#181 Peter Attia - The Science of Longevity, Nutrition Myths and Medicine 3.0

Peter Attia, MD, is a Canadian-American physician, author, and researcher specializing in longevity medicine. He received his medical degree from Stanford University, trained in general surgery at Johns Hopkins Hospital, and completed a surgical oncology fellowship at the National Cancer Institute. Attia is the founder of Early Medical, a medical practice focused on extending lifespan and healthspan, and hosts "The Drive," a popular podcast covering health and medicine topics. Attia is the author of the #1 New York Times bestseller "Outlive: The Science and Art of Longevity," published in March 2023. Attia has been featured in various media outlets, including the Disney+ documentary series "Limitless" with Chris Hemsworth. He is a sought-after speaker, appearing at events such as TEDMED and SXSW, where he discusses longevity science and proactive health strategies. Attia was named in Time's 2024 list of influential people in health and opened 10 Squared, a hybrid testing lab and training center in Austin, Texas. Shawn Ryan Show Sponsors: https://ShawnLikesGold.com | 855-936-GOLD #goldcopartner https://tryarmra.com/srs https://patriotmobile.com/srs | 972-PATRIOT Head to https://lumen.me/srs for 20% off your purchase. https://ziprecruiter.com/srs https://ROKA.com - USE CODE "SRS" https://babbel.com/srs Upgrade your wardrobe and save on trueclassic at trueclassic.com/srs #trueclassicpod https://betterhelp.com/srs https://drinkhoist.com - USE CODE "SRS" Peter Attia Links: Website - https://peterattiamd.com Instagram - https://www.instagram.com/peterattiamd X - https://x.com/PeterAttiaMD Facebook - https://www.facebook.com/peterattiamd YouTube - https://www.youtube.com/c/PeterAttiaMD Early Medical - https://earlymedical.com The Drive Podcast - https://peterattiamd.com/podcast 10 Squared - https://10squared.com Learn more about your ad choices. Visit podcastchoices.com/adchoices

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

• 0:01Speaker 00

  This episode is brought to you by Michelob Ultra. Good times mean competitions between you and your friends. Like seeing who can throw some pigskin the farthest, or rush the field the fastest. Winner gets an ultra. Because it's not just a superior light beer, it's also giving fans superior access to their favorite sporting events. Superior is worth playing for. Visit michelobultra.com/superioraccess to enter. Enjoy responsibly. Copyright 2026 Anheuser Busch InBev Michelob Ultra Beer, St. Louis, Missouri.

• 0:30Speaker 01

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• 1:12Speaker 02

  Peter Attia, welcome to the show. Thank you for having me, Sean. So I'm really excited about this interview. I've been diving into the health space pretty hard about the past month. And had a bunch of your constituents on here. And it's like drinking from a fire hose here for me. So really excited to talk to you about about everything that we're going to cover today. But real quick, everybody starts out with an intro. So Dr. Peter Attia, you're the founder of Early Medical, a medical practice that applies the principles of medicine 3.0 to patients with the goal of simultaneously lengthening their lifespan and increasing their health span. You're the host of The Drive,

• 1:57Speaker 02

  one of the most popular podcasts covering health and medicine. You're frequent number one in the category. Congratulations, that's awesome. And like I said, I've interviewed a lot of your constituents and everybody has amazing things to say about you. You're also the author of the number one New York Times bestseller, Outlive: The Science and Art of Longevity. You're also an accomplished long-distance, open-water swimmer, including being the first male to complete the round trip between Maui and Lanai. I've heard that the only thing you do in moderation is moderation itself, and like I said, I'm really excited to dive into medicine 3.0.

• 2:40Speaker 02

  But we had a little side conversation downstairs when we were getting started. So you're a hunter?

• 2:46Speaker 03

  Yep.

• 2:47Speaker 02

  How long have you been hunting?

• 2:48Speaker 03

  Uh, about six years now.

• 2:51Speaker 02

  What got you into that?

• 2:52Speaker 03

  Well, I got into archery first, just because I really love precision things. Um, and I was just looking for another hobby and something to do and get really into. So I'd been doing archery for a couple of years and really enjoying it and really just enjoying it for the art of learning how to shoot a bow and arrow. Um, and then a buddy invited me on a hunt, and I was kind of ambivalent. I was like, I mean, okay, I get it. Like, I think it'd be pretty cool to kill something that you eat. Um, and I think I just got lucky. You know, we got, we went to a place in Hawaii that was amazing and got to hunt a type of animal that is very difficult to hunt, called, called axis deer.

• 3:36Speaker 03

  That is not only very difficult to hunt, but is very invasive to, to the state of Hawaii, incredibly destructive. Um, and so it's, uh, it's a win for the state. It's a win for the people of Hawaii. Um, it's an important part of population control, and it turns out that I would say along with elk, it's probably the most, you know, delicious sort of wild game there is. And then the rest is history. You know, you sort of get hooked on it after that.

• 4:03Speaker 02

  How often do you hunt?

• 4:05Speaker 03

  You know, I would say these days I'm busier than I would like, so I, I probably went on Five, probably went away for four or five hunts this year. But luckily in Texas, we can hunt locally as well. We actually have access deer in Texas, so I can do, I can do some local hunting there as well.

• 4:23Speaker 02

  The same deer that's in Hawaii?

• 4:24Speaker 03

  Yeah, although it's funny, they're the only two places in the US it exists is Texas and Hawaii. But it's a pretty different animal in Texas. It's a bigger animal based on its diet. In Hawaii, it's, it's, it's smaller and for whatever reason, it, it seems just a little more skittish in Hawaii. Uh, but, but it's a totally different hunting experience. So in Hawaii, it's, um, you're hunting in the mountains. It's, um, it's pretty, it's pretty amazing.

• 4:49Speaker 02

  Yeah, I started hunting this year for the first time, just firearms.

• 4:53Speaker 03

  Yeah.

• 4:53Speaker 02

  Not into the bow stuff yet. But, uh, I love it, man. I think it's just awesome being out there. And, um, and then through these health interviews, been learning a lot about what our, what our proteins are eating at the market and the hormones and the garbage food that they've, I just, I just had this guy on, Paul Saladino, and he was talking about, I asked him about wild-caught salmon versus farm-raised salmon. And he started going on about the, what we're feeding the salmon. Holy shit, Ben. I mean, what do you, is, did that play any role into why you started hunting?

• 5:34Speaker 03

  No, I, I think it, look, I think it plays more of a role today. Um, I feel pretty lucky that I can get away with eating mostly wild game or, uh, animals that are eating what they're meant to be eating. So I also have a friend in Austin who's got a, a large property and he farms, you know, in a sustainable way, everything else that we eat. So even the bacon that we're getting is coming from pigs that are, you know, That are not going through the usual process. So there's, you know, I certainly hope that as more and more people are becoming aware of it's hard to be healthier than the animal you eat.

• 6:19Speaker 03

  So you got to be eating an animal that was pretty healthy to begin with. I hope that there are more and more economic choices for people to do this because right now it's a bit niche, right? Not everybody can go out and hunt. My brother grows cattle and it's pretty awesome. So he's, you know, he lives on a farm and he basically regeneratively farms his cattle and, you know, he and his family are only going to eat one a year. So they're selling all the rest of them and they're just kind of cycling through it. But they're, these are animals that literally just eat grass, just run through a pasture all day. And then when their life ends, it ends in the least stressful way possible, which is to say they don't know their life's about to end until they get shot in the head, which I know sounds harsh to people, but it matters, right? It matters that an animal dies in the least stressful way.

• 7:03Speaker 02

  Why is that?

• 7:05Speaker 03

  Um, look, I think that there's, you know, if the end of an animal's life is incredibly stressful, there are a lot of stress hormones that kind of go through an animal's body. And, and I can't tell you that that necessarily makes a difference in the health of the meat, but it certainly does make a difference in the flavor. Um, I also think there's just something to be said for, for the humanity of it, right? Like, um, you know, we are omnivores, right? We do, we do eat plants and animals, um, but we don't have to be cruel about it. And, and I think we should all aspire to, to, to, to eat animals that, that have lived the best life that they can. Um, and when their time comes, their time comes in the, in the simplest and cleanest way.

• 7:45Speaker 02

  Interesting. I mean, I'm just, it seems like everybody's moving to the farm to table stuff, at least everybody around here is, it's like a big conversation, uh, in the local area. And it seems like a lot more podcasts are starting to talk about that. I mean, how, how important is it, in your opinion? I mean, everybody's got their shtick, you know, and, and so, and some people really lean into it.

• 8:13Speaker 02

  I'm just curious, you know, what your opinion is on, you know, on stuff like salmon or, or, you know, the cows eating.

• 8:20Speaker 03

  I think it's, I think it's a second or third order term. I think the first order term, if you want to just take a step way back and say, okay, what do we know is 100% true about nutrition? The answer's not a lot, right? Despite what health influencers might try to tell you, there's very little that we know is kind of what I'd call capital T true. So we know that eating too much food, regardless of what that food is, is not healthy. So we know that once the body is consuming calories in excess of what it can store safely, and different people have a very different genetic capacity for what that means, you and I could be different in that regard.

• 9:04Speaker 03

  In other words, you and I might have a different ability to put fat into the subcutaneous area around our waist, which by the way is a safe place to store excess energy. But at some point, any person will begin to exceed that and they'll start to put fat into places where it should not be. Fat should never be in your liver, it should never be around your organs, it should never be marbling inside your muscles, it should never be interwoven in your pancreas, around your heart, or around your kidneys. Those are the danger zones. And once fat starts to accumulate there, which will happen in any form of excess energy, awful things are going to happen. And it doesn't matter if you're eating farm to table, or if you're eating McDonald's.

• 9:49Speaker 03

  Now, one could argue, if you are eating highly processed foods, it's an easier path to get there. And I agree with that. I think there's reasonable evidence to suggest that the, the more palatable, the less nutrient dense, the lower quality the food, the easier it is to overeat. But we just shouldn't lose sight of that objective, which is, you don't want to eat too much, and of course, you don't want to eat too little, although that's less of a problem today. It's, we should acknowledge it's still a problem. I think the second order term is you've got to make sure you're getting enough protein for adequate muscle protein synthesis. I always joke about this and my, my, my wife teases me.

• 10:33Speaker 03

  You just, you can't walk through the hospital hallway and interact with people in the final years of their life and find anybody saying, I wish I had less muscle mass. You know, so, so we, we all have to remember that gravity is working against us as we age and sarcopenia, which is the loss of muscle mass, osteopenia, the weakening, weakening of bones. All of these things are enormous causes of age-related morbidity and mortality. And so adequate protein intake, in addition to adequate caloric intake are the two most important pillars. Then you can start to go, okay, well, okay, Peter, I get that. Now tell me what to do. And then, believe it or not, I think we get into a highly variable way that the body works.

• 11:18Speaker 03

  There are some people who do incredibly well on diets that are very high in carbohydrates. There are others who do incredibly well on diets that basically omit carbohydrates altogether. I was one of those people, by the way, for three years, from 2011 to 2014, I was on what was called a ketogenic diet. So that meant for three years, I think I had carbs once, what literally one day on my wife's birthday, I had three pieces of cake. And aside from that, I was, the only form of carbohydrates I had was like lettuce and some berries, but otherwise it was all protein and fat. I did very well on that diet. It, it served me incredibly well, but for some people it did not, and that's fine.

• 11:57Speaker 03

  When you start to get into kind of some of the more minutia that people tend to fixate on, it's a little bit of majoring in the minor and minoring in the major. The evidence gets squishier and squishier. The arguments get more and more mechanistic and less based on actual data. So you can make a plausible argument that maybe you shouldn't eat that type of fat in favor of this type of fat, but there's no actual outcome data to the effect. So maybe time will tell, but I tell people that they should probably focus on the areas where we have far more evidence of doing X is beneficial, doing Y is not. For example, around exercise, sleep and other things like that.

• 12:40Speaker 02

  Why did you come off that diet?

• 12:43Speaker 03

  So, truthfully, I got a little bit of food fatigue, you know. And it wasn't that I was craving to eat like pasta and, you know, rice and potatoes again, but I was craving just a wider variety of fruits and vegetables and things that were basically gonna kick me out of ketosis. And so, I did. And, you know, I'm super happy to be eating what I eat today, which is basically, I'm pretty much an in-the-middle eater, right? Like, I wouldn't say I'm on a high carb diet, I wouldn't say I'm on a high fat diet, I'm kind of, I don't pay attention to any of it. You know what I pay attention to? I pay attention to how many calories am I eating? How much protein am I getting? Are the sources of my food as good as I can make them on a given day on average?

• 13:28Speaker 03

  Yes. Okay. And, by the way, all the biomarkers that any human is capable of checking, they're looking fine. I will use that to make sure I'm doing it correctly. If something were to change, I could revisit it, but I don't think that the incremental leanness that I might have had, because that was certainly a difference. For me, being on a ketogenic diet, I mean, I was probably 6% or 7% lower in body fat than I am today.

• 13:55Speaker 02

  Wow. Do you try to do, I'm just curious, you personally, do you try to do the farm-to-table stuff, or do you...

• 14:03Speaker 03

  Well, again, I think it's, I'm pretty privileged in that between my access to hunting, you know, we were talking about this year, very fortunate that I had two elk tags. So, not only am I gonna feed my entire family with every form of elk you can imagine, right? I mean, we've got elk sausage, we've got elk steaks, we've got ground elk for burgers. I actually had to give away 500 pounds of meat, I had so much this year. So, yeah, I'm in a fortunate position where, because of my hobby, I have access to that. But I don't, I don't tell people to fixate on that, right? I mean, if you don't have access to farm-to-table, you can still go and buy, at your grocery store, grass, you can spend a little more and go grass-fed instead of grain-fed, and

• 14:48Speaker 03

  I think that's a worthwhile trade. You can still spend a little bit more and say, like, I'm gonna opt into something that's organic, that hasn't bed-fan antibiotics, without having to go all the way to farm-to-table. But if you live in an area where you can find a local farmer and say, "Look, I'm gonna commit to half a cow this year with my family," or, you know, a quarter cow or whatever is typically how they'll do it, I mean, I think that's a great option.

• 15:12Speaker 02

  You know, we're getting a little in the weeds before we really start here, but I wanted to, you brought up studies earlier, and, you know, I don't think it's any secret, everybody is, the, there's been a lot of distrust in the, in the healthcare system, and where these studies come from, is Big Pharma the only one doing the studies on the medicine that they're producing, or the food companies, corporations, doing the studies on the food that's coming out, and so, I kind of want to ask you, you know, what do you think about those studies, are they only, is that who's conducting the studies, and, and are there alternatives?

• 15:51Speaker 03

  Yeah, so again, the term studies, obviously, is pretty, pretty broad, so if you look at most nutrition research that's trying to answer the questions that I think people want to know, they aren't actually funded by, by, by industry, they're, they're typically funded by NGOs, they're funded by NIH, and, you know, you're, the list of people who's going to be more critical of NIH than me is not a very long list, I've been quite critical of, of things that the NIH has done, in my view, not correctly, also, you could argue, maybe I'm conflicted, I did my fellowship, my postdoctoral fellowship at the NIH, so I spent two years there, and so I know the, I know the merits of, of NIH, it's a remarkable

• 16:36Speaker 03

  system that gives the United States an insane competitive advantage in biomedical research, like, no other country on the planet has what we have access to, right, so we, we talk about things like, what, why is the US military so far superior to every military on the planet, like, is there a second place, there really, like, the gap between the US and everybody else is so enormous, and a big part of it comes down to investment, and I would say the same is true from a biomedical research perspective, like, nobody can even invest a quarter of what we invest in this.

• 17:13Speaker 00

  This episode is brought to you by Michelob Ultra. Good times mean competitions between you and your friends, like seeing who can throw some pigskin the farthest or rush the field the fastest. Winner gets an ultra. Because it's not just a superior light beer, it's also giving fans superior access to their favorite sporting events. Superior is worth playing for. Visit michelobultra.com/superioraccess to enter. Enjoy responsibly. Copyright 2026 Anheuser Busch InBev Michelob Ultra Beer, St. Louis, Missouri.

• 17:48Speaker 00

  This episode is brought to you by Michelob Ultra. Good times mean competitions between you and your friends, like seeing who can throw some pigskin the farthest or rush the field the fastest. Winner gets an ultra. Because it's not just a superior light beer, it's also giving fans superior access to their favorite sporting events. Superior is worth playing for. Visit michelobultra.com/superioraccess to enter. Enjoy responsibly. Copyright 2026 Anheuser Busch InBev Michelob Ultra Beer, St. Louis, Missouri.

• 18:21Speaker 03

  So we just have to acknowledge that that's a good thing. And yeah, it still makes some mistakes.

• 18:27Speaker 03

  So the majority of people who are conducting this research are good people. They have varying degrees of competence and varying blind spots. But for the most part, when multiple different labs over multiple decades conduct multiple types of trials and the answers largely point in the same direction, you're sort of inclined to think that there's probably not much of a signal in the other direction.

• 18:59Speaker 03

  Now, when it comes to pharmaceutical stuff, there's a different pathway, right? So here, pharma does need to pay independent investigators to do research because of the regulatory pathway to get drugs approved. Now, we might see in the new administration a revision of how some of that is done. I think that I think that there have been mistakes that have been made in the way drugs are approved. I don't think it's nefarious. I don't think it's a conspiracy. People are very quick to attribute conspiracy to what I think is more readily attributable attributable to

• 19:40Speaker 03

  incompetence at times, truthfully, or just people acting in their own best interest, right? Like, you know, water always follows the path of least resistance. So just because water goes down there doesn't mean like, oh, there's a conspiracy that the water's going down there. No, like, that's what gravity and less resistance means. So as one example, I think that there should probably be fewer barriers during the lead up to approval, but more barriers post approval. In other words, I'll give you one example. It's a controversial example, but I feel strongly about it. Paxlovid was a drug that was approved to treat people with COVID, right? This was a drug. I believe it's a Pfizer drug. So if you got COVID, they would give you Paxlovid and it was approved very quickly.

• 20:27Speaker 03

  But I think ask any doctor who's been prescribing Paxlovid for patients with COVID, the drug doesn't work. Like, it just outright doesn't work. And by the way, it might even increase your risk of getting subsequent COVID. And while I can appreciate why the FDA wanted to see that drug approved quickly because of the way the world looked then, and especially if you're trying to treat people who are uniquely vulnerable to COVID, which would primarily be older people.

• 20:57Speaker 03

  I think where a lot of trust was lost in that it would have been great if they did follow up studies that six months later said, hey, we this drug's been in the world today for six months. It's not working. We should pull the drug. Because a lot of money is getting wasted and frankly, a lot of people are being put on a drug. It's not harmful, but it's not helpful. So why would we have a non-helpful drug out there? So, so, so again, I know that that's a bit of a long answer, but I hope that I'm communicating the nuance of the situation, which is it's not black and white.

• 21:26Speaker 02

  Thank you for sure. Then I'm curious to vaccines going to all these things are popping in my head that aren't in the outline. Vaccines are a major topic of discussion in a lot of homes right now. Everybody that has kids, you know, is wondering, me included, you know, should we vaccinate our kids? Should we not? What do we do? You know, and me and my wife have kind of set off on this journey interviewing a lot of different medical professionals. And it gets it gets hard, you know, and it gets for for somebody that's not a medical professional myself, it's, you know, what I find is we'll go to a practice and it feels

• 22:09Speaker 02

  like it's a sales pitch. It's a sales pitch on we don't vaccinate, we're anti vax, you don't have to vaccinate your kids here. And it's like, that's great. Um, but we still need a healthcare professional. We don't just need somebody to tell us, hey, don't vaccinate your kids at all. Like, what if my kid gets a broken arm? What are you going to treat him with? You know, and it becomes like this sales pitch, you know, the whole pitch is, we don't vax, which, like I said, great, you don't vax, but what what do you do here? And other than tell me that vaccinations are horrible for my kids and for myself and

• 22:52Speaker 02

  my wife. And so I'm just curious what your thoughts are on vaccinations, if you have any, what should we be doing? What should we not be doing?

• 23:01Speaker 03

  Well, this is a topic I've put more work into than I wish. I say that because it's not something I'm really interested in, to be honest with you. I don't, there are lots of things I'm interested in. This is not on the list, right? But I've had to put a lot of interest into it. I've had to put a lot of time into it. I suppose because of the position that I have found myself in, where people are saying, hey, Peter, you're a very, very public facing physician, and you're not in the quack category. Like, there are lots of quack physicians out there, but but like, we want to hear what you have to say. I also have a personal interest in it because I have three kids. So. So what have I, what have I learned?

• 23:44Speaker 03

  Well, I've learned that there are certain, so first of all, this is another topic that is not going to be a popular topic because people don't love gray. They want black and they want white. Nothing in science is absolute. It is all probabilistic. So there are very, very, very high probabilistic certainties and there are very, very, very low probabilistic certainties. So for example, I know that if you have a certain type of infection and I give you this type of antibiotic, the probability that it will cure that infection and save your life is exceedingly high. It's 99%.

• 24:26Speaker 03

  But I can't say with 100% certainty that every single person that has this infection to whom I give this antibiotic will be cured. Can't say that. That's not how biology works and biology is the messiest of the sciences. So with that stated, I think there are some high probability certainties out there with respect to vaccine. I think there are some really gray areas and I think everybody needs to ask the question, what am I optimizing for? So I will start that question with, with you, right? What is it you are most afraid of as you think about vaccinating your kids? What are you, what are you, what is the mistake you're worried about? What are you afraid of and what are you hoping to achieve?

• 25:11Speaker 02

  Well, I think, I think something that I'm afraid of and I is, you know, there's a lot of talk and maybe it's rhetoric, maybe it's not about, you know, autism, you know, being caused by vaccines. Well, you know, me and my wife talk about this all the time and there's all the people out there that are, you know, my kid took the MMR shot. Hasn't been the same since. And, you know, and then there's the studies with the rise in autism. But are we testing more effectively for autism? Is, you know, is this is, there's got to be some sort of a scale, like, how autistic are you? Are we diagnosing more, you

• 25:51Speaker 02

  know, based off of that scale because because more and more symptoms or whatever become more prevalent? And so is that the reason that autism is on the rise? Is it's just we didn't diagnose as many people because the symptoms were not as is is is prevalent? Or or is there actually a rise, you know? And so that's one thing. Then there's all the, you know, the COVID stuff about the COVID vaccine. Is it giving people, you know, is it creating, you know, heart problems? Are people dying from the vaccine? I don't know. You know what I mean? I don't know.

• 26:34Speaker 03

  So let's just take those two examples. I think the second one's a lot easier. Because I think we I think the answer there is I would put it a little more in the more certainty category, although I think the previous one as well, we can we can address. So when it comes to the COVID vaccine, one of the concerns, particularly with the mRNA vaccines, and particularly more so with the Moderna one than the Pfizer one, was you saw an above the baseline increase in myocarditis, in particular in young men. So myocarditis is an inflammation of the cardiac muscle. Now, you always have to remember, when you're vaccinating millions of people, there's going to be background noise. People get myocarditis all the time. And you can get any sort of viral infection and get myocarditis. I've

• 27:17Speaker 03

  known countless people and seen in the hospital and been around people who have got myocarditis for no reason other than they got an infection. So you have to know there's a baseline level of this going on. But it really appeared that in particular, for young men, teenagers and in their 20s, perhaps, there was an uptick following that particular vaccine in the incidence of myocarditis. To be clear, most of those men recovered without a vent. I think that the real mistake of policymakers at the time, because this would have been about 2022.

• 27:52Speaker 03

  Was not acknowledging that, right? Like, to acknowledge that is basically to say, hey, this is biomedical science. Things happen and we don't always know when we do studies on a few thousand people, what's gonna happen when it reaches a million people? Because if the signal is so small that it's only 0.1% of people, you're not going to pick that up at a thousand. You gotta be able to do a million. And you're not gonna do that until it's out in the real world. So why not just acknowledge that and say, hey, that's a risk we should be aware of. And we should weigh that risk against the benefit. Because what's the harm to an 18-year-old healthy male when he gets COVID?

• 28:37Speaker 03

  Well, we can quantify that. We know what that risk is. We've seen enough variants of COVID to know that. Is that risk worth that trade-off? And I think reasonable people, when presented with that set of facts, can make their own decision. I know my decision for my kids in that setting when confronted with that information. And it might not be the same as the next person. But that's okay. I think that's... We just want people to be able to make reasonable decisions based on reasonable information. But when it turned into, there's nothing wrong with it, there's nothing wrong with it, you know, the sort of denying it, I think that cost a lot of credibility. And when parents got demonized for asking the question and saying,

• 29:21Speaker 03

  hey, should my six-year-old, who's completely healthy, really get this vaccine? And they got turned into bad people for that. I think that was a huge mistake. And again, I can tell you, taking care of countless people, I have patients that ran the spectrum across there. I had patients that said, I want me and my family to get every single vaccine there is. And I had other people that said, we're not touching this thing with a 10-foot pole. And my job was not to talk anybody into or out of anything. It was simply to make sure they understand and can quantify the risk of both decisions and to be there and help them think through it. And that's it. So I hope that answers your question on the myocarditis.

• 30:06Speaker 03

  Yes, there was indeed a real signal. In absolute terms, it wasn't big, but...

• 30:13Speaker 03

  In my opinion, it was not worth the risk to young males. That was my, it's my personal opinion. I don't think it was worth the risk. And that means as such, I did not vaccinate my kids because they were otherwise healthy. I also feel very fortunate that we live in a state where it was not mandated. And therefore, we didn't actually have to pay a heavy price for it. So I also have empathy for people who live in draconian states where these things were shoved down their throat. But you know, when you, when you live in a great state like Texas, um, they, they tend to defer to what the patient, that what the parents think is right, at least in this regard around a COVID vaccine. And we just felt like, hey, it wasn't necessary. Our kids are super young and healthy.

• 30:58Speaker 03

  Why put anything else into them that they don't need? Mm hmm. That said, I take a different point of view on other vaccines. I think there are a number of vaccines where the risk of not vaccinating them is so much worse than the risk of vaccinating them. The one in particular that I have looked into more than all others combined is indeed MMR. Because I think every parent who has been, um, and I say this word deliberately misled by the fraud that came out of a guy by the name of Andrew Wakefield, uh, will always have in the back of their mind, the lingering concern about autism. So Andrew Wakefield was a guy who has been more than discredited.

• 31:43Speaker 03

  So I say this again, um, with, with, with, with, with complete clarity. He has been more than discredited for what he did to completely and deliberately and fraudulently manipulate data to make a case that the MMR vaccine caused COVID. I've done an autism. I'm sorry, uh, caused autism. I've done a complete podcast on this. So if people are interested, um, they can, I interviewed the journalist who's done great work on this and we kind of go through all the work. His name is Brian Dear. Not a pro vaccine guy, by the way, doesn't care about vaccines one bit, despite the fact that he's been, people have tried to make him the face of MMR. He's like, nope, I just care about science. And this guy was the worst example of bad science.

• 32:26Speaker 03

  So I can tell you with a very high degree of confidence, without wasting the next three hours, why the MMR vaccine is safe. And furthermore, why I think kids who don't get the MMR vaccine are really at risk of getting diseases that are much, much too significant to ignore. An area where I do, sorry, you're gonna ask a question and I'll go to another direction.

• 32:50Speaker 02

  I wouldn't, I mean, I don't want to take you off your train of thought, so go ahead.

• 32:54Speaker 03

  I was just gonna say, now, let's talk about an area that I would put in the middle. Because right there, I'm saying, on the one hand, again, I didn't think the COVID vaccine made sense for young, healthy kids. I really do think the MMR vaccine absolutely makes sense for all kids. So here's an area where I think the system has kind of broken a little bit, and it's the use of the Hep B vaccine for kids early in life. So today, if a child is born in the United States, they are gonna want to give them their first of their hepatitis B shots while they're in the hospital. Now, that has never made sense to me biologically, because unless the mother has Hep B, in which

• 33:37Speaker 03

  case that makes sense, because the risk of transmission is very high. And to be clear, Hep B is an awful disease. So I'm not minimizing Hep B at all. We have no treatment for it. We have no cure for it. If you have hepatitis B, the risk of getting cirrhosis and needing a liver transplant, or the risk of require, or getting what's called hepatocellular cancer, is very high. So you don't want Hep B. But it's a bloodborne transmitted disease. Like, you're not gonna catch it in the air. So if a child is born to a mom that doesn't have Hep B, the risk that that kid's gonna get Hep B in the first five years of their life is virtually zero.

• 34:18Speaker 03

  And for that reason, I don't see the need to subject them to that vaccine immediately. But I also understand where the medical community is coming from, which is saying, hey, we don't want to miss an opportunity to give a vaccine, because if we don't give it now, this kid might never get it. So, so there's a policy decision that needs to be made by people there. Personally, if it were me, I'd like to see it studied. This is where I actually would like to see the NIH fund an experiment. Because I'm genuinely curious. Is it safe to give children that many vaccines that early in life? Or should we limit them to the ones that are absolutely essential?

• 35:00Speaker 03

  Where we know, hey, measles, Mumps, rubella, smallpox, polio, these are devastating diseases. And especially if you have a kid that's gonna go to daycare, where they're gonna be around a lot of kids. And the risk of transmission, if there's an outbreak, is non-trivial. So again, we want to eradicate smallpox and polio. MMR probably don't get eradicated, but we want to protect kids against them. And Hep B strikes me as something like, I don't think we need to do that right away, but I'd like to see it studied. So that's kind of three extreme examples of how to think about this. But as you can tell, given that it just took me 10 minutes to explain those three things at a superficial level, nobody wants to have this discussion. They just want to be black or white. Are you pro-vax or are you anti-vax?

• 35:45Speaker 03

  What about neither? Like, what about? I have a nuanced approach to every single one of these, if you're willing to sit down for three hours.

• 35:52Speaker 02

  Yeah, yeah. That was actually, that was my question is, is, you know, do we, if we were to vaccinate our kids, do we, do we break it up? You know, because, you know, we'll go to the doctor and they want to do, they want to do them all at once. And it's like, you know, like I said, for somebody that's not a medical professional, this is...

• 36:13Speaker 03

  It's overwhelming.

• 36:14Speaker 02

  Is it, is this too much?

• 36:16Speaker 03

  Yeah, yeah.

• 36:16Speaker 02

  In too small amount of time? Do we, do we try to drag this out, you know, so that it's one every month? Or, or, or what? I don't even know the schedule. I'm just saying, do we, do we prolong this so that it's not so many vaccines in such a short amount of time?

• 36:33Speaker 03

  Well, and the other thing to your point is, some kids are gonna have no problem. They're gonna sail right through it. But you don't know if that's your kid. I mean, at the end of the day, you're, you're, you're sort of, your goal is to figure out what's the best thing for your kid and whatever you can do to kind of minimize that risk. And of course, the doctor is looking back at you and your wife saying, yeah, look, we're not opposed to spreading this out, but how do I know we're gonna keep you on schedule? Now, there's also some nefarious stuff that...

• 37:04Speaker 03

  I understand why it takes place, but the optics of it are really problematic. And that is that Medicaid reimburses physicians for vaccinations. So you'll hear that, and people who are really in the anti-vaccine camp will point at that and say, that's a blatant conflict of interest. And the answer is, it is and it isn't. It's not at all uncommon for Medicare and Medicaid to reimburse physicians, to incentivize them to provide good care to patients, right? So just as if you have high blood pressure and you're on Medicare, you might have a physician who's being reimbursed if they can control your blood pressure better.

• 37:48Speaker 03

  That's viewed as a win-win. Your life is better because when your blood pressure is lower, there's less chance of a heart attack or stroke. The medical system is better off because you're now going to cost the system less money by not having a heart attack or a stroke. And they want to reward the physician by saying, here's an extra $100 because you managed to get Sean's blood pressure down. So that's, everybody agrees that that's kind of a good system. But when you now go into Medicaid and you apply that to doctors are getting paid to vaccinate kids, well, a couple of things change, right? The first thing is, we don't know the answer to the question you asked. Like, I don't know, I certainly don't know the answer. And I, and I, I say this with humility, I don't know that anybody does.

• 38:30Speaker 03

  I don't know that anybody knows we should just be ramming all the vaccines in the kids on day one to maximize them and make sure compliance is the highest versus can we take a more nuanced approach and spread them out? So right out of the gate, you take away some certainty. So you lose a bit of the moral high ground to be able to say, I should be paying you to do this. Whereas in as much as you can have certainty in biology, I have pretty high certainty that if your blood pressure is normal, you're way better off than if your blood pressure is high. So that again becomes problematic, but you can, you can see how it can get twisted into something that it's really not. Mm-hmm, mm-hmm. Interesting. Thank you for that. Can we talk about hunting instead? Yeah.

• 39:13Speaker 02

  So I want to kind of do a little bit of a life story with you, but before we get started, I have a Patreon account. There are top supporters. A lot of them have been with us since the beginning. It's grown into quite the community over there. And without them, I wouldn't be sitting in here, and neither would you. So one of the things I do is I give them the opportunity to ask each and every guest a question. And so this is from Christian. "In a time when information is transmitted exponentially and health experts often present contradictory views, how can we distinguish valid analysis from discourses influenced by biased personal agendas?"

• 39:58Speaker 03

  Oh, that's a very, very sophisticated erudite question. Think a couple of things. I think one, look at, look at people who are comfortable talking about uncertainty. So the more that a person is willing to speak in uncertainty versus certainty, I tend to believe them a little bit more. Right? So when a person tells you that it's their way, like, "You have to eat this food," and it's like, "This is, anything that's not this is going to kill you," blah, blah, blah, like, versus, "Oh, we didn't, you know, maybe,

• 40:41Speaker 03

  maybe not." Like, so, so, so that's one thing. And then I think the second thing is you always have to mind for what a person's conflicts are, financial conflicts. So I think it should be required that anyone who describes themselves as, you know, a health influencer slash whatever, like, whatever you call people in this category, they should all have a clear page of financial disclosures. It should be unambiguous. Exactly what, what companies have they invested in? Do they receive pay for promotion? Do they receive financial kickback or remuneration when they talk about a product? All of that should be fully, fully disclosed. Just, you

• 41:26Speaker 03

  know, there should be no ambiguity about that. So I would say those are two really important ways to understand the credibility of who you're listening to.

• 41:33Speaker 02

  Okay, that's a great answer. And then, awesome, everybody gets a gift.

• 41:42Speaker 02

  I get really self-conscious about giving these out to doctors, but Vigilance lead gummy bears, you know, all kinds of stuff that's bad for you and they're but they do taste great. They're made here in the USA and it's kind of a mainstay for the show. It's been going on since

• 41:59Speaker 03

  Beautiful.

• 41:59Speaker 02

  Since we started.

• 42:00Speaker 03

  Thank you very much.

• 42:02Speaker 02

  But, um, all right, let's dive into your life story. So I know you grew up in Toronto and I think your parents came immigrated from Egypt?

• 42:12Speaker 03

  Yep.

• 42:13Speaker 02

  So, what were you into as a kid?

• 42:17Speaker 03

  Um, I mean, the first sport I fell in love with was hockey, which is pretty, um, pretty typical in Canada. Probably at the time, honestly, there were, today, I'm sure kids will have more of a well-rounded sporting background with, you know, the NBA is there, but yeah, I was pretty much just hockey growing up. From a very young age until, uh, until, until my second love came, which was boxing.

• 42:42Speaker 02

  Boxing?

• 42:43Speaker 03

  Mm-hmm.

• 42:43Speaker 02

  Nice. What were your parents? What did they do?

• 42:47Speaker 03

  Um, so my dad, uh, ran a restaurant and my mom worked at the restaurant with him. I mean, she, when I, when she, when they came over, you know, she worked at a checkout, you know, worked in a, like a variety store, grocery store at the checkout. Um, and then by the time I was born, she was mostly working at the restaurant with my dad.

• 43:09Speaker 02

  Any brothers, sisters?

• 43:10Speaker 03

  Yep. I got a younger brother and a younger sister.

• 43:12Speaker 02

  Get along?

• 43:13Speaker 03

  So three.

• 43:15Speaker 02

  You guys get along?

• 43:16Speaker 03

  Very well, yeah.

• 43:17Speaker 02

  Still close?

• 43:18Speaker 03

  Very close.

• 43:20Speaker 02

  What other, I mean, were you a good student?

• 43:23Speaker 03

  Um.

• 43:23Speaker 02

  Were you into, were you into medical growing up?

• 43:26Speaker 03

  Nope, no, not at all. Um, yeah, I think I was, um, I was a bright kid when I was young. I was put into, um, A gifted program, but my mom says when I was in fourth grade, the program lost its funding. So I got put back into the normal program. And she says that's when things started to go not so well. So I think that was fourth or fifth grade. Again, I don't really remember much of this, to be completely honest with you, Sean. But my mom says I just got very bored in school and my performance started to sort of go down. I started to really kind of clash with teachers a lot. And I think by the time I got to high school, just really

• 44:11Speaker 03

  had zero interest in school. Was, you know, you didn't have it, I didn't have a choice to but to be there, but I had no interest in it at all by that point. Get into trouble? I did, but not that much because fortunately by that point, I had gotten into boxing and boxing was, I mean, I think it saved my life because I think it really kept me focused on this goal. I mean, I wanted to be a professional fighter. And even by the time I was 14 years old, I mean, I was training six hours a day. Wow. So I was, you know, training in the morning, training middle of the day at school, training when I got home. And so it was my life was basically training and working at the restaurant.

• 44:57Speaker 00

  This episode is brought to you by Michelob Ultra. Good times mean competitions between you and your friends, like seeing who can throw some pigskin the farthest, or rush the field the fastest. Winner gets an ultra. Because it's not just a superior light beer, it's also giving fans superior access to their favorite sporting events. Superior is worth playing for. Visit michelobultra.com/superioraccess to enter. Enjoy responsibly. Copyright 2026 Anheuser Busch InBev Michelob Ultra Beer, St. Louis, Missouri.

• 45:32Speaker 00

  This episode is brought to you by Michelob Ultra. Good times mean competitions between you and your friends. Like seeing who can throw some pigskin the farthest, or rush the field the fastest. Winner gets an ultra. Because it's not just a superior light beer, it's also giving fans superior access to their favorite sporting events. Superior is worth playing for. Visit michelobultra.com/superioraccess to enter. Enjoy responsibly. Copyright 2026 Anheuser Busch InBev Michelob Ultra Beer, St. Louis, Missouri.

• 46:05Speaker 03

  I mean, I didn't, I didn't socialize. I didn't go, I didn't have time to do anything else. You know, I was working at the restaurant and I was training. I mean, you say it, you say it saved your life? I think so, for sure. Why do you think that? Well, because I think like I look at a lot, I look at, um, like, I don't think, I think I had poor judgment as a young kid, which a lot of young boys have. And I look at some of the kids that I grew up with, and I see where they wound up. And, um, I just don't know which side of that fence I would have been on, right? Like, I, I mean, there are kids I grew up with that were 10 years after high school or in jail for armed robbery. You know, you make a dumb decision. Like, you can do a dumb thing and change your life forever. Yeah.

• 46:49Speaker 03

  And I don't have the confidence to say I would have never been one of the guys that made that dumb decision or been at the wrong place at the wrong time. Because I also don't, like, I don't look at myself, I certainly didn't look at myself back then as a leader. Um, I don't think I was a huge follower, but I was mostly just in my own world. But I think if I wasn't in that world, I could have easily wanted to impress one of the older, tougher kids. And that's how you get sucked into these stupid, stupid things. Um, and it could be stupid things like, God, there was a kid in my high school, and we used to play this game, which was so idiotic, where we would jump into the subway trains and play chicken to see who could get out last. And sure enough, one of the kids didn't get out. Oh, shit. And so, you know, you just like, You see that?

• 47:32Speaker 03

  Uh, no, I wasn't there, but I knew his brother very well. Um, because this, the kid that didn't get out was a year younger than us. It was a younger brother of one of our friends. And I, I just think like, Man, there's so much luck involved in not, you know, not, not ending up in the wrong spot. So, so again, I think for me, boxing and martial arts as well, because I was doing both by the time I was in high school, they just became an amazing thing for me. I, I ended up hanging out with people who were older, right? Because you're, you know, it's not a place for a lot of kids at the time, right? This was, you're, I'm hanging out with grown men. So you're

• 48:14Speaker 03

  sort of seeing these guys who have jobs and you, you know, you're, you're, I think they were just a good influence on me.

• 48:21Speaker 02

  Yeah, yeah. How far did you take your boxing career?

• 48:25Speaker 03

  Well, I was super serious about it. So when I finished, when I was in 12th grade, was when I did make a decision to not become a professional boxer. And, you know, it was really because of this teacher I had. So when I was in 12th grade, I had this teacher who really made a big difference in my life. And again, I'm really grateful for that because even though I was pretty good, like statistically speaking, you have to think in terms of probabilities, statistically speaking, I was going to wind up, you know, brain dead, right? Like very few people are going to hit escape velocity in a sport like boxing.

• 49:05Speaker 02

  I'm curious, one, you said you clashed with teachers. So how did that teacher make that influence on you?

• 49:12Speaker 03

  Well, you know, for reasons that I don't know, I still kept taking math. I think I deep down kind of liked it. And so he was my math teacher, Woody Sparrow. And so this is, you know, 12th grade, I'm taking math, and I'm actually doing reasonably well, right? Like I'm not, you know, top of the class or anything, but I'm, but I'm doing well. And I just liked the guy. Like, he's funny, but he's got like kind of an edge to him. And in the middle of the year, one day, he says, hey, can I, can you come in tomorrow morning? Before class, I said, sure.

• 49:55Speaker 03

  So I came in and he said, you know, Peter, I heard you're not going to university. And I said, that's right. And he said, you know, I, I, I think that's a mistake, but he didn't lecture me, right? He didn't give me the, you know, you're crazy not to go to university. He gave me the, he said something else, which was very touching. And he said, look, I think it would be, I think it would be, I think, how did he word it? I think it would be a waste because I think you have an unbelievable amount of potential. And I just think you should revisit the decision not to go. I think you have a real gift for mathematics that you don't quite see yet. But I think, you know, I just think you should be open to the idea of doing something.

• 50:36Speaker 03

  And there was something about that, I mean, that undoubtedly planted a seed in my mind that over the rest of that year, I kind of changed my thinking. Came back for this fifth year of high school to take all of my prerequisites to then apply to go to university and actually set out to emulate him. So he was actually an engineer before he came back to teach math. So I went off to the same university he went to to study both engineering and math.

• 51:05Speaker 02

  Interesting.

• 51:06Speaker 03

  Yeah.

• 51:06Speaker 02

  Interesting. So you went in, actually, before we go there, I'm also curious, I mean, as a, as a boxer, as a mixed martial arts guy, you know, I've interviewed a handful of, of pro fighters. And I'm always curious, you know, with, with the, with TBIs and all that kind of stuff. What do you think about kids and boxing now?

• 51:32Speaker 03

  You know, it's super tough. Like, again, I think about how lucky I am. I only really had one horrible concussion. It was really bad.

• 51:43Speaker 03

  And I was, I was hurting for about three months, like literally my head hurt for three months. I couldn't turn my head that, even at that speed. That's how badly I was contused. Um, and so I feel insane gratitude again. Like, how many times could my life have ended? And it's really funny. I remember being in the hospital, because I spent two days in the hospital after this one. And this neurologist comes in and he's like, oh, and by the way, the worst part of this story, Sean, I was already in university at this point. Oh, really? Yeah, yeah, yeah. Like, this was already after I decided I'm not going to be a professional boxer, but I couldn't let go of the drug. Like, it was still, I still wanted to fight. So at this point, I was like, training, and I was like, I would fight lots of guys in

• 52:28Speaker 03

  the same day. So on this particular day, I had lined up three opponents for two rounds each, and I'm fighting them at increasing weight. So it was in the fifth round, I'm fighting a guy 25 pounds heavier than me, and I just could not get out of the way of this guy. And, I mean, you know, and I, it, it, he didn't even knock me down. It was just at the end of five rounds, I was like, yeah, I don't feel right. Let's, let's call it a day, Mike. Um, so this, this doctor comes in and he goes, he was just apoplectic. He's like, I heard you're a smart kid. Like, what are you doing? What are you doing? Do you understand what this is doing to your brain? And I, and I, I never thought about it. I was like, yeah, I don't, I never really thought about it. What is it doing? Yeah,

• 53:11Speaker 03

  that's a really interesting thought. So to answer your question, I'm torn because I think that boxing teaches you something about yourself, and it's probably true of other forms of fighting. I just don't know. And I did a lot of boxing, obviously, a lot of martial arts and a lot of Thai boxing. I never did MMA, I never did jiu-jitsu or any of the other stuff that kind of rolls up into, to the, to, to, to what we see today. But I would guess it's true of any combat sport, is you learn how to control your fear, you learn what it is like to be alone in the ring with someone who wants to hurt you.

• 53:51Speaker 03

  I think there's something really valuable about that. Now, my boys both do jiu-jitsu. They've been doing BJJ since they could start. I love that they do that. If they wanted to box, I would love it. I just don't know if I'd want them to spar. I'd love for them to learn how to hit. But I also realize if you're not getting hit, it's not, you're not really learning how to hit unless you're also being hit. You know, it's, it's, you're going to develop a lot of bad habits if you're hitting without the risk of being hit. That said, I just don't think it's worth it. I think, I'm happier that they do BJJ and, and that they're, you know, that their brains are being spared.

• 54:33Speaker 02

  If they came to you and they wanted to start boxing or striking, would, would that be a hard no?

• 54:39Speaker 03

  No, it wouldn't. You know, we have a heavy bag hung up and every once in a while, they're like, Dad, show us how you can hit this thing. And I'll hit it and they'll be like, whoa. Which, by the way, I can only do for like 30 seconds now. Like, that's how bad I am today, right? I can look good for 30 seconds. So I would love it if they would learn. But do I want them in the ring taking hits? I don't think so.

• 55:03Speaker 02

  Yeah. It seems like everybody that I interviewed that's in that space, they, that they, they want their kids in some type of mixed martial arts, but no striking, no headshots. I hear that a lot, pretty much from everybody. And, uh, yeah, that's, that's interesting. So you go to school. When did you become interested in the medical field?

• 55:23Speaker 03

  So when I finished engineering, um, I was getting ready to go and do my PhD in aerospace engineering, which had become the convergence of my interest in math. And I had done mechanical engineering. And then I, I had a total change of heart and decided I wanted to do medicine. And so that kind of derailed me because then I had, I didn't have any prerequisites to apply to medical school. And you have to take this test called the MCAT. It's like the SAT, but for medical school. So I hadn't done any of that stuff. So I had to take an extra year to do it and apply to medical school.

• 55:55Speaker 02

  What, what got your motivation into medical?

• 55:59Speaker 03

  Yeah, so it's, um,

• 56:03Speaker 03

  It's one of those things where there was an instant when it happened. So there was a single moment where I realized it, but it was predicated on a year of angst. So I don't know which it was. You know the story about the, you know, the, the, the, the guy hitting away at the stone? And it's like on the thousandth hit, the stone splits. And it, you realize it wasn't the thousandth hit. It was the nine hundred ninety-nine before it. It just happened. So, so I'd say that the year of angst was really, um, my, something I was struggling with. I was just kind of like, I felt like this tug, like I wanted to help people. I wanted to work more directly with people. But I really loved,

• 56:45Speaker 03

  I loved the problem solving and, and whatnot that we were doing in engineering. But I felt this tug kind of in my heart to do something with people. And I just couldn't figure out what to do. And it's interesting, like medicine never actually crossed my mind. So I was, I mean, I, I had crazy ideas. I was like, should I be a social worker? Which of course, if anybody knows me, they would laugh hysterically at the idea of me being a social worker. Like, you know, I thought about, should I be a lawyer? Like I had all of these ideas for things that I should be doing. And I went and talked to people who did these things. These weren't like idle thoughts. Like, I mean, I was out there talking with people of all of these professions saying, hey, you know, I'm trying to figure out is my, am I going to be good at that? Am I going to be good at that? Am I going to be good at that?

• 57:29Speaker 03

  And, and, and medicine never once entered that calculation. Until one day I happened to be in the hospital, visiting somebody and had this experience. And I was like, it just kind of hit me in the face. I was like, oh my God, medicine, that's the thing I should be doing.

• 57:44Speaker 02

  What was the experience?

• 57:47Speaker 03

  So at the time I was volunteering, the whole time I was in college, I volunteered, for, for kids who had been abused. And I was in the hospital, visiting one of the, one of the kids. And I was in the waiting room and I was. Eating my lunch and another patient, an older woman, came up and sat with me. And I, she had been shunned by a group of patients at another table. It was kind of weird. I don't know why, but they wouldn't, they didn't want her to sit with them. So she came and she sat with me and we, we sat there and had a pleasant conversation while I ate my lunch and waited for the nurse to come out and get me to go in and visit the kid that I was visiting.

• 58:28Speaker 03

  And when the, when the nurse came out to get me, the woman said, she, I think she assumed I was a doctor, but then realized in that moment I wasn't. She goes, oh, I should have realized you weren't a doctor. No doctor would sit here and have had this nice conversation with me for this long. And I remember thinking, boy, that's sad if that's true. But it, it, it just all kind of clicked in that moment, which was maybe, maybe medicine. Maybe being a doctor would be the right way for me to apply both my, my interest and love in problem solving and science, but, but with this kind of more human connection.

• 59:04Speaker 02

  Then fast forward a little bit, you, you left your residency.

• 59:10Speaker 03

  Yeah, 10 years later.

• 59:11Speaker 02

  10 years later. Why did you, what are we missing in between there?

• 59:14Speaker 03

  Well, so then I went to medical school and, and then this, you know, you go to medical school and you decide what do you want to specialize in? And you don't figure that out until you're in your third or fourth year of medical school. And by that point, I decided I wanted to do surgery. And then you pick a place to go and do surgery. And I wanted to go to the best place that was the most hardcore place. And that was this place in Baltimore called Johns Hopkins. And because one of the things that made Johns Hopkins so great and to this day is both the combination of having The high, the high volume of surgeons who do really complicated operations,

• 59:58Speaker 03

  in this case, operating on the liver and the pancreas for cancer. And at the same time, it's in a really, really rough inner-city area. So you get a lot of trauma. And as perhaps grotesque as it sounds, it's really important for surgeons to train in trauma areas. Because you learn so much about how to fix the human body when the human body is getting shot and stabbed every day. And at a place like Hopkins, I think at the time I was there, it averaged 16 penetrating traumas a day. Wow. So if you now think about that, I'm on call every third night for trauma. Wow.

• 1:00:41Speaker 03

  So now think about how many stab wounds and gunshot wounds you're taking care of. You're really, you, you, you know, this is how you learn to have ice in your veins and you're unemotional about it. It's like, what's coming in? What do we need to do? How do we stabilize this patient? Can we fix him? Let's go. And so, again, you don't get that experience at all the hospitals, right? That's, that's, there's, there, you know, but, but people who, you know, will, will, will pick programs that really emphasize in that are gonna go there. So, so, so I went there and, and really honestly had an, I mean, just had a very special experience. I mean, really can't say anything negative about the place I was at, right? This wasn't like, I mean, I had amazing mentors there.

• 1:01:24Speaker 03

  The surgeons at Hopkins were legends. My co-residents were incredible. I mean, it, I'm sure it's like what you feel like being in the SEALs. Like you were with the best of the best. It's the best 1% of the best 1% that all came to this place, not because Baltimore's a pretty city, but because this is the best training we're gonna do. And, but I just, I began, I became really frustrated with the fact that I did not feel like I was moving the needle one bit. And I felt like everything I did was a day late and a dollar short. And it just didn't matter. Like, and that meant, like, I felt like it didn't matter on the cancer side. Like you could do the most perfect operation on somebody

• 1:02:08Speaker 03

  to remove the cancer, but you didn't get every cell out because you couldn't. You know, they were still gonna die 18 months later. And sometimes even on the trauma side, it would be really tragic. You would, you would.

• 1:02:21Speaker 03

  You know, you would use sixty units of blood and operate for eight hours to save somebody, and then the next month, the guy would be out there and get shot in the head.

• 1:02:29Speaker 02

  Jeez.

• 1:02:31Speaker 03

  You know, you would see this. You would see this from time to time, where, you know, um, so, so, so I just felt very frustrated, and, um, I just thought the system, the system didn't make sense to me. I was, and my wife, I was newly married at the time, uh, my wife said incredibly wisely, she's like, "Look, we've only been married for a year. I've only known you for four years, but you, you don't strike me as a person who can live in this state." Meaning, you, only two things are sustainable. You either need to fix the system that we're in, so you have all these complaints and grievances about why the medical system isn't right. You should fix it, or you should leave it.

• 1:03:16Speaker 03

  But if you sit here and just keep bitching about it, like, your life is over. And, you know, I spent the next six months thinking about what she said, and then just decided to leave.

• 1:03:27Speaker 02

  How long did it take you to kind of cut your emotions off from all that trauma that you were experiencing with your patients?

• 1:03:35Speaker 03

  You mean the actual trauma cases?

• 1:03:38Speaker 02

  Mm-hmm. I'm, I'm talking about, you know-

• 1:03:40Speaker 03

  Yeah, like when someone comes in-

• 1:03:41Speaker 02

  Gunshot, stab, gunshot, stab, stab, stab. I mean-

• 1:03:44Speaker 03

  Sometimes never. I mean, I had some, I had some pretty bad failures. I mean, my, I'll tell you this, my, one of my last nights as trauma chief, so I left on June thirtieth. You, um, the residency year runs July first to June thirtieth, so even though I decided to leave, by March, I stuck around for the last three months. So I remember it was like April fourteenth, meaning I've got like six weeks left in all of my medical training at that point in time. And I was the trauma chief that night for pediatric trauma. And we get a call, it's early in the evening, it's like seven o'clock at night, MVA, motor vehicle accident. Um, but, uh, no, no vital signs in one of the two. So

• 1:04:28Speaker 03

  it's two, I don't know anything, other than it's two, two kids driving, and one of them's seems totally fine, one of them's got no vitals, the one that's got no vitals is coming to my trauma bay. So I go down, and this boy comes in, and-

• 1:04:47Speaker 03

  He's, he's, he's got, maybe I convinced myself, he's got a pulse, he's got a thready, thready pulse. And now, um, so, so we, we run a code on him, we can't get him back, I get an x-ray, I see that his aorta is a bit wide.

• 1:05:04Speaker 03

  You know, I'm, you're running through your mind, what's going on here? What's going on? Why do I not have vital signs in this kid? Right? Is this head trauma? His pupils are a little bit big, so that means there's probably something wrong with the head. His aorta is a bit wide, though, that means he could have torn the aorta. So he, when you have blunt trauma, when you have massive deceleration, and in the case of this car, they were, they were, they had the right of way going through an intersection and some idiot T-boned them. So massive deceleration can shear the aorta, so he could be literally bleeding into his aorta. So I have to make a decision, do I open this guy's chest to try to figure out what's going on? Which, by the way, is not the answer, that, that, but, but like, I'm, I'm, I don't want to let this kid die yet, and it looks like he's dead. So we, I keep running the code, I keep running the code, we keep pumping more epinephrine

• 1:05:49Speaker 03

  into him, we keep doing everything, and everybody's kind of like, it's my job to call the code, to say, "Time of death, call it over." And I just can't bring myself to do it. I'm like, "No, no, no, we gotta keep going, we gotta keep going." I'm just feeling this overwhelming sense of sadness, and we finally call the code, and I, you know, it's very unusual, normally you'd walk out as quickly as possible, because they have to get the body out, because you have to make room for the next trauma to come in, you don't know when the next one's coming in, so you can't have that, you can't have too much time with a body just sitting there, so they have to cover the body up, get it out, clean the floor off, and there's a mess everywhere, there's, you know, we've put a million central lines in him at this point, there's needles, blood everywhere.

• 1:06:34Speaker 03

  And I remember leaving the trauma bay and going into the stairwell and just completely breaking down, which was very unusual, right? Normally, you, you sort of, you don't, you just don't even think about it, but, but I was absolutely, I, I couldn't, I couldn't put myself together. And then the nurse came and said, "Hey, you know, can you go talk to the mom?" And I was like, "Yeah, yeah." So now the mom and all the relatives are in a room, they only know that there, turns out, I realize, these are two brothers. The victim, who was in the passenger seat, is 14, the brother was 17. He's fine, by the way. He doesn't have a scratch on him. Um, and the mom just knows your boys were in a car accident.

• 1:07:21Speaker 03

  And I go and tell her what's going on, and I mean, it was the most difficult thing of my life. Um,

• 1:07:32Speaker 03

  I still remember, um, you know, and when you're wearing scrubs, they have a little pocket on them. She grabbed on to me and tore the pocket off the scrubs.

• 1:07:44Speaker 03

  I'd never had somebody do that. Um,

• 1:07:49Speaker 03

  and I spent, I probably spent two hours with him that night, and I was very fortunate that nothing else came in that night. Like, I had the time to sort of be there. Um, and I'm not sure why. I don't, I don't know what it was. His name was Malcolm. I don't know what it was about Malcolm's case that, that devastated me. I also went to his funeral five days later, which I'd never gone to the funeral of a trauma patient before. I've been to the funerals of patients, but never a trauma patient. Because you don't usually have a connection to trauma patients, right? You don't know them. They come in and they die. You don't know them. Um, but I got to know a lot about Malcolm's life. Um,

• 1:08:28Speaker 03

  and at the funeral,

• 1:08:32Speaker 03

  when I walked past the casket, I don't think his mom expected to see me. And when she did, she lunged at me, grabbed me, and I kid you not, she grabbed me so hard, she tore the pocket off my dress shirt, just as she had torn off the scrubs five days earlier.

• 1:08:51Speaker 03

  Um, and it's, it's interesting. I learned more about Malcolm at that funeral that day than I, you know, obviously would have ever imagined knowing. And it's, the story is just even more tragic when you realize what an amazing kid he was and what he meant to his family. Um.

• 1:09:09Speaker 03

  It's interesting. So, he, you know, so a relatively poor black family, and he was this incredible student, and he was going to a really special school because of his exceptional abilities, and that's why his brother was actually driving him. Like, you know, he couldn't go to the local public school in inner-city Baltimore. He was going to a school in the northern part of Baltimore.

• 1:09:34Speaker 03

  And he was, you know, he was the jewel of his mom's life.

• 1:09:36Speaker 02

  Man, man, how do you, you know, as a surgeon that treats that much trauma and sees that much death, I mean, how do you disassociate?

• 1:09:48Speaker 03

  I mean, I could ask you the same question.

• 1:09:54Speaker 02

  You don't?

• 1:09:56Speaker 03

  Yeah.

• 1:09:57Speaker 02

  How long have you been married?

• 1:09:59Speaker 03

  Uh, we're 21 years now.

• 1:10:01Speaker 02

  21 years. Congratulations.

• 1:10:04Speaker 03

  Thank you. What about you?

• 1:10:05Speaker 02

  I've been married for five years. So, what's the secret to a successful marriage?

• 1:10:13Speaker 03

  Pick the right person, I think, is literally the single most important thing. I mean, I think that's not sufficient, right? You still have to do work, but if you don't get that piece right, I think it's harder. And there's no one right person, that's obviously sort of silly. So, there's like an operating window, I think, in which you can marry people. I think I just got really lucky. Like, I think that's the theme of my life, is just obscene luck. But I just didn't understand at the time how lucky I was to meet this woman, and how much she could kind of tolerate all of my challenges,

• 1:10:54Speaker 03

  and all of my focus, and how relentless I could be, and how difficult I could be. And so, it took me a few years to figure that out, but once I did,

• 1:11:09Speaker 03

  yeah, I just, I just think like...

• 1:11:14Speaker 03

  I get it. I get, I get what you, you know, you, you see these people with, that are in their nineties that have been married for 70 years and you hear them talking about each other like, I can't imagine living without each other. And you, you think, really? I mean, he's that special? She's that special? But, but, but now I get it. Now I get it. Now I understand. You know, and my wife will tease me all the time and she'll say, you know, it, it, you know, she'll say, oh, you, you sure you don't want like some young, hot 20 year old wife? And I'm like, absolutely not. You know, I, I, you know, cause it's, I think, once you get to a certain point and you've been through enough tough stuff together, you really understand what it's about. How'd you guys meet? We met at Hopkins. We met, uh, two days after nine 11, actually, because we were still kind of in lockdown

• 1:11:57Speaker 03

  in the hospital. Um, at the time, it wasn't clear what the damage was and how like, would we still need to be on standby for bodies? And of course, it turned out that that wasn't the case at all.

• 1:12:13Speaker 03

  Interesting. So wow. So did you treat a lot of those victims? No, no, that's the point. Like, nothing came up from the Pentagon. Nothing came down from New York. I mean, people were incinerated. There was nothing to treat. Geez, geez. Well, Peter, let's take a quick break and then when we come back, we'll pick up with your medical career.

• 1:12:36Speaker 01

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• 1:13:16Speaker 02

  All right, back to, where were we? We were, oh, we were talking about secretive, successful marriage. And you're leaving your medical residency and you end up at McKinsey modeling credit risk. How did that happen?

• 1:13:31Speaker 03

  Well, when I wanted to leave medicine, I wanted to get as far away from medicine as possible and I wanted to go and get an MBA. But I was in so much debt that the thought of more debt, to go to business school for two years was not very appealing. I met somebody, actually when I was on call one night in the ER, another resident, and they told me about this place called McKinsey, so I learned about it. Sounded like a great place where basically you get paid and you get to learn all the stuff you would learn through an MBA. And so, that's what I, that's what I did. And so, I ended up out on the west coast and working on sort of math problems again,

• 1:14:15Speaker 03

  but in the, in the sort of financial banking section.

• 1:14:20Speaker 02

  And then you wound up back in the medical industry?

• 1:14:23Speaker 03

  Eventually, yep.

• 1:14:24Speaker 02

  How did that happen?

• 1:14:26Speaker 03

  Initially, just through my own kind of interest in trying to figure out my own health. You know, once my daughter was born when I was 35, I, you know, thought about, hey, I gotta, you know, I'd been always interested in performance, obviously, and, you know, you mentioned it, swimming and all sorts of crazy escapades, but, but had never really thought about health per se. And so, wanted to, you know, just better understand my own risk of initially cardiovascular disease, because that's the disease that runs most rampant in my family. And as I just became deeper and deeper in terms of my interest in understanding, understanding

• 1:15:10Speaker 03

  that, I wanted to start applying it to help others. And so... You know, I began to slowly sort of start working with with with other patients. Because I'd never I'd never let my medical license lapse. So the one thing someone gave me advice when they when they left, they said, hey, I know you think you're done with medicine for the rest of your life. Just take the test every two years, keep your medical license, you'll be grateful you did, which was sage advice, because I think if you let the thing lapse, it can be a bit of a grind to reacquire a medical license. So that's kind of how I kind of slowly came back into it.

• 1:15:48Speaker 02

  And you have three kids?

• 1:15:49Speaker 03

  Yeah.

• 1:15:50Speaker 02

  How old are they?

• 1:15:51Speaker 03

  Sixteen, ten, and seven.

• 1:15:53Speaker 02

  Sixteen, ten, and seven.

• 1:15:57Speaker 02

  Any, well, actually, I was gonna ask for fatherly advice, but.

• 1:16:01Speaker 03

  How old are yours?

• 1:16:03Speaker 02

  Mine are one and three.

• 1:16:04Speaker 03

  Okay.

• 1:16:05Speaker 02

  We're in it. We're in it. But, you know, being who you are, and you're a businessman, you're an author, you're a podcaster, you're a medical professional, I mean, you've got all these things going on, you have three kids, successful marriage, how do you how do you balance all that?

• 1:16:25Speaker 03

  Well, you have to make some sacrifices, right? So there are just certain things I don't do. I don't I don't have a lot of idle time. And I and I think that idle time can be beneficial. Like, I think there's value to doing nothing. And unfortunately, I don't have a lot of nothing time. I also don't have a lot of hanging out time. Right? And and you know, it sometimes means I come across as a little bit aloof. And, you know, when people say, hey, you want to get together, my answer is usually, no. No offense, it's not you. But like, on the hierarchy of work and family, like, I just don't have the time. Right? I don't.

• 1:17:09Speaker 03

  Everything I do has to be, has to be somewhat measured. And so between the time I make for exercise and hobbies and spending time with my kids and like, once a month, I want to have a special day with each of my kids individually, right? Once a month? Once a month. So that means like going away, for example, like, you know, take my kid to Disneyland, if that's the thing they want to do. Take my daughter to LA if she wants to go shopping, or take, you know, my son is really into Harry Potter, so we're gonna go to Harry Potterland. Like, I want to have a real special day with each of my kids once a month. So when you start, I mean, there's only thirty days in a month. Like, that's one of them, gone, right? Uh, if I want to have a date night with my wife every

• 1:17:51Speaker 03

  single week, that's one night a week, gone. A- a- and I say gone, not that it's a bad thing, I'm just saying, like, there's only a hundred and sixty-eight hours in a week. And I'm gonna sleep for this many of them, and I'm gonna exercise for this many of them, and I'm gonna work for this many of them, there's not a lot of hours left. Yeah. So that's probably how I get away with it, right? I don't watch TV. I don't know, I don't know the last time I watched anything on TV that wasn't Formula One. Like, Formula One guy? Formula One's the only thing I pay attention to. I have not watched a single football game, literally not a single game of football, in, I don't know how many years now. Yeah, and you're very similar with the TV aspect. Do you race? Um, I drive quite a bit on the track, but not as much as I used to, or not as

• 1:18:35Speaker 03

  much as I would like to. So, i- in an ideal world, I should be on the track two to four days a month. That's not happening right now. So, I probably spend more time in the simulator now, um, and realistically, if I'm on the track,

• 1:18:51Speaker 03

  this year, I'll probably do

• 1:18:57Speaker 03

  sixteen days total, and the whole year on the track. What are you driving? Um, uh, my favorite cars are Formula cars. So, like a, uh, uh, like a Formula Three car, um, but also I love, you know, like Porsches and, you know, a- all sorts of cars. Nice, nice. Well, let's move into Medical 3.0. What, what is it?

• 1:19:23Speaker 03

  So it's a term that I use throughout the book to describe kind of an evolution of medicine, right? So I contrast it with medicine 1.0, uh, cause you can't have a 3.0 if you didn't have a 1.0 and 2.0. And, um, uh, so, so maybe it's easier to kind of explain what 1.0 was, what 2.0 was and is, cause 2.0 is the dominant system of medicine today. And then what, what am I proposing as 3.0 for where, where we go? So medicine 1.0 was medicine through all of human history, basically until the end of the 19th century. And so, so for the longest period of, you know, for hundreds of thousands of years, whatever we thought of as medicine,

• 1:20:05Speaker 03

  this 1.0 system wasn't a scientific thing, right? It was, it was ideas that were based on, um, beliefs that we had at the time that I think were understandable, given that we didn't have a scientific process. So it meant that diseases were believed to result from the gods or from bad humors or from these sorts of ideas. Um, and therefore the treatments were usually pretty ineffective. You know, it wouldn't be uncommon for them to bloodlet people if they, if someone had a fever or to bore a hole in your head if you had a headache. I mean, things that we would look back at today and say, that's crazy. Well, yes, but

• 1:20:48Speaker 03

  they didn't know any better. And that was medicine 1.0. Um, and, you know, people lived pretty awful lives. Uh, you know, I think if anybody, if anybody's feeling sorry for themselves, uh, which I think we're all prone to, myself included, we should just remind ourselves that we weren't born a thousand years ago. You know, like how lucky to just be alive today. Uh, if you're still feeling sorry for yourselves, how lucky if you're listening to this and you live in the United States or you live in, you know, some part of the world where, you know, you, you have the freedom we have. So, so, um, now, You think about how like people just died all the time, right? They died of infectious diseases.

• 1:21:32Speaker 03

  You know, there was probably a 30% chance that a woman was gonna die during her lifetime giving birth. Just astonishing hardship.

• 1:21:41Speaker 03

  All of this changes about 140 years ago with a handful of seminal improvements. One is a real codification of a scientific method. Remember, science is a process. So I really get frustrated when I hear people talk about science as a thing. It's not a thing, it's a process, it's a way of thinking, it's a way of making observations, taking guesses as to what it is that is accounting for the observation, designing a hypothesis that can be tested in an experiment, conducting an experiment and measuring the results of the experiment against what would have been predicted by the hypothesis,

• 1:22:25Speaker 03

  and then if necessary revising the hypothesis and coming up with better and better theories. That's it, that's what science is. Everything I just said is all you need to know. That's the scientific method. And that didn't exist. That is a man-made creation. Very important to understand that. It's a brilliant creation. I would argue it is the single most important creation that allows us to exist today. It allowed us to figure out that washing your hands was a way to prevent spreading disease. It allowed us to figure out that there were organisms that we can't see with our naked eye, like bacteria and viruses that are killing us. It allowed us to create medications to treat those things.

• 1:23:08Speaker 03

  So just on the basis of those few things I said, we basically doubled human lifespan. Just by figuring out how sanitation, addressing infant and mother mortality, treating infections, you know, all of these things had a huge difference.

• 1:23:27Speaker 03

  That is what I call medicine 2.0. Medicine 2.0 was heralded in with that discovery. Medicine 2.0 basically says, look, we treat a disease when we see the disease. And the playbook for medicine 2.0, again, has been really successful for acute conditions. Trauma is another one, right? Like, think about what, think about what a soldier in theater today can survive relative to what they could have survived in World War I or World War II. Especially World War I and even the Civil War. Let's go back. If you want to make it a medicine 1.0 to medicine 2.0, consider a Civil War versus

• 1:24:12Speaker 03

  soldier today, totally different experience in terms of what's a survivable injury. Again, the advances in trauma and critical care are insane. The problem is those things have not extended to life, life extension vis a vis chronic diseases. So, most people that are listening to us right now are going to die from basically one of four things. Cardiovascular disease, including, you know, heart attacks and strokes, cancer, dementing diseases, and metabolic diseases. Type 2 diabetes, fatty liver disease, those things. Like, that's literally like 80% of people listening to us are going to die from one of those things. Dementing diseases being Alzheimer's?

• 1:24:54Speaker 03

  Alzheimer's, vascular dementia, other neurodegenerative diseases like Parkinson's disease and things like that. So, those are all chronic diseases, and we have not made great progress on any of them, with the exception of cardiovascular disease. We're doing a much better job on that. People are definitely getting heart attacks later in life, and you're more likely to survive your first heart attack today than you were 25 or 30 years ago. So, 30 years ago, roughly 2/3 of people would not survive their first heart attack today, slightly more than half will. But I would still argue that all of these results are kind of unacceptable, right? And that we should be able to do better.

• 1:25:39Speaker 03

  And so, now to your question, apologies for the ramble. The first and most important pillar of medicine 3.0 is you have to be able to be better at treating chronic disease, because chronic disease is what's going to kill us today. And again, this is A privilege, right? We've done so well at treating acute diseases that we've now earned the right to have to focus on chronic diseases. But the current medical system was not designed for it. The economics of this system aren't built around it. And again, this is not a conspiracy theory. You get all these sort of health influencers that want to turn this into a Big Pharma conspiracy theory. No, it's not a conspiracy theory. It's simple economics. You have a billing system that is predicated

• 1:26:24Speaker 03

  not on keeping people sick, but on treating people when they get sick. I get so frustrated when I hear people say, "Oh, Big Pharma has the cure for cancer. They just don't want it out there. They want you to be sick." That is, hands down, the dumbest thing I've ever heard. If Big Pharma had a cure for cancer, they would happily profit on it all day long. The bottom line is, cancer is really, really, really hard to cure once it's taken hold. The far better strategy to address cancer is to catch it early or prevent it altogether. And that's not in the purview of pharma. They're not in the business of doing that anymore than the guy who runs the car wash is in the business of making me dinner. They're different businesses.

• 1:27:08Speaker 03

  So Medicine 3.0 has to come up with a better way to treat chronic disease. And though I won't get into all the details, but I write about it extensively in the book. You can mathematically prove that the way to treat chronic disease is to delay its onset. Those are mathematically equivalent. So you want to live longer without disease, not live longer with disease. But Medicine 2.0 aims to keep you alive longer with chronic disease. Medicine 3.0 says that method will fail. You have to delay the period of time before someone gets a disease. The second big principle of Medicine 3.0 is you have to treat this thing called health span as much as you treat lifespan. So lifespan is the thing that I think most people intuitively get is like, how long you live, right?

• 1:27:53Speaker 03

  Are you gonna... You know, if your parents are still alive, you could say, yeah, my, my parents are eighty five and eighty, and hopefully they're gonna live another five years, and that's their lifespan. But there's this thing called health span, which is not as easy to measure, but is more important, which is what's the quality of their life, physically, cognitively, and emotionally. And so how do you preserve and maximize health span? This is another very important principle of medicine 3.0. Medicine 2.0 does not acknowledge health span beyond a very cursory way to describe it. But there's a saying, which I'm sure is true in the military, just as it's true in all of medicine and business, what gets measured gets managed. And in medicine 2.0, you manage to lifespan.

• 1:28:37Speaker 03

  That's the metric everybody's focused on. But in medicine 3.0, you have to pay just as much attention to quality of life. And if you manage to that, how much muscle mass do you have? How strong are you? What's your VO2 max? What's your reaction time? What's your cognitive performance? What are the, what's the strength of your relationships? That's part of emotional health. All of those things figure into the quality of your life. And medicine 3.0 says we should be managing to those just as much as we manage to life expectancy.

• 1:29:04Speaker 02

  Interesting, interesting. So, so it sounds like more of a preventative.

• 1:29:08Speaker 03

  It's, it's preventive, but it's also very proactive, and it's much more broad in its focus. It's not just about how long can I keep you alive? It's how long can I keep you thriving?

• 1:29:20Speaker 02

  So what are some of the, let's go down each, you'd mentioned, I believe, three pillars, but, you know, four, did you mention four chronic diseases?

• 1:29:32Speaker 03

  Yep.

• 1:29:33Speaker 02

  That we're, we're all gonna die from, most people are gonna die from, let's start with cardiovascular.

• 1:29:37Speaker 03

  So it's the leading cause of death for, in the United States, it's the leading cause of death globally, and it's the leading cause of death for men, and the leading cause of death for women. So even though, I don't think it gets that much attention, cause, maybe because it's so common, we just sort of tune it out a little bit. We can't forget, you know, nineteen million people a year globally are dying from cardiovascular disease. Now, this is...

• 1:30:07Speaker 03

  Certainly tragic and ironic, given that of the four chronic diseases, it's the one that A, we have the best understanding of, and C, we probably have the best treatments for. So, you know, we can come back to metabolic disease, because I think a lot has changed there. But we certainly understand what the drivers of cardiovascular disease are. And there's several, right? So lipids, blood pressure, smoking, poor metabolic health. Those are the big, big, big drivers, right? So if you're insulin resistant, if you have high blood pressure, if you have high, what's called ApoB, which is a particular measurement of lipids, if you smoke, those things are

• 1:30:52Speaker 03

  going to drive your risk through the roof. There are people who can certainly get away with having one or two of those things not optimized, but if you're in the business of trying to prevent the disease, you want all four of those things fully optimized. Some of those are purely behavioral, some of those are done through medications. We talked about blood pressure as an example. Lots of ways to control your blood pressure without pharmacology, but if you need pharmacology, it's also pretty easy to manage it that way. So that, you know, really, it shouldn't be the leading cause of death. It just, it just simply shouldn't be. But most people don't have the right timeline on it. They don't realize how long this disease is brewing. So how old are you? Forty-two. Okay.

• 1:31:37Speaker 03

  So, you know, the probability that a forty-two-year-old's arteries, if, let's just say tragically you died in a car accident tomorrow, if they did an autopsy on you, the likelihood that your coronary arteries would look perfect is very, very low. We know this because during Vietnam, they did autopsies on all these young men that were eighteen, nineteen, twenty years old, who obviously were killed in combat, so not, had nothing to do with their hearts, and they did not have perfect coronary arteries. They all had some evidence of disease. And those guys were not going to die of heart attacks for another 40 or 50 years, to be clear, but what it showed us was how long it takes for this disease to progress

• 1:32:18Speaker 03

  below the naked eye. So in the instant that a person has a heart attack, there's an enormous and abrupt change with clotting factors and all these sorts of things, but all of that is precipitated by decades of buildup. And by buildup, I mean sort of impossible-to-see processes that eventually can become visible on certain elaborate scans. So we do want to start preventing this stuff early by managing those four variables. And if we do, I think we get to take that one off the table.

• 1:32:46Speaker 02

  How do you start to manage it?

• 1:32:48Speaker 03

  Yeah, so you again, you look at each of those risks individually. So first, someone's smoking. If they are, I want them, I want them to not smoke, and we're going to do whatever steps we have to do to get them off cigarettes. What's their blood pressure? Again, if someone's got elevated blood pressure, first-line therapy is not to turn to medication. It's actually to look at exercise, sleep, and weight. Those three things can fix blood pressure in many cases, but if it can't, the amount of medication we have that can address blood pressure without inducing symptoms, because that's the other thing you always have to think about, right? Anytime you're giving somebody a medication, you have to be able to do it in a way that it doesn't create another problem. And a lot of the early generations of these drugs, they cause problems. You know, they would, they'd make

• 1:33:30Speaker 03

  you feel horrible in some other way. So if your choice is walk around with high blood pressure, even when you've corrected for body weight, exercise, and sleep, or don't, you're, you know, you're, you're better off fixing it, even if it means taking medication. Metabolic health, I think, is the toughest one to fix, truthfully, and it requires everything from being in energy balance, you know, doing the right kind of exercise, so the right balance between exercise that generates muscle mass and exercise that generates... The ability for the muscles to soak up glucose, that's kind of one of the important functions of the muscle besides the obvious structural components, but the muscles are a huge reservoir for glucose. Putting glucose into muscles is a super important job that drives so much of our health.

• 1:34:15Speaker 03

  And then the fourth one is managing these lipids. So this ApoB marker, which is a very simple blood test, measures the total concentration of all cholesterol carrying molecules in the body that are harmful. So not all the molecules that carry cholesterol in the body are harmful, but a subset of them are, and that's how you measure them. And again, that can be addressed through diet, but if it's not, again, you want to lower those things pharmacologically. So what are some things that people can do just right off the bat to better their health, other than smoking? Yeah, so that's a great one, right? So if you're a smoker, I don't think there's anybody out there who's smoking who thinks it's good for them.

• 1:34:57Speaker 03

  So really, the challenge there is not the what do I do, it's how do I go about doing it? How do I go about a smoking cessation plan, which we could talk about another, we can talk about that as much as you want, by the way, because it's a topic I'm very interested in. Are we talking just cigarettes? Are we talking cigarettes, cigars, marijuana? So cigarettes are the lion's share of this problem because of just the volume, right? So if you're a cigar smoker, you're probably smoking like, first of all, a lot of cigar smokers aren't inhaling the smoke all the way into their lung. And so it's just generally not posing the same risk. It still is risk, but nothing's probably going to be the risk of taking 25 cigarettes

• 1:35:41Speaker 03

  a day and smoking them, right? So even people who are smoking weed are not typically smoking nearly enough to get there. Now, when you get into nicotine replacement products, you want to always be able to differentiate them into with and without tobacco.

• 1:36:00Shawn Ryan?

  I know everybody out there has to be

• 1:36:04Shawn Ryan?

  just as frustrated as I am when it comes to the BS and the rhetoric that the mainstream media continuously tries to force-feed us. And I also know how frustrating it can be to try to find some type of a reliable news source. It's getting really hard to find the truth in what's going on in the country and in the world. And so, one thing we've done here at Sean Ryan Show is we are developing our newsletter. And the first contributor to the newsletter that we have is a woman, former CIA targeter. Some of you may know her as Sarah Adams, call sign Superbad. She's made two different appearances here on the Sean Ryan Show.

• 1:36:43Shawn Ryan?

  And some of the stuff that she has uncovered and broke on this show is just absolutely mind-blowing. And so, I've asked her if she would contribute to the newsletter and give us a weekly intelligence brief. So, it's gonna be all things terrorists, how terrorists are coming up through the southern border, how they're entering the country, how they're traveling, what these different terrorist organizations throughout the world are up to. And here's the best part, the newsletter is actually free. We're not gonna spam you. It's about one newsletter a week, maybe two, if we release two shows. The only other thing that's gonna be in there besides the intel brief is if we have a new product or something like that.

• 1:37:28Shawn Ryan?

  But, like I said, it's a free CIA intelligence brief. Sign up, link's in the description or in the comments. We'll see you in the newsletter.

• 1:37:42Speaker 03

  So, if a nicotine replacement product is derived from tobacco, like snooze, it still carries a ton of risk. Nowhere near as much risk as a cigarette. So, cigarette is still the A-plus risk, but if you're consuming snooze, you're still getting a lot of the carcinogenic risk. It's just gonna be subject to your mouth as opposed to your lungs.

• 1:38:05Speaker 03

  So, when you wanna get somebody off smoking, you wanna create a real awareness of what they're doing. You wanna understand. And so, typically, the first thing we'll have people do is just journal, what, when is it that you pick up a cigarette? What happened that made you wanna pick up the cigarette? This is, by the way, this'll work for any habit, right? If you're trying to understand why you're eating so much junk food... Let's just start with a few weeks of noting every time you go into the pantry for Pringles. What predisposed you to do that? Was there something stressful? Did you have a thought about something? Were you bored? Were you actually hungry? What created the urge? Another one of the things you do is you start disconnecting the urge from the behavior. So let's say you're a smoker.

• 1:38:49Speaker 03

  We would say, hey, Sean, every time you feel this urge to go out and get a cigarette, I want you to not do it, but set an alarm for 15 minutes and then go out in 15 minutes. In other words, I'm not going to stop you from smoking. I'm just going to uncouple the urge from when you do the thing. So that becomes important. Nicotine replacement is a very important part of smoking cessation. There are lots of ways to replace nicotine, right? You've got little patches, I mean, little pouches there. I've got my toothpick here. We've got patches, gum, all sorts of ways to go about doing it. Each of them has their pluses and minuses. I did a whole podcast on this that gets into the itty bitty nuances of this.

• 1:39:33Speaker 03

  But the bottom line is nicotine replacement, very, very powerful tool because nicotine, if derived from a clean source, like a synthetic nicotine, it doesn't carry any of these cancer risks, at least we can be very confident that that's true. Certainly not from a lung cancer perspective. There may be other risks. So we should be mindful about how much nicotine we do consume.

• 1:39:57Speaker 03

  But it allows you to deal with what the addictive piece was. And then the final thing is understanding the oral fixation that a lot of people have with a cigarette. By the way, I think that's why kind of the nicotine toothpicks are kind of nice. Is for many people, it's just, it's a bit of an oral fixation with a nicotine containing thing. There are also different classes of antidepressants that can be very helpful with people that are quitting smoking. So we'll put that aside because it's self-evident that one should not, that one should not smoke. But the sometimes to how to do it is easier said than done.

• 1:40:26Speaker 02

  Now, is there any way to reverse this? Is there any way to clean up your arteries if you were a smoker?

• 1:40:32Speaker 03

  Yep.

• 1:40:34Speaker 02

  How do you do that?

• 1:40:35Speaker 03

  Well, when it comes to smoking, we know that after a certain number of years, depending on how long of a smoker you were, your risk of heart disease and cancer will return to baseline.

• 1:40:47Speaker 02

  It will.

• 1:40:47Speaker 03

  It will, yeah. Now, again, you might not get there because depending on how long you smoked, it could be 30 years before you return to baseline. So if you're a 50-year-old who's quitting smoking, And you've been a pack-a-day smoker for forty years, or you know, say thirty years. You might not make it to eighty without some event. So we still act with enormous vigilance in people who are former smokers. In our practice, we treat former smokers and smokers identically when it comes to cancer screening, because even though we know the risk is coming down, and then we just assume it's still quite high, and so we will still screen them very aggressively for, you know, every cancer that we can, even maybe against the advice of sort of

• 1:41:32Speaker 03

  medical authorities, in terms of how aggressively we'd look at it. The same is also true for cardiovascular disease. We do see that over time, that risk will return to the baseline risk. But remember, as you're aging, what's happening to your baseline risk? It's going way up. Age is the single biggest predictor of risk for both cardiovascular disease and cancer.

• 1:41:52Speaker 02

  Okay.

• 1:41:53Speaker 03

  Yeah. So we never want to escape the fact that even though you're quitting, and that's driving risk down, age is driving it up. So you never really want to take your pedal off the metal when it comes to prevention.

• 1:42:03Speaker 02

  So what are some of the other things you can do to get back to baseline?

• 1:42:09Speaker 03

  Exercise is very important. Again, the benefits of exercise when it comes to brain health, metabolic health, heart health are probably the most obvious. I think when it comes to cancer, it's less obvious. Of all the four diseases, I call them the four horsemen in the book, I think cancer is by far the one we understand the least in terms of what's driving risk. So we know that metabolic disease drives risk. So obesity and type two diabetes clearly driving risk. We have some ideas as to why, but beyond that and smoking, we don't have a great sense. And I don't think there's anybody who's listening to us right now who can't relate to the idea that otherwise completely normal, healthy

• 1:42:54Speaker 03

  people still get cancer.

• 1:42:56Speaker 02

  Uh huh.

• 1:42:56Speaker 03

  Right? I'm sure you know people who are forty, fifty years old, picture of health, and they still get cancer.

• 1:43:03Speaker 02

  Scares the hell out of me. It's like every day.

• 1:43:07Speaker 02

  A text comes in, "My mom's got cancer, I've got cancer, my kid has cancer, my aunt has cancer, so and so died of cancer." I mean, it scares the hell out of me.

• 1:43:20Speaker 03

  Well, and I would say this, once you've got your house in order, health-wise, it's the biggest risk. Because you can drive the risk down of metabolic disease, of cardiovascular disease, and even of neurodegenerative disease, especially dementing diseases. We can drive these down. You know, people often ask me, "Peter, your whole life is this longevity thing. How are you gonna die?" And I say, "Honestly, it's gonna vary by decade, but if you said to me in the next decade, if you had a crystal ball that said, 'Peter, you're not gonna make it to sixty...'" I'm 52. "You're not gonna make it to 62, why?" There's really two things. It's cancer and accidental death. You know, I mean, they're gonna get cancer and succumb to it, or I'm gonna die in an accident.

• 1:44:04Speaker 03

  That would be 90% of what would kill me in the next decade.

• 1:44:09Speaker 02

  Okay.

• 1:44:10Speaker 03

  So you're not alone, right, in feeling that way. That's a rational fear. Fortunately, given your age, you're 42, your 10-year mortality from cancer is still very low. It's probably in the 2% to 3% range. But that's not zero.

• 1:44:25Speaker 02

  Well, you know, it also bothers me, because you see all these weird cancers, you know, coming up from being overseas.

• 1:44:32Speaker 03

  Yep. Some of the stuff you've been exposed to, I'm sure.

• 1:44:35Speaker 02

  Yeah, I mean, I don't even know what I've been exposed to, but there's all these weird cancers. Nobody can explain. You said this guy on Chris Fettis, who we were talking about the jammers that used to jam the frequency for IEDs and stuff, and maybe sitting under that thing, he says there's been studies out there that have said the app definitely increases the risk

• 1:44:57Speaker 02

  by a pretty large amount. And, I mean, it's...

• 1:45:03Speaker 02

  Man, she's ev-

• 1:45:04Speaker 03

  Yeah, I mean, I think the only thing you can do is you sort of have to decide, am I willing to trade that anxiety for another anxiety?

• 1:45:13Speaker 02

  Uh huh.

• 1:45:13Speaker 03

  Cause you're gonna have to deal with some anxiety. So anxiety one is, I'm just gonna worry about it, but I'm not gonna go looking. Anxiety two is, I'm gonna do everything in my power to screen and look for this, but I'm very likely gonna find a bunch of things that aren't cancer. Those are called false positives. So which of those, and this is a very individual decision.

• 1:45:38Speaker 02

  Yeah.

• 1:45:38Speaker 03

  But which of those gives you more stress? Are you more stressed just sitting here worrying about it? Or are you gonna be more stressed if we turn over every stone, screen the hell out of you and find a bunch of things that ultimately will not be cancer, but we're gonna have to chase them down? Which one of those is more anxiety provoking?

• 1:45:56Speaker 02

  I don't know. You know, me, I don't know. Me and my wife have talked about doing the pre-cancer stuff. I've had blood work done. I know there's some kind of imagery that you can do.

• 1:46:07Speaker 03

  Yep.

• 1:46:07Speaker 02

  You know, and we were signed up to do it. And then my wife said, hey, you know, what happens? What happens if something does pop up?

• 1:46:19Speaker 03

  Yep.

• 1:46:20Speaker 02

  And they say, oh, give God this much time to live, then how do we treat each other during that time? And that's something I never thought about. I was like, shit, you know, that's, it will be a whole new dynamic. You'd be thinking about your future without that person. That person would think, oh, I'm holding you back in life. And I mean, so, I don't know. We, we haven't done it for that reason. Like I said, I did do the blood work and she's getting the blood work done. And so far, you know, so good, but-

• 1:46:55Speaker 03

  I mean, what do you do? Do you get? Well, again, it's a very personal decision, just like we were talking about with the vaccines earlier. There's not a right answer. And if every single patient I'm talking to, I'm not trying to impose my will on them, or my beliefs, or even what I do. I want to help them understand probabilities. This is the probability of you getting any of these types of cancers. This is the probability of this test that we do giving a false positive. This is the probability of it giving a false negative. And again, we know all of this stuff. Like, we know for every test we do, there are these two mathematical terms.

• 1:47:39Speaker 03

  One is called sensitivity and one is called specificity. So if you do that liquid blood, so what you're referring to, I assume, is a liquid biopsy. So it's a blood test that's doing a pan screen for cancer. That test has a sensitivity, which is the probability that if you have cancer, it will pick it up. The sensitivity for a liquid biopsy is very low. For a stage one or stage two cancer, it's probably on the order of 30%. For all cancers, That's it? For all cancers, it's probably on the order of 50% sensitivity. Conversely, the specificity, which is the probability that the test comes back negative

• 1:48:23Speaker 03

  if you are free of cancer, is very high. The specificity on those tests typically runs about 99.5%. Now, when you know those two numbers, sensitivity and specificity, and you know the probability that you have cancer out of the gate, what's called the pre-test probability, which says, you're a 42-year-old man, you don't smoke, but maybe you have a slightly higher risk because of your exposure to chemicals, blah, blah, blah, blah, blah. Your pre-test probability is 3%.

• 1:48:58Speaker 03

  Knowing the pre-test probability, the sensitivity and specificity allows us at any point in time to calculate what's called positive and negative predictive value, which means if this test comes back positive, how likely is it you have cancer? And it's going to be very low.

• 1:49:13Speaker 02

  Okay.

• 1:49:14Speaker 03

  The whole takeaway of that whole spiel is the PPV or positive predictive value is going to be like 10%. So even if that test came back positive, there's a 90% chance you don't even have cancer.

• 1:49:25Speaker 02

  Okay.

• 1:49:26Speaker 03

  The negative predictive value is going to be very high. The negative predictive value is going to be above 99%. So if it comes back negative, you can feel really comfortable.

• 1:49:32Speaker 02

  Okay.

• 1:49:33Speaker 03

  If it comes back positive, and this is what I got to earlier, I don't even let people do these tests if they're not willing to live with the consequences of a false positive, because the likelihood of that happening is actually pretty high.

• 1:49:45Speaker 02

  Well, what if you do get a false positive? Then what happens?

• 1:49:48Speaker 03

  Well, I'll tell you. I'll give you a really horrible story of a false positive. Was just talking to somebody the other day who went and got a whole body MRI and it found something in his thyroid that looked a little suspicious. And to be clear, the thyroid gland is notoriously difficult to image. Notoriously difficult. It is so glandular and so prone to over-representation of cancer that we see, we see false positives all the time in the thyroid. I just tell patients, 10%, 20% chance we're going to see something in your thyroid. In this case, saw something in his thyroid, his doctors recommended a thyroid ultrasound

• 1:50:32Speaker 03

  and a biopsy. So they did the ultrasound, they did the biopsy. Now normally at that point, that's the end of the line. The thyroid is really easy to biopsy, you can feel it. Under an ultrasound, it's like shooting fish in a barrel. Pull a couple of cells out, no cancer, you're fine. Sorry for the inconvenience, we'll see you in a year. But in this case, when they did the biopsy, they're like, it might be cancer, we can't fully tell. And they recommended removing the half of the thyroid. So they did. Now they did the surgical operation, they took out his half thyroid and it came back, it was totally fine. Now, is this a life-changing surgery? No. Can you live without half your thyroid? Yes. But that's an example of what can go wrong. Now, how do I choose to live with that degree of uncertainty personally?

• 1:51:21Speaker 03

  Because of my risk appetite, I make the decision to screen. I screen myself very aggressively. So I do get a whole body MRI every year. I'm very aggressive with the frequency with which I do colonoscopy. I do liquid biopsies every year. You know, I'm religious with my skin exams. And again, some of these things are low risk, like, you know, the risk of a skin exam means I'm losing a couple moles I didn't need to lose. Who cares? But a colonoscopy is a huge risk. You know, I shouldn't say huge. I mean, it's just a very non-zero risk. But again, I consider it a bigger shame to get colon cancer and to miss a colon cancer, something that's, you know, third leading cause of cancer death. Right?

• 1:52:06Speaker 03

  I want to make sure I'm not going to succumb to colon cancer. So, you know, I don't have an answer for you, but I could walk you through every number and let you make the best answer for you.

• 1:52:19Speaker 02

  What age should people start getting screened?

• 1:52:23Speaker 03

  Probably depends a bit on family history, which really speaks to risk. Colon cancer is an easy one to talk about. So it used to be that traditional screening for low-risk individuals was 50. I'm very grateful to see that that's been lowered to 45. So that means now people can get insurance to cover them five years earlier, and I think that matters a lot. Personally, I would lower it to 40, although I understand maybe on an economic basis why it doesn't make sense. But as an individual thinking about yourself, look, I still think 3% to 4% of cancer, colon cancer deaths are in people younger than 40. That's a staggering statistic. People just don't think of young people getting colon cancer. And yet, you know, they do.

• 1:53:05Speaker 03

  So I would say somewhere between 40 and 45 is probably the right time for a person to get their first colonoscopy, unless they're high risk, in which case you want to be treated earlier than that. So if you, a person has ulcerative colitis or Crohn's disease or a family history of colon cancer, things of that nature, I would be doing it even sooner.

• 1:53:21Speaker 02

  Okay. Rewind back to cardiovascular stuff. You had mentioned getting back to baseline. How do we know when we're back to baseline?

• 1:53:29Speaker 03

  Well, unfortunately, you can't, and to be clear, baseline, I said baseline risk. So you're never going to take your coronary arteries back to what they looked like when you were 10 years old, right? So what we really aim to do is stabilize the progression of atherosclerosis. And so depending on what sort of screening modality is used to measure, and the most common one that's used is something called the calcium score, but there's a more advanced test called a CT angiogram. So they're both CT scans, but the calcium score just runs over the body, doesn't put any contrast in, and is just looking to pick up the light of calcium. It's not a very granular test, but if you have any calcium in your coronary arteries,

• 1:54:14Speaker 03

  we know that's bad. That's not a good test to measure progression because it's not a very accurate test and it can easily be overinterpreted. So if a person's calcium score is 100, if you had a calcium score of 100 at the age of 42, that's a four alarm fire. Even though 100 is not a very high number, that number could easily be 4,000. At the age of 42, it should be zero all day, every day. But if it was 100 and then five years, and we started treating the heck out of you, and five years later it was 130, that would, in my mind, not constitute progression because of how crude the test is.

• 1:54:50Speaker 02

  Okay.

• 1:54:51Speaker 03

  Now, if they use a more granular version of that test called a CT angiogram, it's a more high-resolution CT scanner where they use intravenous contrast. Now you get to look more at the coronary arteries, and there you can get more subtle descriptions of what's going on. But the truth of the matter is, when you're treating the causal risk factors, we don't tend to fixate on the imaging as much as we fixate on function and the reduction of risk markers. So if you showed up at 42 with a calcium score of 100, there's no doubt in my mind that at least one of those four factors is out of whack. We're going to fix it. We're just going to fix it, non-negotiable. And in five years, even if your calcium score has gone up a little bit, we are still very

• 1:55:36Speaker 03

  confident we've halted the progression of the disease.

• 1:55:39Speaker 02

  Okay. Okay, back to cancer, preventatives. I've talked a lot about this with other health professionals on the show, and it seems like plastics, sugar.

• 1:55:56Speaker 02

  What else? Uh, single ingredient foods. I mean, do you have any, do you have any?

• 1:56:01Speaker 03

  Yeah, again, we can talk about what is absolutely known. What is unambiguous is smoking, obesity, diabetes are driving the, the majority of what we see as preventable risk.

• 1:56:11Speaker 02

  Okay.

• 1:56:12Speaker 03

  So that's, that's the only thing that I would say we know with a very high degree of certainty.

• 1:56:16Speaker 02

  Once again, when you're smoking, smoking cigarettes?

• 1:56:19Speaker 03

  Cigarettes.

• 1:56:20Speaker 02

  Cigars?

• 1:56:20Speaker 03

  Mostly cigarettes.

• 1:56:21Speaker 02

  Okay.

• 1:56:22Speaker 03

  Yeah. Now cigars, even if you're not inhaling, you're still increasing your risk of oral cancers and things of that nature. But yeah, when we talk about a person who smokes a cigarette that they're inhaling, that's increasing the risk of many forms of cancer, not just lung cancer, although it's increasing your risk of lung cancer geometrically. So if you're overweight or obese, if you have type 2 diabetes, if you smoke, any combination of those things is increasing your risk of multiple forms of cancer. They're not all the same, by the way. So the, the cancers that are predisposed or the ones that risk is going up dramatically for type 2 diabetes and obesity overlap with some of the lung cancer, but there's some different ones as well. Um, everything thereafter

• 1:57:06Speaker 03

  that, we are at a lower level of certainty. So I did a lengthy, lengthy, deepest deep dive I've ever done, certainly top three deep dives ever done in my life into microplastics on a podcast a few weeks ago. And I can tell you that the evidence that microplastics, PFAS chemicals, PM 2.5s are causing cancer, PM 2.5s are sub 2.5 micron particles in the air that we inhale. Um, the evidence that they can cause cancer is modest. Um, it's not very strong, but it's also Shouldn't be ignored, right?

• 1:57:49Speaker 03

  I wouldn't, I wouldn't throw it out and say, ah, come on, it's all fine. The question is, what do you do with that information? Like, how hard should one work to avoid all of these things? Because it's impossible to avoid them, period. It's, uh, it's, it's actually, we can't, we couldn't imagine a scenario whereby a person could completely be free of microplastics. Even if you said something as ridiculous as, I'm gonna move to the Antarctic. Well, you wouldn't be able to, because the protective clothing you would need to prevent you from dying in that environment would expose you to microplastics. So, we're gonna be exposed to microplastics no matter what. But there are a bunch of things you can do to like, either inconvenience yourself in

• 1:58:33Speaker 03

  time, money, some other variable, and reduce it a lot. So, you know, um, I actually made a video kinda recently about this, which is like, what's the, what's my 80/20 view of how to do this? And it's, um, some obvious stuff. So, one, don't store food in plastic containers. Just, so if the restaurant's trying to give you your food in plastic container, just don't take it home.

• 1:59:03Speaker 03

  At home, throw out your plastic storage containers, splurge on Amazon for the glass storage containers, and just use those. Don't heat up anything in plastic. So, my kids, because they still throw cups, will still have a few plastic cups, I'll put cold milk in there, but I would never put anything hot into there. And frankly, I can't wait till we're kinda done with plastic cups in general.

• 1:59:30Speaker 03

  One big splurge I did was I got rid of my drip coffee machine, which just had plastic all over it, and I swapped it out for a machine that is all glass and metal. So, it still makes a drip coffee, but the water is, the hot water is only exposed to metal and glass. So, I'm, which, again, anytime hot water was exposed to plastic, you're really increasing your risk. So, that's it, that's, but, you know, it's an expensive coffee machine, but it's a one-time cost. Another thing was, and we had already done this before, but I do think this is a worthwhile investment for people who can afford it, is putting in a reverse osmosis water filter in the home and drinking out of that. Huge source of microplastics and other chemicals that you want to avoid.

• 2:00:13Speaker 03

  Another thing that you can do, which again is a big cost, and this is not something everybody necessarily should do, but especially if you're indoors a lot, is moving your air filtration system up to HEPA level.

• 2:00:26Speaker 02

  Okay.

• 2:00:27Speaker 03

  Again, that requires, that's a, that's a cost. There's a real cost in doing that, not in the filters themselves, they can be relatively inexpensive, but in the HVAC machines that need to blow them are pretty expensive. So, standard residential HVAC units typically aren't powered to do it, so you'll have to upgrade them. Little things like, it sounds silly, but like, I don't take a plastic bottle into the sauna. I use a glass bottle. I don't even keep a plastic lid on it. I just don't want anything heating up plastic. Those are, those are, oh, I switched out my water bottles in, I used to ride my, if I'm riding my bike outdoors, you know, cyclists have plastic water bottles. I just found a company that makes steel ones.

• 2:01:10Speaker 03

  So, those are, those are kind of the big things. So again, a lot of it's a single upfront big cost. You know, the water bottle is like 40 bucks, which is a total ripoff, but whatever. So, single big upfront cost, but then after that, you're kind of done thinking about it. And, and that's probably getting rid of two thirds of it. Now, I'm doing that out of what's called the precautionary principle. Not doing that because I'm telling you, this stuff causes cancer and heart disease. I don't know.

• 2:01:39Speaker 02

  Interesting.

• 2:01:40Speaker 03

  But, the cost of mitigating it is low relative to the cost of being wrong.

• 2:01:46Speaker 02

  Yeah, yeah. What about plastic bottles?

• 2:01:48Speaker 03

  I try to avoid them.

• 2:01:50Speaker 02

  Yeah. I can taste it now. We have, we had a filtration system put in and, and now, if I go to the gas station, I want some more, I, I can taste the plastic. I couldn't before, because I was so used to it, but I definitely taste it now.

• 2:02:05Speaker 03

  And again, let's say you're on a road trip and you're parched and you pull over to a gas station and your choice is to stay parched or drink the water out of the plastic bottle? Drink the water out of the plastic bottle. That's better than getting a kidney stone.

• 2:02:17Speaker 02

  Okay.

• 2:02:18Speaker 03

  Right? Like, again, people have to remember the dose effect of this stuff. Like, I get, I, I'm amazed at how people completely lose the forest for the trees sometime on this thing, and they all of a sudden become so fixated on, I can't ever touch anything that touched plastic, and yet they forget to work out. Like, remember the priority list, right? Okay. Yeah. What about household chemicals? Does that play a big role in cancer? Um, probably not as much as health influencers want you to believe. Okay. Yeah. What about sugar? Does cancer feed off sugar? That's a bit of a gross oversimplification.

• 2:03:00Speaker 03

  The truth of the matter is, um, cancer feeds off glucose. Glucose is the simplest breakdown product of all carbohydrates, or virtually all carbohydrates. Um, the and, the, the, uh, evidence that sugar is uniquely carcinogenic is virtually nonexistent, despite, again, what every anti-sugar health influencer wants you to believe. There's, the, the evidence is awful for that statement. Um, but,

• 2:03:34Speaker 03

  um, sugar almost undoubtedly drives people to overeat. And there are, there are really compelling biochemical reasons for that, and decent experimental reasons for that, especially in animals, that high-sugar diets will drive overeating, and overeating certainly drives cancer. Um, but, sugar does not, uh, cancer does not have a unique ability to consume fructose, which is the actual part of sugar that makes it sweet. So, if you, if you eat a bowl of rice, that's all glucose. If you eat sugar, it's half glucose, half fructose. Well, the cancer does not have a unique ability to consume the fructose. It just consumes the glucose.

• 2:04:16Speaker 03

  So you could frankly argue that rice is more carcinogenic than sugar, except for the fact that, again, as I said, maybe sugar drives people to eat a little bit more. Okay. But, but sugar is, uh, pardon me, the, the bigger driver of cancer from a nutrition perspective, uh, is likely the growth signals that are very prevalent with obesity and type 2 diabetes. So it's undoubtedly much more the high levels of insulin than the high levels of glucose that are problematic when you're trying to prevent or minimize cancer risk. Okay. Let's move into dementia.

• 2:04:58Speaker 02

  That's another thing that scares the hell out of me. More and more, it seems like people are getting dementia, Alzheimer's. How do we prevent that? Can we prevent that?

• 2:05:10Speaker 03

  Well, we can definitely prevent some of it. I don't know that it's entirely preventable, just like I don't think any disease is entirely preventable. The closest of the maiden diseases that I think is, I think, again, I think type 2 diabetes and extreme metabolic disease and heart disease are the most preventable. I think the other two are less so. But we know a bunch of things, right? We know that there are a number of behaviors that really, really reduce your risk of dementia. So you can invert that statement and say that doing a lot of those things helps you prevent dementia, right? So what are those things?

• 2:05:50Speaker 03

  So, exercise has the most potent effect on reducing the risk of dementia. I mean, it's profound, actually. So, there are lots of reasons that that could be the case. It could be that when you exercise, your muscles make these hormones called myokines, and that myokines are pro, basically pro-neuron, right? They promote neuronal growth. Exercise produces other hormones and proteins. So, something called brain natriuretic peptide, another protein called cloto is made, we have a spike in cloto by about 15% right after we exercise.

• 2:06:32Speaker 03

  We know very clearly, through experiments in everything from mice to monkeys, that when you inject people with those proteins, they transiently have an improvement in cognition. And even when you give those things to people or to animals, in the early stages of cognitive impairment, it reverses it. So, so there's a whole bunch of reasons that are profoundly beneficial. Of course, exercise also plays an amazing role in metabolic health and vascular health, which again are two of the biggest risk factors for dementia, metabolic health and vascular health. We look at other things that can get in the way of brain health is disrupted sleep. So, a person who doesn't sleep enough, or a person who doesn't get a high enough quality of sleep.

• 2:07:15Speaker 03

  So, again, anything that we can do to improve sleep duration, quality staging, etc., it's gonna be important. All the things that hurt the heart hurt the brain. So APOB, blood pressure, smoking, we talked about metabolic health. Those things are bad for the heart, they're bad for the brain. So reducing APOB, keeping blood pressure normal, not smoking, being metabolically healthy, exercising are, I mean, that's the, that, that's the playbook. And again, people really want there to be some special nootropic agent out there that you can just take, that is gonna just make your brain perfect. And it's like, you're rearranging the deck chairs on the Titanic. The most important thing is not to hit the iceberg.

• 2:08:00Speaker 03

  Don't hit the iceberg. That's the most important step. And that, those are the things that we just talked about. Everything else is.

• 2:08:07Speaker 02

  I have heard and read and, you know, and like I said, I don't know, I don't really know what I'm reading, if it's, if it's, if it's factual or not. There's a lot of talk about psychedelics.

• 2:08:17Speaker 03

  Mm-hmm.

• 2:08:17Speaker 02

  And helping with ADHD, helping with anxiety, helping with addiction. And, and I did it. I did an ibogaine treatment about three years ago. Came off booze, it'll be three years this Valentine's Day. Does that help with, there's also been talk about that helping with dementia, Alzheimer's?

• 2:08:42Speaker 03

  I'm not, I'm not familiar with that. I'm, I'm, I am familiar with a lot of the, both the stories and, and certainly some of the, some of the reports, case reports of the benefits of iboga and ibogaine on alcohol, on opioids even more potently. Very difficult to ignore. In other words, I, I really think there's something going on there. Actually just spoke with a patient who came back from a long retreat in, it was either Mexico or Costa Rica, I think it was in Mexico. He was there for a week and.

• 2:09:24Speaker 03

  You know, it's interesting, like I asked, I always ask people when they do this, what are you in search of? Like what, what's the, what was the reason for it, right? Um, out of curiosity, of course, not, I'm not judging the experience. Um, and he, he kind of went in there without a very clear objective. Like, well, he wasn't, he wasn't going to solve a problem. Um, but it's, he said, it's really interesting. He came out of it and he was like, yeah, I just don't have any appetite for alcohol.

• 2:09:49Speaker 02

  That's what happened to me.

• 2:09:50Speaker 03

  So you didn't go in there specifically for that reason?

• 2:09:52Speaker 02

  No, I didn't. I mean, uh, used to, used to be very heavy drinker. And then by the time, which I still was a heavy drinker, um, but I'd, I'd kind of like gotten away from hard alcohol. Vodka was kind of my poison and then kind of moved into wine. Seven, I was probably drinking a bottle, maybe a little bit more a night. Uh, but I went there for more anxieties, PTSD, traumatic brain injury type stuff. And that's the same thing. I wanted to be more in the moment with my family. And, um, I had just interviewed former colleague after former colleague over and over again. And, and all these guys were just having these

• 2:10:35Speaker 02

  profound benefits that came out of it. And then when I came out, that was one of the things. It was, I'd kicked caffeine for about six months. I'd kicked marijuana for close to six months. I've kicked booze, uh, completely. I haven't had a drop of alcohol in almost three years. I was more in the moment. Um, and then, and then, yeah, so that there was, all that kind of stuff was kind of a byproduct that I wasn't expecting. Caffeine was gone for quite a while. Um, I only, I drink tea now instead of coffee. Uh, sugar, kicked

• 2:11:16Speaker 02

  that for probably three or four months. And, and then-

• 2:11:23Speaker 03

  And it's interesting, right? This is an experience of 10 minutes long, right?

• 2:11:27Speaker 02

  Oh, no. And I wouldn't say it's 10 minutes. It's, it's, I think it's about 12 hour experience.

• 2:11:32Speaker 03

  Oh, really? Okay.

• 2:11:33Speaker 02

  Yeah. I think it's about, I think the effects, uh, you're kind of in it for about 12 hours. And then, and then came out of it. And then, you know, all these good things happened. I did wind up, um-

• 2:11:46Speaker 02

  It's been what, probably about three months since I've had any marijuana, which really decreased my sugar intake, but um.

• 2:11:55Speaker 03

  And that alone should also help your anxiety.

• 2:11:58Speaker 02

  Mm-hmm. I think it did.

• 2:12:00Speaker 03

  I think a lot of people, marijuana is a very interesting drug where for a, for a, for a high number of people, in the short term, they think it's giving them a reduction of anxiety, but it's actually compounding their anxiety. And I had a woman on my podcast who, who talked about this at length, and she talked about the number of patients where if she can just get them to stop marijuana for a month, they're gonna, it starts to break the cycle of their anxiety. And of course, there are lots of people who use marijuana quite regularly, have zero issues with anxiety. So again, I think like most things in mental health, um, it's really complicated to understand susceptibility windows.

• 2:12:44Speaker 03

  Like, why is it that one person, when they use this drug, something negative happens, another person can use the same drug, and actually something quite positive happens? What, what's the susceptibility of that? Like, you know, we're, we're really in, uh, our, our infancy of understanding these things, to put it mildly. Um, so.

• 2:13:08Speaker 02

  So there is no, there is nothing thus far that, that, that states that psychedelics may help with dementia?

• 2:13:19Speaker 03

  Certainly nothing directly. Now, look, you could make some indirect cases, and, and by the way, I don't include MDMA as a psychedelic, because it's technically not a psychedelic. Uh, it's an empathogen, so it doesn't distort, uh, you know, your perception. But as I'm sure you're aware from interviews you've done, I mean MDMA is, is probably the more promising of all of those agents when it comes to treating PTSD. And it would be hard to make a case that if you took an individual who's suffering from PTSD. And you freed them from the grip of that through MDMA-guided therapy that you aren't

• 2:13:59Speaker 03

  not just reducing the risk of near-term issues that are associated with PTSD, but also long-term issues, including cognitive decline. So again, I think that's that I think there could be indirect and adjacent benefits of this. I just think with each psychedelic, as with each drug, you have to know the operating window of the drug, right? So like, take something that's really obvious and predictable, like Tylenol. So when was the last time you took Tylenol for a headache or something? It's been a long time. All right. So but you know how it works. Your kids get a fever, you give them Tylenol, right? Like, it has a really predictable operating window. You're like, gonna give

• 2:14:42Speaker 03

  this to you, you're gonna feel better. Can't give you too much, or I'll hurt your liver. If I give you too little, you're not gonna feel anything. But like, this is the dose at which it works. Advil. Took an Advil if you pulled a muscle or something. Like, super, super predictable. MDMA, pretty predictable drug, right? Like, for most people, somewhere between about 75 milligrams and 125 milligrams is going to produce a remarkably consistent effect. Now, you layer that in to the right setting, with the right therapist, with the right intention, you start to get amazing clinical results with people. Now, when you

• 2:15:27Speaker 03

  start to look at psilocybin, LSD, oh, it starts to become a lot less predictable. You can give the exact same dose to two different people, or to the same person in two different settings, wildly different result. Now go one step further and start talking about ayahuasca.

• 2:15:46Speaker 03

  I mean, all bets are off, right? Like, it's not even one molecule, right? Does that in any way diminish that people have life-changing effects on these things? No, but there's a real buyer beware on these things in my mind. And I do think that, again, I don't follow this space nearly as much as I used to. So this is, you know, but like, if I think about kind of where my interests in this space were seven or eight years ago, I felt like there was maybe just a little too much indexing on these things or the panacea. Everybody needs a shaman. Everybody needs to be doing ayahuasca all the time. And my view now is that's, that's just insanely irresponsible. And I think for every great story you hear about someone, one, how often is the change durable?

• 2:16:31Speaker 03

  And B, what, what does the graveyard look like of people who have been, you know, kind of ravaged by some of these, some of these things? I think iboga, ibogaine and iboga are really interesting. And, and actually, if I could make one wish of the, of the FDA, it's that I really wish that they would reclassify it to permit it to be studied for addiction. Because I don't know how we can live in the world today where we see more than 100,000 people in this country die from fentanyl overdoses a year. And we, we aren't interested in trying to free people of that addiction.

• 2:17:14Speaker 03

  And by the way, some will say, well, but iboga is very dangerous and you can run into cardiac toxicity. And it's like, yes, all of that is true, but it can be done safely. And the toxicity that comes with it has to be weighed against the toxicity of an ongoing opioid addiction.

• 2:17:34Speaker 02

  Have you personally done any of these therapies?

• 2:17:37Speaker 03

  Yes, I have not done iboga, but I've done most of the others.

• 2:17:41Speaker 02

  And for what reason?

• 2:17:44Speaker 03

  Um, you know, usually trying to, trying to solve a problem, trying to, trying to address a demon. And I've had.

• 2:17:55Speaker 03

  Some incredible experiences that have changed my life forever have given me compassion in areas where I never thought I could have it.

• 2:18:06Speaker 03

  Can you share that?

• 2:18:09Speaker 03

  Yeah, yeah, I think, I think one of the most powerful experiences I ever had was probably 2017. So, and it was, I didn't go into this experience knowing what was gonna happen, but, but I had a remarkable vision of something in my childhood that was quite unremarkable, but, but it was, and I'm sure you've heard this from people who have used high doses of psilocybin, but you sort of disassociate. So you are no longer experiencing this thing from your viewpoint as where you were, and I'm trying to think how old I was, I was probably 13.

• 2:18:54Speaker 03

  So I was no longer 13, I was me as an adult, but I had lifted up to the top of the room, and I was now watching me as the child with, with my father. And I was watching something, an interaction that we had, but through a totally different lens, which was through his eyes. And I saw the world through his eyes, and I gained a compassion for him that has endured to this day in, in a, in a way that I, I'm so grateful for. And, and it was, you know, I mean, it was, I woke up, I remember waking up and thinking

• 2:19:37Speaker 03

  someone had spilled water on the floor and realized it was my tears. Wow. And I couldn't understand how there was so much water on the floor after this many hours. I mean, it was such a profound experience. That said, on the opposite side of that, Sean, I've had experiences with some of these agents that have, I describe them as Guantanamo Bay for my soul. Just horrible experiences.

• 2:20:02Speaker 02

  Do you continue to do those therapies?

• 2:20:04Speaker 03

  No, I honestly think, I think I have, I have extracted the value that can be extracted from them and I'm grateful for it, but I do not believe that there's any more value to me to be extracted from, from those, from those agents, with the exception of MDMA. I think, I think, I still think MDMA, because of its very gentle forgiving nature, offers, offers a wonderful opportunity to, to, to, to, to kind of heal oneself a little bit. But, but I think, you know, I'll never say never, but, but I, I'm not, I'm not at all eager to reengage with any of the others.

• 2:20:48Speaker 03

  What about you?

• 2:20:50Speaker 02

  You know, I, yes, I do, every once in a while, I'm very, have very clear intentions when I do it, and, and have done psilocybin, 5-MEO, Iboga.

• 2:21:08Speaker 03

  And that's what I was confusing, sorry. It's 5-MEO, that's the 10-minute ride.

• 2:21:12Speaker 02

  Yes, yes. But what I see, especially in the veteran community, is I, I see people, friends of mine, that they go and they do Ibogaine, then they do psilocybin, then they do ayahuasca, then they're doing MDMA, then they're mixing it all together, then they're going and doing peyote, and then, and they start living in that space, and it's like, it's like, man, look, what are you digging for here? Like, you, you have to actually take whatever you learned in that, in, in, in, in change the habit, and carry on with your life here in the real world, otherwise, it's just...

• 2:21:53Speaker 03

  Yeah, there's, there's a, there's a book by this title that talks about the difference between altered states and altered traits. And the idea here is, every time you do one of these drugs, it alters your state, obviously.

• 2:22:10Speaker 03

  But unless it's altering a trait, i.e., once the effect of the drug is gone, is it going to change the person I am? Does it make me a better person? If it doesn't, that's a litmus test that you shouldn't be doing it. And so that is the standard I hold myself to on these things. I have no interest in just having my state altered. If it's not going to address a trait, I don't care. I don't need, I actually like the state I'm in. I don't, I don't need to run from this place.

• 2:22:45Speaker 03

  Unless transiently doing so is going to help me fix something. That's a great way to put it. What's the fourth one? Metabolic? Metabolic disease. So this is everything from insulin resistance, fatty liver disease, type 2 diabetes. And this is, in many ways, probably the one that's growing at the fastest rate. So, uh, in the year you and I, well, I guess I'm 10 years older than you, but roughly when you and I were born, you know, we're talking 1% of the US population had type 2 diabetes. It's 10% today. Wow. You know, obesity rates have doubled in that period of time. So something's broken, right? Something is broken.

• 2:23:28Speaker 03

  And if you have type 2 diabetes, your risk of all-cause mortality is 40% higher. Your risk of getting any of these other diseases is up to 50, in some cases, 100% higher.

• 2:23:42Speaker 03

  Not to mention the personal toll this takes, right? That doesn't count the, all the other stuff, the blindness, the impotence, the, uh, amputations of digits, like all the other stuff that comes with this, the cost of the healthcare system. I mean, we could rattle off everything about this, right? So, so what is it that's going on? Like, you know, cause obviously there's an, there's an association between weight and metabolic health, but it's not an ironclad association. And we know that weight by itself, excess weight by itself, is not the problem.

• 2:24:15Speaker 03

  It really has to go back to kind of that thing we talked about before, which is, some people can store a lot of excess energy as in the form of fat, without it becoming metabolically toxic, without it kind of going into those other parts of the body, where, um, where it leads to these horrible compensations. And, um,

• 2:24:35Speaker 03

  I do think that the majority of this problem stems from nutrition. I think exercise can alleviate much of it. And as people are becoming less and less active at just kind of baseline activity level, they're more susceptible to bad nutrition. Sleep factors into this more than most people realize. So if you're sleep deprived, your susceptibility for everything goes way up, including, I mean, I'm sure you know, I know this from back when I was in residency. So every third night, you're not sleeping. Those, that next day, my eating pattern was worse. I was more, I had more cravings. I would eat more crap.

• 2:25:18Speaker 03

  And your cortisol levels are through the roof. I mean, there's just a whole bunch of bad things that happen when you're not sleeping. So something about our food system isn't working. I don't think it's, I think it's actually more the obvious stuff, honestly. I don't think it's, I don't, I don't believe it's red dye in the foods. And I think all that stuff is like, those are rounding errors, right? I think the real issue is we culturally eat too much in this country. Our, we do have a lot of processed food and we eat a ton of it. And any American who has spent time abroad will recognize immediately the difference in food.

• 2:25:59Speaker 03

  Yes, the food quality is better elsewhere, but there's a totally different culture about how much you eat, when you eat, the size of portions. Everything is, you know, everything is geared and kind of rigged against us here. And I think that's probably the single biggest factor that's driving it. Coupled with like, again, just give you a little example, right? Like you don't see places like Costco in Europe, the way you would see it here, right? Cause over there, you're gonna go grocery shopping twice a week and you're gonna just, you know, the fridges are smaller over there, right? They're not supersizing everything. So as much as people want to point to seed oils and red dyes and you're eating too many

• 2:26:44Speaker 03

  animal products, you're eating not enough animal products or like I, that, the data just don't support that. The data suggest it really comes down to we just eat a lot more. Nutri-, you know, calorie-dense foods in way higher quantities than other people do. Now, of course, they're catching up to us. So, in fairness, the rest of the world is doing their best to catch up to the United States because we certainly export the best of our food ideas.

• 2:27:14Speaker 03

  So you don't, you know, there's a lot of talk about seed oils these days. Yeah, oh, I'm actually in the process of trying to engage, and I have engaged two people on this debate, so I won't name them, but you can probably figure out who they are. But two people on either extreme of this debate, and I'm actually trying to bring them on my podcast for a moderated debate.

• 2:27:36Speaker 03

  Now, I think podcast debates usually suck. And the reason is, people can make up whatever they want, and you can't fact-check them in real time. So, I've never actually watched a debate on a podcast that I didn't think was an absolute garbage waste of time. So, in going to these two guys, I said, "Look, I don't have any interest in adding to the

• 2:27:56Speaker 03

  to the volume of crap out there." So, if we do this, we're gonna do it by my rules, and my rules are as follows. The question of what is being debated will be very, very clearly articulated, a priori. All the research that each of you will use to address the question will be pre-submitted, such that everybody can review it. So this is how a court works, okay? So, you will submit all of your data to you, you will submit all of your data to you, and both of you will submit it to me and my research team.

• 2:28:31Speaker 03

  When a person is speaking in the debate, if they are citing a study, they may only cite from what was pre-submitted. There is none of the pulling out of one's ass that is rampant in the podcast space when it comes to debates. And everything you say will be fact-checked.

• 2:28:52Speaker 03

  So, beware. If you're making something up, we will fact-check you. And we will insert fact-check and correction every time you misspeak. Wow, when's that coming out? We haven't, I mean, we're still trying to get everybody to agree to this, and it might not happen, you know? I mean, I've tried to do this for vaccine safety, I've tried to do it for seed oils, I would like to do it for sugar, there are lots of topics we want to do it for. But, you know, when push comes to shove, it's hard to get people to commit to that kind of rigor. Can I ask you who?

• 2:29:25Speaker 02

  Who's apprehensive? Is it the anti-seed oil guy or the?

• 2:29:29Speaker 03

  I, I won't say for sake of who these folks are, um, but, but I will say that even getting to agree on the question has been difficult.

• 2:29:39Speaker 02

  Wow.

• 2:29:40Speaker 03

  Right?

• 2:29:41Speaker 02

  Wow. That's interesting.

• 2:29:43Speaker 03

  But it's, it's, it's really easy to just kind of blame your favorite boogeyman.

• 2:29:49Speaker 02

  Yeah.

• 2:29:49Speaker 03

  Um, but, but when push comes to shove, like what is the data? What is the data?

• 2:29:56Speaker 02

  Let's move into exercise. So it sounds like exercise helps pretty much all of these four pillars, uh, that are these four disease types. What kind of exercise are you doing? What, what should people be doing? I mean, do they need to dedicate three hours a day to this? Does it have to be super strenuous? I mean, what, what do you recommend?

• 2:30:19Speaker 03

  Um, I think the, it's, it's, it's easier to talk about it through the lens of what does the output need to be? Right? I think too much of exercise is talked about the input. You need to do this many hours of this. You need to do this many hours of this. And that's a, obviously a very helpful way to talk about it because it's easier and it's actionable. But, but it's better to at least start with what's the objective? And the objective is, if you at least just look at the, the, the top level of the data, you, you want to have muscle mass that puts you at about the 75th percentile of the population or better. The two easiest ways to measure that is something called Applicular Lean Mass Index and Fat-Free Mass Index. These can both be derived from a DEXA scan.

• 2:30:59Speaker 03

  That's a body scan that very quickly measures how much fat, muscle and bone density you have. And so that's one of our first optimizations. We really would love to get everybody to be at or above the 75th percentile of muscle mass. Now, that's not going to be possible for everybody. There are some people whose build is so slight. I mean, we have patients that come in our practice who are literally at the third percentile for muscle mass. I, I don't expect those people to ever get to the 75th percentile, but I bet I can get them to the 40th or 50th percentile over a few years.

• 2:31:31Speaker 03

  Second thing is, you want to hit certain metrics of strength. And, you know, so you, you should be able to carry some fraction, depending on how old you are, your body weight, or some fraction of it for a certain period of time. Right? You should be able to do a wall sit for a certain period of time. And again, you can discount this over time. As a person ages, the standard goes down. Right? So when you were coming out of BUDs, my guess is like you could, you were Superman. Right? Wouldn't hold you to that standard today. But, but there's a standard for a 40-year-old, a 50-year-old, a 60-year-old, a male, a female, et cetera. And so if you rattle off what all these standards are, I would say that becomes a very important thing that we want to be able to hold ourselves to. And we'll come back to how you get there.

• 2:32:16Speaker 03

  There's a, a measurement that is the, a very accurate way to determine what a person's maximal aerobic capacity is. It's called VO2 max. It's typically measured either on a stationary bike or on a treadmill when someone's hooked up to a mask that measures oxygen concentration and, and volume of, of air consumed and, and you can calculate how much oxygen was consumed. When you know that, you can tell a person where they are relative to people their age and their sex. And we have a very high standard for what me white think you want to be. We, you know, we might say, look, I want you to be at the 97th or 98th percentile for

• 2:33:00Speaker 03

  your age and sex with respect to VO2 max. And then there are other markers of baseline aerobic fitness, what's called zone two. And we would say, we, we have a standard for what we would want you to be able to do. How many watts we would expect you to be able to put out relative to your body weight for an hour under these conditions. And so we can rattle off a whole lot of these goals and then, then we can come back to your question of how should one do that? And I don't tend to prescribe like you gotta do this many hours of exercise. What I then do is I say, how many hours a week can you exercise, Sean? You tell me what you're willing to do, not for one week, when you're being a hero.

• 2:33:43Speaker 03

  Like, tell me what is sustainable for you for the next year? And then if you came back and said, Look, man, my kids are one and three. I got this podcast. I'm doing 20 interviews a week. I got this business thing. I got this business thing. I can't do more than six hours a week of training right now. I'd say, okay, we're gonna work with six hours per week and we're gonna, we might not get you to those goals within a year, um, but we're gonna put you on the right path. And this is how we're gonna balance the portfolio. If you came back and said, I can only do three hours per week, I'm gonna be like, oh, God. Okay. We're probably not gonna make that much progress. But unless you're starting from zero, if you're starting from zero, three weeks or three hours a week is pretty awesome. But if you're a reasonably, you know, quasi-fit person who's at about the 50th percentile,

• 2:34:28Speaker 03

  we're not gonna make huge progress in three hours a week, but we're not gonna take any steps backwards, and that's important. Um, and if you come in and say, I'm going for broke, man, you got me for 12 hours a week, then it's a different, then it's a totally different training program. How often do you exercise? Um, I mean, almost every day. I didn't exercise today because I had to, you know, fly in and then I'm gonna fly back tonight, but I did today's workout yesterday. So I, I mean, my, my, my schedule is set up to exercise pretty much every day. But at least twice a month, there's kind of a forced day off due to travel. Okay, so how, how many hours a week? Um, right now, let me think.

• 2:35:06Speaker 03

  Maybe eight hours a week. Eight hours a week? Yeah. What kind of exercising? Um, it, these days, you know, it's mostly just cycling and, uh, resistance training. Um, I'm gonna resume swimming again in a couple of months. So I think I'll probably increase to about 12 hours per week total training time by spring, summer, and I think just bring swimming back in permanently to my life. I haven't swum in a long time, um, and I kinda miss it. And I also think it's, um, you know, kinda going back to something you said earlier, like, how do I spend my time? Um, swimming will be a form of exercise where I'm killing two birds with one stone.

• 2:35:49Speaker 03

  Well, I'll get the exercise, but it's also a bit of a mental health check. Whereas when I'm on my bike... I'm usually like I'm indoors, I'm listening to a podcast or an audio book. I'm not really turning it off. I'm trying to learn. Um, when I'm strength training, I've got music on, so I'm kind of focused on what I'm doing there. But swimming is, as you know, you probably spent a ton of time in the water. Uh, you only hear the water. You hear yourself breathing and you hear the sound of the water. So that's why I'm kind of excited to get back into swimming and that'll probably take me up to 12 hours a week.

• 2:36:20Speaker 02

  Let's talk about emotional health. This is something you talk about, about kind of broached psychedelics. What, what other kind of things should people be doing for emotional health?

• 2:36:31Speaker 03

  No, I mean, I think just asking themselves questions, you know, like trying to, trying to understand the root of, of, of what's going on. Like what, you know, uh, how can I name my emotions, right? Um, why do I feel a way, why do I feel the way I feel? Who am I, uh, who do I feel connected to? Who do I not feel connected to? Um, so I think just being kind of curious is a, is a very important step. I think this is an area that comes a lot easier to women than to men. I think men, uh, particular young men, um, just don't necessarily possess the vocabulary sometimes to even think through some of this stuff. Um, and I think you can, you, you just, you get into trouble for it, right?

• 2:37:15Speaker 03

  You, you, you end up, um, going, going down a road where you can, you know, you, you, you can, um, poison relationships because you didn't know better, right? Because you didn't, you didn't, you didn't know how to act. You, you, maybe you didn't have a role model in that way. Um, and, and I think there's different, there's different ways to do it. I mean, you can, you know, I think in my, in my case, the, the issue was, you know, workaholism, perfectionism, anger being great tools that were highly valuable when I was young, um, that, that start to become maladaptive when you get older.

• 2:37:53Speaker 03

  And then you have kids and then you realize, um, you know, uh, what served me well when, when I was a 16 year old is not going to serve me well when I'm a 46 year old.

• 2:38:06Speaker 02

  It's sleep.

• 2:38:09Speaker 02

  How do we improve our sleep? Do you recommend everybody do a sleep study?

• 2:38:13Speaker 03

  No, I don't think so.

• 2:38:16Speaker 03

  Look, a lot of people, if you spend two minutes with them, asking them questions, you can figure out they don't have an issue with their sleep. Their sleep is great. There are a couple of really great surveys you can take online. There's one called the PSQR, which is probably the most important one anyone should take. So if you just Google PSQR and go and take the survey, it asks you a bunch of questions and it'll pretty quickly tell you if you have a sleep issue. And if you do, then you kind of want to get into the, well, what's going on? And just start doing some accounting, like what time do I go to bed? Am I consistent in my bedtime? Am I consistent in my wake up time? How many hours am I getting in bed? Because if you're not even spending seven and a half to eight hours in bed, yeah, you're probably going to be shortchanged in sleep because it's hard to sleep more than 90% of the time you're in bed.

• 2:38:58Speaker 03

  So, you know, I try to be in bed for eight to eight and a half hours to get seven and a half to eight hours of sleep. And of course nowadays, you know, tracking devices are ubiquitous. So you can measure with reasonable accuracy, like how you're sleeping, what staging you're getting and things like that. And then there's just a whole bunch of really, really straightforward sleep hygiene things that everybody, I think, should be doing. And everybody knows what they are. I could rattle them off, but I don't think anybody would be surprised by them. It's just a behavioral challenge, right? Like, I don't think there's anybody who's going to listen to us, who's going to think, wait, I shouldn't be looking at my phone before bed?

• 2:39:42Speaker 03

  Right? So everybody knows that. But sometimes it's just hard to make the discipline of not looking at your phone for, let's say, an hour to two hours before bed.

• 2:39:54Speaker 03

  Having a bedtime routine, keeping the room really dark, really cold, not having, you know, electronics in the room,

• 2:40:05Speaker 03

  not eating before bed for maybe three hours, not having alcohol before bed. All these things. Make such a big difference. And then when you stack them all together, it's like you're gonna, you're gonna sleep well. And then, of course, there's always a subset of people where after doing all of that stuff, sleep is still problematic and then a sleep test can be really helpful. You know, you, you do learn that, hey, a person might have sleep apnea. And even if they lose weight, it doesn't fix, or maybe their normal weight. Cause there are still people who get sleep apnea that are of totally normal weight, even though it's a condition that disproportionately afflicts people who are overweight. And then, yeah, you might, you know, you give that person a CPAP machine and it changes their life.

• 2:40:47Speaker 02

  Man, that's a lot of, that's a lot of great information. Thank you. Uh, is there anything that we didn't cover that you'd like to cover?

• 2:40:57Speaker 03

  No, I don't think so.

• 2:40:58Speaker 02

  Then what with this? Just wanna know, what is, you know, what is your daily routine? Not when you're on travel and going to podcasts. What is, what is your picture perfect daily routine that you, that you don't like to interrupt?

• 2:41:13Speaker 03

  Um, you know, I like to get up early, make coffee. Um, in an ideal world, have 15 minutes with my wife. Um, where we're sitting in the dark, having coffee, catching up. Um, kids are up then, uh, getting the kids ready for school. So making breakfast, uh, in a really good day, uh, get a chess game in with, with one of the boys before school, um, get the kids off to school. By now it's about 7:15. Um, I will typically head right into my office at that point and do my first scan of email. And then, you know, just address anything that needs to be addressed. And then actually at that moment in time is when I can turn my attention to whatever

• 2:41:54Speaker 03

  my most important task of the day is, uh, from a creative perspective. So that's when I can do my best writing, editing, thinking, um, I've done my prep for the day before, the night before, or for that day. So I know which patients I'm talking to. I've already gone through all that stuff. And then I'll typically go and exercise.

• 2:42:16Speaker 02

  What time?

• 2:42:17Speaker 03

  It depends, but probably now it's like 8:30. So I'll, I'll work out and I don't, so I don't schedule anything until 10 or 11 in the morning. So I just have a hard rule. Unless I have a call in Europe, then I'll typically do that at 7:15, the second the boys and my daughter leave. So, but assuming I don't have a European call, it's going to be 10 or 11 is first scheduled meeting. And so if it's 10, I need to be in the gym by

• 2:42:50Speaker 03

  8. If it's 11, I'll go 8:30 and then I like to try to get a quick sauna in for 20 minutes and then get ready for work. And then, so work from 11 to 5, 5:30. And then, you know, help with dinner.

• 2:43:08Speaker 03

  Goof off a little bit after dinner. Again, play some chess, just, you know, kind of hang out with the kids. It depends on the season, right? So in the summer, you get a little more leeway. We go outside, we'll play baseball or, you know, do something. In the winter, you know, or during school, you know, it's maybe more directed towards kind of the, the, the night routine. Once the kids are down, I'll typically work again for another one to two hours and then kind of like to spend the last hour before bed off work. Just, you know, vegging, hanging out with my wife, you know, watch Netflix, maybe do a sauna if we, if I didn't do one earlier in the day.

• 2:43:47Speaker 02

  Right on.

• 2:43:48Speaker 03

  Boring life, man.

• 2:43:49Speaker 02

  Hey, that sounds, that sounds pretty good to me. But Peter, I just want to say thank you for your time. Thank you for coming. I learned a ton from you and I hope to see you again.

• 2:44:00Speaker 03

  Well, thanks for having me, Sean.

• 2:44:01Speaker 02

  Best of luck.