56: Overcoming Stress, Sleep Deprivation, and The Darkness with Peter Attia

0:00:00 - Opening - "The Corner" 0:08:55 - Peter Attia Intro 0:11:03 - Beginnings Of Peter Attia. From Mechanical Engineering & Math to Medicine. 0:20:02 - Johns Hopkins Hospital and turmoil. 0:27:24 - Addiction to Pain-killers 0:39:53 - Sleep Deprivation 0:52:03 - Desensitized to the horrors of the Hospital VS Emotional attachments to patients. 1:09:01 - Surprising Negatives and Positives about Human Nature. 1:16:36 - Peter Attia Self Reflection and Lessons learned. 1:30:21 - Frustration and Fighting the system. Then leaving. 1:41:45 - Switching to Consulting 1:56:09 - Health, Nutrition and Lifestyle 2:20:34 - Final Thoughts 2:26:20 - Interesting Support stuff. Onnit Supplements http://www.onnit.com/jocko, Jocko Store http://www.jockostore.com, Amazon Click-Through https://www.amazon.com/?&tag=jocko20-20&camp=216797&creative=498521&linkCode=ur1&adid=11SG8BPFMYFBF0M9ZBDJ&, Psychological Warfare on iTunes. 2:37:09 - Jocko White Tea https://www.amazon.com/gp/product/B01M1MMR3F/ref=as_li_qf_sp_asin_il_tl?ie=UTF8&tag=jocko20-20&camp=1789&creative=9325&linkCode=as2&creativeASIN=B01M1MMR3F&linkId=38f7fa0b472f4151b127ea49e2cf57d9, Extreme Ownership Muster 002 http://www.extremeownership.com 2:42:57 - Final Gratitude and Closing Support this podcast at — https://redcircle.com/jocko-podcast/exclusive-content

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Jocko Willink?

  This is Jocko Podcast number 56 with Echo Charles and me Jocko Willink. Good evening, Echo.

• 0:09Speaker 01

  Good evening.

• 0:14Jocko Willink?

  Silent screams and broken dreams. Addicts, junkies, pushers and fiends. Crowded spaces and sad faces never look back as the police chase us.

• 0:31Jocko Willink?

  Consumed slowly by chaos, a victim of the streets. Hungry for knowledge, but afraid to eat. A life of destruction, it seems no one cares. A man child alone with burdens to bear. Trapped in a life of crime and hate, it seems the ghetto will be my fate.

• 0:57Jocko Willink?

  If I had just one wish, it would surely be

• 1:02Jocko Willink?

  that God would send angels to set me free. Free from the madness of a city running wild.

• 1:12Jocko Willink?

  Free from the life

• 1:15Jocko Willink?

  of a ghetto child.

• 1:20Jocko Willink?

  And that is a poem written by a young DeAndre McCullough.

• 1:29Jocko Willink?

  A criminal drug dealer. Who, when he wrote that poem was doing time.

• 1:38Jocko Willink?

  After being one of the main subjects in a book called The Corner. Which is written by David Simon and Edward Burns, which documents the violent drug trade in Baltimore, Maryland.

• 1:54Jocko Willink?

  And that sort of morphed into an HBO series that was called The Corner as well. Which paved the way for another series, which is called The Wire, which is just an outstanding mini-series that came out on HBO. But The Wire is fictional, even though it's based on kind of the same situation in Baltimore, but The Corner is real. The book, The Corner is real, and it gives a very clear and a very grim view. At the life of drugs and crime in the inner city,

• 2:32Jocko Willink?

  namely in Baltimore. And I'm gonna go back to the book now.

• 2:40Jocko Willink?

  We can't stop it. Not with all the lawyers, guns, and money in this world. Not with guilt, or morality, or righteous indignation. Not with crime summits, or task forces, or committees. Not with policy decisions made in places that can't be seen from the lost corner of Fayette and Monroe. No lasting victory in the war on drugs can be bought by doubling the number of beat cops, or tripling the number of prison beds. No peace can come from kingpin statutes, and civil forfeiture laws, and warrantless searches, and whatever the hell else is about to be tossed into next year's crime bill. Down on Fayette Street, they know.

• 3:25Jocko Willink?

  Today, as on every other day, the shop will be open by mid-morning, and the touts will be on the corners chirping out product names as if the stuff is street-legal. The runners will bring a little more of the package down, and the fiends will queue up to be served. A line of gaunt, passive supplicants stretching down the alley and around the block. The corner is rooted in human desire. Crude, and certain, and immediate. And the hard truth is that all the law enforcement in the world can't mess with desire. Down at Fayette and Monroe, and every corner like it in Baltimore, the dealers and fiends have won because they are legion.

• 4:11Jocko Willink?

  They've won because the state of Maryland and the federal government have imprisoned thousands, and arrested tens of thousands, and put maybe a hundred thousand on parole and probation rolls, and still it isn't close to enough. By raw demographics, the men and women of the corners can claim victory. In Baltimore alone, a city of fewer than 700,000 souls, with some of the highest recorded rates of intravenous drug use in the nation, they are 50, perhaps 60,000 strong. Three of them available for every prison bed in the entire state of Maryland.

• 4:49Jocko Willink?

  The slingers are manning more than 100 open-air corners, serving up the product as fast as they can get it off the southbound metro liner. And the fiends are chasing down that blast 24/7.

• 5:04Jocko Willink?

  In neighborhoods with, where no other wealth exists, they've constructed an economic engine so powerful that they'll readily sacrifice everything to it. And make no mistake, that engine is humming. No slacking profit margins, no recessions, no bad quarterly reports, no layoffs, no naturalized unemployment rate.

• 5:28Jocko Willink?

  Get it straight, they're not just out here to sling and shoot drugs. In drug markets in cities across the nation, lives without any obvious justification are given definition through a simple, self-sustaining capitalism. The corner has a place for them, every last soul. Touts, runners, lookouts, mules, stick-up boys, stash stealers, enforcers, fiends, burn artists, police snitches, all necessary in the world of the corner.

• 6:03Jocko Willink?

  Each is to be used, abused, and ultimately devoured with unfailing precision. It's about the fiends, thousands of them, who want that good dope. They need it, the way other souls need to breathe air. It's about the slingers, the young crews working the packages, all of them willing to trade a morality that they've never seen or felt for a fleeting moment of material success. They are working the package with the hidden knowledge that they will fall, that with rare exception, the money won't last and the ride will be over in six months, or four, or three.

• 6:54Jocko Willink?

  Violence.

• 6:57Jocko Willink?

  Violence is no longer the prerogative of the professional, but a function of impulse and emotion. The contract killers and the well-planned assassinations of earlier eras are mere myth on these corners. Now, the moment of truth generally comes down to some man-child with hurt feelings waving a 38 around, spraying bullets up and down the block. The accidental shooting of bystanders is now commonplace.

• 7:32Jocko Willink?

  Even 15-year-old hoppers have loaded 38s hidden in the alley. The job is a little better than a death wish.

• 7:48Jocko Willink?

  And in the end, the corner best serves the hardcore. The junkyard dogs with neither the time nor the inclination for pity.

• 8:04Jocko Willink?

  The corner proves itself every day. It destroys whatever it touches.

• 8:17Jocko Willink?

  And eventually, the corner destroyed Deandre McCullough. Even though he received a second chance in his life and he actually got to play a small role in that series that came out on HBO, The Wire. He got some other jobs in the entertainment industry as well, but the corner called him back.

• 8:41Jocko Willink?

  And that guy, Deandre, who wrote that poem, he ended up dead of a heroin overdose in 2012 at the age of 35.

• 8:53Jocko Willink?

  Now, there's a reason I'm bringing all this up, and that is because we have a guest tonight.

• 9:00Jocko Willink?

  A guest that is actually more responsible for this podcast than anyone, and we'll get to that later.

• 9:09Jocko Willink?

  But his name is Peter Attia. And he grew up a boxer, has been a long distance endurance athlete, got his degree in medical engineering and applied mathematics, and then got his doctorate as an M.D. from Stanford. And did his residency in surgery. And the reason that I started off this whole

• 9:37Jocko Willink?

  talk about the corner is because he did that residency at a place called Job- John Hopkins Hospital, which is about three miles from the actual corner of Fayette Monroe Street.

• 9:54Jocko Willink?

  The war zone that's pictured in the book. The place where DeAndre McCullough lived and where violence was, and in many ways, still is just a part of life. And Peter was at ground zero in the war zone and saw more darkness and suffering probably than any person should have to.

• 10:17Jocko Willink?

  And learned a lot from it.

• 10:20Jocko Willink?

  And we're going to get to that in a bit. But first of all, Peter Attia,

• 10:27Jocko Willink?

  welcome to the show.

• 10:28Peter Attia?

  Thank you for having me, sir.

• 10:30Jocko Willink?

  Glad to have you on, finally.

• 10:34Jocko Willink?

  And

• 10:37Jocko Willink?

  you grew up, we'll get, we'll get right into it. You grew up, tell us a little bit about just growing up. You grew up in Canada, and I know you've covered, for those of you that hasn't listened to the Tim Ferriss's interview with you, listen to him. What is that, three of them?

• 10:50Peter Attia?

  Yeah, I think so.

• 10:51Jocko Willink?

  I think there's three of them. You can listen to those and get more details on, you know, Peter, his whole background. But for those that are just listening right now, you grew up in Canada, give us a little, little, little statement about that.

• 11:04Peter Attia?

  Yeah, I grew up in Toronto. Um, you know, immigrant parents. So grew up, you know, sort of in the wonderful lower middle class. Uh, not the best suburb of Toronto. Toronto, like New York, has five boroughs. Four of them are nice. One of them is not. I grew up in the one that's not so nice. Um, and, uh, meaning it's just a dump. Not like it's, you know, it's not like a war zone or anything. Um, and I have lived now in the United States for about half my life. So I, high school and college was in Canada. And then everything from med school beyond has been here. And I am now a dual citizen of both countries.

• 11:44Jocko Willink?

  How did that transition work? Cause you didn't, you, you obviously you got applied mathematics degree. And then you worked in the civilian world a little while with that degree, right?

• 11:54Peter Attia?

  Yeah, so, uh, my plan was always to do a PhD in aerospace engineering. Um, and so I, that's why I did the mechanical engineering and applied math. I did the two things for undergrad.

• 12:06Jocko Willink?

  Got it.

• 12:07Peter Attia?

  And then was sort of just in the, almost about ready to go and start that PhD in aerospace. And then I had a, just a complete change of heart and decided I wanted to go into medicine. And so that, so what I had to do for a year then was you got to take this thing called the MCAT, which of course I didn't have any of the courses to take it. So I had to sort of teach myself the chemistry and biology that summer, took the MCAT. But then I still had-

• 12:33Jocko Willink?

  A lot of times that's what I do in the summertime is I'll, I'll teach myself, you know, chemistry and biology and some of that.

• 12:39Peter Attia?

  Yeah, well, I didn't, I didn't do that well. And then, uh, and then I had to do what's called a post back year where you go back and you're in the process of applying to medical school without actually having the courses to get in. So if you get in, it's conditional. And, and so that year, because I'd already graduated, I just taught calculus. Um, so I, you know, was like a, you know, adjunct lecturer at the university and taught calculus, which I, I always enjoyed. I mean, cause I'd taught it for a couple of years before.

• 13:07Jocko Willink?

  And so, and so that's why you're waiting to get into med school?

• 13:09Peter Attia?

  Applying and then, and getting my courses. Like, I forget what I had to take biology and psychology, biochemistry. I had to take a few prerequisites to get it because in engineering and math, I'd never taken a single course. In fact, the day before I took the MCAT, this, this is only going to be funny for geeks who get biology, so I'll clarify in a moment, but

• 13:29Jocko Willink?

  That won't be me.

• 13:30Peter Attia?

  Yeah, I'm studying for the MCAT this summer that I'm supposed to take the test and the whole time I'm studying, I'm like, you know, I can't believe how sloppy these textbooks are. They keep confusing meiosis and mitosis. Like, why can't they just spell it the same way both times? Like, they, I didn't realize that it was two separate things, right? Meiosis is when a cell separates,

• 13:50Jocko Willink?

  Separates and the other one.

• 13:51Peter Attia?

  But doesn't replicate its DNA. Mitosis is when it creates an equal copy. And I literally, not until the day before the MCAT, realized that those are two separate things. I mean, that's how, that's how clueless I was going into this test.

• 14:05Jocko Willink?

  Yeah, and the only reason I knew that was because I was helping one of my daughters study for their biology something.

• 14:10Peter Attia?

  Yeah, anybody who took any biology course should know that, but, but I hadn't taken any, so.

• 14:15Jocko Willink?

  And so then you get into med school?

• 14:16Peter Attia?

  Yeah.

• 14:17Jocko Willink?

  You go there, what's that, four years? Another four years of school?

• 14:20Peter Attia?

  Uh huh.

• 14:20Jocko Willink?

  And then you get done with that and now it's time to do your residency. So you, do you get to pick where you're gonna go?

• 14:26Peter Attia?

  Not, sort of. So it's a funny system called the match system. So when you're in your, I guess you're beginning your fourth year of medical school, by that point, you have to figure out what you want to do. Do you want to be a surgeon? Do you want to be an internist? Do you want to be a pediatrician or radiologist? Whatever you want to do, because all of those have different programs. And then you have to apply to those programs. So let's say you wanted to do orthopedic surgery. You would send out your application to all the orthopedic programs in the country. Hopefully you'd get interviews to a good number of them. You'd go do the interviews.

• 15:05Peter Attia?

  And then you would submit to a match system, a rank order of the places you'd wanna go. And you don't put something on there that you don't wanna take. So if you, if you, you know, if you applied to thirty programs, you got interviewed at fifteen and you liked ten, you rank those ten in order. Similarly, the programs, after they interview everybody, do the same exercise. They do the rank. And then a computer matches you one to one.

• 15:32Jocko Willink?

  That's actually pretty squared away.

• 15:34Peter Attia?

  Yeah, so you, the only way you're gonna guarantee you know where you're going is rank one program and hope you get it. So, um, in my case, I, I think I ranked five programs. Um, and I ranked, um, Johns Hopkins first for surgery. Not because I wanted to live in Baltimore, though in many ways, I think it was a blessing to do so. But, you know, because at the time, I don't know that this is true today, but at the time, it was probably the best general surgery training program in the country. And that was a combination of two things. One is you had these kind of legendary surgeons there that had pioneered some of the most complicated, what are called hepatobiliary surgeries.

• 16:19Peter Attia?

  Surgeons, you know, surgery of the pancreas and the liver and stuff like that. But at the same time, as you alluded to, it was in a war zone. And so the other aspect of training to be a good surgeon is having great exposure to penetrating trauma. So trauma, you always wanna divide into blunt and penetrating. Blunt trauma is not often operative. So people that get hit by cars and things like that, you know, ends up being more orthopedic. But if you're a general surgeon and you need to be able to cut open the chest and the abdomen and things like that, it's penetrating trauma. It's, it's, you want knife and gunfight. Um, not that you want it, but that's, that's the training ground to be in. So, and, and sort of Baltimore would have been, you know, probably in the top five.

• 16:58Jocko Willink?

  What year was this?

• 17:00Peter Attia?

  Two thousand? Two thousand one? Yeah, two thousand, I think.

• 17:03Jocko Willink?

  Okay. And.

• 17:07Jocko Willink?

  When you were, what was the, what was the thing that slipped, or this is going backwards a little bit, what was the thing that transitioned in your mind where you all of a sudden wanted to do medicine?

• 17:15Peter Attia?

  Well, yeah, it's funny, I don't think I've ever talked about this publicly. So, when I was in engineering school, I, in my second year, I started doing some volunteer work. And I, the reason why is too complicated, but I started volunteering with some kids that were in a shelter that had been abused, so it was a home for sexually abused kids. And that got me interested in sort of volunteering in a hospital. So, I was volunteering at a hospital that had, you know, it was a pediatric cancer ward. So you would just sort of, you know, you'd go up there and you'd kind of hang out with kids and just play with them and stuff like that.

• 17:58Peter Attia?

  And so between that experience and then I was still doing this volunteer work with these kids who had been sexually abused, a lot of those kids were suicidal. So I also found myself in the hospital a lot with these kids after they'd attempted to kill themselves. And I think somewhere in my senior year of engineering, I kind of had this, you know, I don't know what the word is, you know, I don't think it's an existential crisis as much as maybe a nervous breakdown, but just a bunch of things were kind of going on, probably some undiagnosed psychiatric issues on my part. But I realized, like, I love engineering and math intellectually, but I, there's no emotional connection outside of the joy of solving a problem, which by the way is probably plenty enough.

• 18:42Peter Attia?

  But I wondered if there was something else that I'd be more interested in that could scratch two itches, right? It could scratch sort of the intellectual itch, but also maybe an emotional itch. And so I spent the majority of my senior year thinking about, was there something else I ought to do?

• 19:00Peter Attia?

  But I'd been successful in my undergrad, so it was sort of a given that, you know, if you're going to graduate at the top of your class, you're going to go off and do the best PhD program. So at the very end, when I sort of declined to do that and I turned down a bunch of scholarships, it seemed a little odd that I would go and do medicine. But that's really the reason. It was, you know, it was kind of this epiphany I had one day, actually, while I was in the hospital. I sort of had this... Actually, it's really funny. We just moved, as we were talking about earlier. You know, one of the things moving is great for is cleaning up stuff. And I actually found my essay that I wrote when I applied to medical school back in, you know, whatever, 95 or 96. And it was really interesting to go back and read the story because it's exactly kind

• 19:44Peter Attia?

  of how I remembered it, right? Which was like this moment, I had this sort of insight, this is what I wanted to do. So that's kind of the series of events that led me to have that seemingly orthogonal change in direction.

• 20:00Jocko Willink?

  Okay, so now you go through that, you end up, you get your accepted do you residency at John Hopkins. You show up there. What's that like?

• 20:10Peter Attia?

  Well, I remember when I interviewed at Hopkins for medical school as well. And I was lucky enough to get in there for medical school. And at the time, I think Hopkins was technically the best medical school in the country. I think it was Harvard and Hopkins were the best two, and Stanford was, you know, maybe third, fourth, fifth. But I remember when I interviewed there for medical school, at the end of the interview, like I had to spend a night there. And so they put us up in the dorms for the med students, which, great idea, you get to meet your upper classmates. And I remember I said, that Friday night, I said, "Hey, I'm going to go walk down to the harbor." It's like a mile and a half down the road. And they were like, "Oh, no, no, you can't do that." I said, "What do you mean?" They said, "You can't walk outside of the hospital."

• 20:56Peter Attia?

  And then they pointed out that on every corner, there was like a booth with an armed guard. There's a guard in full armor with an automatic weapon. And so I remember at the time thinking, yeah, I probably don't want to go here for med school. So, and of course Stanford sort of for a guy who'd never been to California and who'd lived in miserable cold weather his whole life. I was like, it could have been the 100th ranked medical school. I was still going there.

• 21:21Jocko Willink?

  Yeah, I have some actual stats that I pulled up. So war zone in 1993, there was 48 murders for every 100,000 people. There's what 700,000 in the, in the city. The next highest was in 2015, 55. And in 1993, again, there was 353 homicides, homicides.

• 21:42Peter Attia?

  Yeah, almost one a day.

• 21:44Jocko Willink?

  And so, you know, I have to put this in there just, you know, because we're sitting here calling it a war zone. So when I was in Ramadi in 2006, the 118D, which is the, the Ready First Brigade, you know, 5,600 soldiers. While we were there with them for six months, they lost 61 guys. So what I'm saying is now that doesn't count the enemy casualties, but it counts the friendly casualties that are showing up at our med center. Right? So there, you know, you're talking three or 400. Well, you just said one a day.

• 22:19Peter Attia?

  Yeah, about one a day.

• 22:21Jocko Willink?

  Okay.

• 22:21Peter Attia?

  So.

• 22:25Jocko Willink?

  So you knew how bad it was when you got, because you'd already visited it.

• 22:28Peter Attia?

  I sort of knew it was dangerous, but, but I think when I decided that, you know, for this, that season of my life, you got to sacrifice everything and you have to go to the place where you're going to get the best training. And I didn't want to leave California because, you know, four years in California for the first time was, you know, I mean, you know, you guys know what it's like. I mean, it was like, I don't ever want to leave this place. But I also knew I just couldn't get that level of training on the West Coast. And it was, you know, you basically had to go to a place like Hopkins, Brigham and Webens in Boston, maybe Wash U in St. Louis was going to offer a very similar environment.

• 23:05Peter Attia?

  So then, you know, so then I ended up ranking it first. They ranked me first. So away we go. We get lucky. It's a match made in heaven. And that's like, kind of February of your senior year. And then reality sits in, which is you've got sort of four months until you have to show up. And that was kind of like the, oh shit moment, right? Like, I really just signed up for this. And a good friend of mine, who was two years ahead of me in medical school, his name is Brian Dunham. He's now a pediatric head and neck, ear, nose and throat surgeon at CHOP in Philadelphia. He was at Hopkins, which was at the time the best ear, nose and throat program in the country. And he actually recommended I

• 23:45Peter Attia?

  read this book, The Corner. Because, and Brian's one of these guys who's just, you know, he's just, he's like a Renaissance man, you know, like, not only is he a great surgeon, he's like a gifted artist, you know, his side job is medical illustration. Like, you can't believe what this guy can do. But he's introspective, right? And he was, he said, look, you know, you're, you're going to sign up to be in this war zone, and you're going to be taking care of people that it's going to be very easy to despise. So he said, you need to read this book to gain a sense of their perspective. Because very, like I said, you know, so, so at the time, I can't remember the stats, I feel like at the time that I

• 24:27Peter Attia?

  was there, we averaged about 16 penetrating traumas a day. Now, to put that in perspective, in general surgery, you're on call every second to every fourth night. So average about every third. That means every third night, 120 times a year, you will spend the night in the hospital, not sleeping, waiting to take care of any trauma patient. So if every third day and night, you know, 16 of these people are getting shot and stabbed, you're going to have a lot of time in the ER, in the trauma bay, dealing with that. And it's really easy to get jaded really quickly. It's fun for the first month, and then all of a sudden, every time somebody gets shot, it's preventing you from sleeping. Which, when we're sitting here all well rested, sounds like a very callous thing to say,

• 25:11Peter Attia?

  but all of a sudden, you're sort of like, Damn it, man. Like, I can't eat because the trauma pager just went off again. To this day, I still eat shockingly fast, and it drives my wife nuts. But she doesn't understand. I said, I think it's just, I'm a victim of, you never know when you're going to have to stop what you're doing, and that might be your last meal. Even I shave quickly, because the worst thing that could happen is you got shaving cream all over, and the trauma pager goes off, and you gotta run down half shaved. You got one side of your beard down and the other side down. So it's stupid things like that. So, so that was Brian's recommendation. So I got the book immediately, devoured it, found it to be the most depressing thing I had ever read.

• 25:53Jocko Willink?

  It is. It's heavy.

• 25:55Peter Attia?

  Made more depressing by the fact that they pull no punches, no names are changed. So every person you read about, you were reading about it in a completely uncensored, unfiltered way. And, I mean, you read it, you know, there's nothing happy about this book. Like, you just finish it and you think, yes, you have more empathy, and you understand where, where these folks are gonna be coming from, but it's, like, I don't, it's not like you finish that book and go, ah, here's the solution. We need a six-point plan that's going to do X, Y, and it's like, I don't, gee.

• 26:26Jocko Willink?

  That's kinda why I read that one excerpt, it's like, we can't win, which is an awful thought. And that's what, that's the impression the book gives you, is we can't win. And I, that, the way he phrases it of being like, it doesn't matter how many police and whatever you do, you're, you're going against human desire.

• 26:44Peter Attia?

  Well, the stat that you reiterated, and I remember it very well from when I read this book the first time, was, you couldn't take every junkie and put them away. If you took every federal and state prison bed in Maryland, you'd have three people for it if you just looked at the users, never mind the guns, the money, and everything that comes with it. So, yeah, that's not a solution. Now, there's a second reason that I don't think Brian knew, because I don't think anybody knew, that that book really hit home, which was, it, it's, it's, it's, it sounds tangential to this story, but it becomes highly related. And at the beginning of, uh...

• 27:27Peter Attia?

  End of my third year of medical school, I'm going to the gym one day, riding my bike as I always do. I get up, I get to the gym, I get off my bike, go to lock it up and I was like, my back really hurts, like really hurt, not like, oh, it's a little stiff, like something feels horrible.

• 27:45Peter Attia?

  So I started walking down the steps to the gym and I was like, not gonna happen today. Like, I mean, I couldn't, I couldn't do any, I couldn't tie my shoe. So I just went back, got on my bike, rode, rode back to my apartment. Told my roommate, I was like, hey, man, I'm gonna go lay down upstairs. The next morning I woke up, I couldn't get out of bed. And to make a very long story short, over the next two weeks, I completely deteriorated. You know, I was at the point where I could get in and go to the hospital, but I had to like, have the nurses, this is back in the Wild West days where you could just sort of get anything you needed at the pharmacy. You know, I'd get nurses or residents to inject Tordol into me, which is a really strong NSAID.

• 28:28Peter Attia?

  I could only sleep if I laid in an L shape over the nurses' station.

• 28:35Peter Attia?

  And it just wasn't getting any better. And then one day, it, the pain changed immediately. I realize in retrospect what happened, a herniated disc had fragmented, had broken off. So the pain in my back dissipated, but now I had this, what turned out to be a four centimeter fragment sitting on my S1 nerve root. So now it felt like my left foot was being skinned from the bottom. But that was constant, so that was an unrelenting pain. And it could only be sort of brought under control if I could put my foot into a bag of ice, because then I could make my foot go numb and then I could take some pain medicine. So this went on for another week and then the dean of the medical school saw me limping through the hospital, he said, what's wrong? And I told him and he dragged me down to the ER. We got an MRI that showed all of this and I was in surgery the next morning.

• 29:20Peter Attia?

  This was a Sunday night, Monday morning I'm in the OR. It turned into a disaster. The guy who operated on me operated on the wrong side. So I woke up, the left issue was still present, but now I had what's called a foot drop on the right side. So foot drop is when the nerve that holds your foot up, which we take for granted when we walk. But if you don't have the ability to what's called dorsiflex, your foot would drop. You can't walk. You'll end up dragging your toe when you keep tripping. This story, I mean, we could spend three hours on the story because it's so idiotic. The punchline is I eventually needed many trips back to the operating room. This guy refused to believe there's anything wrong with me.

• 30:02Peter Attia?

  It took another amazing doctor, a neurologist, to actually intervene on my behalf. And three months later, I'm unable to walk. I'm unable to do anything. My mom actually had to fly down from Toronto to look after me.

• 30:18Peter Attia?

  And I'm sort of, you know, you go through the checklist, right? So there's, I don't know if you've ever heard of Elizabeth Kubler Ross. I don't think she's alive anymore, but she wrote a very famous book on the stages of dying. And it goes through like anger and denial and finally acceptance at the end, right? And so, you know, bargaining, like it's something that would make sense if you, and I'm sure you've I've heard of that before. Yeah. And you've probably watched it on really small scales. Yeah. You know, like in combat, you might see these things over the course of Compressed and dealt with it. And with a cancer patient, you might see this stretched out over a year. And so I was kind of going through this on my own, right? Where initially it was like, oh my God, what if I don't finish this rotation I'm doing right now?

• 31:03Peter Attia?

  What's called a surgical sub internship to, oh, what if I don't graduate on time? To what if I can't be a surgeon? And then it was, what if I don't walk ever again? So somewhere along the way, I don't remember exactly when.

• 31:20Peter Attia?

  Probably like a month and a half into this, I finally caved in and started taking pain medicine.

• 31:26Jocko Willink?

  I thought that's where the story was going. I was like, at some point, he's gonna get on the opiates.

• 31:32Peter Attia?

  Yep. And I had been so reluctant to do so initially, been so stoic, you know, just taking my NSAIDs and even using Benadryl, which is a horrible pain medication, of course, but it sedates you through some of the pain. And so I, you know, I started taking Percocet. And Percocet is, it's typically 10mg of oxycodone. So oxycodone is the fast acting version, and it's stronger than say a Vicodin. So Vicodin is Tylenol and hydrocodone, immediate acting, but hydrocodone is not as strong as oxycodone. So Percocet is stronger than Vicodin. They both have Tylenol. It's just the opiate is stronger. And so, you

• 32:15Peter Attia?

  know, if you take a Percocet, which would have 500mg of Tylenol and 10mg of oxycodone, you know, I probably was taking, you know, you start taking two, three, four, five, six of those a day, you develop a tolerance. And eventually, you, there's a longer acting version called Oxycontin, which is just a time released version of oxycodone. So then you would take that twice a day. So at my peak, I was probably taking 80mg of Oxycontin a day, plus another 120mg of oxycodone. I just got rid of the Tylenol altogether. You can just get straight oxycodone. And so I'm about 200mg a day of oxycodone equivalent.

• 33:00Peter Attia?

  And again, if, you know, if I took that today, I would just die. I would just stop breathing. But at the time, you know, you build up this tolerance. But it also, there was this point where I realized that I wasn't just taking it for the physical pain, right? And I think this is the single most important insight I had, that when coupled with reading that book six months later, was the, I think, the single most important realization I ever had with respect to, to this problem, which was At some point, it was, I was just so depressed that I couldn't walk and I was so worried that, you know, I'd never be able to do anything again, that at least the drug gave me a high that took me away from that. And so then it got to the point where I was just

• 33:41Peter Attia?

  taking that drug all the time and I just stopped engaging, like wasn't engaged with anyone, anything. And then I sort of had this realization that that was happening and I was like, I, I want to stop. So at the time I was dating, um, this girl, she was an anesthesiology resident. She was a few years older than me, re, just the coolest, coolest person. And I'd said to her, she was kind of the only one that knew what was going on. Because at the time, even the doctors who were prescribing this, like, this just wasn't on people's radar as a problem back then. I think today, people would be like, homeboy's got 200 milligrams of OxyContin a day, that's probably not good. But at the time, it was just like, it was like Tic Tacs, right?

• 34:23Jocko Willink?

  So that would legitimately kill, like, if I took 200 milligrams, would that, that would really jack someone up?

• 34:29Peter Attia?

  I would think, I think if I took 200 today, I would stop breathing. Yeah. Cause that's how opiates kill you. They repress, they, they inhibit respiratory drive. That's what, whenever, whenever someone overdoses on heroin, they just stop breathing. Um, so yeah, I think 200 would, I don't know, we'd have to, I'd have to look at the pharmacy.

• 34:46Jocko Willink?

  We don't have to actually, I'll just take your word for it on this one. So the girl you're dating?

• 34:51Peter Attia?

  She, she said, you can't just stop, right? You, the withdrawal is so painful that you have to taper off. You have to probably go on methadone and then you'd have to start some pretty potent antidepressants, um, like MAOIs or TCA. So you have to go on a drug like nortriptyline, which is in and of itself kind of a crazy thing. And I was like, yeah, but I think I'm just going to stop cold turkey. Now, unlike alcohol, so if you took an alcoholic, you know, you took someone who's drinking 20 alcohol, you know, alcoholic beverages a day, and they've been doing that forever, and you stop them, they will die. They will get something called delirium tremens and they will die a horrible cardiac

• 35:35Peter Attia?

  death. They will break into arrhythmias and they will die. So when we had alcoholics in the hospital, let's say we had to operate on somebody who happened to be an alcoholic, we would actually just put them on an ethanol IV. We weren't even trying to detox them. We just wanted to make sure they didn't die and go into these delirium tremens. But heroin and opiate is not like that. It is not physiologically lethal to stop cold turkey. It's just unbearable. And so I was like, I'm gonna do it. So against her better judgment, I just stopped one day. And she could not have been more right. It was the darkest, I mean, I can laugh about it now. It was the darkest month of my life.

• 36:19Jocko Willink?

  It was a month?

• 36:19Peter Attia?

  Oh, at least. I mean, it was, I would just sit on a park bench for the whole afternoon, like, complete flat affect.

• 36:30Jocko Willink?

  But it's all mental? It's not a physical thing?

• 36:33Peter Attia?

  No, there's physical stuff going on. I mean, but, but no, it's, it's, yeah, you're, you know, you, you sort of, like, you know, opiates make you itch like crazy. You get constipated. So there's like a reversal of a whole bunch of physical stuff. But the biggest thing is the craving and the depression. And so the depression of coming off this thing was brutal. In many ways, and I don't tell that story to say, well, look at how special I am that I detox. That's not the point at all. I had two things going for me that virtually no junkie has going for them, right? The first is, I didn't have a network of people around me that were doing the same thing. So I was sort of the only guy doing it. So for me to go and be around my friends was to be around people who weren't

• 37:15Peter Attia?

  doing this. We always used to joke that if you really want to kick a heroin habit, you have to get a whole bunch of new friends. Like, you, you don't get to decide you're not doing heroin and then go back and hang with your friends that are doing heroin. You need to watch Trainspotting to learn that. The second thing, and perhaps the more important thing, is I finally did connect with a doctor who was able to put me on the right path. So I had ended up going back to the operating room. Probably a half a dozen times over the course of the year to have all these problems corrected. And then I found something else to fixate on, which was physical therapy. So I started to, you know, even though it didn't seem like exercise, it wouldn't seem like exercise today. At the time, it was the first activity I was able to do. And so, you know, within six months, I could like walk

• 37:57Peter Attia?

  like a reasonable distance again. And so I would be spending three hours a day at physical therapy, just doing like the most trivial exercises. But basically, the root cause of my depression was getting better. So that's really the only reason I think I was able to kind of detox off this stuff. Whereas I think for many people, A, it's not clear what the root cause is, or B, it's not getting better if it is clear. And so that's why I think it's really, it's a brutal addiction.

• 38:23Jocko Willink?

  And it seems like also you had a future, right? You had a life, you were in medical school, you're gonna, you know, you're gonna do something. Whereas a lot of these people that are drug addicts, what do they, they have no life that they're looking forward to. They're just looking forward to nothing.

• 38:36Peter Attia?

  And so in February of that senior year, when I had to submit my rank list, I think we match in March, I misspoke earlier. I was still not functional perfectly. Like, there was no way in February of 2001 that I could have withstood a surgical residency. But I had to make a decision at that point, which was, will I be ready on July 1? And if I won't be, I should not submit my rank. I should defer a year, sit out a year in medical school, whatever. And I remember that was the hardest decision I had to make. And I just gambled. I was like, you know what, I'm going to be ready, and I'm gonna make it happen no matter what. And so I submitted, matched, and then, in addition to now reading the corner to prepare for Baltimore, and reflecting on my own sort of

• 39:21Peter Attia?

  struggle with addiction, which was completely fresh in my mind, I'm also like rehabbing like it's my day job. And going through like, and I, most people take the last quarter of med school off, but I didn't have the ability to do that now because I had to, I had to go straight through till graduation day, because I'd missed so much time during my injury. So when I showed up in Baltimore a couple of days before July 1, I mean, it still wasn't crystal clear to me that I could go, you know, two days without sleeping, stand in an OR for eight hours at a time, all those sorts of things.

• 39:56Jocko Willink?

  Now, that's one of the things, the sleep deprivation, because people always, obviously, I take a lot of flack, because I don't sleep a lot, and, and the sleep deprivation. So what did that look, what's that like when you're going through residency? And you're just saying, I mean, there's days where you're going 24 or 48 hours, no sleep. And how did that affect you? What did you think of that? What do you think, looking back at it? What's your opinion of it now?

• 40:23Peter Attia?

  Well, you know, when I decided that, that I was going to go into surgery, I mean, I always, I'm pretty insecure in general. Most people don't necessarily appreciate that on the outside, but always thinking, I don't know if I've got what it takes here, how do I figure it out? And so my, my whole MO in life is test the system hard. So when I was in medical school, still deciding this, I figured, well, every Thursday night, I'm going to pull an all nighter in my room, standing up, not allow myself to eat, sleep, drink, pee, do anything. And I'm going to stand at my desk for eight hours and practice suturing. You know, sort of try to mimic what it would be like to be in an operating room all night, not being able to go pee, not being able to drink, not being able to do this thing.

• 41:08Peter Attia?

  And so I had a little bit of confidence, you know, I figured, okay, I can do this. Like I can pull an all nighter once a week. That's, you know, not that that's a good thing to do, but it was like kind of a confidence thing.

• 41:18Jocko Willink?

  Right.

• 41:18Peter Attia?

  So then you show up, but there's no preparing you for what you're in store for. Now, I got to point out, this is not the way it is anymore. So in 2000, I want to say like four.

• 41:32Jocko Willink?

  It's almost like labor laws came in.

• 41:33Peter Attia?

  Exactly. They, a whole bunch of laws came in that we could spend hours talking about how it turns out the laws haven't, they haven't fixed the underlying root problem. But nevertheless, a whole bunch of work requirement hours stuff got fixed, right? So you couldn't work more than 80 hours in a week or 88, depending on if your program had an exemption, and you couldn't work more than 24 hours consecutively and stuff like that. But by the time those laws really kicked in, I was already gone. And, and so I don't really know what it's like today, but I would imagine it's, it's less demanding from a sleep deprivation standpoint.

• 42:12Peter Attia?

  But at the time, there were no such rules and you were at the sort of every second, every third or every fourth night call, but then your post-call day, you would still work. So our mutual friend Kirk Parsley, which of course is how we met, this is one of his favorite stories about me. He loves this story because it's so crazy. So this is.

• 42:37Peter Attia?

  July of 2001. So I am one month into being a doc, right? And I'm on an every third night call rotation at this hospital called Bayview, which is about five miles from what we call the mothership, which is Hopkins. And it's out in like east Baltimore. It's in a real crappy part of town. Not that there's a real, I mean, I hate saying this, but I don't, there are not that many good parts of town, at least back then in Baltimore.

• 43:04Peter Attia?

  And so I'm, uh, so I show up on a Monday at five o'clock in the morning. So I slept in my own bed Sunday night. So Monday morning I show up at five to round. We do our whole thing. And

• 43:19Peter Attia?

  that night I'm supposed to go home. So that's my off, that's called your swing day. You show up at five, you'll be home by 7:00 PM that night if all goes well. So you worked your, you know, 14 hours. And then you sleep in your own bed and then you get to come back the next day and then you're going to be on call. So at the, so we're rounding that afternoon. So, and the, uh, one of the, the, one of the senior residents says, hey, so and so didn't show up for their shift in the ER. The ER always staffs one surgical resident full time. And this guy just didn't show up. And she's like, and it's a 7:00 PM to 7:00 AM shift. Can you cover it? And you know, this would be like if you asked the most junior guy,

• 44:01Peter Attia?

  you know, to do something like he, he, he'd be kicking his own ass to say yes. Like he couldn't wait to do that. Right? So I was like, hell yes, I will do that. So then I go down to the ER and I work all night, seven to seven. And then the next morning is now my on-call day. So now I'm 7:00 AM, cranking away until that night and then I'm up all night on call. So, and then it's now Wednesday and it's my post-call day and I'm there till five or 6:00 PM. So I've basically been up from about 4:00 AM Monday and it's now 5:00 or 6:00 PM Wednesday.

• 44:41Peter Attia?

  And I get in my car to drive home and I have to make it, I have to go down this miserable street called Eastern Avenue to hit the 83 to drive up to my place. And I'm driving along Eastern Avenue, which is like red light after red light after red light or stop sign or whatever. And every time I'm at a stoplight, I fall asleep, my foot pops off the clutch and I stall. Like I am so tired. I can't even, you know, handle like the gradual, you know, easing off the clutch and the gas just to move up and up and up. I can't do it. So finally, in one moment of lucid clarity, I'm like, you can't get on the freeway. You're gonna die. So I was like, what's the solution?

• 45:26Peter Attia?

  I was like, you gotta get over and take a nap. So I pull over my car on the side of Eastern Avenue, right in front of this park called Patterson Park, which at the time, I don't think I fully understood that that was an open air drug traffic market. So I got up, but here's the best part, sorry. The logical thing to do would have been just been stayed in the car and take a nap. But I was like, I haven't seen the sunlight in like days and it's, the sun is still out. Like, I'm gonna go nap in the park. So I get out of the park, I'm in green scrubs that are covered in, you know, blood stains because I was too dumb to not change. I go lay down in the park, I take my pager off and I clip it to my neck and I set the alarm to like go off in one hour.

• 46:10Peter Attia?

  You know, so like 7:00 PM, it'll wake me up and I'll feel perfectly rested and I'll be able to drive home. So I lay down in middle of Patterson Park and the next thing I know, I wake up, it's like one in the morning, two in the morning. There's needles everywhere. There's, I have like bites on my arm that look like they're from rats because they're like nothing I've ever seen before, like these bites all over me. And I'm just thinking to myself like, how did I not get killed here? Like the only thing that prevented me from dying was how ridiculous the sight was. You know, if something's so strange, like not, you know, so I was like, God damn it, man. So I get back in my car and drove home. And when I tell Parsi that story, he loves it because he's like,

• 46:53Peter Attia?

  that's the classic example of how complete deprivation of sleep impairs your judgment.

• 47:00Peter Attia?

  So, you know, there were a couple of stories in residency where I had to do like those three night back to back to backs. Another time it happened, I remember was in oh five.

• 47:07Jocko Willink?

  Did you feel like though, okay, driving a car is kind of boring, right? Stoplights, but when you're really tired, but then all of a sudden something happens like boom. I feel like when that happens, I feel like I can lock on.

• 47:19Jocko Willink?

  There's almost no amount of sleep deprivation that will stop me from functioning and getting something done. That's important on task, on time.

• 47:25Peter Attia?

  Absolutely.

• 47:25Jocko Willink?

  Is that true? Does that true?

• 47:26Peter Attia?

  I think so. Yeah, no, I think, I think an adrenaline rush in the moment can provide any amount of clarity and focus that's necessary. The problem is very few things are life or death that way. Now, in your world, there were plenty of things, but in my world, not. And this is the extra show I was going to tell was in probably my third year. I think it was my third year. I was the same, same sort of deal. I ended up covering for somebody and then covering for two people in two consecutive nights. And then it was my turn. So that was like three straight nights of not sleeping. And it's the middle of the night and this guy comes in the ER who's, you know, got a really diseased gallbladder. And in retrospect, it should have never come out that night. But a lot of times the dirty little secret is surgeons want to operate at night because they can get better OR time

• 48:12Peter Attia?

  electively as opposed to waiting the next day if it's not emergent. So sure enough, we're in the middle of the operating room doing a laparoscopic gallbladder removal at two in the morning, when we don't really need to be there at two in the morning. We could have slept and done it the next day.

• 48:28Peter Attia?

  And sure enough, so, so in removing the gallbladder is a two surgeon procedure. So there's the main surgeon, which because we're a teaching hospital, I'm the main surgeon. I'm actually doing the operation and then there's the attending who's holding the camera and retracting for me. So I'm, you know, like I'm doing this and yeah, that's a stimulating activity. But of course I've done a hundred of them, so it's not that stimulating. Well, I can't stay awake and I finally somehow managed to fall asleep on this patient. Like I faceplant into the patient. Luckily, it was laparoscopic, so I didn't contaminate the surgical. But so even something as stimulating as surgery.

• 49:06Jocko Willink?

  Right.

• 49:06Peter Attia?

  Because it look, if the guy's aorta was bleeding.

• 49:09Jocko Willink?

  Right, right.

• 49:09Peter Attia?

  I'm sure I would have studied. Yeah, exactly.

• 49:11Jocko Willink?

  But all you're doing is pulling out.

• 49:13Peter Attia?

  Yeah.

• 49:13Jocko Willink?

  Pulling out his gallbladder is no big thing.

• 49:15Peter Attia?

  Yeah, yeah, it wasn't stimulating enough to overcome three days of sleep debt.

• 49:19Jocko Willink?

  Did you do? Did you figure out any tricks, any, you know, for instance, I can tell when I was going through SEAL training and even my whole career and even to this day. I take these, I take little power naps. If I'm feeling that tired, I elevate my feet and I sleep for like six to eight minutes. And it totally recharges me. Did you? Do you take power naps?

• 49:39Peter Attia?

  No.

• 49:40Jocko Willink?

  Aside from your power nap in Patterson Park that lasted seven hours and almost got you killed?

• 49:45Peter Attia?

  I do. I once took a power nap in my car. Again, same thing. I was like, it was like eight o'clock at night. I got to the pool. I had a rule, which was after you left the hospital, you never went home. Because I knew if I went home, I wasn't going to leave. So I would always go from the hospital to the gym or the pool or whatever I was doing. And on this particular night, I get there, it's eight o'clock at night. I am so tired. I'm nauseous, like the thought of.

• 50:08Jocko Willink?

  You didn't want to go home just because you knew you'd go home and go to sleep?

• 50:10Peter Attia?

  I'd fall asleep.

• 50:11Jocko Willink?

  You didn't want to go to sleep because you've been awake for three days? Why didn't you want to, why, why didn't you want to go and fall asleep?

• 50:15Peter Attia?

  Well, because I, you know, it's really funny. A good friend of mine, who again, a couple of years ahead of me, gave me interesting advice, whether it was right or wrong, I don't know. He said, look, you're going to be tired no matter what in residency. Don't stop doing all the other things in your life because you'll still be tired. Now, I don't know that that was the right advice, but I took it to heart.

• 50:33Jocko Willink?

  I heard that advice.

• 50:33Peter Attia?

  And my view was, I'm going to continue to work out every day. I'm not on call. I'm going to, you know, do all the stuff I want to do. And unfortunately, sleep always took the brunt of it. So yeah, so it would be to the pool. And so same thing, I got there, but on this particular night, I was so tired. I was so nauseous, like I couldn't suppress the desire to vomit. And I was like, I'm not going to, I can't, if I puke in the pool, they'll kick me out. I won't get to swim. It's just not going to be worth it. So I was like, just sit here for like 30 minutes and take a quick nap. So same thing, took the pager out, which normally could wake me up, clip it here. And it was freezing because it was like the winter. So I left.

• 51:12Peter Attia?

  No, it wasn't cold, but I remember I wanted to leave the radio on like a dumbass. So the car is off. So alternator is off, radio is on. Well, you know how the story ends. I wake up at two in the morning, battery is dead. I'm in the middle of the parking lot. I can't, you know, had to call my girlfriend to get jumper cables to get me out. That's a one that girlfriend went on to become my wife, by the way. So, short answer, no, I didn't have a great strategy. I did have a friend who, and I never tried this, but he told me he would put coffee grounds in his eyelids. Apparently it hurts so much that you couldn't close your eyes.

• 51:49Jocko Willink?

  You know, that's, I mean, I would not that, but I've told people this all the time too. You know, do, do a little bit of physical exercise if you're super tired. That definitely picks you back up. There's got to be some reality or some scientific reason for that happening. So that's another thing you can do. But, um, so you were so, okay, we know it sucks. You're not sleeping and you're dealing with these patients. And, and how do you start to detach from this reality that's around you? So you're not getting, you know, because you, you, you said already you liked the kind of the emotional involvement with people, but then at the same time, you said it didn't take long before you despise these patients that are coming in because they're interrupting your sleep and bothering you.

• 52:35Jocko Willink?

  That's gotta be a crazy balance to try and strike as a human being. I mean, human beings are not meant to be dealing with 16 puncture wounds a day. That's, that's not right. So what, what happens in your brain? What happened in your mind? What did you notice about your mentality in this whole business as time went on?

• 52:55Peter Attia?

  Well, what I noticed, so again, not everybody becomes jaded, but most people do. And where, where my sense of jaded developed was actually towards, you know, the patients with diabetes, the patients who had complications from being overweight. Like when those people would show up with, you know, the abscess in their foot in the middle of the night that needed to be debrided, those people I would get, again, pretty pissed at. Amazingly, the, what we, you know, these, these trauma folks, like I kind of always maintained a soft spot in my heart for them. And interestingly,

• 53:32Peter Attia?

  You know, it's, it's, it's, it's, once they die, so what happens is, like, let's say a guy comes in, guy's been shot. You know, generally, people who are dead in the field don't make it in. So, so, but, but sometimes there's this gray zone where, you know, someone comes in who's basically dead, but because they had a little bit of a pulse on the way in the door, like, we're gonna do everything we can. But a lot of times when those patients die, like, the room has to be turned over really quickly, which means someone's gotta come in, take the body, put it in a body bag, gather everything, because usually, these are criminal investigations, so the police are there. The housekeeping staff has to come in and mop all the blood off the floor, because depending on where the gunshot wound was, like gunshot

• 54:13Peter Attia?

  wound to the head, for example, tons of blood, because the head's a confined space. And in that moment, it's really easy to just immediately walk out the door, but I find myself, you know, I'd, I'd sometimes like flip through their wallets, right? And, you know, invariably, you'd see something, like, you'd see a picture of a little kid. So you, you see this guy who's huge, who's just been killed, he's probably 25, and you'd see like this six-year-old girl in his wallet. And you, you know, you'd start to sort of wonder what the narrative is, right? Like, was that his daughter? Probably. Did he know her? Probably. Did she know him? Maybe not. Like, you just don't know. And all of a sudden, that's, that's, that's sort of humanizes these, these guys. And, and again, I think

• 54:56Peter Attia?

  because of my own understanding of what they were dealing with, because of those 16 penetrating traumas, 15 had to be drug-involved, in one way or another. And so, everybody who we're taking care of, for the most part, was some part of the cycle that's being described in the corner. Now, occasionally, it wouldn't be. I mean, one of the examples that stands out that was, I would say, sort of like the top five saddest things I ever saw in residency, was July 1st, 2002. I just happen to remember that day. And this girl on her 16th birthday came in and she was just, she was just hit by a stray bullet in her neighborhood. It was her 16th birthday, stray bullet from, you know, unrelated gang violence, hit her in the head. And, you know, she's an example of someone who came

• 55:41Peter Attia?

  in basically dead, but in situations like that, like you'll, you know, I'm sure you can relate to this. You're just gonna do something that's so beyond heroic. You want to do anything and everything to try to save her. And of course, we couldn't. So, you know, those examples are kind of rare, but the majority of the times, it's, you know, executions for people who stole money. Um, that's, those, those would be hard to see, right? Cause you could, these are, you know, this is like, this is a deadly game.

• 56:08Jocko Willink?

  Oh, and even the, even the girl, the 16 year old girl, she's part of the cycle too, because that's just a stray bullet.

• 56:13Peter Attia?

  That's right. She's in a, she's in a lousy neighborhood. You can almost guarantee that, you know, if she's living in where she's living to get hit by a stray bullet, like, you know, yeah, she wasn't living in, you know, Roland Park.

• 56:24Jocko Willink?

  And when, once you, did you, would you ever see any family? Would any family ever come in?

• 56:31Peter Attia?

  Yeah. So there's two types of things going on, right? So, so the, the biggest problem we would have would be real gang on gang stuff because it became sort of a feed forward loop, right? So if one guy came in and he was killed, you immediately knew the floodgates were gonna open because there was gonna be retaliation that night. I don't remember, the, the police were pretty good about trying to make sure that like when someone came in and who was killed, like if you weren't immediate family, you were not allowed there. Um, and they also tried to create a little bit of a delay in letting that information out. Again, maybe that wasn't the, the, the most considerate thing to do,

• 57:14Peter Attia?

  but their view was trying to let the violence dissipate. Um, yeah, the family stuff's hard. I mean, the hardest family interaction I ever had was with a, was with a, actually a blunt trauma and it wasn't involving drugs at all, right? This was a, this was a, um, A boy, he was 15 years old. He and his brother, his older brother, who was probably 18, had picked him up after school. They were driving home and they were, they had the right of way and a guy ran a red light and T-boned them on the passenger side. And this, the 15 year old boy, both of them came in as separate traumas, but the older boy came in as an adult

• 57:55Peter Attia?

  trauma. So he went to the adult side. I happened to be on pediatric surgery, like I was the senior resident on pediatric surgery that month. So I ran the pediatric trauma, which is where the 15 year old came in. And it turned out the older, the driving son was fine. He didn't have a scratch on his body. But this kid came in basically dead on arrival, though it wasn't clear why, but his pupils were blown, um, you know, little bit of a pulse. We did, you know, probably 30 minutes of everything imaginable before accepting the reality that he sheared his aorta. So if a, a high enough force can actually shear the aorta and it dissects and you basically bleed to death inside the wall of the aorta, and that's why he died. And that

• 58:40Peter Attia?

  was another example of how everybody just sort of scatters after that. But, you know, his mom is in a waiting room, wondering where her boys are, who, you know, could have been an offender vendor for all she knows. So tho- those were, I mean unquestionably the most difficult discussions ever because trauma is the one area where there's complete surprise. Like, it, you know, it's tragic when somebody dies from cancer. It's even tragic when somebody dies during an elective surgical operation, which happens unfortunately from time to time. But at least there, you have some heads up that something dangerous is going on. But this kid, like, you know, said goodbye to his mom that day, went to school and never came back. And

• 59:21Peter Attia?

  now she hears, oh, he's in a car accident and she's in the hospital, never imagining that he could be dead. And then you have to be the guy that goes in and say, you know, I'm really sorry to tell you this, but your son is dead.

• 59:35Peter Attia?

  You know, there's actually a really interesting article written in the New York Times on this exact topic by, so it's kind of an interesting story. So my mentor in medical school, to this day, one of the closest mentors I've ever had is a guy by the name of Steve Rosenberg. So Steve Rosenberg is the chief of surgery at the National Cancer Institute, and he's kind of one of the luminaries in immunotherapy. So I did my postdoc with him at the NIH, and I actually spent time there in medical school, and actually, he just called me yesterday out of the blue. We ended up having a great catch-up for 30 minutes. His daughter, he has three daughters. His youngest daughter is Naomi Rosenberg, who's a resident at, and I think she's an emergency room doc at Penn, which is also

• 1:00:18Peter Attia?

  in a war zone in Philly. And she wrote a great piece on this, which maybe we could link to in the notes or something. It's probably like the last three months, about the difficulty of having to communicate to families when tragedies like this happen, which of course, you know, she would see a lot of as well in Philly.

• 1:00:38Jocko Willink?

  And then that happens. So you do everything you can to save this kid's life, and then you walk in, you face the mother, you drop the most devastating possible imaginable news on her. You gotta go back to work. I mean, right? I mean, don't you then have to, isn't, don't you have to go work again now?

• 1:01:03Peter Attia?

  Yeah. That night in particular, that was, you know, that was, that was, I remember that day pretty well. That was April of 2003, when that boy died. And by the time, you know, by the time we had declared time of death, and I had gone to talk to his mom, it was probably like 10 o'clock at night. You know, I probably spent an hour with her. And of course, it's disruptive because you're in there and your pager's going off. I've got the ER calling me about this kid, and I've got the ICU calling me about this, and, you know.

• 1:01:37Peter Attia?

  And she's, you know, I mean, like, I, I, I, I sure hope I never have to know what she went through because I can't, can't really imagine, right? I mean, she's hysterical at a level that you just, like, a movie doesn't do justice to that. Like, you don't see that level of hysteria normally.

• 1:01:57Peter Attia?

  And I, I, that, that was certainly like one of kind of the three or four that really upset me the most. I mean, I, I had a real hard time, and I think I got lucky that night. I think that night ended up being a pretty calm night. I remember I got to probably spend some time just alone in a call room that evening, you know? And, and for me, that was a, so the, this is the awful thing here is we tend to project what's going on in our own life into any situation. I mean, I, I think I realized that pretty early. And so I think in the case of that particular trauma, I, I saw in that boy my brother, my younger brother. And so I, so I was dealing with two things in that moment. One was, um, meaning from my own end, not, not, not the immediate issue, which is this boy died.

• 1:02:41Peter Attia?

  One is, I'm imagining now, like, this could have been me and my brother in high school. Like, this, this could have been us. And how, how your life changes after that. Like, I thought his brother's life is never gonna be the same.

• 1:02:54Peter Attia?

  The second was, this was already after I had decided to leave medicine altogether, which was in June of 2006. And this, this trauma was like April of 2006. So I had decided in March of that year that I was just gonna finish that year and then leave. So, so the other thing that was sort of, that I was struggling with, which probably makes this a little heavier than it needed to be, was, as painful as this is, it's a privilege to be this person. It's a privilege to be the guy who gets to try to save a life. And even when you fail, That interaction you're going to have with that family, which I think is something Naomi wrote about in that piece, it's so important. It seems trivial to us because you have that

• 1:03:37Peter Attia?

  interaction over and over and over again, but to that family, it's so important. That will be with them forever. And I think I felt that I felt that that was a privilege. And so I think I realized like, I'll never do this again. I'll never again have that privilege to, even if I fail to to try to, you know, sort of save somebody, to actually then be able to comfort that family. And that sounds really weird. It's a very morose sort of thought to have. But all of those things, I think, in that particular example, you know, made for a really difficult set of, you know, days and weeks that followed. I went to his funeral, his first patient I ever went to a funeral of, a first trauma patient. Certainly went to the funerals of patients you got to know through, you know,

• 1:04:21Peter Attia?

  people who were dying of cancer and stuff. But, you know, trauma patient, like, you just wouldn't think to go to someone's funeral that you'd never known. Because like, I'd never known the boy, right? I stayed in touch with his mom for a few years, and not surprisingly, their life just completely fell apart, you know?

• 1:04:37Jocko Willink?

  Does it make it that much worse that you got this, you juxtapose the, the, kind of this normal kid, right, who dies this random accident? And then at the same time, every night, you're, you've got people that are killing each other. And you're dealing, and you're seeing the results of that, and you can't do anything about it? How does it, does that also play into your, your thoughts about, hey, I'm here trying to save these people's lives, and they're out there killing each other for over nothing, over the street corner, over this, over that? Did you go down that road mentally?

• 1:05:16Peter Attia?

  Not there. I'll tell you the one time I felt really ethically, maybe ethically is too strong a word, but just to be blunt, I mean, the one time I was really pissed off that I was trying to save somebody's life, was a guy that came in. Who killed his wife, killed his daughter, and then put the gun in his, under his chin and pulled the trigger and missed. So he basically blew off the side of his face and was still alive. His brain was completely intact. This guy was going to survive after 23, you know, face operations. And, you know, I'm taking care of this guy in the ICU and I'm kind of pissed off about it, actually. Right? And, and maybe I shouldn't be, right?

• 1:06:01Peter Attia?

  Who am I to judge this guy? But I'm like, you know, you killed your wife, you killed your kid and you wanted to die. Why the hell am I putting anything into you? Now, of course, that is a slippery slope because in medicine, we're never supposed to play that role. Right? We're never, we never play God. Right? People, you know, some doctors want to act like they're playing God, but we never play God. We're just there to do a job. And on that day, I remember thinking, I don't want to do this job. I don't want to, I don't want to take care of this guy. I want this guy to die, actually.

• 1:06:30Jocko Willink?

  How do they, how do they, how do they address that when you're going to medical school? That whole idea? They've got it covered on, or is it just so underlying, the, the underlying theme of everything you do? That by the time you get done, you're, it's there?

• 1:06:45Peter Attia?

  That's a, that's a really good question. I don't know the answer.

• 1:06:48Jocko Willink?

  Are there ethic, ethics classes in medical school that teach you that?

• 1:06:52Peter Attia?

  I am sure there are. I, the fact that I can't tell you one thing about an ethics class I took tells you it's, that whatever ethics you have are going to be independent of whatever class you're taking. And who knows, you know, today, you know, these pendulums swing from one end to the other. For all I know, you know, half the curriculum could be ethics today. I, I don't know. But, but the short answer is I think, you know, it's, it's sort of internal and, and the reality of it is, you know, if you're in a good program, and the one thing I'll say, I mean, As much as Hopkins was a brutal place to exist, the camaraderie there was unbelievable. I mean, you know, the nickname for the residents was the Halsted Marines, right?

• 1:07:34Peter Attia?

  Which again, doesn't do justice to real Marines, but that was sort of the camaraderie, right? It was like you would do anything for your, you know, that's why you'd always volunteer to stay up three nights to help somebody else out. And so, you know, I had really great friends there. In fact, to this day, like some of my closest friends, people that I'm in touch with almost every day were, were guys I went through that experience with. And you could talk about those things with each other, right? I mean, you know, it was, it was okay to say, like, I really wish this motherfucker would die, um, cause he's taking up a bed, he's costing the state a million bucks and I hate him. And I somehow being able to talk about that, I think makes it a little bit easier, right?

• 1:08:19Jocko Willink?

  Well, absolutely. I mean, and he, that's what happens in the military. You get guys that go through tough situations, tough battles, and they, they become closer going through it. And part of the thing that brings them close together is you're talking about what's going on as it's happening and after it happens. What did you?

• 1:08:37Jocko Willink?

  So a lot of times in this, this podcast, I say that this podcast, yeah, we talk about war and we talk about leadership and we talk about history, but I find that the actual root of what the podcast becomes about is, is really about human nature and what people, what human beings are like. Was there, I'll give you both sides of this question. Did you learn anything about people, about human nature there that was surprisingly positive? And before you answer that one, did you learn anything about human nature while you were there that was surprisingly negative?

• 1:09:24Peter Attia?

  So I'll give you one thing that I learned that I don't know that I would call positive or negative, but it was an observation that in retrospect seems obvious, but it never would have, I never would have thought of it before, and to this day, it still serves me well to understand it. So the first, this is the first observation is that when you look at a significant illness, like a, a, a completely disruptive insult, you know, cancer, you know, you have pancreatic cancer, which means you're going to die, and you're going to die soon. There are two types of families that come into that situation.

• 1:10:07Peter Attia?

  So families that show up already fractured, get blown apart. Fractures that, families that show up already tight, become the tightest of any family. The same would be true when you see, you know, a kid that comes in, you know, a burn victim, right? This kid that gets burned badly on the 4th of July, and this kid's going to spend the next two months in the hospital. You know, a couple that comes in with tension already in their marriage, they get splintered wide open. If they came in and everything was fine, they're going to be there for each other, they're going to be tighter. So, so that was an observation that I just saw over and over and over again, and I saw

• 1:10:47Peter Attia?

  it in probably even more vivid color when I was at the NIH, because the two years I was there, you know, I was mostly doing research, but you still had clinical responsibilities. And so you're, you're basically seeing patients who are coming to receive experimental therapy for cancer. So these are patients who are all, you know, otherwise going to die within six months, and most of them will still go on to die, obviously a subset of them we can help, but you're seeing that over and over again. So that was the first observation. And then the second was that there were just a couple of residents who, I couldn't believe how amazing they could be, who, how, how they could never sort of...

• 1:11:30Peter Attia?

  Do the wrong thing. So, so there were two residents in particular, one really, he was, he, he, his name is Chris Sonnen Day. He is now a, uh, he's a transplant surgeon at the University of Michigan. Amazing guy. And so Chris was two years ahead of me. And I mean, he was like that guy that I would have done anything for. And I remember when I was leaving, thinking to myself, you know, I'm really glad I'm leaving because if I stayed, I'd know I could never be as good as Chris. Like that, like, how can someone be this good? And I don't mean, like, he can sew this good and cut, I don't mean even medically.

• 1:12:09Jocko Willink?

  Good human being.

• 1:12:10Peter Attia?

  Just as, exactly, as a human being. He is on a level I can't get to. And,

• 1:12:19Peter Attia?

  you know, I don't know anybody else who can get there either, but the fact that I can't get there is a little upsetting to me. Um, and I'm glad I don't have to spend the rest of my life chasing him. Which of course, Chris would never think of it that way, because that's the nature of being that guy is you, he's just completely humble, modest, unassuming guy, who just happens to be a god.

• 1:12:41Jocko Willink?

  You know, it's, it's, uh, going back to the first point that you mentioned, and it's something that I've heard people talk about as well. My buddies talk about, is, you know, the, the whole idea of post-traumatic stress and all that, and, and what war does to people. And one thing that I happen to agree with is pretty similar to what you're saying, and that is going into the war, right? If the person is got a good, stable mindset, and a good attitude, and is a positive person, and they're going to come out of it with all those good, positive things amplified. They're going to be more positive, they're going to be stronger, they're going to be mentally tougher. It's the people that go into it that are already somehow.

• 1:13:26Jocko Willink?

  Fractured, those fractures are going to get worse through the trauma of combat. Again, this is a broad generalization and there's definitely great guys that see things or do things that they, that it hurts them and it takes them a while to get through it. But there's also some guys you go, you know, that guy was messed up when we showed up and now he's worse and it's that pressure that opens up those fractures even wider. And it's interesting that you got to, you saw that with family structures as well. And I could completely see how that happens and that happens, right? That happens and you don't even need trauma to make that happen. I mean, you get the financial trauma on a family if they're not tight, that'll, that'll make them blow up.

• 1:14:06Peter Attia?

  Yeah.

• 1:14:07Jocko Willink?

  Whereas if they're tight, you know, going through some financial problems, they'll get tighter, they'll buckle down, they'll save money together, they'll skip the movies, they'll start, you know, they'll enjoy cooking ramen noodles together. So that trauma can, can expose those fractures. That's why it's important to try and create the most solid foundation you can with your family and with your own mind so that when these traumas hit, you don't get fractured.

• 1:14:32Peter Attia?

  Do the SEALs screen for that?

• 1:14:35Jocko Willink?

  They try to, but you'll like this story. So we had to take a psychological screening. This is in the nineties, so it wasn't like we were super advanced on any of this stuff. And I'm going, and when I was going through boot camp, they gave us a psychological screening for, for our attempt to go to SEAL training. And so they asked a bunch of questions and it was complete the sentence questions. And so it would, it was really obvious what would, what would flag you. And for, and, and so I made every answer, uh, cause we, I was in boot camp and the food sucked. And so every answer that I gave was just all about food. So for instance, they'd, they'd say, complete the sentence, I hate when my mother, right?

• 1:15:20Jocko Willink?

  So it's, it's pretty easy to, to say, you know, I hate when my mother shuns me in front of my sisters and I want to kill her. No, no, no, no. All my answers were like, you know, I hate when my mother overcooks the steak and doesn't put enough pepper on it. You know, just like every answer. Answer I gave was about food, but it was really easy. My point is that it was really obvious. If you were not a complete, even if you were, if you, in fact, if you were a psychopath, you would very easily say, answer all the questions correctly and get through it. And there's been plenty of guys that made it through SEAL training that, you know, there's, there's some bad criminals. There's a, there's been a couple really heinous crimes committed by guys that were SEALs and

• 1:16:00Jocko Willink?

  just, just, they made it through. They got screened. So yeah, they, they had a screening, but I wouldn't say it's the most effective. They've gotten better now, you know, and some of those guys that committed horrible crimes, it, you know, kind of inspired the SEAL teams to step up that screening process as much as possible to make sure that we're not letting guys through that are, that are deranged in some way that are gonna do something horrible like that.

• 1:16:27Jocko Willink?

  You kind of already talked about these, but is there any other thing that, that you learned about yourself?

• 1:16:35Jocko Willink?

  In that situation and, and you, I didn't really know too much about the, uh, where you went afterwards at the NIH.

• 1:16:42Jocko Willink?

  If you want to go into that a little bit, but what did you learn about yourself through this whole process? Obviously you learned something because at some point you decided, you know what? I, I don't wanna, I don't wanna do this.

• 1:16:53Peter Attia?

  Yeah. I mean, that's, those are, those are some of the, the most interesting years of my life and I, I'm pretty glad that I didn't have my first kid till I was 35. Which on the one hand, you, you sort of think, well, God, I'm so old, you know, like I'm not gonna be, I'm not gonna be like the 50 year old grandfather, right?

• 1:17:13Peter Attia?

  But on the other hand, I think it's a really good thing because when I think about what was going on in my mid to late twenties, you know, the, the sort of really difficult decisions I had to make. I mean, leaving medicine after being in it for 10 years was a really difficult decision, especially to go and do something that had nothing to do with medicine. I mean, when I left, I joined a consulting firm, McKinsey and Company, and I did credit risk modeling. Like I didn't have a thing. The fact that I was a doctor was like a liability. There was no, like, it was like starting all over again in life.

• 1:17:46Peter Attia?

  So to get to that point, yeah, you, I had to go through a whole bunch of stuff. So I think. I mean, I don't, I wouldn't even know where to begin. I mean, I think one thing I learned was, so this fellow that I alluded to earlier, Steve Rosenberg, who is, again, to this day, probably one of the most important mentors in my life, outside of family members.

• 1:18:09Peter Attia?

  Just an amazing human being, right? So just kind of on another level. And I remember even asking him after being in his lab for two years. Because remember, we had a couple of people in the lab who I just didn't think were that good. They really bugged me. Their existence bothered me.

• 1:18:25Peter Attia?

  And I, you know, I finally, after being in the lab for two years, worked up the courage to ask him, like, how he, because he's like this guy who's gonna win a Nobel Prize, like, he's changing the game. And yet, we had a couple of people that I kind of thought were bottom feeders. And I was like, "You never get upset at them." Like, ever, "I've never seen you get upset at these people." "How?" And he said, "You know, Peter, I just look at everybody and I figure out at least one thing that they can do well, and I just figure out a way to empower them to do that one thing, even if they can't do the 10 things that I would expect you to do." I remember thinking, "I understand in theory what you're saying. I can't do that."

• 1:19:12Peter Attia?

  "I can't tolerate mediocrity." So that was a huge thing that I learned.

• 1:19:19Peter Attia?

  And it never really hit home again until I was running a nonprofit. Because, you know, there wasn't a lot of mediocrity at Hopkins, right? You sort of had your pick of the best residents there. Everybody there was the best at what they did. You had amazing nurses, amazing residents, amazing respiratory therapists, and like, everybody there was like, the best of their field, right? And then I go to McKinsey, same thing. You've kind of got the best of the best all over again. But, you know, fast forward five years, I'm now running a nonprofit. Well, all of a sudden, you don't get the best of the best anymore. You're drawing from like, the third pool. And I remember coming back to that, which is, you know what? You're probably not cut out to do this. You have two choices. Don't be a leader.

• 1:20:03Peter Attia?

  Just be your own dude, or be a leader, but only with A players. But this notion of like, you have the capacity to mentor the C players and maybe turn him into a B plus player. Like, I don't have those genes. I can't do it. And not only that, like, I will destroy the C player. And I don't mean to, but I will bury them in the ground and become a horrible human to them. So I also realized, like, I can be a really bad person.

• 1:20:33Peter Attia?

  If I don't, if I don't respect the work that someone's willing to do.

• 1:20:37Jocko Willink?

  So do you, did you, or do you ever have to find a counter to that? Cause like, if you were in the military and you and I were working together, I would be like, hey, Peter, you gotta get, you gotta get, you gotta act like Rosen, what is it?

• 1:20:49Peter Attia?

  Yeah, Rosenberg.

• 1:20:50Jocko Willink?

  You gotta act like him. Because in the military, you're not getting A players. I mean, you got some great guys, even in the SEAL teams, you got some great guys that are studs. You got some okay guys that are in the middle. You got some losers down at the bottom. Guess what? You need every single one of them to go on deployment with you. And they all gotta give you what you, everything they can. And the more you create conflict with them, and the more you are talking down to them, the less they're gonna do. You know how they're already a C level player or a D level player?

• 1:21:12Peter Attia?

  They're going down.

• 1:21:13Jocko Willink?

  Yeah, they're going down. You're not, you're not making them any better. So that's a, did you ever try and correct that? Or do you just go through and say, you know what, you've realized that that's like a weakness of yours?

• 1:21:23Peter Attia?

  I want to be clear. There are two attributes that you can be a C player in. And I can cope with one, but I can't cope with the other, and I accept it fully. I can cope with someone who has a C plus intellect. So if you think about the intellect as the CPU of the computer, I don't need everybody to have the fastest CPU. I accept the fact that like, we all have different sort of innate capacities to sort of process and do, and you know, we all move at different speeds. I can cope with variability there, where I cannot cope with variability, or maybe I've just chosen, I don't want to. Is I can't cope with variability on intent, work ethic, integrity.

• 1:22:04Peter Attia?

  Like when you are, if you can't be an A player there, I actually don't want you in my life anymore. And I think I'm old enough now that I've just said, fuck it. You know, I'm not going to deal with it anymore. Life is too short and I'm not going to deal with C players who fail on those metrics.

• 1:22:19Jocko Willink?

  Right, right.

• 1:22:20Peter Attia?

  I don't care how smart you are, but if you can't show up and work your ass off, if you can't be honest, if you can't care, if you can't want to get better, I actually don't want you in my life. So you're right, I probably, I mean, I think I'm probably not cut out to be a leader. Because I can't take those people who are failing on those metrics and work with them.

• 1:22:40Jocko Willink?

  Well, you just need to be a leader of a very high performing team, not of a regular, regular team. Yeah.

• 1:22:49Peter Attia?

  Yeah, I never had problems, right? So when I was a resident, you know, residency is very hierarchical, right? You know, you've got the med student, the sub I, the intern, the second year resident, the senior resident, the chief resident, the fellow, the attending. I mean, it's, it's, it's as clear as day who's in charge at any moment in time. And as I'm going up through those ranks, for the most part, I never really had difficulty, you know, with the teams underneath me. But again, I had the luxury of being at Hopkins. Everybody there is the best, the med student, they're the best, the resident, they're the best. McKinsey, same thing, you know, you're dealing with the best of the best. But yeah, running a nonprofit, it was like a totally different world to me. And so I think the difference is a great leader could have succeeded in any environment.

• 1:23:33Peter Attia?

  You know, they could have done, they could have figured out like, okay, the reason this person like acts like a lazy sack of shit is actually because of this. And you can like figure out a way to like touch them and help them out of that. And I was just like, yeah, I'm not doing it.

• 1:23:51Jocko Willink?

  So that was, so that's, that's going back to NIH and you, that was the first time you dealt with people.

• 1:23:57Peter Attia?

  That's the first time I'd sort of seen in a long-term working environment, like a couple of people who weren't top agents. And again, maybe part of it's because you're in the government at that point. And you get some staff people there, maybe who, you know. And part of it, I think, was just because Steve Rosenberg was such an amazing guy and he could get the best out of everybody that he might've just had a greater tolerance for that. I think the second thing I learned was. I would never be a world-class scientist. So when you go to NIH, you're really only going for one reason. I mean, I'm sure there's some people that go there just to check the box and say, I was at the NIH. That wasn't why I went. I went because Steve Rosenberg was my hero. When I was in medical school, I read his book called The Transformed Cell.

• 1:24:42Peter Attia?

  And I was like, that book just, now that book, along with another book by a guy named Richard Feynman, called Surely You're Joking, Mr. Feynman, became kind of two of the most important books, you know, I read during, you know, my twenties. And I actually wouldn't date somebody. I wouldn't date a girl until she read them.

• 1:25:03Jocko Willink?

  I'm gonna, we're gonna go into a, after, after the podcast, you and I are gonna go into a full, full-on counseling session. You need help.

• 1:25:13Jocko Willink?

  So.

• 1:25:14Peter Attia?

  So, so I went to NIH because I was like, look, this, you know, this guy is my god. And like, I want to be like that, right? I want to be the best surgeon scientist that ever lived. And then I got there and I realized that surgery and science couldn't be more different. Surgery is the ultimate immediate gratification. Like, surgery, you get to fix the problem in hours. Science is a lifetime of work, a lifetime of failure before successes. In fact, one of the most remarkable stories from Rosenberg's book, which of course I read while in medical school, but it wasn't until a decade later, when I'm living it, that I really understood

• 1:25:59Peter Attia?

  why he was great and why I couldn't be great, was from when he arrived at NIH in 1974, until he really had his first success was about 10 years. So for 10 years, everything he was trying was failing and every patient died. Every single person that showed up died.

• 1:26:21Peter Attia?

  Until this one woman in 1984, when finally they figured out how to dose something called interleukin-2, and they finally sort of cracked the first piece of what has turned into a very long code that 30 years later, we're just starting to make really amazing traction on. Now, think about that for a second. Forty-three years ago, he started that job. For 10 straight years, he just lost. It's like, you're gonna go play pickup every day for 10 years and lose every day. So what I realized was, actually, I don't have that intestinal fortitude.

• 1:27:00Peter Attia?

  I cannot fail that frequently and still be at my best the next day. And again, I mean, I hate admitting that because it sounds awful. It sounds like I'm, I suck, and I guess I suck, but like, I realized like, I could be good, meaning I could go after easier problems to solve where you can like, you know, get grants and, you know, just play the game, and that's frankly what most people do in this space. But if you want to like, change the game, if you want to change mankind, if you want to do something seminal, you have to be willing to fail forever. And I realized like, I don't, I find that, again, it's not that I'm addicted to the win.

• 1:27:43Peter Attia?

  It's not like, oh, I have to be told, good boy, good boy, good boy, but I need some win. I need to know that I have some control over my fate, whereas in surgery, you have some control over your fate. You know, there is a difference between being a good surgeon and being a bad surgeon. And it's not to say there's not a difference between being a good scientist and a great scientist, but in science, you are far less in control of what's going on than in surgery.

• 1:28:04Jocko Willink?

  Now, he must have had some long-term vision hypothesis that

• 1:28:08Peter Attia?

  He absolutely did.

• 1:28:09Jocko Willink?

  Was out there.

• 1:28:10Peter Attia?

  Oh, he did.

• 1:28:11Jocko Willink?

  That he believed it.

• 1:28:12Peter Attia?

  He laid it out. He said, there are four things that have to be true if we're going to ever figure out a way to get the immune system to fight cancer. These four things have to be true, and if they're not true, the immune, the human immune system will never be able to fight cancer. And it took 10 years just to figure out the first proof of concept in a human. So yes, they had a couple of successes in mice where they had demonstrated, okay, like at least in mice, you can do this. But in cancer biology, you know, you don't get terribly excited about doing stuff in mice for very long. You know, there's a really famous Italian cancer biologist who once famously said, if you can't cure cancer in a mouse, you need a new profession.

• 1:28:49Peter Attia?

  That's, that's pretty low hanging fruit. You, you gotta be able to do it in people.

• 1:28:54Jocko Willink?

  So.

• 1:28:56Jocko Willink?

  At the, it was while you were there that you decided you weren't, didn't want to go into medicine anymore?

• 1:29:00Peter Attia?

  No, so then it gets complicated, right? So then I decided.

• 1:29:03Jocko Willink?

  You're still.

• 1:29:04Peter Attia?

  I was still in the midst of my residency. So what I, so then I went back to Hopkins to finish my surgical training. But then I decided, you know what? I think I might actually go into cardiac surgery, which I'd always been interested in. So when I was in medical school, I was really torn between cancer surgery and cardiac surgery. And.

• 1:29:22Peter Attia?

  You know, to, to go into cancer surgery, I think the real focus is going to be on research. Like you want to, you know, you have to be involved in science and, and surgery. Whereas I thought in cardiac surgery, you know, it's just pretty much the coolest surgery. Like it's the most technically demanding surgery by far.

• 1:29:38Peter Attia?

  I shouldn't say by far. I mean, I think there are other things that are partly on par technically. But I was like, I also came back in the mindset of, you know what? I'm just going to become like a great technician, right? I just, and I loved operate, I mean, the heart is in one sense, the simplest organ in the body. Like it's really simple to understand what it's doing, you know, unlike the brain or the liver where it's just like 10 layers of complexity. Like we kind of know what's going on with the heart. And when it comes to operating on it, you know, it's all a mechanical problem. Like, you know, oh, this valve doesn't work. Oh, this pipe doesn't work. Oh, this thing doesn't work.

• 1:30:09Peter Attia?

  But that was sort of my concession of, well, you know what? You don't have to be the best surgeon scientist. Why don't you just be the best surgeon?

• 1:30:18Peter Attia?

  Because there you're more in control, right? That's, that's now just a function of how hard you want to work.

• 1:30:24Peter Attia?

  And that was, that was, that was sort of right up my alley.

• 1:30:26Jocko Willink?

  And so then how did that path then drift to you don't want to do any of this anymore?

• 1:30:30Peter Attia?

  You know, I think over the next couple of years, I mean, just a couple of things changed. I mean, one was.

• 1:30:38Peter Attia?

  You know, I wasn't getting frustrated with these patients that we were talking about earlier. It wasn't the trauma patients that were getting to me. There was something else that was getting to me that was much more frustrating, which was the entire system. It seemed like everything we did was this last ditch effort to put incredible resources into a person's life at the very end. And we didn't really move the needle that much, right? So. It just seemed like a broken system. On the other end of the spectrum, there's something else that did strike me as broken, which actually contrasts or contradicts a little bit of what I said earlier. I did feel that there was a subtle difference in the quality of residents.

• 1:31:20Peter Attia?

  So there was this guy Chris Ananday, who's like the best resident that ever lived. You know, I think I was a good resident. I think there were some other really good residents, but there were others that just, you know, they were good, but they weren't great. And the thing about residency that really bugged me, and I think part of this was I was watching my brother, who was a lawyer. So he came out of law school when I came out of medical school, like we were the same time. And so I start residency when he starts this law practice, or he joined like this law firm. And I remember seeing that it was a totally different world. Like their promotions seemed more merit-based. Like they went up the ranks, they got bonuses, like all these things happened that were a function.

• 1:32:02Peter Attia?

  So my brother was like, you know, he was like breaking every record at his law firm, right? Like, nobody could work as hard, nobody could bill as many hours, like, nobody could like crush it like he could. And he was being rewarded for it. Now, he ended up hating it, he left, he's now a public defender, or he's prosecutor, rather. So, you know, takes a huge pay cut to go and become a prosecutor, because that's what he really wanted to do. But the point is, he could have risen all the way up that chain. And I remember thinking in residency, I'm like, we all get paid the same, we all take the same number of years to get through. It seems crazy to me. Like, there's no other system where this would be the case. Like, I couldn't think of another system where you just had this complete, total lack of meritocracy. It was really hard to get fired from residency. Like, I saw some real knuckleheads do some real stupid things.

• 1:32:46Peter Attia?

  I never actually saw anybody get fired, which is not to say you couldn't, I'm sure you could. But I felt like I was working a lot harder than was necessary, because I just wanted to be better. And I thought, God, it's still crazy that this is gonna take this many years to get through. So, so, and I also, there was just a whole bunch of things about this system structurally that I thought were completely broken. And then, on the other side, I just felt like healthcare was completely broken as a system, right? We have this idea, yeah, I don't remember the exact stats, but you're gonna spend like, you know, 50, 60% of your entire healthcare dollars in like the last year or two of your life. I mean, something asinine, right? And, uh, so at the time...

• 1:33:32Peter Attia?

  My wife said to me, you know, you are clearly upset about this system. I think you have two choices. You should either fix the system or leave it. But I think that what you're doing now, which is staying in the system and not changing it, will probably not be sustainable. And so I think the toughest decision I ever made was at that point, because I'm thirty,

• 1:34:01Peter Attia?

  probably thirty-two, thirty-three. I've invested ten years into this. And I'm thinking, I want a do-over. I want a complete do-over. Which, you know, everybody knows that the sunk cost fallacy is called the sunk cost fallacy for a reason, but it's still a damn compelling reason to keep doing something. So that was like, that was a super difficult time. And, you know, in part, you sort of feel like you're letting your mentors down, because a lot of people had invested a lot in me, right? Hopkins had taken me, right? You're, I was like, one of the six chosen ones. They only take six categoricals a year. So now you're going to leave that program. And there were, you know, a couple of attendings I'd become really close to,

• 1:34:46Peter Attia?

  who really believed in me and really said, like, you're gonna, you're gonna do something really special. And then to say, actually, I'm gonna leave. And I'm not even gonna be a doctor anymore. I'm just gonna go in.

• 1:34:57Jocko Willink?

  So then you roll straight to Mackenzie?

• 1:35:00Peter Attia?

  Well, so I, so what I wanted to do is actually go back and get an MBA. Because I really, the other thing I missed a lot in medicine was, I missed quantitative stuff. Like, I missed math. Like, I missed being an engineer. And the few times I tried to bring that into medicine, I got spanked. Right? So there, you know, there's one story, I think I've talked about this maybe on a podcast before. I don't think so, though. This is actually probably my first or second year. I'm in the ICU taking care of this patient, and this patient's on a very, very toxic drug called gentamicin. This is a drug that has to be dosed very carefully. So if you give too much of it, you can destroy their hearing permanently and destroy their kidneys permanently. If you don't give enough of it, the bacteria that you're trying to kill will kill them.

• 1:35:46Peter Attia?

  So you're, you're, you have a very narrow range in which to give the dose. So there is no standard dose. It's not like, oh, just take 875 milligrams of this every 12 hours. No, it's take a first guess based on the patient's body weight. So this many milligrams per kilogram, give it to them and then measure a level. And then, once the level comes below a certain point, give it again. And I remember thinking, that doesn't even make sense. Like, surely we know enough about the kinetics of this drug that we could build a mathematical model to predict when to give it. So I looked up, you know, a couple of papers, a couple of books, one night on call. Sure enough, I find like, there's a very predictable alpha and beta decay cycle for this drug.

• 1:36:31Peter Attia?

  So like, literally in Excel, I build a model that uses a very simple differential equation. And it needs a few inputs and it will predict the kinetic curve of this. And I'm like, alright, let's try it out. So, take one of my patients, gonna be on gentamicin. I do everything the standard way, but I plug my numbers into the model to see, would my model have predicted this better and better? And the answer was unquestionably. So now I start to get a little confident in the idea. So like, the next night, I'm like, alright, I'm actually gonna start dosing the patient based on the model, which never puts the patient in jeopardy, because you're always gonna check the level before you dose, but you're gonna do so at the exact right moment. And so my model predicted like, at 4:31 a.m., this patient will nater. Which means, that's when you need to dose them.

• 1:37:15Peter Attia?

  So sure enough, at like, 4:00 in the morning, I get the pa- I ask the nurse to draw the patient's blood to confirm they're just about to nater. We're gonna re-dose them and away we go. So the next morning on rounds, you know, in the ICU, you round as a big team. I'm presenting that, you know, this patient is one of my patients. And I start explaining that, okay, so the patient received their dose of gentamicin at 4:30 in the morning, and the attending says, well, what do you mean 4:30 in the morning? We never dose gent at 4:30 in the morning. We dose it at 7:00 a.m., always. And I'm like, yeah, yeah, yeah, but the patient hit their nater at 4:30. It's like, I don't care, you know, and so we got into this huge fight and like, you know, I almost got fired. That would have got me fired, by the way.

• 1:37:56Jocko Willink?

  Finally, someone gets fired.

• 1:37:57Peter Attia?

  Finally, someone gets fired. And so, I mean, that pissed me off beyond words, right? It pissed me off that, like, it just struck me as so anti-intellectual. Like, maybe my model wasn't perfect. We never know. But the fact that nobody even cared to say, is there a better way to do this? That drove me batshit crazy. And that's just one of many stories like that that happened through residency where I was like, it's almost like we want to live in the 1950s here. And so, you have that sort of pain of problem solving is not valued. At least it didn't seem valued to me. It was valued in the lab, but I had decided now I'm not going to be in the lab.

• 1:38:41Peter Attia?

  So here I live in this world where problem solving is not valued. And I don't actually, I'm not a quant anymore. Like, I don't do math anymore. And I really loved math. So I started, so I started tutoring kids in math. I made like a little bit of free time so I could like tutor high school kids in calculus, just to like get my calculus on again, missing it, but it wasn't the same. So then I was like, you know, maybe I'll go back and get an MBA. So I looked into that. Didn't feel like I was already drowning in debt at that point in time. You know, you've got med school debt is sort of painful. And, you know, residency, you're making, I think at the time, we're making about 34,000 bucks a year. So it's, you're not even putting a dent in your $200,000 debt, sort of thing.

• 1:39:24Peter Attia?

  So, so then I remember one night, I was in, I was on call, and I was really pissed to be on call this night. This, and you can relate to this better than I'll ever be able to relate to it, because I'm sure this happened to you your whole life. But my best friend from high school tells me in February, he's getting married that August. And I'm the best man. He lives in Toronto. So he's like, this is the date of my wedding. I forget, it was like August 5th. It's a Saturday. I want you to be the best man. Completely honored. So I tell my program director in February, can I not be on call that day? Or the day before? I just need to, I need to be able to fly out of Baltimore on a Friday and come back on a Sunday. And he's like, yeah, yeah, that's no problem.

• 1:40:10Peter Attia?

  I remind him three times. No problem, no problem, no problem. Sure enough, the call schedule comes out, I'm on call Saturday. I'm on call the day of the guy's wedding. Like, you gotta be kidding me. So it's two o'clock that morning, I'm down in the ER, looking at a chest CT scan on a guy who I'm worried has a, what's called a dissecting aorta.

• 1:40:31Peter Attia?

  And the radiologist, you know, I, I introduced myself and she's very nice and she sort of walks me through the CT scan. And then we just start shooting the breeze a little bit. And she says, oh yeah, you seem kind of down tonight. What's up? And I was like, ah, I'm just kind of pissed off. I mean, I wish I wasn't here, blah, blah, blah, blah, blah. And she's like, yeah, I can, I can relate. I used to be in a surgical residency myself. And I was like, oh, really? She goes, yeah, yeah. I did my internship in surgery up at the University of Seattle and I just hated it so much that I left and actually joined this company called McKinsey. You know, I worked there for two years, but then decided I wanted to come back to medicine. So I, but I wanted to do it in sort of a kinder, gentler way. So that's why I'm back here doing radiology. And I was like, huh, what's this McKinsey thing? I'd never heard of it. And so she told me all about it and I was like, huh,

• 1:41:16Peter Attia?

  that sounds interesting. How do I apply? You know, and that was sort of the beginning of it. So she introduced me to some folks and, you know, then I had to like study all over again because to, the way they interview at these consulting firms is very specific. And it's not, you, you can be the smartest dude in the world. If you show up and you haven't thought through how to solve a case, like what are called these case interviews, you're, you're going to flail. So you have to actually put in some like work and, and study. So I, you know, got a bunch of books on case interviews and I'd be sitting in the trauma bay, waiting for bodies to come in. I'd be like reading my cases, you know, case interview things before. So that, that's, that was sort of the, the transition.

• 1:41:51Jocko Willink?

  And then you walk, you walk, you walk away from medicine, you go into, so were you doing medicine specific consulting?

• 1:41:59Peter Attia?

  So I was recruited to do that because McKinsey.

• 1:42:04Peter Attia?

  And I'm sure this is true of like Bain and BCG, which are kind of the other two really big management consulting firms. They recruit about a third of their consultants who, out of sort of what we call non-typical, or atypical rather, backgrounds. So people who have PhDs or JDs or MDs, but who didn't go to business school. And then so they send you off to do business school that summer. They do this thing called the mini MBA, which was, I mean, it was like being a kid in a candy store again. Because I got to go spend a whole summer in school again, learning finance, like, learning all of these things that, you know, for some people might seem kind of dry, but when you're like, just dying to get back into numbers, I was like, oh my god, like, you know. I remember the first time we learned

• 1:42:47Peter Attia?

  what was called the efficient frontier, which is basically this differential equation that describes, you know, an investment philosophy. I was like, like, I can't believe I'm doing this again. I can't believe it. So, so then I, we show up for orientation. I'm in San Francisco at this time. That was the other thing. I wanted to get back to California. So I was like, you know, San Francisco, please. So during the first, during, during orientation week, I was approached by one of the staffers there and they said, hey, you know, your background looks like you've done a lot of mathematics. I said, yeah. They said, well, you know, we know you're a physician and you're probably here to work on, you know, that all the medical teams are going to try to grab you to have you work on some biotech thing or whatever.

• 1:43:27Peter Attia?

  But we have this banking issue that is very important to some of our clients and it requires, you know, an ability to do stochastic calculus. Would, would you be up for doing that? And I was like, of course. And so then, you know, that was basically the beginning and I never really stopped doing that stuff. So, so I ended up doing what was called credit risk modeling, which then, which started out around this thing called the Basel II Accord, which was a type of, this was a regulation that came out in the mid 2000s that required banks to hold a certain amount of capital against unexpected losses. So, banks have a long history of knowing how to hold capital for expected losses, but they don't really know

• 1:44:10Peter Attia?

  what to do for unexpected losses. And in particular, the problem that was damning was something called asset value correlations. So-

• 1:44:18Peter Attia?

  If you're a bank, you could have 27 lines of business. You do first mortgage, second mortgage, auto, student, credit card, like you name it. And the problem is, nobody really understood how those assets correlated. So if your loss rate is X in this, what's the probability that it impacts the loss rate in that?

• 1:44:40Jocko Willink?

  So where the rubber meets the road is if I can't make my house payment, I'm probably not making my car payment either.

• 1:44:47Peter Attia?

  That's right.

• 1:44:49Jocko Willink?

  And that's what nobody got to realize. Everything went down.

• 1:44:52Peter Attia?

  Oh, yeah. Yeah. So that turned into, as we were in the midst of that.

• 1:44:57Jocko Willink?

  Because the banks used to leverage themselves so much that they could, well, in, when the market crashed, they weren't ready for, they couldn't handle it.

• 1:45:07Peter Attia?

  You know, it's such an, I mean, it's like literally one of my favorite topics, actually, which I'm sure your listeners don't want to get bored to tears on it. But the, first of all, the best movie of all the movies that have like, tried to explain what's going on, The Big Short by far does the best job. Because it actually explains the, the sequence of events that went, that took this from being just an isolated problem to a systemic problem. Most people miss the subtlety of how this thing ceased to be contained. You know, because technically, a housing crisis shouldn't have affected the global economy. So it was these instruments called CDOs that effectively allowed this problem to become enormous.

• 1:45:53Peter Attia?

  But at the time, the bigger issue was, you know, just a great example of hubris that exists everywhere, right? Which is, one, we don't like looking at data that contradict our point of view. And we're all guilty of this. I'm guilty of this. I find myself doing it. And I actually am now quite amused. I'm so attuned to it now that I'm quite amused. Like if I'm flipping through Twitter, I'll see a story that is completely against how I feel, and I don't want to read it. And then like the next one will be like exactly how I feel. I want to read it. And I'm like, dude, look what you just did, man. You've got to stop, pull back, go, assume you are wrong and keep going and try to figure out. But so, so at the, at the banking level, I mean, and we, you know,

• 1:46:37Peter Attia?

  the canary in the coal mine here, well, there were many, but in 2000, early 2006, 2000, yeah, mid 2006.

• 1:46:47Peter Attia?

  We had, when we were trying to do these asset value correlations, one of the biggest problems we had is we couldn't, we only had 10 years of data. The banks only had this data recorded for 10 years. We didn't have losses to model. And I remember saying to like, you know, the controller at this bank, I'm like, hey, man, like, it's going to be really hard to build you a model of losses when you don't have any historical losses. And he goes, well, that's mortgages. Mortgages can't lose money. Right? So that was, and we can laugh at that now, but at the time, that was like, not an unreasonable point of view. Right? Like, you can't lose money on a first mortgage. Think about it. You gotta put 20% down. You want to buy a home for a hundred grand?

• 1:47:31Peter Attia?

  You better show up with 20. You better be able to document you have a job. You better do this, you better do that, you better do that. So you now, the bank's only on the hook for 80 on a home that's been legitimately appraised for 100, and you've shown documentation. So you're at least going to pay that thing down to 70, such that worst case scenario, market falls by 10%. House is worth 90. You lose your job. Guess who still gets paid?

• 1:47:54Jocko Willink?

  The bank.

• 1:47:55Peter Attia?

  The bank. They still get their 70. Sure, if you're in the business of creating a second mortgage, you take a little bit more risk. But there's no reason you should have been losing money on first mortgages. And so you fast forward a year.

• 1:48:08Jocko Willink?

  Well, especially because, don't worry about the value of the house, because that's going to go up.

• 1:48:12Peter Attia?

  Always going to go up. That's right.

• 1:48:14Jocko Willink?

  So we're good to go.

• 1:48:15Peter Attia?

  Oh, well, that's where, and I remember, even when I was in Baltimore, one of my buddies, because, you know, the residents were always looking for a way to make a buck on the side, right? When you're making 34K a year, you gotta, you gotta come up with, and the only saving grace is you can't spend money. Like, your clothes is free, you're in scrubs all the time, you're kind of eating for free all the time, because you, I eat off the patient's trays, whatever they didn't finish. I'd like go to the nurses' station and eat all this crap. So I didn't, I didn't actually spend much money. Pens was like the only thing I wasted money on. Like, I collect Montblancs, and so even through residency, I would still buy these beautiful pens. So.

• 1:48:55Peter Attia?

  So yeah, I remember one of my buddies being like, dude, we gotta start buying houses in Baltimore. Because like, they're so cheap and you can get them with no money down. So you could buy a house for 200,000 bucks, put like $5,000 down. If that house goes up to 220, you just made 25K. You made 20K on your five.

• 1:49:14Jocko Willink?

  We're going all the way.

• 1:49:17Peter Attia?

  And no one does the math of, what if it goes down to 190? You just lost everything, right? So luckily, I didn't get in on any of those sweetheart deals. Although, you know, if you timed them right, a lot of people did make a lot of money on those deals before the shoe fell. So when, when, when, when things started to become clear, so in early,

• 1:49:41Peter Attia?

  in early 07, it became clear subprime mortgages were going to be a problem. By August of 07, a, a very famous, then famous analyst, what's her name? Meredith Whitney, I believe is her name. I think she was at Oppenheimer, called something that at the time seemed crazy. She said Citigroup is gonna cut its dividend next month. So for Citigroup, you know, huge, one of the largest banks in the country, to not pay a dividend for Q3 seemed impossible. But she'd done the math. She's like, yeah, there's no way. They're, they're getting crushed on these mortgage-backed securities. And everyone was like, she doesn't know what she's talking about.

• 1:50:23Peter Attia?

  Sure enough, Q3 comes along, Citi cuts its dividend, Chuck Prince, the CEO of Citi, gets fired. And at that point, it's like, god damn.

• 1:50:33Peter Attia?

  But again, everybody was still thinking, this is just a subprime problem. It's an inch wide, and yeah, it's a mile deep, but it's an inch wide. Well, in the background, we're working on another problem, which is prime mortgages. That which everybody thinks is totally fine. That which has a historical default ratio of less than half a percent. And we're seeing in the data, the data that was right in front of this bank the whole time, oh. There's a tsunami coming. Your default rate's gonna hit 4%, 5%, which, again, that might not sound like a lot. That's 10 times your default rate. It's gonna be actually higher than that, as we learned. And your loss, given a default, is going up much higher. So, loss is actually the dot product

• 1:51:18Peter Attia?

  of probability of default and loss given default. Okay? You guys are my only two customers. Probability you default is 50%. The probability you default's 10%. If you default, you will lose 100,000. So it's 10% times 100,000. I expect to lose 10,000 on you. If you default, it's 2,000. So 50% times 2,000, 1,000. So my total expected loss is 11,000. So, you do this 88 million times for every account you have. And the model to predict probability default and loss given default are enormous models that each have 50 variables in them. Actually, the PD does, the LGD doesn't. But what people didn't realize is the loss given defaults were skyrocketing.

• 1:52:00Peter Attia?

  It was like, in fact, again, at the level of just being kind of a math idiot, like, that, to me, was so amazing to watch, right? It was like, holy shit. Watch these LGDs go. They're just like blowing up, like and then you knew, once the PD triggered, meaning, once the probability of default went, oh, it was going to become a nonlinear catastrophe. And it turned out, so November 15th, Thursday, November 15th, 2007, was kind of the day, like, that was the matrix moment. So I had a team, great example. I was able to be a leader for once. Because I had an amazing team. I had a team in San Francisco of four people.

• 1:52:43Peter Attia?

  I had a team in India of four guys. We worked round the clock, 16 hours a day, every day. Except Sundays, we took off. And we would pass the model back and forth to each other. Amazing. Like, it was like, it was, it was pure bliss to be working that hard on this problem. And on that day, we basically came up with four independent models that all predicted how bad this thing was going to be. And we presented it to the leadership of this bank. And it's really funny. I was a manager. So, so at McKinsey, you have these levels like analyst, associate, manager, junior partner, partner director. For a meeting of that stature, meaning you're talking to the entire leadership of the bank, the, the senior partner would only be the one to predict.

• 1:53:28Peter Attia?

  I'd be in the corner, working the PowerPoint, answering a question if piped up. Because there's going to be a technical question. But the senior partner would do all the talking. But on that day, we go into the meeting and the senior partner says, Peter, you should present this. And I said, are you sure? Because I'm like the third most junior guy in the room here. And he said, yeah, two reasons. One, you're the only one who actually understands how all of these models work. And two, and this is the funniest thing he said. He goes, two, because of all of your experience with cancer patients, you're going to be very good at answering hard questions about bad things happening.

• 1:54:04Jocko Willink?

  Wow.

• 1:54:05Peter Attia?

  And I was like, okay. So I stepped in and I did my best to be empathetic and nonjudgmental and like just as evidence fact-based as I could. And this is what this says, and this is what this, when you look at the run rate model and the P G D says this, and the L G D says this, and the vintage model says this, and, you know, here, and so finally, like, the president of the bank says, how much money are we going to lose? Like, she was kind of like, you know, like all good leaders, she's just like, just tell me the goddamn answer first. So I said, I had to think on my feet, like, pretty quickly about a way to put it in terms. So I said, you're going to lose more money in the next 18 months than you've made in the last 10 years.

• 1:54:49Jocko Willink?

  And See, the Jocko answer to that question, how much money would we lose, would have been all of it.

• 1:55:00Peter Attia?

  That's the difference between you and me on Twitter, right? Like, you always have the best answer. Like, always, because that would be like, hey, Jocko, like, he just pictured on Twitter. Hey, like, you know, the CEO of, like, the bank. Hey, Jocko, how much money are we gonna lose? All of it. Peter, one of three. Well, start with your EBITDA last year. Multiply that by two of three.

• 1:55:24Peter Attia?

  Three of three.

• 1:55:27Jocko Willink?

  Yeah. Did they, did they listen to you at all? Yeah. Didn't want to believe that data, huh?

• 1:55:31Peter Attia?

  They, that was impossible. That was impossible to fathom. Years later, because I had, by this point, left McKinsey, but I stayed in close touch with that team. And I reached back out to that senior partner who, actually, I'm still very close with him. I just got a mail from him two days ago. I said, hey, man, remember all those models? Yeah, yeah, yeah. Did we, were we roughly close? And he goes, oh, no, the model's underestimated by a third. I mean, I was like, it seemed like we kept trying to tone the models down because they kept giving us these answers. And we were like, god damn, like, there's no way it can be this bad. And we were like, oh, let's make this assumption more conservative and let's do this and let's, you know? And in the end, it was like, nope, it was actually that bad.

• 1:56:14Jocko Willink?

  Brutal. So then, now, I remember, I saw you tell a story one time. It's on, it's on YouTube somewhere, but you're talking about a patient you were working on. You kind of alluded to this earlier. You know, either pre-diabetic or diabetic, and you're sitting there going, you gotta be kidding me. Because the day before, you tried to save someone's life that was, you know, a young kid. And that was sort of the, was that the first time that you started thinking about nutrition as a, you know? And earlier, you talked about, hey, we do all this stuff at the end of life. It's all this prevention to prevent someone from actually dying. But if we would have invested some of that money upfront, taught these people how to eat.

• 1:56:54Peter Attia?

  We would have been better off. Is that sort of where it came from? Or? Not at all. I mean, I never made that connection at that time. Right? So at that time, it was just what you described. It was just the visceral reaction of, I'm so angry at you. How can you not take care of yourself? How can you be sitting here so fat, so diabetic? You know, over and over again, you come in here to have these ulcers debrided and to have these things amputated. And you know how the story is going to go, like, just get it together. So this was, I mean, I didn't say those words, but that's how I'm feeling. Right. And so that's, that's just part of like the, the callousness that developed towards that subset

• 1:57:37Peter Attia?

  of patient. It wasn't until probably 2009. So I'm, you know, out of medicine now. But I was becoming overweight and I was pre-diabetic. I wasn't diabetic, but I was pre-diabetic. And I was, you know, that I was sort of come full circle, right? That I was like, wait a minute, wait a minute. I do everything right. I mean, I'm swimming four hours a day. I'm following that goddamn food pyramid to the core. And I don't eat saturated fat. I'm like, you know, I, I carb load like a banshee. Like, why am I, why is all this stuff happening to me? And so then when I, you know, went through my whole discovery process of figuring that out,

• 1:58:20Peter Attia?

  it was only then that I really thought back and reflected upon, you know, the horrible way I had treated not just that patient in particular, but, but obviously many other patients like her. I remember her case specifically because it was probably like the absolute low point of my existence. So unfortunately, it took me sort of failing on my own because at least then I could say this isn't a willpower problem. It's not like you don't care. It's not like you're not trying. You're doing what you're told to do and you're failing miserably. So either you're an outlier or maybe the advice is incorrect.

• 1:59:00Jocko Willink?

  So you're eating what you're being told to eat. You're carb loading and you're still getting fat.

• 1:59:06Peter Attia?

  Yep.

• 1:59:06Jocko Willink?

  Even though at this time you're swimming, we were just talking about it before the podcast, you're doing ultra-long swims, dozens of miles worth of swimming, which by the way, in SEAL training, in basic SEAL training, the longest you swim is five and a half nautical miles, which is

• 1:59:21Peter Attia?

  About six and a half.

• 1:59:22Jocko Willink?

  6.2 statute miles, which, and that's with swim fins on. So you're out there and you're out there in the open ocean, swimming 12, 15, 18 miles at a time. And you're training for that, working hard, and you're quote unquote, eating right because you're not eating saturated fat. And yet, you're getting fat, you go into the doctor, you get blood tests, and they say, oh yeah, by the way, you're prediabetic. And you just say to yourself, what is going on?

• 1:59:49Peter Attia?

  Yeah. And, and truth be told, I was actually more pissed, just from the vanity standpoint, at being fat. I mean, I wish I could

• 1:59:57Jocko Willink?

  Echo is nodding, for those of you on the podcast, Echo is nodding his head enthusiastically to that.

• 2:00:02Peter Attia?

  I mean, I, I mean, I wish I could say like, oh, it didn't bother me to be fat. It did bother me to be fat. It really bothered me to be fat. Right? It bothered me. It bothered me a lot, actually. And so much so that I actually wanted to get a gastric bypass. And so I

• 2:00:18Jocko Willink?

  How big were you?

• 2:00:19Peter Attia?

  Uh, it's like, so right now I'm about 175. I was like, probably 205 to 210.

• 2:00:24Jocko Willink?

  Oh dang. Okay. So once again, after this podcast, you and I, we're going into counseling session.

• 2:00:29Peter Attia?

  I know.

• 2:00:33Peter Attia?

  So I went to, I finally got my doctor to get me a referral to this guy named Ken Fujioka, who's like a very prominent bariatric physician here in San Diego. So I finally go to see Fujioka. So I'm sitting in the waiting room and actually, I think I told this story on Tim's podcast. I don't remember telling it.

• 2:00:52Jocko Willink?

  You did tell it.

• 2:00:52Peter Attia?

  But it is in, it's in the book. It's in the

• 2:00:55Jocko Willink?

  Oh, yeah, yeah, yeah.

• 2:00:56Peter Attia?

  I think this story's

• 2:00:57Jocko Willink?

  It's in Titanic.

• 2:00:57Peter Attia?

  Yeah. So I, but in the spirit of assuming nobody listens to or reads multiple of the things. So I'm in the waiting room. I'm finally waiting to see, and the nurse comes out and before you go back to the, to the clinic room, like you have to get weighed. That's just part of the protocol, right? So. Like they call my name. So I walk up and I get on the scale and the nurse comes out and weighs me and it's like, you know, whatever two 10 and she's like, congratulations. And I'm like, what? She goes, you're post-surgery, right? And I'm like, no, I'm here to be evaluated for surgery. She like looks at me, looks out at the waiting room where everybody's 400 pounds and like doesn't

• 2:01:39Peter Attia?

  say a word, but the look in her eyes is basically like, what the hell is wrong with you, kid?

• 2:01:45Jocko Willink?

  You got serious issues, son.

• 2:01:52Peter Attia?

  It seems like a reasonable idea.

• 2:01:54Jocko Willink?

  Well, yeah, very reasonable, very reasonable. You might want to check your reasonable ideas with me in the future because that is not a reasonable idea. So you get done, you don't do that surgery, obviously, but what?

• 2:02:06Peter Attia?

  Yeah, he, that guy had no patience for me.

• 2:02:08Jocko Willink?

  What clicked in your brain? Did you just all of a sudden say to yourself, okay, how is this happening? And then you remembered your A and P class and said, this is what's happening?

• 2:02:16Peter Attia?

  So I remember clear as day. So, uh, September 7th, 2009, I did, I sort of did like one of these long swims a year. You know, you do a bunch of short ones, a bunch of training, but Joey's, I had one main event. So my main event this year was I went back to Catalina Island and I wanted to swim from now LA out to Catalina. I had previously gone from Catalina to LA and

• 2:02:45Peter Attia?

  it was a tough swim. I had a torn labrum. So about six hours in, you know, it just became unbearable pain. And you don't usually have a head current in the Catalina Channel. So the San Pedro Channel, you know this, you probably trained out there. The current's usually running from point conception down or up. So you usually have a little bit of a cross current, very rare to get anything back or forth. And if anything, it's generally a little bit towards the island. And when I had swum. Four years earlier, from Catalina to LA, it took 10 and a half hours, but that was only 18 months after I learned how to swim.

• 2:03:25Peter Attia?

  I was a much better swimmer in 2009, and I was going in the theoretically faster direction. So a great example is, expectations can kill you. So I'm expecting this to be like a nine-hour swim back. And really, the only thing I'm thinking about, which is the worst thing you think about in marathon swimming. You should never, ever, ever think about how long this is gonna take, because you're just setting yourself for misery. The only real question I had is, could I break nine hours? You know, I should be able to break nine hours, right? So, to make a long story short, I don't even come close. This is a total disaster scenario. The other thing, you'll appreciate this, just because you'll appreciate the stupidity. You never want to look anywhere when you're swimming, except down.

• 2:04:10Peter Attia?

  It's very demoralizing when you're in the middle. Like, if you're in the middle of the channel, you don't see land from the water level. You just, you just don't. So that's, so before you get in the water, you tell the crew, and every, I've crew chiefed for a lot of great swimmers. I mean, it's the, the crew asks the swimmer, what do you want? What information do you want? So we're starting to swim at midnight at Point Vicente. I said, okay, I want to know when there are exactly 10 miles to go and exactly four miles to go.

• 2:04:42Jocko Willink?

  What's the, what's the total distance of the swim?

• 2:04:44Peter Attia?

  Well, as a crow flies, it's 21.

• 2:04:48Peter Attia?

  And if, so if you don't have a current, you're doing a 21-mile swim. If you do have a current, you're gonna swim more than that. So, so that's what I said. I said, guys, I want to know when there's 10 to go and 4 to go. Why? 10 to go, you're just a little over halfway. I'd like to just know that. At 4 to go, it's put your head down and swim for two hours, don't do anything. You're there. So we start the swim at midnight. This is in September, so I forget what time the sun was rising back then, but I knew that I would have ten to go before the sun came up. So in other words, I knew that once the light was up, I was gonna be inside the ten stretch. And one of the most amazing things about swimming in the middle of the ocean, I don't know if you got to experience this during training, is in the Pacific, the bioluminescence

• 2:05:33Peter Attia?

  is so strong. And so on a clear night, which I was always lucky to have, every time I swim out, I've done a lot of the channel swims, every time I've been out there, I've always been blessed with these clear nights. It's so dark, because once you get out of LA's light, under the water, so your hand is coming down, you are seeing the bioluminescence flare off your hands. When you breathe, you were seeing the stars. You can't tell the difference. It is so dark, you cannot see the difference between stars and bioluminescence. It's like being in this amazing chamber. And so that's the, that's the reward you get for swimming at night, which is otherwise incredibly lonely. And then, the first thing you notice is the bioluminescence gets harder and harder to see, which means, oh, the sun's gonna be

• 2:06:16Peter Attia?

  up in an hour. And the sun comes up. Now the sun's like up there. I haven't heard anything. And I'm like, those guys, they forgot to tell me I've got ten to go. That's okay. Probably down to six to go now. And I'm swimming, I'm swimming, I'm swimming. It must be like 10 o'clock in the, I mean, I'm being facetious. It's probably like 8:30 in the morning. And they're like, ten to go. And I was like, Jesus, what? And, because at that point, I had no clue what the current was like. Because a swimmer can't feel current, right? Swimmers can only feel relative velocity, not absolute velocity. So, you know, that coupled with the torn labrum, coupled with, like, it ended up being over 14 hours of swimming. And this

• 2:07:01Peter Attia?

  is a very long story, because your question was so simple, but I remember getting on the boat.

• 2:07:05Jocko Willink?

  I don't even remember what my question was.

• 2:07:07Peter Attia?

  Nutrition about like when I finally decided.

• 2:07:12Jocko Willink?

  I was over here in Biooluminescenceville.

• 2:07:16Jocko Willink?

  Okay, so this is the day.

• 2:07:17Peter Attia?

  So, so finish the swim, get back to the boat. And they've got like two burgers and two cokes waiting for me. And I mean, like, I couldn't have eaten those things quicker. Like, the biggest, juiciest burgers you've ever seen, like, the cokes, like, they tasted so good, right? Because you know, your mouth is so salty, like, you actually really want something sweet. And my wife, this, you know, my wife hates when I tell this story because she denies that she said it, but she completely said it.

• 2:07:45Peter Attia?

  She, I'm just sitting there like, I remember this, I have a picture.

• 2:07:48Jocko Willink?

  Enjoy the burger fatty.

• 2:07:50Peter Attia?

  I've got like a USA towel wrapped around my waist, inhaling, like, I'm two-fisting burgers, drinking my cokes. And she just looks at me and she goes, and again, just in the sweetest way possible, she said, you, you should probably work on being a little less not thin.

• 2:08:09Jocko Willink?

  Wow.

• 2:08:13Peter Attia?

  Is that like the kindest way to just tell somebody, you're kind of getting a little fat?

• 2:08:18Jocko Willink?

  Wow. Post fourteen hour swim, open ocean, get some.

• 2:08:22Peter Attia?

  So, that was the last time I had a coke. I've never had a coke since. And, and all I did frankly, at the time was just say, like, I'm just gonna try and experiment. Because I was like, look, at that time, I still thought it was just calories in, calories out. I thought it was really just simple arithmetic. And my view was, all right, I can't do anything more on the calories outside. There's only one hundred and sixty-eight hours in a week. I'm not willing to exercise more than twenty-eight of them. So calories out, I don't get to change that anymore. And frankly, I didn't really want to change the calories inside because I hated being hungry. Every time I tried to eat less, I would just be so hungry, I didn't know what to do with myself. So I was like, I'm gonna try a new experiment. What if it's the type of calorie that might matter?

• 2:09:04Peter Attia?

  Sugar strikes me as not great for you, even though I can't tell you why. I'm gonna stop having sugar. So that was my first experiment in September of oh nine. And that led to everything that's come since that time. Which obviously ultimately led to me coming back to medicine as well.

• 2:09:21Jocko Willink?

  Yeah. And that's where you're at now. And, and, and by the way, um, listen to Tim, Tim's podcast. What else should people listen to to get all that nutritional information, the, the rest of the story? I think it's Tim's.

• 2:09:36Peter Attia?

  Yeah, I mean, a couple of things with Tim. I did a podcast with Chris Cresser. Earlier this year, talked about longevity a little bit. I did one, I did, I probably have a, maybe, oh, you know what? Probably get more into nutrition on that. There's an IHMC video I did, probably like three or four years ago.

• 2:09:53Jocko Willink?

  That one's like an hour long and you go pretty detailed in it?

• 2:09:56Peter Attia?

  Yep.

• 2:09:57Jocko Willink?

  Okay, yeah, I've watched that one. Yeah, those are good. Those are good. And again, if you had to kind of

• 2:10:07Jocko Willink?

  tell people that aren't going to go listen to those podcasts, aren't going to watch that, that video, what would you tell them? You know, what would you tell them to eat? Overall?

• 2:10:19Peter Attia?

  You know, I, I generally don't like talking about nutrition because, and don't worry, I will answer this question, but I want to at least preface it why I don't like, I don't like talking about this stuff.

• 2:10:32Peter Attia?

  Nutrition is kind of a pseudoscience that masquerades as a religion for many people. And so I find it difficult to have a discussion about biochemistry when it's so cloaked in emotion, religion and dogma. Now, that's not to say I don't have a strong point of view. I certainly do. It's also an evolving point of view. I feel different today than I felt four or five years ago. I feel different today than I felt two years ago. And also, my life is one big experiment. Right? So, you know, like we were joking before I came in here, man, I've got a glucose meter buried within me at the moment. I've got like all these heart rate variability things, like everything I'm doing, actually, let me just check.

• 2:11:16Peter Attia?

  I actually did an experiment before I came here today. I ate something and I want to see how much it raised my blood sugar.

• 2:11:24Peter Attia?

  That's not bad.

• 2:11:26Jocko Willink?

  What did you eat?

• 2:11:27Peter Attia?

  So I ate this product that I've been doing some research on. It's called No, K N O W, like No Foods. And I was introduced to this product by one of my patients who said, hey, Peter, I want you to kick the tires on this a little bit. It's um, it's, it uses a sugar substitute called allulose. And it tastes amazing and apparently like it doesn't raise your blood sugar at all. And I was like, yeah, I'm familiar with allulose. Uh, for, for those who might not know, allulose is a sugar that occurs in nature in very small quantities. That looks exactly like this sugar called fructose, which is fruit sugar, the sweet component of sugar.

• 2:12:12Peter Attia?

  With one small exception, but that one small exception carries with it some very important things. One, it's not quite as sweet as fructose. It's about 70% as sweet, but by giving up that little bit of that sweetness, you get a whole bunch of stuff in return. First of all, it's not metabolized by the liver, which is the real problem with fructose. Two, you barely absorb it. So 99% of it or more or less is excreted by the kidneys. And three, it actually seems to lower blood glucose. So this company, No Foods, is putting this, like making stuff out of this, but stuff that is like carby. Like bread and waffles and muffins and stuff.

• 2:12:51Peter Attia?

  So anyway, to make a long story short, I'm at this patient's house and he's force feeding me these things, which is really my way of saying he's left the bag open and I'm inhaling them. And he's like, yeah, yeah, you gotta, you gotta like, tell me if this stuff's legit. So to make a long story short, he plugs me into the guy who founded the company. And he has sent me a bunch of this stuff to just play with, cause he knows what I do. And so that's what I've been doing. So today, I normally don't eat breakfast, so I worked out this morning. And then before I came here, I had a big piece of their toast covered in almond butter. And then two of their huge waffles covered with almond butter and bananas. Like I made a big sandwich out of that. So the almond butter, not gonna have a huge glycemic response, cause it's got so much fat and protein in it.

• 2:13:35Peter Attia?

  But the bananas should skyrocket my blood sugar. Not to mention the two freaking waffles the size of my head and the piece of toast. So interestingly, so that was at nine o'clock that I ate those. Now I've been up since 3:30, but I didn't eat anything. I worked out from seven to eight. So admittedly, there's a bit of a glycogen debt. So at nine o'clock, when I ingested, my blood glucose was sixty-five. And at its peak, which was eleven eighteen AM, it was up to ninety. And it's now down to eighty-three.

• 2:14:09Jocko Willink?

  What would real waffles have done to you?

• 2:14:11Peter Attia?

  I think they would have sent me to like one forty. Three huge pieces of bread slash waffle with the full banana. So, anyway, I've been doing these experiments all week, which is just a great excuse to eat this stuff. And I'm kind of actually surprised. I'm kind of blown away. So, okay, with all that said, what's my advice for what people should eat?

• 2:14:33Peter Attia?

  In an ideal world, everybody would have this thing embedded in them like I do. This thing is called a Dexcom G5. It's a continuous glucose monitor.

• 2:14:43Peter Attia?

  Typically only used by people with type one diabetes.

• 2:14:47Peter Attia?

  We're now starting to see people with type two diabetes wear them, but I was really completely lucky one day, sitting on an airplane next to a dude who happened to be into watches. I'm into watches. We got talking about watches. I find out he's the CEO of the company that makes this thing. The rest is history, right? I'm like obsessed with this stuff. And so, because the answer is this, right? If you were a computer program, I would say, Jocko, eat whatever you want to eat such that your average blood glucose remains below eighty-five milligrams per deciliter and your standard deviation below ten milligrams per deciliter.

• 2:15:25Jocko Willink?

  So translate that into English?

• 2:15:26Peter Attia?

  Okay, so eat in whatever way your genetics and epigenetics permit you to, such that your glucose levels stay low and the variability stays low. And those two things will ensure that your insulin levels stay low. So what I'm trying to do is optimize for something called the insulin AUC or area under the curve. Now, we can't measure that test clinically. The only way I could measure that is put you in a hospital, put a central line in your neck and, excuse me, sample your blood every thirty minutes over the course of a day where you somehow act normally. And every day, so then I'd have a time axis, Y axis, the, sorry, the X axis would be time, the Y axis would be insulin level and we'd generate a curve and we'd calculate the area under that curve.

• 2:16:10Peter Attia?

  And we want that number to be as low as possible. So we can't do that outside of the research setting. So then the next best thing is keep your average glucose as low as possible and the variability. So you could have an average glucose of a hundred with low variability. And that actually wouldn't produce that much insulin. Or you could have a glucose of a hundred with high variability. Same average glucose, higher variability is going to have higher insulin, all things equal. So just through empirical testing in myself over the past year and a half, I've realized that an average blood glucose, and this thing tells me every time I hit click, like it gives me my last 14 days.

• 2:16:52Peter Attia?

  I just realized like for my average to be below 85 and my standard deviation to be below 10 is like super dialed in. So what you can eat to achieve that varies tremendously by individual. You know, there are some people who just dispose of glucose remarkably. So that blood test we're going to do in you next week is going to be our best test at measuring that. And so glucose disposal is mostly a function of the insulin sensitivity of the muscle. Because the muscle is where we dispose of the majority of glucose. But it's more a little more complicated than that, right? Sleep impacts that, right?

• 2:17:32Peter Attia?

  So sleep deprivation makes us more insulin resistant. Though this has been experimentally demonstrated, even with two weeks of sleep deprivation. So there's a, it's a small but very well-controlled experiment that was done at the University of Chicago probably six years ago. They took a very small number of subjects, like I say, about eight subjects. And for two weeks, let them only sleep four hours a night. And they did a very invasive test called a euglycemic insulin clamp at the beginning and at the end of the experiment. And their insulin sensitivity, their glucose disposal deteriorated by 50%. And with no change in what they were eating.

• 2:18:14Peter Attia?

  So, so it's highly variable, right? So that's theoretically the answer. On a practical level. I would say the answer is this, right? If it comes in a package, you're probably better off not eating it. Right? Um, if your ancestors couldn't have eaten this even 200 years ago, it's probably not worth eating. So if you just followed that advice, think about how many things you'd eliminate from your diet. Right? If you just took packaged foods away.

• 2:18:48Jocko Willink?

  Right.

• 2:18:49Peter Attia?

  From your diet. And again, notice I'm agnostic. You want to be a vegan? Knock yourself out. You want to be the paleo man of the century? Go for it. I don't give a shit. Okay. Like, I couldn't care less. Right? But if you can largely adhere to those principles, you're kind of going to be fine. Do you want, you know, you're going to get 70% of the way there. You want to get 80, 90, 100% of the way there? Yeah, well, then there's no simple answer. Now, at that point, you got to dial in and you got to go full immersion into, how do you tweak to your biochemistry? How much protein? What's the timing of the meals? When do we fast? I mean, all of the stuff that, uh, is, is my world and maybe soon to be your world, uh, that, that's, um, that's the, that's the stuff for which you cannot provide, you know, systemic advice.

• 2:19:34Peter Attia?

  But at the, at the societal level or at the, just the most basic level, yeah, I mean, think about that advice. Like, you don't, you don't eat sugar anymore. You won't eat refined carbohydrates anymore. You're not going to eat, you know, processed crappy foods anymore. What are you going to eat? You're going to eat fruits. You're going to eat vegetables. You're going to eat meat. You're going to eat grain, you know? What kind of grains are you going to eat? Well, you know, you're, you're, you know, you're not going to really eat these sort of refined crappy grains that people eat. You're going to, you know, your, your starches, I'm sorry, not grains. Your starches are probably going to be in the form of potatoes and rice. So, again, a lot of people, you know, again, I just, I sort of, I think the reason I don't like talking about nutrition anymore is I don't find it to be an intellectually honest discussion anymore. I find it to be just a discussion of dogma. Right? So if you're a low carb camp, you're a low carb camp.

• 2:20:16Peter Attia?

  If you're in the, you know, whatever, the vegan camp, you're in the vegan camp. Like, there's the, you can't even have a discussion about this stuff. And at least not with most people.

• 2:20:27Jocko Willink?

  Yeah.

• 2:20:27Peter Attia?

  So I just, you know.

• 2:20:28Speaker 01

  You ever read the book called Diet Cults?

• 2:20:31Peter Attia?

  I know.

• 2:20:32Speaker 01

  Bro, so.

• 2:20:33Peter Attia?

  Does it get into this nonsense?

• 2:20:34Speaker 01

  What you just said right there? That's the whole book. Really so interesting, fond to read too. So good.

• 2:20:40Peter Attia?

  I will have to check that out.

• 2:20:42Speaker 01

  Diet Cults.

• 2:20:43Jocko Willink?

  Now, I'm kind of open with this and since we're.

• 2:20:46Jocko Willink?

  Since we're a little over two hours right now.

• 2:20:48Peter Attia?

  Come on.

• 2:20:49Jocko Willink?

  Uh, I said that you're probably the most responsible individual for this podcast. And because you originally through Kirk, uh, set me up to do a podcast with Tim Ferriss, which sent me up to do a podcast with Joe Rogan, which was just all awesome. And both those guys told me I should do my own podcast. So anyone that's listening to this podcast, say thanks to Peter for that.

• 2:21:18Peter Attia?

  Actually, they should thank Kirk, right?

• 2:21:20Jocko Willink?

  Yeah, Kirk was the man.

• 2:21:22Peter Attia?

  You know, I mean, Kirk is, I don't need to tell you, but Kirk's one of those guys where, like, he doesn't have to justify and ask, right? So when he introduced me to you, he didn't have to explain. He was just like, I want you to meet Jocko. Jocko's my friend. Like, that's good enough. And so, you know, to me, like, that's the measure of when life is good. And because I feel that way with all of my friends, like, if Tim introduces me to somebody, like, Tim's introduced me to, like, a dozen people. A dozen amazing relationships have come out of that, right? And so, you know, you know, really, it was just very easy for me to sort of take Kirk on his word that, like, if, you know, Jocko's a great guy, then that's, that's all I need to know. I knew you were gonna be a great guy. And then similarly, like, I could tell Tim, like, hey, you gotta meet Jocko. And, and, you know, Tim gets quote unquote pitched all day long.

• 2:22:07Jocko Willink?

  Yeah, he does.

• 2:22:07Peter Attia?

  But, you know, he knows that I'm, I'm not gonna send him somebody that's not, you know, gonna be really interesting and going to benefit his listeners, not just, you know, whatever agenda that person might have.

• 2:22:19Jocko Willink?

  Yeah, yeah. No, it was awesome. And that, that really did, I mean, the way Tim, the way Tim advised the way he was gonna release the podcast in order to support the book. I mean, he just nailed it. It was kind of ridiculous, the way he understands that stuff and how helpful it was to, you know, getting our book out there and getting it sold and, and all that, and getting all these people on board. And then, you know, that turned into this podcast, which, you know, he, he definitely has promoted the podcast in a fantastic way, along with Joe. So that's both been awesome. But again, started with Kirk, connecting me with you, and then you connecting me with Tim. So, uh, appreciate that.

• 2:22:59Jocko Willink?

  And, um, speaking of this podcast, my almost silent partner over here, Echo Charles, if somebody wants to support the podcast. How would you recommend they go ahead and do that?

• 2:23:15Speaker 01

  You always, I have a question.

• 2:23:17Jocko Willink?

  Oh, oh.

• 2:23:18Speaker 01

  How'd you hurt your back originally?

• 2:23:21Peter Attia?

  You know, I don't think we ever really have a diagnosis. Uh, there was certainly nothing on that day that I did, that day I'm riding my bike to the, to the gym. I, I, you know, I think about the sins of my youth. Um, you know, I was really into martial arts in addition to boxing. And I used to spend a ton of time. Um, I was really obsessed with spinning back kicks. Now, I don't know if that could have done it or not. I, but I used to practice 75 spinning back kicks with each leg every single day. For probably about six years, seven years. Um, it's possible, even though in theory a spinning back kick, if done correctly, should really not put any torque on the lower back.

• 2:24:02Peter Attia?

  It's much more in your hips and technically the flexibilities in the thoracic spine, not the lumbar spine. But you know, God knows, maybe I just wasn't doing those things correctly. Um, I did squat and deadlift really heavy growing up. I did powerlifting as sort of a side sport, but you know, certainly never hurt myself doing that. Um, I rode crew for a year. And so I always, I've always wondered if that was the most destructive thing I did because, um, in an eight man boat, it's eight, you're asymmetric, right? So when you skull, you're symmetric, when you sweep, you're not. And so I was like, I was a sweeper. And so I almost wonder if like, that's the most destructive thing I ever did.

• 2:24:39Speaker 01

  Yeah. And then you figure if you're asymmetric like that, your everyday life is asymmetric really. Cause you have a little bit of overdevelopment on one side. Damn, that might've been.

• 2:24:49Peter Attia?

  So I, I guess I've never really known, but I take it really seriously today. In fact, you know, Jocko, you'll dig this. Um, two weeks ago, I, I did a video in New York with a friend of mine named Jesse Schwartzman. And, uh, he's like, I call him the savant of movement. This guy's like, just like the kinesthetic man and. I wanted to put a video together of how do you train to train? How do you prepare your body to train? So it's basically three sections. It's what, what's the sort of dynamic? Well, the, the sort of tissue preparation, the static prep and the dynamic prep. It took us eight, maybe, maybe six hours to shoot this video. It'll be edited down into probably three 10 minute videos.

• 2:25:35Peter Attia?

  And as soon as they're done editing, I'm just gonna throw them up on YouTube and my blog. So I'll make sure you've got a copy. Awesome. It's, it's, I mean, Jesse's just, you know, he walks me through all the exercises. But I get the sense like if I had done that stuff all the way in my life, I probably never would've been hurt. And luckily, knock on wood, to this day, I mean, I never thought I'd be able to squat and deadlift again after going through that year of my life. But amazingly, I'm totally fine.

• 2:25:59Speaker 01

  And it was a herniated disc that popped off.

• 2:26:02Peter Attia?

  Yeah, so it was an L5S1 really big herniation, but then a four or five centimeter fragment broke off. And then floats down the canal and that was sitting on the nerve root. And then I developed a few other problems after. So I developed this thing called a facet arthropathy, which resulted in the feeling of having my testicles torn out from the inside. I'm not even joking, that's just so, it's just unbearable.

• 2:26:25Speaker 01

  Yeah, I would imagine that's unbearable.

• 2:26:27Peter Attia?

  I don't recommend that.

• 2:26:28Speaker 01

  No. All right. Um, well, that being said, I guess we can talk about, um, if we can talk about Onnit. I was talking with Greg and Terry. And I was showing him about, uh, I was showing him the Warrior bars. Right, like, these are, these are dope. And then, then he was like, oh yeah, like what else is there? There's some good stuff, Onnit has good stuff. So I brought out the, that new pre-workout one, which is good, by the way, I ever report on that. So that one comes out and then the krill oil comes out, oh yeah, this is good for this. So we're talking about this, this big table of like all this stuff. It's not a lot, it's like four things, the Warrior bar, the krill oil and the pre-workout. And, uh, three things.

• 2:27:12Speaker 01

  And we're like, yeah, this does this and this does this. And then I kind of stepped back and I'm like, yeah, we're those guys with all our supplements, talking about supplements, talking about supplements, right? Which I've never done. And Greg goes, yeah, if we weren't such nice guys, this would be a real douchey conversation. So the, kind of the irony there is him saying that he's the one having the douchey conversation, but he is the nice guy.

• 2:27:39Speaker 01

  You get it?

• 2:27:40Jocko Willink?

  I guess so.

• 2:27:41Speaker 01

  Anyway. Point there, or actually, the second point there is on it is good supplement. So if you do talk about them while you're taking them, you're not having a douchey conversation. And this is why.

• 2:27:52Jocko Willink?

  I heard Joe Rogan talking the other day about like how hard it is when you're a stand up comedian and you tell a joke and it's just flat.

• 2:27:58Speaker 01

  Yeah.

• 2:27:58Jocko Willink?

  I think we just got a little.

• 2:27:59Speaker 01

  Yeah, but that wasn't. Here's the thing. Here's the thing.

• 2:28:01Jocko Willink?

  That hurt me over here.

• 2:28:03Speaker 01

  There were.

• 2:28:03Jocko Willink?

  I always give you a mercy laugh, but I didn't do it because I'm not a merciful person.

• 2:28:06Speaker 01

  That was, that had joking elements, but this is true. And this is part of a bigger point that I'm making.

• 2:28:11Jocko Willink?

  I hope so.

• 2:28:12Speaker 01

  I don't expect you to laugh at everything I say, even though you pretty much do.

• 2:28:18Speaker 01

  Anyway, the reason that it's not a douchey conversation, here's the point, is because on it supplements, the krill oil, all that stuff is actually good quality. It's not like, hey, I'm gonna meet it, I'm gonna get buff and all this stuff. It actually helps your performance. Anyway, so in the event of you wanting on it stuff and supporting this podcast, while at the same time supporting yourself, go to onnit.com slash Jocko, 10% off. Boom.

• 2:28:46Speaker 01

  Second way to support, Amazon click through. Christmas is over, but we still need stuff. Duct tape, whatever, knives, etc. If you want to support this podcast, just go to the website, choco podcast.com, click through the, the Amazon banner link before you do your shopping. You can support that way. It's a good way to support.

• 2:29:13Speaker 01

  Oh, wait, yeah, you're into chemistry, right? Sodium, when you put a little piece of sodium in the water, right? It makes this big commotion. So that's what, kind of what the Amazon click through does. It seems like this small little thing, but applied properly, it makes a big impact in the podcast. Support wise, anyway, but you get that.

• 2:29:32Jocko Willink?

  Can we verify that, doctor?

• 2:29:34Peter Attia?

  I will have to go and look at the Amazon click through.

• 2:29:39Speaker 01

  I tell Jocko, he typically doesn't really understand because he doesn't know what sodium does.

• 2:29:43Jocko Willink?

  No.

• 2:29:44Speaker 01

  Might've been potassium or both, actually.

• 2:29:47Jocko Willink?

  So now this whole thing's been a lie.

• 2:29:49Speaker 01

  No, no, no.

• 2:29:50Jocko Willink?

  Or it's unsure.

• 2:29:50Speaker 01

  No, no, no, I'm pretty sure. I'm actually fairly certain.

• 2:29:54Jocko Willink?

  Pretty sure goes a long way with that, I guess.

• 2:29:57Speaker 01

  Yeah. Anyway, you can subscribe to the podcast on iTunes, which seems obvious. Cause typically the podcast you listen to, you subscribe to, but sometimes you don't so subscribe if you have not already and you want to support this podcast.

• 2:30:14Jocko Willink?

  Google Play, Stitcher, also in the game.

• 2:30:16Speaker 01

  Yeah.

• 2:30:17Jocko Willink?

  And iTunes, yeah.

• 2:30:18Speaker 01

  Yeah, it's kind of unfair that I don't think about that as much. You know, when you have an iPhone, like you kind of forget all this other stuff.

• 2:30:24Jocko Willink?

  I'm over here to help out.

• 2:30:25Speaker 01

  Yeah, man. Good thing you're here, yeah? On this podcast. YouTube, of course. We're working on putting more videos on there aside from the whole podcast. So some of those videos, and I have gotten like messages saying like those shorter clips are helpful.

• 2:30:44Jocko Willink?

  They are helpful.

• 2:30:45Speaker 01

  You know? Rather than listening to the whole podcast.

• 2:30:47Jocko Willink?

  And there's been people that have been submitting to you on Twitter.

• 2:30:50Speaker 01

  Yeah.

• 2:30:51Jocko Willink?

  Which excerpts.

• 2:30:52Speaker 01

  Yeah.

• 2:30:53Jocko Willink?

  Are in high demand out there in the world.

• 2:30:55Speaker 01

  Yeah. Yeah, I've been following now and in fact I have them all like it's a, it's a process, but yeah, we're working on that. So subscribe to YouTube.

• 2:31:03Jocko Willink?

  We are working on that.

• 2:31:04Speaker 01

  We are.

• 2:31:05Jocko Willink?

  I like it.

• 2:31:06Speaker 01

  Collectively.

• 2:31:07Jocko Willink?

  Just so you guys know, I'm not working on any of that, but Echo apparently is, which is cool.

• 2:31:11Speaker 01

  Well, technically you saying, hey Echo, put this one up.

• 2:31:14Jocko Willink?

  Okay.

• 2:31:14Speaker 01

  Boom, you did your part. Yeah, man, exactly. And then in the event of you wearing like, what, like a T-shirt or something or a hoodie? Jocko has a store. It's called Jocko Store. The URL is jockostore.com. Is that a calculator watch you have? I was gonna get to that. So you mentioned, see now we've got to change the subject real quick, which I like, by the way. Remember you were talking about you're into watches. Yeah. I was gonna show, I didn't want to interrupt what you're saying, but. That is. You appreciate that, right? That is ridiculous. I just reincorporated this one back, cause.

• 2:31:50Jocko Willink?

  What is it, a calculator watch?

• 2:31:52Speaker 01

  Yeah. Actually, one of the first pictures I posted on Twitter was up before the enemy and it was like. You know, Jocko was always like, yeah, four thirty a.m.

• 2:32:00Peter Attia?

  Which one is that? The Casio?

• 2:32:01Speaker 01

  Yeah, Casio.

• 2:32:01Peter Attia?

  Oh, cool.

• 2:32:02Jocko Willink?

  Dude.

• 2:32:03Peter Attia?

  Circa nineteen eighty-four, eighty-five. That watch, when I was a kid, dude, like, I would have killed someone for that.

• 2:32:12Speaker 01

  Only the cool kids had the calculator one.

• 2:32:14Peter Attia?

  Oh.

• 2:32:14Speaker 01

  Usually, if you had a watch, it was just the regular Casio. And the cool kids had the calculator.

• 2:32:19Peter Attia?

  I had the first Iron Man.

• 2:32:22Jocko Willink?

  Did you?

• 2:32:23Peter Attia?

  Yeah. It was black with like a little red trim on it. I asked for it for Christmas. My parents got it for me, but I knew where they hid presents. So every day after school, I would go into their room and I would take it out of the box. And I would, I had set the time. I would wear it. I would just hang out there. And then before I go to bed, I'd like sneak back, put it in. And so like on Christmas Day, it was like I'd been wearing the watch for a month.

• 2:32:47Speaker 01

  Right, right. Those are your watches. Actually, I think you got a.

• 2:32:51Jocko Willink?

  I'm into watches too.

• 2:32:52Speaker 01

  Yeah.

• 2:32:53Jocko Willink?

  Yeah. Well, I got one. Actually, I got, I got quite a few of these.

• 2:32:56Peter Attia?

  Jocko, you should have your own brand of watches.

• 2:32:58Jocko Willink?

  Yeah. We'll see how all that turns out.

• 2:33:01Peter Attia?

  Yeah.

• 2:33:03Speaker 01

  Nonetheless, yeah, I am very proud of this calculator watch. Back to the store, though. Jocko's store, no watches, but.

• 2:33:11Jocko Willink?

  Yeah.

• 2:33:11Speaker 01

  There are, yeah, yeah, not yet. But there are some cool shirts, in my opinion. I think they're cool. Discipline equals freedom, all these things. Jocko's head, good, written in backwards. Various layers to these shirts, not just like, oh, picture, that's it. So if you like any of that stuff, I'm not even saying go buy this stuff. I'm not saying that. Just go to the jockostore.com, see if you like it. If you like it, you want one, then you buy one. And that supports the podcast.

• 2:33:42Speaker 01

  You know, it's a systemic thing.

• 2:33:45Jocko Willink?

  Good.

• 2:33:46Speaker 01

  There you go. Patches on there as well. Rash guards.

• 2:33:49Jocko Willink?

  Oh, you know what you didn't mention? That you should have mentioned, because apparently it's been pretty cool out there in the world.

• 2:33:54Speaker 01

  Lay it on me.

• 2:33:55Jocko Willink?

  Psychological warfare.

• 2:33:57Speaker 01

  Yeah, I didn't mention it this time, but I mentioned it last time and in my everyday life and I use it. So there you go.

• 2:34:05Jocko Willink?

  Cool. Psychological warfare. You use it?

• 2:34:08Speaker 01

  I use it.

• 2:34:09Jocko Willink?

  Every day?

• 2:34:10Speaker 01

  When needed. Here's the thing, you can't use it every day. No, you can't. Actually, you can. I'm not gonna say you can't use it every day, but the reason, the whole reason that I was like, hey, Jocko, what do you say, you know, when you're

• 2:34:22Jocko Willink?

  Oh, cuz you don't need it every day.

• 2:34:23Speaker 01

  I don't need it every day.

• 2:34:24Jocko Willink?

  Okay.

• 2:34:24Speaker 01

  But it varies, you know, from season to season. So like, you know.

• 2:34:30Jocko Willink?

  So if, if you are coming up against moments of weakness.

• 2:34:34Speaker 01

  Yep.

• 2:34:35Jocko Willink?

  We have a little method to get you over those humps.

• 2:34:38Speaker 01

  Yeah, we, it's kind of like coaching a little bit because

• 2:34:43Jocko Willink?

  Psychopathic coaching.

• 2:34:44Speaker 01

  Yeah, psych, for sure. It, cuz it kind of

• 2:34:49Jocko Willink?

  I played it for, I played one of them for my seven year old daughter the other day cuz she was about to eat some candy or something. I was like, come here for a minute.

• 2:34:54Speaker 01

  Yeah.

• 2:34:55Jocko Willink?

  So I played her that one, you know, the snack time one.

• 2:34:58Speaker 01

  Yep.

• 2:34:59Jocko Willink?

  Yeah, sugar coated lies. She was, she was pretty impressed, but what impressed me was later in the evening, she was kind of saying it.

• 2:35:05Speaker 01

  Yeah.

• 2:35:06Jocko Willink?

  I was, hmm.

• 2:35:07Speaker 01

  See? And that's what I was gonna say where you explain, it's like, cool, it's Jocko telling me to do this. So yes, I'll do it or not do it or whatever. But you explain some, some, some good stuff like to, to remember, you know?

• 2:35:20Jocko Willink?

  Like there is sugar coated lies.

• 2:35:22Speaker 01

  Yeah. And that's kind of catchy too. So it sticks in your mind.

• 2:35:25Jocko Willink?

  Poison. So you can buy that on iTunes.

• 2:35:29Speaker 01

  Yes.

• 2:35:30Jocko Willink?

  It's somewhere else too, right? Google Play, if you want it. And also everyone that asks for an alarm tone to wake up.

• 2:35:36Speaker 01

  That's it?

• 2:35:37Jocko Willink?

  That's it. It's there now. You don't have to ask anymore. You can just go to iTunes and get that psychological warfare.

• 2:35:41Speaker 01

  Clear it with your wife though, or whoever you sleep with.

• 2:35:43Jocko Willink?

  Yeah, we've gotten some serious feedback on that one.

• 2:35:45Speaker 01

  Yeah.

• 2:35:46Jocko Willink?

  Because what happens is the alarm goes off. If you have it set, then it's gonna be my voice and it's gonna be weird cuz it's gonna sound like there's some strange man in your room talking.

• 2:35:55Speaker 01

  At four thirty in the morning, which is kind of weird. Yeah.

• 2:35:58Peter Attia?

  Does the alarm only work at four thirty AM like?

• 2:36:01Jocko Willink?

  No, it's just, it's just, it's just a, it's an album. It's, it's an album of tracks and each track talks about some moment of weak, generally a moment of weakness that you have. Like there's ones to wake up in the morning. There's ones to, you know what? You don't feel like going to the gym? Go to the gym. There's ones you feel like eating a donut. Don't eat the donut. There's one, L, I'm gonna, I'm gonna put this off for a while. I'm gonna procrastinate. No, you're not gonna procrastinate. So all the little moments of weakness that we all have as humans can be countered using psychological warfare, factually.

• 2:36:36Speaker 01

  Yeah, there's, there's actually two on there. There's one called like, I think it's called like no more. It's basically like, I'm not doing this anymore.

• 2:36:43Jocko Willink?

  No more is a good one.

• 2:36:44Speaker 01

  That one's good because it puts into words exactly like what you wanna think like, you know, cause you always feel that like, you know how like, you know, you're gaining some weight or I mean, a lot of times you know why you're gaining weight. And so it's a little bit different, but you're like, you know what? I'm not doing, drinking is one where you wake up kinda hungover and you're like, I'm not drinking anymore. You know, like that thing, but you never really.

• 2:37:04Jocko Willink?

  Execute.

• 2:37:05Speaker 01

  Yeah, you know, man, it's perfect cause it sticks with you. You're like, no more. And then the other one was, uh, when you're talking about every day, it's called every day, I think. Every day is a Monday. That, that, that one, that one's dope, man.

• 2:37:19Jocko Willink?

  So you can get after that. Also, if you wanna get some tea, if you're a tea drinker, or if you're not a tea drinker, you can get some Jocka White Tea. You can get it on Amazon. It's fully in stock. Yeah, all those days of being out of stock, I think we've got them under control for now. And I won't make any promises because last time I made a promise, you guys went psycho. So I'm not gonna make a promise, but you can get the Jocka White Tea. I figured out, again, it doesn't, it doesn't taste like tea. Really? It doesn't taste like coffee. And for a long time I was at a loss for words to describe what it tasted like. And I figured it out. I was responding to someone and I figured it out what it tastes like. And it's pretty simple.

• 2:38:01Jocko Willink?

  The Jocka White Tea tastes like victory.

• 2:38:07Jocko Willink?

  So if you need to, and we need to trade, I need to trademark that one stat.

• 2:38:13Speaker 01

  The fact that.

• 2:38:14Jocko Willink?

  Jocka White Tea tastes like victory. Boom.

• 2:38:18Jocko Willink?

  So get some of that if you need to deadlift more, if you need to overhead squat more weights, this will increase all those numbers beyond anything you could have hoped for.

• 2:38:30Jocko Willink?

  You can drink it from a Jocko mug. Says get after it on it. That's good.

• 2:38:34Speaker 01

  Oversized by the way.

• 2:38:35Jocko Willink?

  Yeah, it's big. It's big. It's not. Somebody, somebody made the comment that it's not comically big.

• 2:38:41Speaker 01

  Right.

• 2:38:41Jocko Willink?

  It's not a joke.

• 2:38:42Speaker 01

  Yeah, it's not like clown shoes.

• 2:38:44Jocko Willink?

  No, it's not a clown shoe. Oh, no, no. But it's big enough to, you know, it's big like a pair of work boots. It's as big as a pair of work boots. It will kick you in the ass if needed.

• 2:38:53Speaker 01

  Yeah.

• 2:38:54Jocko Willink?

  So it's that big. If you haven't got the book Extreme Ownership, you can pick that up there. It's about leadership. It's about combat leadership. I'm going to give my friend Peter Attia about three copies of it just to make sure he reads it. So if he has to deal with any C players, he's going to step up his game a little bit, hopefully.

• 2:39:12Peter Attia?

  Pre-publication.

• 2:39:13Jocko Willink?

  That's right.

• 2:39:14Peter Attia?

  But I clearly missed that chapter.

• 2:39:15Speaker 01

  Wait, what's a pre-public? What does that mean?

• 2:39:17Jocko Willink?

  Meaning before the book came out, hey, here's what the book is.

• 2:39:22Speaker 01

  Okay, but it's still, that's it. That's the book.

• 2:39:25Jocko Willink?

  You got the pretty.

• 2:39:25Peter Attia?

  It's a paperback. Yeah, it was like.

• 2:39:27Jocko Willink?

  Yeah.

• 2:39:27Speaker 01

  You got the VIP free screening.

• 2:39:29Jocko Willink?

  Yeah, yeah. Um, hey, speaking of extreme ownership, we're having another muster. If you don't know what it is, check out the website, extremeownership.com. It's going to be in New York City. So everyone can come because if you're on the East Coast, no matter where you're on the world, it's easy to get to New York. And

• 2:39:50Jocko Willink?

  May 4th and 5th, if you're a leader or you want to be a leader, come and get it. There's every level of leaders there, CEOs, mid-level managers, every industry you can think of too. People that manufacturing and finance and construction and health and pharmaceutical and there's police there and fire and military and oil industry and energies, everybody. All working on leadership, talking about leadership. So, and I've said, it's gonna sell out. We're moving in that direction quickly. And Echo hasn't even released his videos yet, because he's on Hawaiian time.

• 2:40:25Speaker 01

  No, no.

• 2:40:26Jocko Willink?

  Oh, you're not?

• 2:40:26Speaker 01

  No, I'm, I'm working diligently and I'm going for quality, not, you know.

• 2:40:31Jocko Willink?

  You're not gonna put out any scrub material.

• 2:40:33Speaker 01

  Right.

• 2:40:34Jocko Willink?

  Once those videos come out, my feeling is gonna sell very quickly. So, get there now, sign up for it. If you need a police or a fire discount, or a military discount, or if you're gonna bring a group of people, I think the biggest group we had at the last one, one company was around sixteen people, from one company, or twelve people. But there's some pretty big numbers of companies that are showing up there. Come and, come and get it. Echo, you got any closing comments?

• 2:40:59Speaker 01

  My pleasure. Uh, no other closing comments, thank you.

• 2:41:02Jocko Willink?

  Other than it was your pleasure. Peter, any closing comments?

• 2:41:06Peter Attia?

  I would only echo Echo's comment. And that didn't even get planned until it came out.

• 2:41:13Speaker 01

  Perfect, perfection.

• 2:41:15Jocko Willink?

  Hey, and if you wanna continue these conversations with Peter, on Twitter, you're Peter Attia M D. What are you on Facebook?

• 2:41:26Peter Attia?

  Um, I don't know, probably, uh...

• 2:41:31Jocko Willink?

  Do you still have Eating Academy?

• 2:41:32Peter Attia?

  Yeah, yeah.

• 2:41:33Jocko Willink?

  Okay.

• 2:41:33Peter Attia?

  Probably the...

• 2:41:33Jocko Willink?

  Is that the place to look?

• 2:41:34Peter Attia?

  I don't, I don't do a lot.

• 2:41:35Jocko Willink?

  So Twitter's your most prominent?

• 2:41:38Peter Attia?

  And I've been berated into doing something on Instagram. I just can't cope at the moment.

• 2:41:44Jocko Willink?

  Yeah, there's a way to connect the two. I've tried it, I don't like it. I do them separately.

• 2:41:51Speaker 01

  Yeah, you don't really connect Twitter to the Instagram. I think it's the other way around.

• 2:41:54Jocko Willink?

  Well, there's a way to connect some of them, somehow.

• 2:41:56Speaker 01

  Yeah.

• 2:41:56Peter Attia?

  I just don't have enough pictures to show.

• 2:41:58Speaker 01

  Right.

• 2:41:59Peter Attia?

  I don't have anything to...

• 2:42:00Jocko Willink?

  Don't you have a bunch of watches?

• 2:42:02Peter Attia?

  Yeah, but...

• 2:42:03Jocko Willink?

  See, I'm showing a watch, the same watch every day.

• 2:42:06Speaker 01

  Show that ring, how you were explaining it, bro. You could do like, twelve pictures just on the ring.

• 2:42:12Peter Attia?

  What if my, what if my whole Instagram shtick became this? Like, my blood glucose at every moment.

• 2:42:19Jocko Willink?

  That'd be pretty cool.

• 2:42:20Speaker 01

  And you kinda indicate what you ate or something like this.

• 2:42:22Jocko Willink?

  You could just, uh, save that screen and post it up there.

• 2:42:26Peter Attia?

  So much work.

• 2:42:27Jocko Willink?

  It's, it's work. It's hard labor to save that thing and press submit to... It actually has a little switch that you can just make it go. It's not that much work. For somebody that's swimming 18 miles. I know. Too much work to post an Instagram picture. You got issues, son?

• 2:42:45Jocko Willink?

  Uh, all right, Echo and I, we are also present and accounted for on the interwebs. On Twitter, on Instagram, and also if you're going to be looking around that face, booky boha, we gonna be there. Echo is at Echo Charles and I am at Jocko Willink and again, I would like to thank you, Peter, for coming on and more important for everything you've done for me, which really, the way it's connected all together, getting me through Kirk to Tim Ferriss, which was the book and getting me on Joe Rogan, which led to this podcast.

• 2:43:23Jocko Willink?

  It's been awesome. So to you and to Doc Kirk Parsley for introducing us, but thank you and him for what you guys have done for me. So men and women in uniform out there, holding the line.

• 2:43:40Jocko Willink?

  Thanks for your service and your sacrifice to the police on the corner. Fighting crime, the firemen fighting fires. Thanks for keeping us safe. To the medical people in the medical professions like Peter, doctors, nurses, physicians assistants, EMTs, all of you working to save lives, thank you for your commitment to service and it's obviously a massive commitment when you hear about the hours and the emotional trauma that it takes to go into any one of those industries and services.

• 2:44:22Jocko Willink?

  And to everybody else that's listening, thank you. It's your communications, your questions, your participation, your feedback and your spreading of the word that makes this possible and it's what makes this worthwhile.

• 2:44:44Jocko Willink?

  So thank all of you for all of that.

• 2:44:50Jocko Willink?

  And finally, thanks to all of you for getting out there.

• 2:44:56Jocko Willink?

  And getting after it. So until next time, this is Dr. Peter Attia.

• 2:45:04Jocko Willink?

  And Echo. And Jocko. Out.