 bucks a pack.

They were 25 a pack.

Not going to let that deal go away, right?

Saving money.

Makes sense.

Also, I wanted new tips for my arrows, new field points.

And I just, I wanted to go from, I wanted to basically take one 64th of an inch off.

So I needed to just buy a whole bunch more.

Yeah.

Let's see.

Oh, I also realized I probably needed more B12 methylfolate because I only have one extra bottle.

And again, I don't know.

I just sometimes have this irrational fear they're going to stop making them.

So I wanted to buy another three-month supply.

So I got that.

Sometimes they do stop making our favorite vitamins and then we're up the creek.

I use, uh, for my whole life I've used three by five cue cards to write my goals for the day.

And my daily goals are always written on a green card.

And then my weekly goals are written on a pink card and then yearly goals are on a yellow card.

And, um, I didn't like the shade of green that my current one was.

So I went on Amazon the other day and picked out a better one.

But you'll be paused.

I only ordered one pack.

And then when it came, I really liked it.

So then I just went the other day.

Then you got to order more.

I ordered all of them because these absolutely do go out of shape.

100%.

Yeah.

So anyway, this has been a week of numbing.

Was there something specific going on that you can identify?

You're like, Oh, that's what was stressing me out.

Or was it a generalized stress that was happening?

Very good question.

And I had um, I actually spoke with two of my therapists yesterday and um, to be honest with you, I'm struggling to identify what is going on because I I feel, at the surface, like everything is pretty fine.

And I do have a list of kind of yellow light behaviors that I'm always on the lookout for.

And very few of them are triggering.

So I'm not exactly sure.

I know that's not a satisfying answer, but I'm looking at it.

I think it's very helpful when we talk about understanding our behaviors.

You can see the downstream of your stress response, equaling Amazon cart purchases and then going backwards to see where the trigger is or what the yellow behavior is.

And it's not always totally clear, even to someone who is at this and has a professional help.

So I think it's helpful for people to know, hey, look for the downstream behavior.

It may lead you to what's up, but also it may just be an indication of an overall stress in the system.

Yeah, I'll tell you this.

It's very personal, but two weeks ago was the last time I had kind of a hiccup.

That was a great discussion for a therapist.

Which was this totally irrational feeling I had of wanting to show off to people who had rejected me when I was younger right,

So it was sort of, I was, you know, reconfronted with sort of childhood rejection.

And amazingly, I had this comical, immature desire to basically show off as much as possible in front of them, as if to say like look at me now.

You know, you did this to me then, but look at me now.

It's literally every minute of my life.

Like, I totally relate.

Yeah.

And the fantasies I was developing about what I wanted to do, not to harm anyone.

I'm saying how I wanted to portray myself.

And after three days of this I was like you literally have not had one moment of stillness where you have not been able to fantasize about this like this is now.

This really requires some therapeutic intervention.

It's so much more fun to hurt ourselves.

I mean, that's the thing.

You don't even need to plot revenge because like the easiest target is me.

I mean, that's how, you know, many of us are wired, especially if we have that perfectionism.

What I hear when you share that story is this idea of There isn't the stillness.

In order to have a sense of calm, usually we have to have a certain amount of stillness.

However, we get that.

And if we're revving at that higher level, it's going to come out.

In all these other areas.

You've spoken a lot about anger, which is, I actually think, one of the most socially acceptable, although it's still not acceptable to lash out at people.

It's almost the most socially acceptable male expression of emotion.

And I'm curious, as you looked at that, as you started to say, I don't want to behave like this and started to peel back and make adjustments, what was beneath that anger for you?

Um, it's almost always, um, uh, helplessness, right?

So I think um, there might even be a line in the book where, one of the very first times I met Terry real, who was uh, just an incredible therapist I worked with,

I think he was just kind of a throwaway line.

I remember him saying when we were talking and I was like scribbling in my journal, and he said 90 of male rage is uh, is or wouldn't say something like 90 of male rage to simply masked as you know, or over overlying male helplessness, or something to that effect.

Um, and I think that's really, really true.

When I think about the, the last time I got, you know, really upset at something it was.

It's so clear to me now that I felt a total loss of control of something that was genuinely potentially a bad situation, genuinely potentially a harmful situation.

My response should have been a 4 out of 10 in terms of.

In other words, I had every right to be angry, but it was 4 out of 10 anger.

But it was 9 out of 10 anger.

And so... that's, you know, therein lies the problem, right?

Which gets to how do you regulate that?

How do you slow things down?

And probably the most helpful.

I hate the word hack, but probably one of the most helpful tools that has factored into me being less destructive.

Again, I never want to represent that.

I'm like some guy who's got it all figured out and isn't, you know, walking around still wreaking havoc in his personal life from time to time, but I'm way less destructive.

And this, this trick was to detach behaviors from urges.

So when I, so, so again, like I, you know, I really like the lights being left off in the house.

I'm just kind of like one of those orderly people, right?

Well, when you have a house full of kids, it's not orderly.

So if I've told my daughter like 15 times, like when you're in the basement and you're done, like you got to turn the projector off, you got to turn the lights off and it's not done,

Like the fifth time.

I'm getting pretty angry.

But detaching behavior from urge says okay, it's okay to talk to her about that, but don't do it when you're angry.

So my urge is right now I want to talk about it, but I'm not going to do the behavior of talking about it.

And if I wait half an hour and I don't even have the urge to talk about it, but I set an alarm on my phone to go back and talk about it now?

It's a totally different discussion.

And it's a loving discussion.

It's not a belligerent one.

You're getting a need met versus just being propelled by the emotion.

And that's a huge shift.

Yeah.

I found that your discussion and kind of elucidation of trauma really concise and really appropriate for sort of the way I think many people may not think of framing it.

In particular, you talk about you know, many people think I don't have trauma.

And you know, on your list of sort of categories of trauma, obviously abuse, you know, is number one, meaning the thing that people think about.

Physical abuse, sexual abuse, also emotional and spiritual abuse, which I really appreciate that you included.

But you include other categories of trauma like neglect and And abandonment and meshment.

You know that's the blurring of lines between parent and child and witnessing tragic events.

Most people I know tend to minimize trauma and accuse me of catastrophizing every experience that I've had.

And this often comes lovingly from people.

But you know even my own therapist.

You know who I've been with.

I'm a psychotherapy believer so I've been with this person for over 20 years.

You know even she has to caution me from not kind of pathologizing every emotion, thought and you know intuition that I have.

But you know the, the way that you kind of talk about.

You know trauma as something that you know needs that comprehensive and understanding of places where there may be I don't want to say holes, but you know tender spots right.

That, that needs some sort of repair.

Um, You don't talk a lot about it, but it's something that kind of keeps coming up over and over again, no matter what physician we speak to, no matter what PhD we speak to in this field, the reprocessing of trauma keeps coming back and around to some aspect of spirituality.

And I'm not asking you to speak to religion.

I'm not asking you to speak to a religious experience.

I went to school with Sam Harris, so we've had this conversation both off camera and on.

But you know, you mentioned something in the book which has gained a lot of traction, which is psychedelic experiences, specifically in therapeutic environments.

And I'm not just talking about, like, let's do shrooms and see God.

Like, Mazel Tov, if that's what your life is about, that's great.

But in terms of getting people in touch with something spiritual, a notion of something greater than themselves.

I wonder if you can speak a little bit to is there a notion of spirituality as a healing component of any of these aspects that we talk about?

When we talk about trauma, when we talk about, you know deep, chronic depression, when we talk about, you know, terminal illness, does spirituality or that kind of connection play a role, either for you personally or in kind of the way you see this aspect of medicine?

Probably in some areas more than others.

So I would say, if we're going to go right to the crux of it where where, where would spirituality play the greatest role?

I think it is in helping us reconcile our finitude on earth.

And I think that that is the single biggest struggle that I, deep down, can't fully reconcile.

I can some days, but i can't some days, if i'm being brutally honest, right.

So there's like the intellectual side of it, which is and i've got great intellectual arguments for why even if i died today Or, you know, even if I was struck with a diagnosis today that was terminal, that would, you know, end my life in six months, I should be filled with nothing but gratitude.

Like I have the intellectual machinery and scaffolding to make that argument, you know, based on the fact that look, there have been 110 billion Homo sapiens born to date.

Think of where I rank in fortune amongst them.

What am I, at the top 0.0000001%?

I mean, I wake up thinking about you every morning.

No, no, but I'm saying like all of us are, right?

Like anyone who was born in the United States today, relative to anyone born over the last 250000 years.

Like we're so lucky.

It's ridiculous.

So if God forbid I was diagnosed with the worst disease on earth, like ALS today.

Okay, but that's the intellectual.

Yes, exactly.

That's the intellectual.

So, so how, so, so where, so you're asked about spirituality.

I mean, I feel like the closest I can come to understanding, that is, from a spiritual standpoint, is saying look um, it's part of the carbon cycle and I don't believe in a spirit per se.

I don't believe, I do believe that when I'm gone, I'm gone.

And I believe that I can't really understand what that means, but I know that some part of me is going to remain in my kids.

And that's probably the closest I can come to wrapping my head around this.

So I mean, I'm going to ask this a different way, if you don't mind, because this is really.

I love the way you're talking about this.

Do.

People who study the things that you do and people who make their lives about like legit outliving.

Are you afraid?

Are you afraid to die?

Are you afraid of the process, the inevitability?

Or is that not it?

Yeah, I talk about this briefly in the epilogue.

I think this, you know, this book came close to not being written so many times.

But the biggest issue was the processing of the information that ultimately became that final chapter.

It's really clear to me that when I started working on this book, which I think was 2016, it was mostly about running from death.

It really did become a book about how to live.

And that is what I think of this as an operating manual for how to live.

It's not a manual for how to not die, because we're going to die.

It's how do you live and how do you live better?

And am I afraid of the mechanics of death?

No.

I mean, fortunately, I think my rational brain covers me on the mechanics of death.

But, as I expressed a moment ago, I still express some sadness at the thought of not being around or being healthy enough to be functional with what will hopefully be grandkids or maybe one day, great-grandkids.

I think of the bliss involved in being a parent.

And maybe for people listening to this who don't have kids, a lot of this gets sort of sounds fuzzy and silly, but for me that's a great source of joy.

That's a remarkable source of joy.

So what do you make of people?

I've been sort of recently very interested in not just near-death experiences, but the kind of archetypal continuity over thousands of years of history of the things that psychedelic experiences produce intellectually and kind of conceptually and how they do connect to a lot of the sort of near-death experience, which again has been you know, catalog for a long, long time.

I'm curious... And I'm not looking for proof of God.

Like.

For me it's like I don't need to.

I mean, I can prove gravity in terms of like, I can run the equations and to me that's divine.

Like, I don't have an issue with, like, you need to explain God to me or not.

But...

I am curious if, especially because a lot of the therapy world that you explore does you know, look for kind of, you know, larger purpose, larger meaning,

It is where a lot of this like psilocybin research is going.

And I'm not talking about microdosing.

Again, like that's not my jam.

It's not.

I'm not interested really necessarily in entertaining that, but I'm talking about sort of like, when you get outside of yourself like is there, you know that notion, which you know for many people who have near-death experiences, literally guarantees for them that a safety, you know, in feeling that there's something eternal.

And look it's.

You know I come from a religious, cultural and ethnic perspective.

That's like very strange in terms of death.

Like we specialize in that ritual, you know.

But this notion that there's a spirit like that, there's a soul, you know, is something that you know.

When I gave birth to humans, there was something divine there that it was, you know, not quantifiable, you know it's just, it's not.

Do you have those experiences?

Have you thought about it in terms of you know when I talk about sort of like the near-death experience and you know the sort of psychedelic experience that people have?

Does that occur to you anywhere?

Does it mean anything to you as a physician?

Yeah, it does.

And I've had several psychedelic experiences, some of them positive beyond words and some of them awful beyond words.

And I would say that the places where I have more typically found myself agnostic lie more around trying to make sense of the stochastic nature of the universe.

Like.

It's much harder for me to explain exactly how our bodies exist purely through stochastic means.

So again, I certainly don't believe in a God in the way that I think is typically conceived and don't have a particularly strong spot in my heart for religion.

But at the same time, I would say I'd like to maintain at least some intellectual humility around the fact that I simply am not smart enough to make sense of how the universe came to exist and how we exist within it.

I think back to one of the worst psychedelic experiences I had.

Were these therapeutic?

Or were you just like tripping balls in Joshua Tree?

No, no.

This one was quite therapeutic.

But for whatever reason, I got into this very bizarre death loop.

And the only image that I could muster up was basically that I was at the bottom of a guillotine and the blade was dropping, but right before it would hit my neck it would stop.

And there's that sound that you can hear of the blade coming down and you're feeling like it's over, but then it stops.

But then that plate is a loop for about six hours.

So it was like six hours of almost dying over and over and over again.

Um, was that divine?

I don't know.

It's so bizarre to me that that would be an image that would play over and over and over again.

But then conversely, I've had other out-of-body experiences on the same molecule that have been incredibly positive, because they've given me an empathy for an individual who has hurt me in a way that I could have never had without it.

Well, and I don't mean to answer for you, but I also can't help but point out that you know the notion of whatever force.

This is as good or evil is as pointless to me as trying to decide if gravity is good or evil.

So, you know, when gravity, you know, allows me to not fly off the planet...

It's good, right?

And when I trip and fall and I crack my head on the sidewalk, it's bad.

That's simply not true, right?

So, again, not trying to insert myself into your guillotine fantasy, but...

You know also that notion that, and as a you know, as a person who's so, you know, into the brain and what it does, like whatever we, whatever is produced, whatever we produce, whatever we're experiencing to me is part of you know, the universe that I find myself in.

And sometimes there's horror and terror and death and destruction and people get sick who shouldn't.

Also, I don't know what was happening in your life at that time, but there is a lot of symbolic nature in psychedelic experience, with the notion of death as a rebirth.

So, you know, was there a transition happening in your life?

Were you looking at some form of emotion or behavior that was sort of crashing down?

It sounds like six hour loop is obviously excruciating.

I mean, I had a kid in half that time.

Like I thought that was intense.

Can I do a rapid fire with you?

Just because I would love to see what you say to some quick questions.

This is rapid fire with Dr. Peter Attia.

What was your mother right about?

That I had no desire to be happy growing up.

What was your father right about?

A lot of people are lazy.

Location that promotes your best mental health?

Maui.

Do you have a mantra or like a saying that you like?

Here I go.

Who's been your best spiritual teacher?

Sam Harris.

Oh, I love that.

Do you have a moment of best intuition? like a time of day or an actual experience?

No, I just like, I don't know.

Yeah.

Like um, you know, Matthew McConaughey said, like the second, that his future wife entered the room, but you know, I don't know if it was leaving medical.

You know, leaving after residency.

I don't know.

Sometimes people are like, that was the moment that I knew.

I, I, I'd have to borrow from Matthew.

It wasn't the moment I met her.

It was um a day before the wedding when I wanted to call it off, presumably because I was scared out of my mind.

And I decided against my better judgment, I thought, to go ahead with it.

Point being, I'm really grateful that I married my wife and I'm really grateful that I wasn't so stupid to walk away.

Who are you most competitive with?

Myself.

And what do you know to be true?

I'm absolutely obsessed with my kids.

Peter Atiyah, it has been such an honor to talk to you.

We've really been looking forward to this and appreciate your candor and your intelligence and your awesomeness.

We're so appreciative and thank you so much for being here.

Well, thank you guys.

Again, I really appreciate this.

It was a lot of fun.

Okay, Jonathan, I have to apologize to you.

I owe you a prompt amends.

I feel like you introduced me to somebody at a party.

And I didn't let you talk to them, even though they were your friend.

And I just talked to them the whole time.

You had a lot to say.

I had many things I needed him to answer.

Look, we didn't get to a lot of stuff that... You wanted to know if you should eat meat or not.

I wanted to ask him about the need for protein as balanced by all the information that is out of the blue zones, the people who live to be centurions, and how they're calorically restricted and eat a ton of protein rice and vegetables, mostly in beans, and have very little meat.

And yet in all the modern health literature it talks about the need for, like the amount of grams of protein per your body weight.

And you know, And the need for meat, he does like a whole deep dive.

He does a whole deep dive on the difference between meat protein and vegetable protein and how meat is a more bioavailable protein than in beans itself.

And I need a consultation with this man.

And if we have a podcast, I'm not sure what the point is for not getting all of our medical questions answered by the experts.

I'm going to answer it for you.

Well, so you're correct.

People in blue zones, they don't eat a lot of meat.

The meat that they do eat isn't processed also.

I mean, that's the thing.

Are you answering the question for yourself?

Yes, I think that's probably the take home message.

If you had more friends, you could eat all the meat you want.

So I mean look, I can't speak to this like I'm not a doctor of this variety, but much as Peter you know, seems to compartmentalize, you know, a lot of aspects of mind and body.

Yeah, I do think that you know what we know about these blue zones, these places where people not only live longer but live, you know, their health span is better.

Yeah.

Yeah, they live a much more active lifestyle.

They also live a lifestyle where they're intellectually stimulated or in different ways.

I don't mean like intellectually like they're all reading Sartre, but they are conversing more.

They're interacting with other humans.

Most of their social life is with other people.

You know, in a lot of those areas also you get a full strata of people of different age ranges interacting, hanging out together.

So there's a different level of stimulation.

And you know, I also think there's, you know there's some.

There's something to this notion of the, the standard American diet.

You know, and I know that's not how you're necessarily eating, but you know the sad diet as it as it were.

And I'm sorry that we didn't get to ask Peter Atiyah that.

I mean, he opened up tremendously.

First of all, you know this is not a book for the faint of heart in terms of like, this is a long book.

It's a big book.

And it's full of a lot of research.

It's full of a lot of stuff about genes.

And it's also very, very nicely and concisely organized.

It's a pleasant read.

I enjoyed it very much.

But when we get into those last chapters where he does talk about mental health trauma, his two separate excursions into a mental health facility, like into getting help

You know, that's the part of the book that really that moved me very deeply.

And I think that...

I appreciated him talking about how for some people, this will be more of a factor than for others.

And I think also for many people.

There are pathways that we take to avoid dealing with the mental stuff.

That leads to other physiological problems.

So you know, if you try and pile enough food on top of feelings, you know eventually that can have a different impact on your physical health.

You know the notion of stopping eating when you're full.

You know, I think it was right Louis CK who said the meal is not over when I'm full, the meal is over when I hate myself.

You know, I think that's like it's something that is said as a joke, but I think for a lot of people, the notion of soothing with food, you know, and and that is one of the things he talks about in the book.

You know I'm not really into like calorie restriction and everybody's like fasting and like fast every other day.

Like to me, there's no way that for me with my background that that's going to be healthy.

But the notion that we are eating too much food just in any, in any given setting, and the notion that the kind of food that we're eating too much of is hurting us.

I think in so many places that is trying to fill an emotional need.

Like I find it hard to distinguish between the mind and the body.

I think this is the problem though.

I think most people do not even know.

I mean, I didn't know what that felt like until I had to learn.

And part of it is knowledge and part of it is time.

Yeah.

But, but think of kids.

I didn't get to ask him about kids.

Like kids don't, they don't give a shit what it tastes good.

They want to eat candy and they want to eat fast food.

It tastes delicious.

I mean, look, I I knew kids who were who were raised by parents who had a lot of restrictions.

And the notion was like as soon as they get out of the house, like everything goes crazy and they're just going to drink soda for breakfast.

And like that might happen.

Like, I think that also as parents, like we want to believe that we figured out the formula.

But like, I don't we don't know.

We have no idea.

And so much of American culture, so much of Western culture is just about convenience.

You know, I mean the fact that, like when you tour college campuses now, or when you go to a college campus like the salad bar actually looks like something you could eat at.

You know, back like when I went to college, it was like a piece of lettuce and a hard boiled egg.

And I could only eat one of those.

Right.

Like.

The fact is, I have to believe that we're doing better.

You know and it's not just for the girls who are like I only eat iceberg lettuce on weekdays, you know which also those people exist.

And that's OK.

I don't know.

That just sounds depressing AF, Jonathan.

The kind of take home messages for me from Outlive the science and art of longevity which you know.

Really grateful that Dr Atiyah came on to talk with us about today.

No big surprise.

Eat less processed foods.

Eat less food in general meaning, do not eat your feelings.

Sleep is an incredible priority which is very, very difficult to get in alignment with, but it absolutely impacts your mental health, your physical health.

And the notion of physical activity that, just like when you're a kid and you're encouraged to go out for recess every day, I mean we used to play before school, at recess and after school.

So physically moving your body.

It's like if you don't use it, you will lose it in terms of mobility, in terms of ability in general.

And obviously, mental health, you know, component is a larger one.

But all of this is in Outlive.

And I'm grateful that we got him to to smile a bit and talk a little bit playfully, because you know, The Drive is a very cerebral podcast.

It really is.

And I also want to direct people there.

Jonathan, you've been talking about it for quite some time.

I think it has over 75 million episodes downloaded.

And he covers literally everything.

He covers everything.

I wanted to ask him what he thinks about the popularization of this information.

You and I actually often have a conflict, but our opposing view, or the view that you bring up you brought it up in the David Sinclair episode.

If people haven't listened to, this is a good adjoining episode.

You should check it out.

It's in the back catalog.

You often talk about health, well-being practices, and you have a similar approach.

Do you know what that is?

Panic and Cry?

You talk about it's elitist and only people who have money.

And I thought his response was perfect for you because you know that's a common go to for you when we talk about these types of modalities and these approaches to well-being.

And you're like, no one has time and only people who have certain resources.

And he's like, the information is free.

It's about prioritizing it.

And it is about building a protocol, and what can you do in terms of what are you going to prioritize, Because it's hard to fit it all into the day.

And the second thing he said is time.

How do you fit it all in?

Or what do you do first in order to make a successful impact on your well-being?

So I love that he said that to you.

So what I would say about The Drive is I mean, I find the episodes that I'm most interested in and that have the most impact for me.

And his voice is very soothing also.

I just bought his cue cards.

I'm going to get my own cue cards, my own color-coded cue cards.

I'm going to start putting my goals for the week and the month and the year.

Maybe we'll do a special Instagram Live where Mayim shows us her goals for the year.

Also I do want to mention I really appreciated him talking about how much there is available for people to learn more about all of the things that he talked about.

And The Drive is a wonderful place to start.

But I also we should mention He started Early Medical, which is a set of videos and conversations with patients and activities and supporting resources.

It's a 12-module program that people can also learn about.

It's called Early Medical.

And the idea is to start early with a lot of these medical kind of interventions, and That's another place to get information.

And again, that's more of a program that you commit to and you get a lot of different things.

But I really appreciate, you know, I'm very grateful that he took the path that he did.

I think he's been able to communicate with the public and millions and millions of people in a way that, for many people, this was information that was only accessible if you had a functional medicine doctor and were in a very specific aspect of society.

And I really believe it's a human right, you know, to have access to this information.

And we wish you all, you know, more knowledge and more time to implement these things.

So from our breakdown to the one we hope you never have, we'll see you next time.

It's my ambiolics breakdown.

She's going to break it down for you.

She's got a neuroscience PhD or two.

And now she's going to break down.

It's a breakdown.

She's going to break it down.

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[Redefining Longevity: Dr. Peter Attia on Medicine 3.0, Healthspan, and the Art of Living]-[What Medicine is Getting WRONG, with Dr. Peter Attia!]

📋 Summary

The Shift from Medicine 2.0 to Medicine 3.0

The Four Horsemen and Metabolic Health

Knowledge and Time: The True Bottlenecks

The Integration of Mental and Physical Health

🎯Key Sentences

📝Key Phrases

📖 Transcript

[Redefining Longevity: Dr. Peter Attia on Medicine 3.0, Healthspan, and the Art of Living]-[What Medicine is Getting WRONG, with Dr. Peter Attia!]

📋 Summary

The Shift from Medicine 2.0 to Medicine 3.0

The Four Horsemen and Metabolic Health

Knowledge and Time: The True Bottlenecks

The Integration of Mental and Physical Health

Deep Learning with ListenLeap

🎯Key Sentences

📝Key Phrases

📖 Transcript

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