392: Life, Death, Darkness, and Light. "OUTLIVE" with Dr. Peter Attia

>Join Jocko UNDERGROUND< https://www.jockounderground.com/subscribe Peter Attia, MD, is the founder of Early Medical, a medical practice that applies the principles of Medicine 3.0 to patients with the goal of lengthening their lifespan and simultaneously improving their healthspan. He is the host of The Drive, one of the most popular podcasts covering the topics of health and medicine. He is also the author of the #1 New York Times Bestseller, Outlive: The Science and Art of Longevity. Support this podcast at — https://redcircle.com/jocko-podcast/exclusive-content

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

• 0:00Jocko Willink?

  This is Jocko Podcast number 392 with Kerry Helton and me, Jocko Willink. Good evening Kerry. Good evening.

• 0:09Jocko Willink?

  The truth is, we died together, once before.

• 0:17Jocko Willink?

  We died together, once before, so says the character, Thomas Shelby, in the series Peaky Blinders. He's, speaking of himself and his brothers, who had served as British soldiers in World War I. He and his brothers, Arthur and John, as well as three of their friends, Danny Whizbang, Jeremiah and Freddie Thorne, were in the field. And they were cut off from the British retreat. As the British left, the battle, they couldn't get away.

• 0:56Jocko Willink?

  They had no bullets left.

• 0:59Jocko Willink?

  They were simply waiting for the Prussian cavalry to finish them off.

• 1:06Jocko Willink?

  And while they waited, they decided they should sing the old hymn, "In the Bleak Midwinter."

• 1:17Jocko Willink?

  And they waited to die.

• 1:23Jocko Willink?

  But in the end, they were spared.

• 1:26Jocko Willink?

  For whatever reason, fate, or providence, or chance, or destiny, the enemy never came. And so, they lived.

• 1:39Jocko Willink?

  And Thomas Shelby says at the end of this story, that, "We all agreed, everything after that, was extra."

• 1:53Jocko Willink?

  Bonus. And that attitude, that perspective permeates in the way that the Shelby brothers lived.

• 2:04Jocko Willink?

  And the way many veterans live after war. This is something that war can do to a person. If you've

• 2:11Jocko Willink?

  accepted death, then the rest is all extra.

• 2:17Jocko Willink?

  It's all a bonus.

• 2:20Jocko Willink?

  And so how do you live? What do you do? Are you taking risks? Reckless risks? Are you taking advantage of every second that you have? Are you living to honor the ones who didn't make it home?

• 2:34Jocko Willink?

  Or are you guilt ridden that you did make it home?

• 2:40Jocko Willink?

  Are you trying to remember? Or are you trying to forget?

• 2:45Jocko Willink?

  Are you trying to leave a mark? Or just trying to leave?

• 2:53Jocko Willink?

  I've seen some of my friends do some of those things. Or all of those things. I've done some of those things.

• 3:05Jocko Willink?

  That's war.

• 3:08Jocko Willink?

  My friend Peter Attia told me a story once, and I've probably morphed it in my mind over the years.

• 3:16Jocko Willink?

  But it was something like this. He was an ER doctor at the time of this story. And there was a teenage girl who was brought in by her mother. And this teenage girl had

• 3:32Jocko Willink?

  broken up with her boyfriend or experienced some other kind of adolescent drama.

• 3:40Jocko Willink?

  And she tried to kill herself by taking an overdose of Tylenol.

• 3:49Jocko Willink?

  And some time had passed and the young girl realized that this wasn't that smart and she didn't want to die. And so she apparently told her mother and her mother had brought the girl to the hospital. Where the girl's mother politely told Peter, the ER doctor, what had happened.

• 4:10Jocko Willink?

  And I can hear the conversation in my head, you know, the kind of casual, oh, my daughter, she broke up with her boyfriend and, you know, she took a bunch of pills and, and I think she probably just expected Peter to

• 4:23Jocko Willink?

  pump her stomach or give her the antidote or give her an IV or give her an injection of something or perform whatever simple routine medical procedure that would resolve the issue.

• 4:36Jocko Willink?

  And then the girl and the mother could carry on happily with their lives, having learned from this little innocent naive mistake by this young girl.

• 4:47Jocko Willink?

  And Peter asked some questions and did some math in his head. And realized based on how long it had been since she had ingested the drug and how much she had actually taken. As he ran that math in his head, he feared it would be too late because with Tylenol, there's a certain point of absorption in the blood.

• 5:11Jocko Willink?

  Where too much has been absorbed. And the liver is poisoned and the liver fails and the body breaks down.

• 5:20Jocko Willink?

  And you die.

• 5:24Jocko Willink?

  And there is no procedure.

• 5:27Jocko Willink?

  And so Peter quickly ran the necessary tests. And his fears were confirmed.

• 5:37Jocko Willink?

  It was too late.

• 5:40Jocko Willink?

  There was nothing he or anybody else could do.

• 5:45Jocko Willink?

  She was going to die.

• 5:52Jocko Willink?

  I've thought about that story a lot.

• 5:55Jocko Willink?

  From the girl's perspective, from the mother's perspective, from Peter's perspective.

• 6:01Jocko Willink?

  And I think about that story. And how it relates to my own experiences with death, which because of the war. Those experiences have been too often and too close.

• 6:18Jocko Willink?

  And I wonder sometimes, do we realize the value of life when we have it?

• 6:26Jocko Willink?

  Does an encounter with death bring fear or does it bring comfort?

• 6:34Jocko Willink?

  And what do we do and how do we act when we realize?

• 6:39Jocko Willink?

  It's all going to end.

• 6:44Jocko Willink?

  Because.

• 6:47Jocko Willink?

  It is all going to end.

• 6:51Jocko Willink?

  For everybody.

• 6:53Jocko Willink?

  There is no escape. No one gets out of here alive. Days, months, minutes or years. We don't know how much time is left, but the clock is ticking.

• 7:05Jocko Willink?

  Like Thomas Shelby and his brothers, we are all caught off from the retreat.

• 7:14Jocko Willink?

  We will run out of ammunition.

• 7:18Jocko Willink?

  And we will be waiting for time.

• 7:22Jocko Willink?

  To come and finish us off.

• 7:25Jocko Willink?

  In the bleak midwinter.

• 7:31Jocko Willink?

  Now strangely, or I don't know, maybe not so strangely, I thought about all of this as I was reading. Peter's new book. The book is called Outlive. A much more positive title than the subject matter I just addressed. But it's a book that should be required reading for everyone. And really it is.

• 7:56Jocko Willink?

  It at least touches upon or borders upon being a textbook. A textbook where Peter does his best to teach us what he's learned. About health and about happiness and about disease and diets and drugs and about life and about death.

• 8:18Jocko Willink?

  And Peter's been on this podcast before. I think it was 2016, episode number 56. And it is a privilege to have my friend Peter back here again to discuss. Well, to discuss all these things. So Peter, thanks for coming. Thanks for coming by.

• 8:38Peter Attia?

  Thank you for having me back.

• 8:41Jocko Willink?

  In the bleak midwinter, how close am I on that story?

• 8:45Peter Attia?

  Um, one small detail off, one large detail off, and the large detail is a good one to be off on. So I wasn't the ER resident, I was the surgical resident. So I wouldn't have been the first person they encountered. But the good news is she was one of the lucky ones in that while her liver did fail, we managed to get a liver transplant for her in time.

• 9:06Jocko Willink?

  Oh, she lived.

• 9:07Peter Attia?

  She lived.

• 9:08Jocko Willink?

  That wrecks my whole story. It actually makes my story a happy ending.

• 9:11Peter Attia?

  It does, but it's, but it's the same point because I was the first person that she saw when she woke up. So, um, most people in that situation die because the liver, unlike other organs in the body, you don't have a way outside the body to support it. We call that extracorporeal support. So if you take a drug that destroys your kidneys, you could be put on dialysis for a period of time, years in fact, until you got a transplanted kidney. Even the heart is true in that way. If you took something that was so toxic to the heart, you could be put on a ventricular assist device or something like that until a heart transplant came along. The liver, we have no option for that.

• 9:54Peter Attia?

  So you've got, got in the case of this girl, if I recall, you probably have about a 20, a 36 hour window to get her a liver. And that's not big odds. So there's a decent chance that you just die. She was one of the really lucky ones. So she got a liver. And I, you know, I just remember taking care of her when she's, you know, in the ICU and, you know, I think it's a, I mean, again, she was very young, right? So she was probably late teens, early twenties. Probably an unbelievable feeling of shame. Um, and you know, I'm sure you read these accounts of the few people who have survived jumping off the Golden Gate Bridge.

• 10:31Jocko Willink?

  Yeah.

• 10:32Peter Attia?

  And they all say the same thing, right? I mean, there's only a handful of them that have survived. And then two things they all say are they can't believe how long it takes to hit the water. It's technically about a three second fall, but they describe it as taking like minutes. And two, they, again, it's an, it's a small N, but they all say the second they jump, they can't believe how much it puts in perspective, whatever it was that made them jump.

• 11:02Jocko Willink?

  Sketchy. That's, uh, that's crazy. I was looking at statistics on the Coronado Bay Bridge.

• 11:08Peter Attia?

  Hmm.

• 11:09Jocko Willink?

  And I think I, I want to say like 10 people have survived. Is that too big of a number? How many people did you say survived, uh, San Francisco?

• 11:20Peter Attia?

  It, it's on the order of, of 10 or so. And, and I'm trying to think like the Golden Gate Bridge probably averages two a month.

• 11:29Jocko Willink?

  Yeah.

• 11:30Peter Attia?

  I don't, I don't know about Coronado.

• 11:31Jocko Willink?

  Coronado is a similar number. It's a similar number. It gets shut down all the time because people are, jumpers are up there.

• 11:38Peter Attia?

  Hmm.

• 11:39Jocko Willink?

  Um, all right. So you wrote this book. We're going to get into it a little bit. And you've also done a bunch of podcasts about the book, the book, you did the audio book of the book. I'm going to try not to read too much of the book, but you know me, I probably will read more than I should. Um, it starts off with this, going into the book, the intro of the book. Once again, the book is called Outlive, The Science and Art of Longevity. And it's a lot more than just that. "In the dream, I'm trying to catch falling eggs. I'm standing on a sidewalk in a big, dirty city that looks like a lot like Baltimore, holding a padded basket and looking up. Every few seconds I spot an egg whizzing down from me from above."

• 12:21Jocko Willink?

  And I run to try and catch it in the basket. They're coming at me fast. And I'm doing my best to catch them running all over the place with my basket outstretched like an outfielder's glove, but I can't catch them all. Some of them, many of them smack the ground, splattering yellow yolk all over my shoes and medical scrubs. I'm desperate for this to stop. Where are the eggs coming from? There must be a guy up there on the top of the building or on the balcony, just casually tossing them over the rail. But I can't see him and I'm so busy, I barely even have time to think about him. I'm just running around trying to catch as many eggs as possible and I'm failing miserably. Emotion wells up in my body as I realize that no matter how hard I try, I'll never be able to catch all the eggs.

• 13:04Jocko Willink?

  I feel overwhelmed and helpless. That's the opening of the book. This is a very similar, like military dudes like me, we have a dream where the enemy's coming and we're running out of ammo. It's kind of like the Tommy Shelby thing, like we're running out of ammo and then you run out, you're looking for other magazines and the enemy's closing on you and you know what's going to happen and you, that's when you wake up drenched in sweat. And you're all happy, you know, you're like, oh, I'm just in bed, we're all good. But this was the, this is how you viewed what medicine was doing, what you call in the book, medicine 2.0, which is here's a problem right here, let's fix it right now

• 13:49Jocko Willink?

  and not try and figure out where it's coming from. That's the impact that this dream had on you is to, to, to make you think of medicine in a different way.

• 13:59Peter Attia?

  Yeah, although not at the time, right? It's only in retrospect that I put two and two together. At the time, um, yeah, it just seemed like, I mean, it's amazing to me that it wasn't obvious what that dream was about at the time, because it's so obvious in retrospect.

• 14:13Jocko Willink?

  Oh, so what you thought it was about at the time was you needed to get better with the basket and be able to move quicker and be able to catch more.

• 14:20Peter Attia?

  Just some stress, just stress, like it was just some dream about internalizing stress.

• 14:27Jocko Willink?

  How often do you remember your dreams now?

• 14:30Peter Attia?

  Oh, you know, it's funny, if I'm really deliberate about thinking about it first thing in the morning, I would say probably more than half the time.

• 14:38Jocko Willink?

  Are your dreams good or are your dreams bad?

• 14:43Peter Attia?

  Very rarely do I wake up and think that they're significant about.

• 14:50Peter Attia?

  Oh, I don't know.

• 14:52Peter Attia?

  Maybe a little less than half the time that I do remember a dream, I can at least say, I bet that's me ruminating on this fear or this concern. But there, I would say that the valence of my dreams tends to be negative. It's rare that I wake up and think, oh, I wish I was still sleeping, having that dream. It's usually, I'm glad that's over.

• 15:15Jocko Willink?

  That could be some kind of a bias, though, because if you're having a bad, bad dreams seem to wake you up more than good dreams. I bet we just like happy, good dreams, you keep sleeping. I can always tell when I've had like a, a, a bad dream because I wake up just drenched in sweat. And it's nasty and my wife is like, you are disgusting. And I'm like, yeah, I'm sorry. But it's always like you're running for ammo, you're doing something, you're trying to catch someone, like something's going on like that. It's weird that you physically sweat even when you're not moving.

• 15:49Peter Attia?

  Yeah, for sure. I mean, it's still, there's still huge sympathetic, you know, nervous system is, is activated. I mean, it's, I wouldn't know the difference, right?

• 15:58Jocko Willink?

  Yeah, I guess. Well, mine doesn't, that's for damn sure. All right, I'm going to fast forward a little bit and go read another chunk of the book. I'll never forget the first patient whom I ever saw die. It was early in my second year of medical school and I was spending a Saturday evening volunteering at the hospital, which is something the local school or the school encouraged us to do. But we were only supposed to observe because by that point we knew just enough to be dangerous. At some point, a woman in her mid 30s came into the ER complaining of shortness of breath. She was from East Palo Alto, a pocket of poverty in that very wealthy town. While the nurses snapped a set of EKG leads on her and fitted an oxygen mask over her mouth and nose, I sat by her side trying to distract her with small talk.

• 16:41Jocko Willink?

  What's your name? Do you have kids? How long have you been feeling this way?

• 16:46Jocko Willink?

  All of a sudden, her face tightened with fear. And she began gasping for breath. Then her eyes rolled back and she lost consciousness. Within seconds, the nurses and doctors flooded into the ER bay and began running a code on her, snaking a breathing tube down her airway and injecting her full of potent drugs in a last ditch effort at resuscitation. Meanwhile, one of the residents began doing chest compressions on her prone body. Every couple of minutes, everyone would step back as the attending physician slapped the defibrillation paddles on her chest and her body would twitch with immense jolt of electricity. Everything was precisely choreographed. They knew the drill. I shrank into a corner, trying to stay out of the way, but the resident doing CPR caught my eye and said, "Hey, man, can you come over here and relieve me?

• 17:30Jocko Willink?

  Just pump with the same force and rhythm as I am now, okay?" So I began doing compressions for the first time in my life on someone who is not a mannequin. But nothing worked. She died right there on the table as I was still pounding on her chest. Just a few minutes earlier, I'd been asking about her family. A nurse pulled the sheet up over her face and everyone scattered as quickly as they had arrived. This was not a rare occurrence for anyone else in the room, but I was freaked out, horrified. What the hell had just happened? Do they give you any heads up at all?

• 18:11Jocko Willink?

  Are they talking to you about this, any of this from a psychological perspective when you are going through doctor school?

• 18:20Peter Attia?

  Certainly not when I was there. I don't know what it's like today. But, you know, it would only go from bad to worse, right? I mean, I went to medical school at Stanford where that's often how you saw somebody die. But, you know, in residency, I was at Hopkins, which was more of a war zone. So there... What I saw as death was penetrating trauma for the most part and car accidents as well. But, but I would say the majority of the people that died while, um, you know, right in my hands would have been trauma victims. Um, and you certainly saw people die post surgical procedures, you know, somebody dies after cancer surgery or heart surgery. Um, but they usually didn't die right while you were watching them. The, the ones who die when

• 19:04Peter Attia?

  you're standing there pumping on their chest and trying to do something heroic were usually trauma victims. And that was just very, that was a very common occurrence. And no, I don't think that was ever, um, yeah, there was just, there was no, there was no sense of how do you process this? Um, and I, I don't know that I did a great job of it. I mean, I probably internalized it more than was healthy. Um, I, I, I feel like, um, yeah, there were many times when I, after, right after that person would die, I would do something like I'd pick their, I'd take their wallet and look through it and like find a picture of them or something like that. And it's, it, you know, I mean, I'm sure your audience can handle it, but like, I remember the first time I saw somebody literally whose brains

• 19:46Peter Attia?

  had been blown out. We use those terms very loosely, right? But, but you know what that's like. I mean, when you see a person with an entry wound, yay big, and an exit wound on the other side of their head, yay big, and their brains are on the gurney. That's not what they looked like 10 minutes earlier, an hour earlier. That's not what they look like in their driver's license photo. And, um, yeah, I just think, I think that is something that we would be better prepared to, or we would have been better off if we'd had some sense of how do you compartmentalize that?

• 20:19Jocko Willink?

  Yeah, I can tell you that I don't think the military does a good job of that kind of stuff. At least it didn't when I was in, we didn't talk about it. It's, in fact, it's interesting. We didn't even talk about like, hey, If someone dies, what do we do? What's our replacement plan for that individual? Like, are we gonna get another guy? I was like, oh, no, that won't happen. It was so far from our heads of thinking it could happen that we didn't even have some kind of a replacement plan. You know, you talk about World War II, they had replacement plans. In Vietnam, they had replacement plans. Oh, here's what you're gonna get for replacements. We have another platoon full of stragglers that they're gonna come in on the, you know, the fourth wave and they'll fill in whoever's, whatever spots are empty. We didn't have that. So that means you're not even thinking about it. So now you're not thinking about it. It's like, okay.

• 21:02Jocko Willink?

  What, what, what goes on? What goes on? What, how do people, how are people supposed to handle it? So it's interesting that even in medical school where you are 100% going to see people die. You're not giving any sort of prep for that. Now, listen, it's also like, oh, you're gonna be inundated with that. And we've been doing it for however many years, 100, 200, 300 years, there's been people going to medical school and people figured it out. So we're good.

• 21:28Peter Attia?

  Yeah, I mean, I think that, I think the disadvantage of that approach in medical school is that it produces a level of callousness that I think all of us experience to some extent, which is you tend to retreat from, from death. Now, when it's acute death, you don't have a choice. You, you don't have time to retreat. I mean, when that patient comes in who's been in a horrible car accident or who's been shot or stabbed, you're gonna be there and do your job and they're gonna die and that's that. But you do tend to retreat from their family. And, and, you know, you have an enormous obligation, I think, to the family of someone who dies under your watch. And in trauma, it is especially difficult to wrap your head around this.

• 22:09Peter Attia?

  Because by definition, the last time that family member saw them, they were 100% normal. Like, their kid left the house today, totally fine, and got T-boned in a car accident, and now they're dead. Who, who should be the one to talk to them? I, I think that the physician has to be there. Now, it's, it's true that hospitals have social workers and have people that can come in to help with that. But, but I think that the doctor needs to be there.

• 22:40Peter Attia?

  And, and we don't, we didn't certainly get any training in, in that. And, and I think a lot of doctors don't want to be there for that because they don't feel equipped.

• 22:49Jocko Willink?

  I was on my first deployment to Iraq and...

• 22:55Jocko Willink?

  I'm not going to go into the details of what happened, but essentially we had ended up recovering a body of an American soldier. And we put this, this individual, you know, he's in a body bag, he's in the back of our vehicle, in, in the back of a Humvee, and one of my friends was in, in the backseat, I'm in the front seat, and um, it was, yeah, it was, we're, we're driving and the, the, the body, the bag started to leak, and my friend who is in the backseat, like, he's, all of a sudden, there's, the blood is kinda going on to his boots, it's running down his seat

• 23:38Jocko Willink?

  or whatever, and he's yelling at me, you know, he's yelling at me, and yelling, you know, fucking pull over, we fucking, you know, he's, he's, he's, he's, he's mad, he's irate, and we can't, like, pull over, you can't just, like, stop in, on the middle of a convoy, or we could, but like, well, now what additional risk are we incurring? And he's yelling, and this guy's a dear friend of mine, but it, it was one of those things where I'm thinking, this is gonna leave a deep mark on, and this was, we, this was a soldier that we didn't know, this was a soldier that we went out and, and helped

• 24:17Jocko Willink?

  recover, and, so we didn't know this, this soldier, at all, and yet, my friend is in the backseat, he's got, his, you know, this guy's blood is leaking into the, the way a Humvee's set up is sort of like you're in a, in a, I guess a way to describe it would be, you know, the lunch, the school lunch trays that you have that have, like, a little dish for, yeah, so you have, like, the division for your seats, and there's a place where your feet go, and it's all one big molded thing, and so that is what kinda tracked blood into my friend's feet, and I could hear in his voice, he was just, um, you know, yelling at me, like, fucking stop, babe, we got, this, and he, I'm like, hey, bro, we're gonna be okay, we, we can't stop right here, come on, man, we can't stop.

• 24:59Jocko Willink?

  And uh, yeah, again, that was, he probably hadn't thought about that at this juncture in his career in the military. And be, and you know what I did when we got back? Nothing. I didn't pull him aside. I didn't say, hey, bro, are you K? I didn't do any of that. We just like, hey, what's our next mission? You know, so it's another case where sure. And you know what he did? Got ready for the next mission. You know what I mean? That's what he did. But it, it, it functions, but as you mentioned, it's, it's definitely not the optimum way to go about dealing with this kind of thing.

• 25:40Jocko Willink?

  In life. Um.

• 25:46Jocko Willink?

  Listen, this book is big and 410 pages of actual book. And then I think it's got a little more after that. Um, I obviously I'm not going to read the whole thing. And you, you read the, I listened to the sample, the audio book, you read it, you did an outstanding job. And I think you realized how hard it is to read books. It's the hardest thing I've ever done. It's a challenge for sure. But get the book, get the audio book, listen, you've done a bunch of podcasts, you, you, you've been on Rogan's, you've been on Huberman's, you've been on Peterson's, like you've been, you've done a bunch of podcasts around the book and there, and there's a lot, there's, you guys deep dive into a bunch of different stuff.

• 26:26Jocko Willink?

  So I'm feeling like I'm getting a little, gonna be getting a little bit tangential in this with what I'm gonna be talking about, or what I want, what may, what the book makes me think about that's outside of the normal stuff. You say in this section of the book, I think about health span and, and its deterioration in terms of three categories or vectors. The first vector is of deterioration is cognitive decline. Our processing speed slows down. We can't solve complex problems with the quickness and ease that we once did. Our memory begins to fade. Our executive function is less reliable. Our personality changes. And if it goes on for long enough, even our sedient self is lost. Fortunately, most people don't progress all the way to frank dementia, but many people experience some decline in their cognitive capacity as they age. Our objective is to minimize this. The second vector of

• 27:09Jocko Willink?

  deterioration is the decline and eventual loss of the function of our physical body. This may precede or follow cognitive decline. There is no predetermined order, but as we grow older, frailty stalks us. We lose muscle mass and strength along with bone density, stamina, stability and balance until it becomes almost impossible to carry a bag of groceries into the house. Chronic pain prevents us from doing things we once did with ease. At the same time, inexorable progression of disease might leave us gasping for breath when we walk to the end of the driveway to fetch the newspaper. Or we could be living a relatively active and healthy life until we fall

• 27:48Jocko Willink?

  or suffer some unexpected injury that tips us into a downward spiral from which we may never recover.

• 27:57Jocko Willink?

  My patients rarely expect this decline to affect them. And when I read that, we had a guy on the podcast, a guy named Dean Ladd, who's in the United States Marine Corps in World War II. And he had done, I forget which island, he did multiple island assaults with the Marine Corps in the Pacific. And he was on, I think it might have been his second. But he had already done one or two island assaults in the Pacific. And so he's going into Tarawa. And as he's going into Tarawa, I was asking him, I said, hey, were you scared?

• 28:36Jocko Willink?

  And he was like, no, because in his mind, this is what he said on the podcast, he's like, he said, I, none of this stuff could happen to me. Like it was gonna happen to the other guys. I'm sure the other guys must have been scared because, because maybe they thought they were going to get shot, maybe they thought they were going to get blown up. But I wasn't scared because that wasn't going to happen to me. And he ended up actually getting gut shot 800 meters off the beach and only by the disobeying orders of two other Marines that dragged him back to a boat and threw him on, did he live? But what do you think that is? What do you think it is in human beings? Myself included, a hundred percent. I, by the way, believe that if I'm on a commercial aircraft and it blows up in the sky, I'm gonna survive. So what is that?

• 29:21Jocko Willink?

  And how does that, how do you have to try and convince people that they are actually part of this?

• 29:30Peter Attia?

  Well, the first question is the hard one, and also the one for which I just don't think I have an answer. I mean, there's probably some evolutionary reasons for it. I think there are, I think it stems from a broader problem. So I don't know if you've read Oliver Berkman's book, 4,000 Weeks.

• 29:46Jocko Willink?

  No.

• 29:46Peter Attia?

  It's a fantastic book, and I've had him on the podcast as well, although by the time this one comes out, it might not yet be out because I just interviewed him recently.

• 29:55Peter Attia?

  But he talks about sort of one of the most important issues with respect to the human condition is our inability to cope with finitude. Like, we simply can't accept the finite nature of our lives. And that's why he really uses this 4,000 Weeks thing. It's a very jarring thing. I keep a calendar in my office on the wall with one block for each week. So it's got 52 blocks per row, and it's got 88 rows, you know, assuming I'm going to live to 88, which of course there's zero guarantee I will. And every Sunday, I color in a block. So, you know, I'm into like the 51st row of coloring in those blocks.

• 30:37Jocko Willink?

  Those rows are looking lean, boy.

• 30:39Peter Attia?

  Well, there's no denying I'm more than halfway done. And my kids, every day, they come and they look at this thing. And even they're starting to figure out, like daddy's more than halfway through life. And so I think there's something important about putting that in front of our face. Now, I have an advantage that I think the average person doesn't, which is I've spent a lot more time observing the end of life. This thing I call the marginal decade. So the marginal decade is just defined as the last decade of your life, which by definition, nobody knows the day they enter it. Like, nobody knows that, including people who die of natural causes. They don't know the actual day they are standing 10 years away from the end of their life.

• 31:26Peter Attia?

  But most people know when they're in it. You know, most people have a sense of, I've got less than 10 years to go. As someone I once spoke with about, described it to me, he goes, "I'm on my last roll of toilet paper,

• 31:42Peter Attia?

  and I'm going to be very careful about how I use each square."

• 31:47Peter Attia?

  No more gratuitous toilet paper using around here. Every minute counts. And of course, if we could apply that principle at the beginning, you know, that's a different situation. So, so I suspect that, that this is such a painful concept for us, that we just simply irrationally block it out and say, "That's not going to be me." Like, you know, and also, it's so, you know, it occurs over a relatively long period of time that you think, "Well, all right, look, I'm in my 50s today and, I mean, I'm, I can do anything. There's nothing I can't do. It's not like I'm going to wake up one day and not be able to do all of these things." So when we ask our patients to go through this exercise,

• 32:31Peter Attia?

  which is a part of the marginal decade exercise, which is, define, we define your centenarian decathlon. So, we give them a list of like 50 activities. Some of these are activities of daily living. Like, "Do you want to be able to carry a piece of luggage up an escalator that's broken?" So 30-pound luggage, carry it up two flights of stairs functionally. Some of these are, you know, very recreational specific. Like, "Do you want to be able to go and hike? You know, this many miles at this speed over this type of terrain."

• 33:03Peter Attia?

  And we show people this list of 50 and we're like, "Pick the 10 that matter most to you." The ambition that people come up with is remarkable. "Oh, I'm going to be heli-skiing in my marginal decade." And they're very serious about this. They're very serious about this. Because they can heli-ski in their 40s, which is when I'm asking them to do this. And in their mind, there's no reason they shouldn't be heli-skiing 50 years from now.

• 33:31Peter Attia?

  And I don't want to tell them they're not. I just want to show them that the amount of strength, eccentric strength, concentric strength, cardio-respiratory fitness, like we march through the measurable metrics. The amount of things you need to do that are here.

• 33:49Peter Attia?

  If you want to do this when you're 85 and we know the rates at which these things decline, this is where you need to be at 45 in terms of those metrics and you're only here. You're well below that. So you're still above the threshold to do them, but nowhere near above the threshold, given the inevitability decline. In other words, you're telling me that you want your glider to be able to fly another two miles, but you're only 500 yards in the air. If you want to go another two miles, you need to be a mile up.

• 34:21Jocko Willink?

  The deterioration is inevitable. The decline is inevitable.

• 34:28Peter Attia?

  Decline is inevitable. We have some control over the pace of it. We do. So, so in other words, the first derivative is absolutely negative. Once you reach a certain age, but you have a lot of say in the magnitude of that derivative.

• 34:49Jocko Willink?

  So you got this, this chapter in here is called Centurions and you look at a bunch of people that are over a century old, which is pretty awesome, which is pretty awesome to be, "Oh, how old are you? I'm a century old." That's pretty awesome. And you got a bunch of different examples in there. And of course, you cite a bunch of examples where the people are drinking whiskey and smoking cigars and you go through all of that. When I was reading this,

• 35:17Jocko Willink?

  you know, I've written some books and the fiction books I've written, which are one adult fiction book and a bunch of kids fiction books. Story needs an arc, right? You kind of have a story arc. And

• 35:36Jocko Willink?

  sometimes I look at a lifespan of 80 years or whatever you said, 88 years, 70 years, like, that's a pretty good story arc. You can fit a good solid story arc in there.

• 35:50Jocko Willink?

  How long is long enough?

• 35:53Peter Attia?

  In terms of lifespan?

• 35:54Jocko Willink?

  Yeah.

• 35:56Peter Attia?

  Well, I mean, look, there's a lot of cliches and ways to look at this, right? It's not about the, the, the length of life, it's about the quality of life. It's, it's, it's not the number of years, it's the life in those years. Look, I think there are extreme examples that we would all agree are not ideal. Okay, so I think we would all agree that if you take someone who has the greatest quality life, they're the greatest person, they, they're living life to the fullest, and yet they die prematurely at 50, they're struck down by an accident or by a cancer diagnosis, that, they didn't live long enough, right? They should have lived longer. I think we would all agree on that. I think similarly, we would agree that a person who lives a long life from an actuarial perspective, you know, someone that lives into their 90s, right?

• 36:41Peter Attia?

  Remember the median, uh, life expectancy today in the United States for a male is probably hovering around 80 or just slightly below. So you take somebody who outlives that by 15 years, but, you know, since they were in their 70s, they've been in a stage of, a stage of such fragility that they haven't really been able to enjoy anything. Or they've been physically totally fine, but cognitively they're in such a state of decline, or both mind and body are fine, but they're miserable sons of bitches, and they have no meaningful relationships and contribute nothing to the world. Well, maybe that's too long. You know, so, so, so I just, I don't, I just don't think we know the answer to that question. I think, I think it's a, it's a complex integration of, of, of lifespan and health span, and that's

• 37:25Peter Attia?

  why I think this health span concept is so important. And it's something that, for understandable reasons, because it's not as objective, um, at lea- especially on the emotional side, uh, is, is largely ignored by the medical community, right? The medical definition of health span is freedom from disability and disease.

• 37:47Peter Attia?

  That's a, that's a broad definition, and in my view, not a helpful definition. Because are you as free from disability and disease as you were when you were 20? I mean, you are. But if push comes to shove, the Jocko of today couldn't physically do what the Jocko of, you know, 30 plus years ago could do.

• 38:07Jocko Willink?

  Yeah.

• 38:08Peter Attia?

  You don't have the recovery capacity, right? Now, you have other things. You have more wisdom, right? I would bet that you're emotionally more competent. So, so health span has to include these more nuanced ideas. It can't be just about disability and disease.

• 38:24Jocko Willink?

  I have two comments on this. Number one, my, my mom, I think it was last year, my mom was talking to me, I was talking on the phone, and she said something along the lines of like, you know, it's been a hard, you know, my mom's, my mom and dad are getting in their 80s, late 70s, 80s, and so their friends are all late 70s, 80s. And my mom was saying, you know, it's been really hard for three months, four months, whatever, because this person died, this person died, this person died. And I said, hey, Mom, I have gone to like so many funerals of guys that were 27, 32,

• 39:03Jocko Willink?

  41, 29, and all your friends lived a full, happy life. I mean, I, I get it, it's sad, but be thankful. That's part one. The other thing I wanted to say, which is on a lighter note, I have a friend who had sleep apnea, and so he had the big machine, and he was in an unhappy marriage. And he would rip the machine off at night, because he's a very aggressive, hostile, you know, form, seal friend of mine, and he would rip the machine off at night. And his wife one time was trying to put it back on him in the night, he's batting her

• 39:48Jocko Willink?

  hands away, and they woke up in the morning, and, and she said, you know, you need to let me put my machine on, you know, put your machine on, you need to keep that on. And he says, if I, if I take it off, just leave it off. And she says, what do you want me, you want me just to leave it off? That's what you want me to do? You don't want me to do anything? And he goes, no, just let me die.

• 40:09Jocko Willink?

  Just let me die. So that's the other end of the spectrum. Um, I guess if you're in an unhappy marriage, that can be a, that can be a real bummer. Uh, you know, the other thing, uh, have you ever seen a show?

• 40:21Peter Attia?

  By the way, I want to go back, I want to go back to the first point you made because I really, I've been thinking a lot about that lately. And just to take it back to, to Oliver Bergman's book. That's one of the framings that he talks a lot about. And it's this idea that, okay, we're really struggling with this idea that we're only here for 4,000 weeks. Like, we as a species, because we have, because of the sentient nature of our consciousness, like we can really process that in a way that an animal can't, right? So they're not tormented by their, by their finitude. We are. And he said, look, you know, if you think about it through the lens of cosmic insignificance,

• 41:02Peter Attia?

  one, none of us matter, right? So let's just, let's accept that none of us matter. But another framing is, the probability of any of us being here is infinitesimal. It can't even be calculated. It is so small. Like, on the day you were created, like, the probability that that, that that was the day that your parents had sex, and that one sperm, and that one egg managed to meet to create you, because if it was a different sperm and/or a different egg, it would be your brother. It wouldn't be you. Right? So the probability of your existence is so remote, we can't put a number on it. It's functionally zero. And he said, you know, look, you think about this, another way to imagine this is, how

• 41:45Peter Attia?

  grateful are you to have any number of weeks? And again, I still would argue that just the way we're wired, I think sometimes it's too short, right? I don't think that the 29-year-old at the funeral, no matter how much they accomplish in their 29 years, you're still mourning on some level. But, you know, if you make it to 80, and you die, it is sad. And I, I just saw somebody I sort of know reasonably well die at 83. And he was one of those guys you never thought could die. So it was a little... Just it's sort of it was it was just upsetting in a way that it would be more so than just anybody dying.

• 42:25Peter Attia?

  But, you know, how amazing is it that any of us might get 4,000 weeks?

• 42:31Jocko Willink?

  Be stoked.

• 42:32Peter Attia?

  Yeah.

• 42:35Jocko Willink?

  Have you ever seen the show True Detective? Okay. I watched the first one. Did you watch the first one?

• 42:43Peter Attia?

  Is it like a Netflix series or something?

• 42:45Jocko Willink?

  It's a I don't know what's on.

• 42:46Peter Attia?

  HBO.

• 42:47Jocko Willink?

  HBO series. The it's done two, three?

• 42:50Peter Attia?

  Uh, I think they've got three out, but

• 42:52Jocko Willink?

  Three out.

• 42:52Peter Attia?

  The first one's where it's

• 42:54Speaker 02

  Like three seasons?

• 42:55Peter Attia?

  Yeah.

• 42:55Jocko Willink?

  Three seasons. The first one is really, really good, especially the the first, the early episodes. Anyways, cops, mayhem going on, but there's a character in there called Russ Cole, who's it's just an unbelievable, unbelievable character, amazing character, uh, just a really smart cynical guy who's going through life and and at this one point, he's being investigated for crimes. There's a whole plot, but he's being investigated. He's sitting down interviewing. There's there's cops that are interviewing him. And he goes on this speech, which you can go watch on YouTube, but basically what he's saying is

• 43:36Jocko Willink?

  he's talking about looking at DBs, dead bodies. He's talking about looking at DBs for 14 hours and he's going through pictures and he and he's saying, look, it doesn't matter if you're looking at pictures or if you're looking at real or if you see them just before they die or just after they die, you'll see that in that last moment, they realize they they're okay because they realize that everything that they've loved and everything they've hated and everything that they've lived and everything that they've worried about and everything they've been sad about and everything they've been happy about.

• 44:12Jocko Willink?

  I think he says it's just a dream that they had in their own head and they can just let it all go.

• 44:19Jocko Willink?

  Just let it all go.

• 44:23Jocko Willink?

  What do you think about that?

• 44:26Peter Attia?

  Hmm.

• 44:38Peter Attia?

  I don't know, I don't know if everyone goes through that. I don't know if everybody experiences that, right? And again, it might depend on the timescale, right? It might, if, if, if that's a statement about the milliseconds prior to expiration, maybe there is something to that. And we also just really don't understand death. I mean, it really is a vexing problem. Like, we don't understand the neurochemical process of death. We don't, you know, when you, you know, I'm sure you've heard, like, all of these people that have near-death experiences come back and basically say the exact same thing. It's kinda hard to believe they're just making this up or something, right? Like, there's clearly something really profound that's occurring, neurochemically, in that, in those final moments. You know,

• 45:21Peter Attia?

  presumably for the people who aren't, like, decapitated or something like that, where there's instantaneous surprise death. But what I find interesting is that, you know, like, there are some people who I hear talk about it. So, look, we're all dying. We're all terminally dying. So, we're all, we all have a terminal disease. But there are some people for whom that terminal disease is so apparent. So, I'm sure you've heard Sam Harris talk about the hourglass. Have you heard about this? This is, I, I find this to be a very powerful way to think about life and death. So, all of our lives are represented by an hourglass. So, when you're born, there's, you know, all the sand is in the top, none is in the bottom, and then

• 46:02Peter Attia?

  immediately, the sand just starts flowing. But the hourglass is opaque at the top. So, you never actually know how much sand remains in the hourglass. So, we watch the accumulation of sand in the bottom with clarity. That's the years we're living, but we have no idea how much time remains. Now, some people, you know, let's say someone gets a cancer diagnosis, and it's a very bad cancer diagnosis. So, it's, you know, you have pancreatic cancer, and it's, it's spread to your liver. This is as close to a certain diagnosis as possible. You know you've got six to nine months to live. What that means is now there's, all that opacity starts to become transparent in the upper bulb. And you see that there's actually very little sand there. And as those days get closer and closer to the end, it

• 46:47Peter Attia?

  becomes more and more clear. And I would say that there are very different reactions that people have to that. And maybe I spend a disproportionate amount of time thinking about that.

• 47:01Peter Attia?

  And wondering, you know, what's my reaction going to be because I've seen many people in that in that final stage of sand and I've seen very different reactions.

• 47:14Peter Attia?

  But I would imagine that yes, virtually everybody, if they're being honest with themselves realizes that many of us, certainly I would be the heavyweight champion of this, probably spend time worrying about things that don't justify worry.

• 47:29Jocko Willink?

  I have a really, I had a really weird, kind of horrible comparison to this. I was thinking of people that quit. People that quit, whether they're quitting, you know, in SEAL training, whether they're quitting, like you're training with them and you see them just quit. And you can see, sure, there's, there's a, there's a moment of, they end up with the, the shame and the, you know, should I stuck through it. But there's also like a split second where they rationalize with themselves and they say, I don't have to do this anymore. That's what I think of when I, when I think of that. Like someone getting that just life is upon

• 48:11Jocko Willink?

  them and it's the weight and you can't keep it together anymore. I'm good. I hope I don't feel on my deathbed like a quitter. I really hope I don't. That would send me, um, I don't know, I just want to appreciate that. I don't think at all. All right. Um, I'm going to fast forward. Again, the book is 410 pages long. Get it. Get it. There's so much good, so much incredible information in here. Um, it's, it's, to me, it's like a textbook as well, right? It's a textbook because it is so filled with, with knowledge and, and information

• 48:55Jocko Willink?

  that, look, there's a bunch of great stories in it, but it's a textbook to teach you this stuff and a reference back to, unless you're a medical doctor, you're not going to read this thing one time and be like, or like, you know, it's cool for me because I've been listening to you and known you for a long time. So I've, I've heard you talk about these things a lot. So I get to read them and now I go, oh, that's, that's the definition I've been missed. So get the book. Going a little bit here. Autophagy represents the catabolic side of metabol- and again, I'm fast forward. This is a totally different section. Autophagy represents the catabolic side of metabolism when the cell stops producing new proteins and instead begins to break down old proteins and other cellular structures

• 49:37Jocko Willink?

  into their amino acid components, using the scavenged materials to build new ones. It's a form of cellular recycling, cleaning out the accumulated junk in the cell and repurposing it for or disposing of it. Instead of going to Home Depot to buy more lumber and drywall screws, the cellular contractor scavenges through the debris from the house he just tore down for spare material that he can reuse, either to build and repair the cell or burn to produce energy. Autophagy is essential life. If it shuts down completely, the organism dies. Imagine if you stopped taking out the garbage or recycling, your house would soon become uninhabitable. Except instead of trash bags, trash bags, this cellular cleanup is carried out by specialized organelles called lysosomes. Did I say that right? Lysosomes.

• 50:20Jocko Willink?

  Lysosomes, which package up the old proteins with other detrius, including pathogens, and grind them down via enzymes for reuse. In addition, the lysosomes also break up and destroy things called aggregates, which are clumps of damaged proteins that accumulate over time. Protein aggregates have been implicated in such diseases as Parkinson's and Alzheimer's. So to getting rid of them is a good thing. Impaired autophagy has also been linked to Alzheimer's disease-related pathology. Parkinson's disease and other neurodegenerative disorders. Mice who lack one specific autophagy gene succumb to neurodegeneration within two or three months.

• 51:03Jocko Willink?

  By cleansing our cells of damaged proteins and other cellular junk, autophagy allows cells to run more cleanly and efficiently and helps them- and helps make them more resistant to stress. As but as we get older, autophagy declines. Impaired autophagy is thought to be an important driver of numerous aging-related phenotypes and ailments, such as neurodegeneration and osteo- osteoarthritis.

• 51:33Jocko Willink?

  So, this is, how, how long have people known about autophagy? This is something, look, I went to high school in the freaking eighties, right? But I remember some stuff from biology. I don't remember a damn thing about autophagy.

• 51:46Peter Attia?

  Well, I mean, I think, we'll put it this way, the Nobel Prize for the genetic elucidation of how autophagy works was awarded relatively recently. So, long after you and I were in high school.

• 52:00Jocko Willink?

  Okay.

• 52:00Peter Attia?

  Um, so in that sense, it's, it's a little more recent of an understanding.

• 52:07Peter Attia?

  It's, you know, the, the million dollar question, because you can't read what you just read and not ask, okay, how do I make sure this is happening? What do I need to do to make sure I'm in the right balance? And of course, there is a balance. Very few things in biology are just a straight line or a monotonic increasing or decreasing function. They're usually U's or inverted U's. Not always, and we'll talk about some exceptions potentially. Fitness is an example of one where there's no U or inverted U. It's just a straight up, the more fit you are, the longer you live on average, period. Higher your VO2 max, longer your lifespan. But with autophagy, there's a Goldilocks principle. You want to have the right amount.

• 52:46Peter Attia?

  And the, the, the most important things that are required to signal to autophagy are generally reduction of nutrient in one form or another. Now, the two obvious ways to do that, one is obvious, I guess, one is less obvious. The most obvious way to do that is fasting, right? So, when you are fasting, after some point in time, and most people are surprised to learn, we don't know how long that is in humans. So, we, we know in mice very well how long a mouse needs to fast before it, you know, has a sufficient amount of autophagy going on. But the metabolism of mouse is so much faster than ours that we can't extrapolate. So, um...

• 53:25Peter Attia?

  You know, in humans, we could probably say that a day is not long enough. Five days is probably long enough. No idea where the balance is. But what's interesting is at the cellular level, exercise is a really important tool for autophagy. Because at the cellular level, when you are exercising, the cell is actually experiencing enough of an energy deficit that it triggers this process. So this is why exercise and fasting would probably be the two most important tools we have. Outside of pharmacology, there's one drug that may also, you know, be used for this purpose. But again, it's a little too soon to say, at least in humans. And so that's where we want to point people.

• 54:10Jocko Willink?

  What a, that's another thing, and I think I'm gonna get to this later, but you know, you talked about the chances of us being here is so small. This freaking system that we're rolling around in is a damn miracle. I mean, think about this stuff going on inside your body, something you've never thought about before that we didn't even know was going on until pretty recently. It's insane what our body is doing all the time to be here, to be sitting here, surviving, living.

• 54:37Peter Attia?

  Yeah, my kids right now, you know, my boys, they're young, of course, and you know them well. They're going through that very predictable stage that five, six, seven, eight year olds go through, which is total obsession with dinosaurs and sharks. So pretty much all we're doing is watching everything there is to watch on YouTube about dinosaurs and sharks. And my, the oldest of them, who's eight, like, he knows every fact about these things. Do you know that if a spinosaurus lost its spine, he would still be able to survive? Because I was like, I didn't even know what a spine is. Like, I knew what a T. rex was and a triceratops. Like, I just didn't, I don't have any recollection of this. He knows all of them. And, you know, if you think about it, like, how many millions, you know, so let's just say, like, 30 million years ago, you had these things roaming the earth

• 55:21Peter Attia?

  with their little tiny pea brains. And to think that like we're here today, like this is unbelievable. And we, I love talking about evolution and natural selection with them. Like, I really enjoy talking about it. Yesterday, my, my son was debating with me and he might be right. I think he's wrong, but he was trying to convince me that the great white shark is, has evolved from the megalodon and the megalodon did not really go extinct. And I'm like, I don't think that's true, buddy. I think the megalodon is extinct and maybe the great white, you know, anyway, you just, but, but these things are kind of unbelievable. And even at the simplest level, I still can't believe it works. Like just at the level of a great white shark.

• 56:06Peter Attia?

  Or, you know, never mind something that's as sophisticated as we are.

• 56:09Jocko Willink?

  Yeah. When, when you got all this, like, just sitting here thinking about your kids, right? And I was thinking about jujitsu the other day. Jujitsu is evolving. It's so much faster right now than it did 30 years ago. And it's because more people are participating, but it's more because the information is just readily accessible. So you can go on YouTube and you can learn all this stuff. And I heard an interview, I think it was, I think Lex Friedman was interviewing, the chess player, the greatest chess player.

• 56:45Peter Attia?

  Garry Kasparov?

• 56:45Jocko Willink?

  Yes, he was interviewing Kasparov. And he, he asked Kasparov if he could meet, if he could beat Magnus Carlsen. And Kasparov said, no. But what was interesting, there's two things that he said. Number one, he said, cause I thought you could beat him, of course, cause you've been playing longer and you're like the guy. He said, I can't think as fast as I used to. So there's the greatest chess player in the world. And he's saying, no, I can't do what I used to do. Which is crazy, cause it's no physical thing. We, this was such, it was like one of the first times I ever accepted the fact that the cognitive decline is a real thing.

• 57:24Jocko Willink?

  That was number one. Number two, he said, he, he, he said Magnus, he has all my moves and he's had all my moves. And so he didn't have to create any of my moves. He just got them. And so now he's creating, he's building on what's already there. So when we advance in medicine, let's say, are we advancing at a faster rate now than we did 50 years ago? Because everyone's just, the information's all there. I mean, now we've got AI that can pull up all this old information. You could do studies. Is it, are we getting better? Are we getting faster?

• 57:58Peter Attia?

  Yeah, in some ways, I mean, the, the, the concept, of course, that you're describing is the most important concept of our evolution, right? And, and I think one fun way to think about this, actually Leif was over a couple of weeks ago and we were having dinner and, and sitting around, you know, our job was making sure that none of the food got burnt on the grill. So while we were sitting there, this, I, I posed this thought experiment to him, which was, which I'll pose to you now. So you, you, you know what you know. It's 2023. This is everything you know. I'm going to put you in a time machine and send you back 2,000 years. No, make it, let's make it 5,000 years. Here we're going to send you back 5,000 years. How much can you bend the arc of civilization with the knowledge you have now?

• 58:44Peter Attia?

  5,000 years ago.

• 58:46Jocko Willink?

  Yeah, well, that depends if I don't just get, you know, die.

• 58:50Peter Attia?

  Let's assume I put you back in the appropriate part of, you know, the, 5,000 years ago, I'd have to put you in Egypt to be in the center of civilization, right? So I'm going to put you back in Egypt. I'm going to color your skin the right color. I'm going to make you look like you're Egyptian, right? So you're not going to-

• 59:04Jocko Willink?

  I have the knowledge that I have currently.

• 59:06Peter Attia?

  You have the knowledge you have now, but let's be clear, you don't have any more than the knowledge you have now.

• 59:11Jocko Willink?

  Right.

• 59:12Peter Attia?

  So you know what 2023 looks like? And you're in 3,000 B.C. Can you bend the arc of the universe?

• 59:20Jocko Willink?

  In some areas.

• 59:22Peter Attia?

  Where? Let's talk about it.

• 59:23Jocko Willink?

  Well, I can tell you straight up, like, because I'm sitting here thinking, if they want, I would probably provide little to no value in medicine. Now, look-

• 59:32Peter Attia?

  There's one area you could-

• 59:33Jocko Willink?

  I could, I could say, collect cleanliness, right?

• 59:34Peter Attia?

  Exactly. Sanitation is the only thing I can think of where if you put me back in time, I could make a difference. Now, that assumes people listen because remember, and I write a whole chapter, not a, I write a whole section about Semmelweis. He came up with this idea first and they put him in an insane asylum where he died. So you also have to assume people would listen. But outside of that, man, I got nothing to offer.

• 59:58Jocko Willink?

  Yeah.

• 59:59Peter Attia?

  Imagine you standing there, you'd sound like a prophet. We're gonna have these things, they're gonna be called iPhones. And you're gonna, and we're gonna have this thing called the internet, like, what? I mean.

• 1:00:09Jocko Willink?

  That's like the Connecticut Yankee in King Arthur's Court, you remember that book?

• 1:00:12Peter Attia?

  No.

• 1:00:12Jocko Willink?

  Yeah, it's like this guy goes back from Connecticut Yankee, he goes to King Arthur's Court. One of the things he does, he knows when the eclipse is gonna happen. And so he's like, I'm gonna blot out the sun and oh my gosh. But, okay, sorry, continue.

• 1:00:25Peter Attia?

  Yeah, so my point is like, all of the, the modern nature of the world we have today is all predicated on knowledge transfer. It's codification and transfer of knowledge. And until that happened, like, we were in the Dark Ages for hundreds of thousands of years. And then the reason I think we're, you know, technology is increasing exponentially is due to, to that. It's, and these have fed off each other, right? So the, the more we can codify knowledge, presumably starting with the printing press, the more we could get to the point where we could generate knowledge that could do all these other things. So to answer your question, I think it's nonlinear, I think there are some spikes. So I'll give you an example.

• 1:01:04Peter Attia?

  You know, most things that people think about, most people understand Moore's Law, which is kind of like the, you know, it's about an 18-month doubling or halving, depending on how you look at it, of, you know, semiconductors, you know, sort of chip size and in capacity. Well, there's actually been one thing in medicine that has taken a step function faster than Moore's Law, and it's genetic sequencing. So when the first human genome was sequenced in about the year 2000, the cost of sequencing went down at a Moore's Law rate. Until about 2006, and then it just went, boom, just dropped to nothing. And now it's continuing at Moore's Law rate, but from a way lower baseline.

• 1:01:45Peter Attia?

  And that big drop was high throughput sequencing, next-gen high throughput sequencing. So like, that's one example where there's been a step function change in recent years, in the past, you know, 15 years, that has made at least genetic sequencing. Completely transformational, but you know what? It hasn't translated to a huge impact in health. So it's been a big scientific breakthrough that hasn't really translated to a huge impact in health. I think there are other areas where I think we are starting to see areas where I'm optimistic.

• 1:02:22Peter Attia?

  So in cancer therapeutics, I think it's been largely pretty unsuccessful for, you know, 75 years. And then in the last 10 years, there's been a pretty big improvement in harnessing the immune system. Now, we're still in totally nascent days, but I would say, and this is probably a conservative estimate, 8% of people who would have died even 25 years ago are living today with metastatic cancer. And, and we made zero progress from 1950 to 2000 on metastatic solid organ cancer. And, and so now we've, you know,

• 1:03:06Jocko Willink?

  So we're moving.

• 1:03:06Peter Attia?

  We're moving.

• 1:03:07Jocko Willink?

  Yeah. That's good. Your initial question about what I would do 5,000 years ago, and I was like, well, there's one area, like I know jujitsu and you don't need anything for that. Cause like, look, I know about weapons, but I couldn't, I don't know how to make the metal to make a weapon, right? I know there's, I know you can take like bat guanu and make freaking gunpowder somehow, right? But I wouldn't be able to pull it off. But I know jujitsu, I'd be, I could, I could jack some people up. I'd put together an army, we'd take over the world. I can say that.

• 1:03:38Peter Attia?

  Well, what kind of weapons were they using 5,000 years ago? What did the Egyptian armies use?

• 1:03:42Jocko Willink?

  My guess is,

• 1:03:43Peter Attia?

  Spears?

• 1:03:43Jocko Willink?

  Spears, yeah.

• 1:03:45Peter Attia?

  Show them the trebuchet?

• 1:03:46Jocko Willink?

  Yeah. I don't know if I, yeah, I could show the trebuchet. There's something we could, we could start, if they didn't have, I guess if they didn't have bow and arrow yet, we could get the bow and arrow out, start using that.

• 1:03:55Peter Attia?

  Crossbow.

• 1:03:55Jocko Willink?

  Yeah, crossbow. But again, like figure, I'd have to go through all the procedure.

• 1:03:59Peter Attia?

  The broader concept here is that military advancement would be the most important thing that we could bring to us as civilization.

• 1:04:06Jocko Willink?

  Well, that's the most important thing I could bring. I think you would be a much better person to send back in time. I would make things much worse.

• 1:04:15Jocko Willink?

  It would be much smarter to send Peter and Tia back, not Jocko. We just end up in some weird warlike freaking dystopian time right now.

• 1:04:23Peter Attia?

  But, but, but, you know, so let's say you sent me back, right? And let's say by some miracle, I could convince people to wash their hands. That would have an enormous impact. But you know what I couldn't do? I couldn't build a microscope.

• 1:04:34Jocko Willink?

  Yeah, I was gonna say, you couldn't build, I mean, could you build a scalpel?

• 1:04:39Peter Attia?

  It wouldn't be as much value. They would probably already have it. It's the anesthetic. I wouldn't be able to build ether. I wouldn't be able to make ether. And that was the big breakthrough. And by the way, that didn't happen until the late 19th century. Can you believe they used to cut people surgically until just 140 years ago without, call it 150 years ago, you would undergo surgery like white knuckle in it.

• 1:05:00Jocko Willink?

  Yeah. Damn. They were hard back then, huh? Do people just pass out? Or you think they just got through it?

• 1:05:07Peter Attia?

  Um, so it's totally, it's really interesting when you go back and read about surgical, what was prized in a surgeon, pre anesthesia versus post? Pre anesthesia, the only thing that mattered was how fast you were.

• 1:05:19Jocko Willink?

  Damn.

• 1:05:20Peter Attia?

  Like literally, it didn't matter how accurate you, it was like, can you operate fast?

• 1:05:24Jocko Willink?

  Did they used to operate in front of crowds?

• 1:05:26Peter Attia?

  Yeah. That was actually not, that was, you would even see operating theaters that exist probably in, up until the 1940s or 50s.

• 1:05:34Jocko Willink?

  Who's going?

• 1:05:36Peter Attia?

  Uh, usually students and other people there to observe.

• 1:05:38Jocko Willink?

  But it's not just like Friday night, date night.

• 1:05:41Peter Attia?

  Yeah, yeah, yeah. No, it's like the medical students.

• 1:05:44Jocko Willink?

  Okay, well then that makes sense. They still do that, right?

• 1:05:46Peter Attia?

  Uh, I mean, not in a formal theater, but where, you know, not, not, yeah.

• 1:05:49Jocko Willink?

  But you, but you're probably watching videos.

• 1:05:52Peter Attia?

  Yeah, look, when I was in, when I was in medical school, I, I'd have VHSs of procedures that I would watch. So that I, you know, I didn't, I didn't want to go in and try to like assist on my first one without having watched it a bunch of times.

• 1:06:06Jocko Willink?

  That's crazy. There was a guy in Ramadi, Army Captain, awesome guy. And he would sit back, like go out on ops and he would run a camera the whole time, a video camera from his Humvee. And then he'd go back and just sit there and watch. And he'd be like, oh yeah, he would know that little, what that door looked like, what that courtyard looked like. That's squared away. You know, that's the, why, why would you not do that? Freaking awesome. All right. I'm gonna fast forward a little bit. In the 1950s. A surgeon in Topeka, Kansas, named Samuel Zelman was operating on a patient whom he knew personally because the man was an aide in the hospital where he worked. He'd known for a fact the man did not drink any alcohol. So he was surprised to find out that his liver was packed with fat, just like one of my patients decades later. This man did,

• 1:06:49Jocko Willink?

  in fact, drink a lot. A lot of Coca-Cola. Zelman knew that he consumed a staggering quantity of soda, as many as 20 bottles or more in a single day. These were the older, smaller Coke bottles, not the super size we have now, but still, Zelman estimated that his patient was taking in extra 1,600 calories per day on top of his already ample meals. Among his colleagues, Zelman noted he was distinguished for his appetite. His curiosity piqued, Zelman recruited 19 other obese but non-alcoholic subjects for a clinical study. He tested their blood and urine and conducted liver biopsies on them, a serious procedure performed with a serious needle. All the subjects bore some sign or signs

• 1:07:30Jocko Willink?

  of impaired liver function in a way that eerily, in a way eerily similar to the well-known stages of liver damage seen in alcoholics. This syndrome was often noted but little understood. It was typically attributed to alcoholism or hepatitis. When it began to be seen in teenagers in the 1970s and 80s, worried doctors warned of a hidden epidemic of teenage binge drinking. But alcohol was not to blame. In 1980, a team at the Mayo Clinic dubbed this hetero unnamed disease, unnamed disease, non-alcoholic steato hepatitis. Am I saying that right?

• 1:08:10Peter Attia?

  Steato hepatitis.

• 1:08:11Jocko Willink?

  Steato hepatitis, or NASH. Since then, it has blossomed into a global plague. More than one in four people on this planet have some degree of NASH, or its precursor known as non-alcoholic fatty liver disease.

• 1:08:27Jocko Willink?

  How disturbing is that?

• 1:08:30Peter Attia?

  Yeah, the hidden epidemic.

• 1:08:33Jocko Willink?

  They thought initially that kids were just binge drinking and that's why they had this fatty liver, but it was just because our freaking diet was heinous.

• 1:08:42Peter Attia?

  Yeah, in fact, I think I opened this chapter talking about a patient that I, you know, this is when I was an intern and I was assisting on a procedure. This was a patient who had colon cancer. He was there to get the right part of his hemicolon removed and, you know, we, and my job was to pre-op him. So that meant I had to go and ask him all the mundane questions. Among them is how much do you drink? And that's relevant from an anesthesia perspective, right? So you got to know if somebody's a big drinker. He claimed to not drink at all. So, fine. So we get into the OR and again, my job is to pretty much just retract and suction. That's it. I'm a lowly intern at this point. And we, we open him

• 1:09:24Peter Attia?

  up and like the biggest fat liver just pops out of this guy. And the attending surgeon is upset at me thinking clearly I didn't even do the one thing I was supposed to do, which was figure out if this guy was a drinker. And of course, it turned out he wasn't. And, you know, none of us really thought much about it at the time. And, but, you know, this was more than 20 years ago. And we now realize today that NAFLD and NASH are the leading indication for liver transplant in the United States.

• 1:09:56Jocko Willink?

  And this chapter is called the crisis of abundance because this is just too much Coca-Cola, too much freaking crap, which is crazy, right? Like, that's where we're at? That's what's going on?

• 1:10:09Peter Attia?

  Yeah. I mean, let's, let's start with the positive spin, going back to our evolutionary discussion.

• 1:10:15Jocko Willink?

  Well, okay.

• 1:10:16Peter Attia?

  Mr. Positive Peter Tia coming on. I like it. All right. So you talked a minute ago about how amazing it is that we're here. And I assume you were mostly referring to humans. It's obviously true of all species, but, but it is true. Like we are, we're in a league of our own. But what puts us in the league of our own? Is it our strength? No. Even your strength, right? No. Is it our speed? No. I mean, it's, it's one thing that catapulted us out of the swamp and passed every other species pre or current, and that is our brains. Our brain is the defining feature of our species.

• 1:10:59Peter Attia?

  And we pay a price, if you will, to have a brain like ours. And it's a metabolic price. So your brain takes up 2% of your body weight. And yet it consumes 25% of your metabolic rate. 25% of the calories you eat go to feed that 2% of your body weight. So how could we possibly get where we are without evolving a very elaborate system to make sure you never run out of energy? And that's what we had to do. Right? And so, and if you, by the way, if you look at primates today, right? These would be our nearest evolutionary relatives.

• 1:11:45Peter Attia?

  They don't have this capacity. Right? When you overfeed primates, they get more muscular. When you overfeed humans, we get fatter. And again, in light of all we're going to talk about, that's not a good thing. But from an evolutionary perspective, it's important because muscle is a lousy source of energy. Fat is not. Fat is a wonderful source of energy. So basically, we were the, we were like the only electric car to show up with a huge battery. Everybody else basically had an electric car with a mini battery. And that meant they couldn't drive very far. We were the only ones that could drive all over the place. So if you think about it, up until a couple hundred years ago, those, you know, tens

• 1:12:30Peter Attia?

  of thousands of years of evolution served us really, really well. We were incredibly active. Food was incredibly scarce. We didn't have natural, we didn't have unnatural light. And we didn't really have chronic stress. We only had acute stress. So you've got acute, but no chronic stress, no, you know, unnatural light, scarce food, and you're active as hell. And by active as hell, I don't mean we were like running marathons a day, but like But you're We're more Gathering, gathering, you're moving around. Yeah. And we conserved energy. Like, it's a bit of a myth to say that humans were like constantly hoofing it. We looked for every reason to not move an inch because of the scarcity

• 1:13:13Peter Attia?

  problem, right? Like, you never wanted to waste. But you put all of those things together, and we were in perfect energy balance. And then, you know, 100 years ago or so, all that started to change when we tried to solve a problem. So the problem was, hey, we don't want to be in farms anymore. Like, we want to do other things. We want to set up a society where people can do things other than be in charge of growing their own food. So we're going to centralize that. We have to be able to scale that problem. So we have to be able to grow food at huge scale. We have to be able to preserve food to be able to ship it and distribute it. We should really make it taste good as well. You know, start to

• 1:13:58Peter Attia?

  get into the hedonic side of this. And you basically arrive at this thing called the standard American diet. And it, you know, none of those things I mentioned that were part of the optimization state involved make it not harmful. Like, that was neither a goal nor a thing to be avoided. It was just, it wasn't considered. It was, how do you make it cheap? How do you make it abundant? How do you make it non-perishable? And how do you make it taste good? Those were basically the criteria. And so what we have today is the standard American diet. And so when you take our genes and superimpose them on the standard American diet, it's the crisis of overabundance. And for most of us, that

• 1:14:40Peter Attia?

  requires being deliberate. Because if we just let our brains run rampant,

• 1:14:47Peter Attia?

  I mean, for most of us, we end up in an unhealthy state.

• 1:14:50Jocko Willink?

  Yeah, because part of our, part of the evolution that we made was to want to eat all this stuff that tastes good and that's just, you have to fight against that.

• 1:14:59Peter Attia?

  Absolutely. I mean, if you think about it, like, you know, it's not an accident that we like sweet things. I mean, that was a very important characteristic to have, right? I mean, we, depending on which, which ancestral tribe you look at, I mean, some of them got up to 20, 25% of their calories from berries and honey. I mean, we were, we really wanted to know what, what sweet was. That was a very important trait. In fact, I, I, I think I write about it very briefly. I, you know, one of these things, I'm sure you can relate to this, Jocko, is you're writing a book. You sometimes forget the first version versus the published version because it's been hacked down. So like, the first version of this book was 200,000 words. What people are reading here is 120,000 words, which is still, to your point, a very long book.

• 1:15:41Jocko Willink?

  A big book.

• 1:15:41Peter Attia?

  But the 200,000 word book, that was a treatise. And I think some of this got, I think there was a much longer section I wrote about the evolution of an enzyme called uricase and how, basically, there was a period of time in which we, we also couldn't get very fat. By we, I mean apes that became us, right? So these apes basically left Africa, went to Europe, Ice Age comes, and there, only the subset of the apes that developed a mutation to preferentially store fat out of fructose survived,

• 1:16:24Peter Attia?

  because they could eat enough fructose in the fall to fatten up for the lean times during the winter. And the ones who couldn't develop that mutation died off. The surviving ones came back to Africa. They basically became the precursor to us as humans. So, again, very valuable set of mutations up until, you know, the last 0.001% of our time on this planet.

• 1:16:52Jocko Willink?

  That's an amazing system. This freaking flesh bot we're running around. It's nuts. Speaking of that, I'm gonna fast forward here. Scientists have been exploring the medical mysteries of the human heart for almost as long as poets have been probing its metaphorical depths. It is a wondrous organ, a tireless muscle that pumps blood around the body every moment of our lives. It pounds hard when we're exercising, slows down when we sleep, even micro-adjusts its rate between beats, a hugely important phenomenon called heart rate variability. And when it stops, we stop. Our vascular network is equally miraculous, a web of veins, arteries, and capillaries that,

• 1:17:32Jocko Willink?

  if stretched out and laid end to end, would wrap around the earth more than twice. About 60,000 miles if you're keeping score. So that's each individual human. So I have that.

• 1:17:47Jocko Willink?

  Are these like microscopic? That's why?

• 1:17:49Peter Attia?

  Yeah. So if you think about it, like, coming out of your heart is one huge artery called the aorta. And then it immediately splits. So it comes, it has three things that hop off it. Okay, so they're major arteries. But if you trace the like, the major arteries, they become smaller and smaller arterials that become capillaries, that become venules, that become veins, tiny veins, that become bigger veins and bigger veins, that become the two major veins that flow back into the heart. So what it's saying is, yeah, you take all of those things. Because once you're at the capillary level, you have a whole bunch of these things in parallel. It's not just a serial process. So it's take all of that out. And yeah, it's insane.

• 1:18:29Jocko Willink?

  Each blood vessel is-

• 1:18:30Peter Attia?

  By the way, not to just harp on this idea. This is one of those things that I don't think gets enough attention in terms of like, how that even works. Like, we, like, the best and brightest engineers, material science engineers on this planet can't come close to making materials that can do this. Because if you think about it, how does something that's small stay patent? It shouldn't. Like, we can't even figure out a way to make an artificial coronary artery. Like, if someone needs a coronary artery bypass, we can only use their native blood vessel from somewhere else. And that's a, an artery that's like, a millimeter and a half wide in diameter.

• 1:19:12Peter Attia?

  It's even visible to the eye. We still can't come close to making something that's small, let alone the microscopic stuff.

• 1:19:22Jocko Willink?

  Going on same path here. Each individual blood vessel is a marvel of material science and engineering capable of expanding and expanding and contracting dozens of times per minute, allowing vital substances to pass through its membranes and accommodating huge swings in fluid pressure with minimal fatigue. No material created by man can even come close to matching this. If one vessel is injured, others regrow to take its place, ensuring continuous blood flow throughout the body. Then it's interesting. My, my note here was F1 engineering is F1 car engineering is like a miracle and but compared to the human hand, the human heart, the human brain, like it's just not even, it's nothing. It's a joke.

• 1:20:07Peter Attia?

  Yeah, it's pretty amazing how our bodies manage to work.

• 1:20:10Jocko Willink?

  So my other note here was

• 1:20:19Jocko Willink?

  what is, what is it that we, do we know what we don't know? What is the spark that makes life? Cause we can't create an amoeba right now, can we? Do we know what we're missing? Do we, can we, can we identify what it is that we don't know?

• 1:20:40Peter Attia?

  Well, I mean, I, I should clarify this. Um, there, there are some ways to create synthetic life. At the, at a very, like an algae or something like that. There, there is some type of synthetic biology that can be done.

• 1:20:55Jocko Willink?

  So we can take no algae. We can take the material that is in algae.

• 1:21:04Peter Attia?

  No, I shouldn't, I shouldn't say that. Here's what we can't do. Let's go going with algae, which is really simple, right? So what makes algae special or makes plants special for that matter is photosynthesis.

• 1:21:16Peter Attia?

  We can't in a black box make photosynthesis.

• 1:21:21Peter Attia?

  In other words, we can't in a black box make something that takes carbon dioxide and light and fixes carbon atoms and spits out oxygen and water. Like we can't do that.

• 1:21:42Peter Attia?

  You know, it depends. Okay. So, so your question's a bit difficult to answer because we can, you could argue.

• 1:21:51Peter Attia?

  We can take an egg and a sperm and merge those together using in vitro fertilization and we can grow that out.

• 1:21:59Jocko Willink?

  Yeah, I get that.

• 1:22:02Peter Attia?

  But we're starting with the perfect genetic material at the outset. Like, we're starting with a perfect egg and a perfect sperm and we inject them.

• 1:22:11Jocko Willink?

  And both those things are alive, right? When you say they're alive?

• 1:22:14Peter Attia?

  I don't know. I mean, I guess this, that's a bit of a semantic question, right? What, I mean, how do we define alive?

• 1:22:20Jocko Willink?

  Uh, it's not dead. Meaning, if you take an egg and you put it out on the shelf and hit it with a hammer and put it in the sun, it's not gonna work anymore, right?

• 1:22:32Peter Attia?

  That's right.

• 1:22:33Jocko Willink?

  Same thing with a sperm.

• 1:22:34Peter Attia?

  Yep.

• 1:22:35Jocko Willink?

  So there's something, there's some attribute that they have that I believe we would call life. It's alive.

• 1:22:40Peter Attia?

  Yeah, there's, there's, yeah, I mean, I guess you could say it's cellular respiration would probably be.

• 1:22:45Jocko Willink?

  The definition or the line?

• 1:22:47Peter Attia?

  I think, I think cellular respiration would be the cellular definition of life.

• 1:22:51Jocko Willink?

  So.

• 1:22:52Peter Attia?

  Which, which is metabolic, right? So it's a metabolic definition of life.

• 1:22:55Jocko Willink?

  And we can't create that?

• 1:22:56Peter Attia?

  No.

• 1:22:57Jocko Willink?

  Do we know what it is that we're, what we're missing? Do we understand that is a chemical thing?

• 1:23:03Peter Attia?

  Well, I mean, what, we understand why it's happening. We don't, like, we can't make a mitochondria.

• 1:23:10Jocko Willink?

  Yeah, that's what's so freaking crazy, right?

• 1:23:12Peter Attia?

  We can't make the engine that drives cellular respiration.

• 1:23:15Jocko Willink?

  Is someone working on that?

• 1:23:19Peter Attia?

  I mean, we're not even working on that. What we're working on is how do we minimize the damage to our mitochondria, right? Because if you think about aging, there are hallmarks to aging. I list all nine of them in the book, right? And I think one of the most important or significant hallmarks of aging is mitochondrial dysfunction. So as we age, our mitochondria become less and less functional. So, well, as interesting it would, as it would be to see if we could make mitochondria, I would settle for, can we figure out how to stop or decline, stop the decline of and/or reverse the decline of mitochondrial dysfunction?

• 1:24:03Peter Attia?

  And the good news is we have some interventions that do, exercise does, right? Like, exercise clearly blunts that effect. And if you take a person with type 2 diabetes, which would be kind of the hallmark state of mitochondrial dysfunction, and you get that person exercising like crazy, and their diabetes goes away, like, you've improved the state of their mitochondria, absolutely, full stop. So, we have functional tests that are usually exercise-based to determine mitochondrial health. But shy of that, like, it's not like we've got a drug that we can give somebody to tinker with that system, or to take an 80-year-old and give them 20-year-old mitochondria.

• 1:24:40Jocko Willink?

  Hmm, just not happening.

• 1:24:43Peter Attia?

  Not yet.

• 1:24:44Jocko Willink?

  We got a long ways to go, don't we?

• 1:24:46Peter Attia?

  I think very long, and in a way, that's kind of what, like, you know, there's an entire topic I don't touch on in this book, and it's a very deliberate decision, right? And it's basically the entire topic of the sci-fi of anti-aging. Right, so, in some ways, I'm sure there are some people who will read my book and come across, and come to the end of the book and go like, "Where's all the cool shit?"

• 1:25:13Jocko Willink?

  Oh, you mean like cryo...

• 1:25:15Peter Attia?

  Yeah, or just like...

• 1:25:16Jocko Willink?

  Like where you freeze yourself?

• 1:25:17Peter Attia?

  Yeah, or like, "Where's all the, you know, cellular engineering stuff? And where's all the, you know, the highfalutin, really cool ideas that are, you know, "We're gonna become immortal"? And the reason I don't write about that stuff is, one, I think enough other people are, but more than that, I think that I'm trying to write the operating manual for what you can do today. And if nothing else, even if any of those other things come to be viable in our lifetime, and I don't think they will, this would still be your hedge, right? This is the what you can do today. Like, why does exercise matter? Why would exercise add a decade to your life?

• 1:26:01Peter Attia?

  And more importantly, even if it didn't, even if, you know, I've often said this, I think I even make the point in the book, even if you told me exercise was gonna shorten my life by a year, it would still be worth it based on the dramatic expansion and quality of life. And if you're, I think most people, if they really think about it, they don't care as much about length of life, outside of those extreme states. Nobody wants to die at 50, no matter how good their life is.

• 1:26:25Peter Attia?

  But if you say to somebody, do you care if you live to seventy eight versus eighty eight? If you told them that the eighty eight was going to be fifteen years of poor quality? And the seventy eight was going to be six months of poor quality? I'm not sure I know anybody who wouldn't take the seventy eight. So, um, as bringing it back to the mitochondria, like, we might not know for a very long time how to rebuild those things. Um, but we sure as hell know how much exercise will give you better mitochondria, more of them and better ones.

• 1:26:57Jocko Willink?

  Uh, uh, speaking of high school science, I was taking my high school science class. And I remember it was in, I think it was in chemistry. And like, we finally got to something where my teacher was like, well, we don't know why this happens. And it was the first time in my scholastic career. And I was like, well, you know, I was, I was sitting there doodling or doing something. He's like, we don't actually know why this happens. And I was like, wait a second, what? He's like, we don't know. It should have been the thing that sparked me to enter physics and become a scientist. But instead, I was like, man, that's messed up. You know, I was too knucklehead to try and think, oh, I could go try and figure that out. Uh, interesting. Fast forward a little.

• 1:27:37Peter Attia?

  Kids are great for that, right? I mean, the, the amount of stuff that like, you know, cause kids are, they just don't care. They'll just ask questions and they'll keep asking and they'll keep asking and they'll keep asking.

• 1:27:46Jocko Willink?

  Have they asked you a question where you, where you've gotten to? I don't know yet.

• 1:27:49Peter Attia?

  Oh, yeah, tons, tons.

• 1:27:50Jocko Willink?

  They ask you that stuff all the time.

• 1:27:52Peter Attia?

  Yeah, my, my, especially the boys, right? Cause they're at that age where they're, my daughter now just doesn't ask me too many questions.

• 1:27:57Jocko Willink?

  She knows that you don't know anything. She's like, that guy.

• 1:28:00Peter Attia?

  But, but the boys love asking, like, you know, all those kinds of questions.

• 1:28:03Jocko Willink?

  Yeah, that's good. All right. Um, fast forward a little bit. Richard Nixon declared a national war. Again, I'm skipping through like massive chunks of this book. Go get the book. And I don't think I'm doing a good job of skipping parts. I think I'm skipping too much, but anyways, that's what we're doing. Richard Nixon declared a national war on cancer in nineteen seventy one. Initially, the hope was that cancer would be cured within the next five years in time for the bicentennial. You want to talk about some presidential promises gone wrong? Good job. Yet it remains stubbornly undefeated in 1976 and still by the time I finished medical school in 2001 and today for all intents and purposes.

• 1:28:43Jocko Willink?

  Despite well over a hundred billion spent on research via the National Cancer Institute, plus many billions more from private industry and public charities. Despite all the pink ribbons and yellow bracelets and literally millions of published papers on the PubMed database, cancer is the second leading cause of death in the United States, right behind heart disease. Together, these two conditions account for almost one in every two American deaths. The difference is that we understand the genesis and progression of heart disease fairly well, and we have some effective tools with which to prevent and treat it. As a result, mortality rates from cardiovascular disease have dropped by two-thirds since

• 1:29:25Jocko Willink?

  the middle of the 20th century, but cancer still kills Americans at almost exactly the same rate it did 50 years ago.

• 1:29:35Jocko Willink?

  So.

• 1:29:39Jocko Willink?

  Cancer, horrible.

• 1:29:42Jocko Willink?

  That being said, I read one time that nurse, they surveyed nurses.

• 1:29:50Jocko Willink?

  You know, how would you want to die? And the nurses chose cancer. And, and I guess it was, what they said was, you have time, you can say goodbye, you can set things up correctly.

• 1:30:08Jocko Willink?

  That's what they thought.

• 1:30:13Jocko Willink?

  I had a friend die of cancer.

• 1:30:16Jocko Willink?

  Pancreatic cancer.

• 1:30:17Peter Attia?

  How old?

• 1:30:19Jocko Willink?

  Forty-eight, something like that. Uh, very fit, very fit, triathlete type guy. And, and I remember, I didn't, I Googled it, it was, it was early internet, so this was probably.

• 1:30:38Jocko Willink?

  No, it was not earlier, but it was like 2000 and let's say 2010, 2011, 2012, something around that. And one of my other friends called and said, hey, we just got, you know, he has cancer. He's got this kind of cancer, pancreatic cancer. I Google it. Pancreatic cancer, cancer, survival rate after two years, 0%. Something that maybe a survival rate after five years.

• 1:30:59Peter Attia?

  If it's spread, yeah.

• 1:31:00Jocko Willink?

  Zero percent.

• 1:31:01Peter Attia?

  Well, overall, it's like less than 5% for everybody.

• 1:31:05Jocko Willink?

  Yeah.

• 1:31:07Peter Attia?

  It's the most lethal cancer, along with a certain type of brain cancer.

• 1:31:11Jocko Willink?

  He died four months later. I mean, it was, he must have not known about it until late, which I know you get into in the book. But yeah, it was awful what it did to this incredibly healthy guy in a very short period of time, which is what surprised me when these nurses said, I think cancer would be the best way. But I guess you have that time to make things right.

• 1:31:40Peter Attia?

  I'm really, I don't know why you telling that story really reminds me of another one of these memories I have from residency. So I was doing a rotation in the ER. So as a surgical resident, you will do typically one month a year as the surgical lead of the ER. So you're in the ER taking care of everything that walks in, but they're, they're driving to you the surgical cases. And so that means, you know, anything that needs to be stitched up, sewn up, drained, pus, this, that, and the other thing, put a chest tube in, you're kind of doing all those things. So I'm in the, I'm in the surgical wing of

• 1:32:17Peter Attia?

  the, of the ER at Hopkins. And this young girl comes in and, God, she was, she was, she was probably 21. She's, her mom brought her in and she was just complaining of back pain. And it had been like, pretty significant. It been, it sounds like it had been going on for weeks. And she finally, you know, they just came to the ER, which again, is kind of an unusual place to go for back pain. You normally would go and see your doctor or go and get a referral to PT or something like that. And You know, I examined her and she's really in a lot of pain and I remember there's a handful of things you just sort of remember and I remember like just beautiful, beautiful,

• 1:33:00Peter Attia?

  completely healthy looking 21-year-old. But there was no question that as I pressed on her spine, like it was really quite tender. And so I suspected maybe she had a fracture, like it's possible. She didn't report any trauma. And who knows, like I just assumed, look, either she's got some fracture there because there's some tenderness or, you know, more likely, maybe she's, you know, really had some serious disc disease. And so, you know, for a fracture, the test you want to do is a CT scan, not an MRI. At the time, it was too, it would take too long to get the MRI. So I figured, look, let's do the CT scan. If nothing else, we don't see a fracture, we would probably just admit her for pain.

• 1:33:43Peter Attia?

  And then, you know, she would get, you know, she'd go to the, you know, orthopedic floor or something, they would do an MRI and figure out, okay. So anyway, to make a long story short, do the CT scan. She's got metastatic pancreatic cancer and it's spread to her bone and that's why she's in so much pain. And I mean, it's, again, it's just one of those moments where, like, I can't believe this is happening. And how do I go and tell this girl and her mom, and her mom looks like she's, you know, 45, like her mom's a young woman. And at that point, she's going to be admitted to not a surgical floor because this is not a surgical case when the cancer has spread.

• 1:34:24Peter Attia?

  She's going to be admitted to a medical service, to a medical oncology service. And, you know, they're gonna, they're gonna palliate her at this point. They're probably, and they might give her some ineffective chemo, but it's mostly palliation. And I just, you know, I just remember not wanting to let her go. Like, I just had this sense of like, God, I wish I, I wish I could admit her to a surgical service, which of course was, made no sense at all, right?

• 1:34:54Peter Attia?

  But pancreatic cancer is awful. I mean, it is awful. It's, you know, it's, it's, it's one of those cancers that gives cancer a bad name. And it's interesting that there's a subset of pancreatic cancer that is curable. So, most of them are what are called exocrine pancreatic cancer. So, the adenocarcinoma of the pancreas. So, the pancreas is made up, just broadly speaking, 5% of the pancreas is endocrine. That's the part that secretes insulin and glucagon and these peptides. And then 95% of it is exocrine. It secretes the digestive juices. That's where the majority of cancers arise. And those are the cancers

• 1:35:37Peter Attia?

  that are essentially uniformly fatal. But every once in a while, someone will get a pancreatic cancer of the endocrine system, like a glucogenoma, or an insulinoma. Believe it or not, those cancers are almost always survivable, provided you don't let them fester forever. Do you know who died of a pancreatic endocrine tumor unnecessarily? No. Steve Jobs. How'd that happen? So, he was diagnosed with a tumor, and for reasons I don't, I was never involved in his care, of course, I didn't, I never knew the guy. But, based on everything I've

• 1:36:19Peter Attia?

  read, he just decided he was gonna beat this treatment. He was gonna beat his cancer with juice and stuff like that. So, he went way too long without getting treatment. And by the time he did get treatment, the cancer had spread to his liver. It was a bit too late. They treated him, but ultimately, he needed a liver transplantation, which is a very unusual procedure you would do. You normally would never do a liver transplant for cancer that has spread to the liver, but you could do it for this type of cancer. But even then, it was too little, too late, and he ultimately died as a result. So, it's sort of one of the great ironies, right? Which is, you have this person who, you know, had such a remarkable impact on the world.

• 1:37:04Peter Attia?

  Gets diagnosed with a cancer, but gets really lucky in that he gets diagnosed with a cancer that is survivable, but you know, for reasons of his own, just felt that he could sort of beat this without traditional treatment. But you know, the people I've spoken to, and I do know people who were involved in his care, and they've all said that had he undergone the standard treatment for that immediately, you know, he'd probably still be alive.

• 1:37:31Jocko Willink?

  Is this just crazy ego?

• 1:37:36Peter Attia?

  I don't know. I mean, I, again, having never met the guy, knowing nothing about him, you know, literally only having read a bunch of his biographies, you know, his biographers would certainly speculate, and they have. But I don't understand.

• 1:37:51Jocko Willink?

  Yeah. And at a certain point, your doctors are telling you, and then you're, you know, I'm sure he went and got a second opinion and a third opinion, and they're all like, hey, bro, you need to get this taken care of. And he's like, no, I'm good. Pass me the carrot juice.

• 1:38:07Peter Attia?

  Yeah.

• 1:38:07Jocko Willink?

  Damn. That's insane. I did not know that.

• 1:38:15Jocko Willink?

  Fast forward a little bit. Important to bring this up. The final and perhaps most important tool in our anti-cancer arsenal is early aggressive screening. This remains a controversial topic, but the evidence is overwhelming that catching cancer early is almost always net beneficial. Unfortunately, the same problem I encountered in residency applies today. Too many cancers are detected too late, and after they've, after they've grown and spread, very few treatments work against these advanced cancers. In most cases, outside of the few cancers that respond to immunotherapies, the best we can hope for is delay, is to delay death slightly. The 10-year survival rate for patients with metastatic

• 1:38:56Jocko Willink?

  cancer is virtually the same now as it was 50 years ago, zero. We do, we need to do more than hope for novel therapies. When cancers are detected early, in stage one, survival rates skyrocket. This is partly because of simple math. The early-stage cancers compromise fewer total cancerous cells, or sorry, comprise fewer total cancerous cells with fewer mutations, and thus are more vulnerable to treatment with drugs that we do have, including some immunotherapies. I would go so far as to argue that early detection is our best hope for radically reducing cancer mortality.

• 1:39:34Jocko Willink?

  Where does the resistance come from?

• 1:39:37Peter Attia?

  I think it comes from an overly simplistic view. So let's take a step back, right? You alluded to kind of medicine 2.0 earlier and we, you know, I, the, one of the first chapters in the book is kind of devoted to explaining the difference between medicine 2.0 and 3.0.

• 1:39:53Jocko Willink?

  And by the way, it's the underlying, that's the underlying theme of the book is that medicine 2.0 is, hey, we treat what hits us. Medicine 3.0 is, or sorry, medicine 2.0 is we catch the eggs that are dropping from the, from the building. Medicine 3.0 is we go and find out who's dropping these eggs and we get them to stop. So it's, it's prevention, interdiction, early interdiction, early detection. That's what medicine 3.0 is.

• 1:40:18Peter Attia?

  Yeah. So as you go deeper and deeper into that, you realize that one of the hallmarks of medicine 2.0 is an appropriate reliance on randomized control trials. So again, if you take a step back and go into the medicine 1.0 days, which was basically all of human history up until the late 19th century, we were just making stuff up. Like every, everything was just sort of made up. Everything was a story, right? I mean, I mean, if you go back and really think about it, like that's how we made sense of the world around us. We are storytelling creatures and we had to make sense of the sun, the moon, the stars,

• 1:40:58Peter Attia?

  darkness, bad things happening. Every, you know, how, why is Johnny sick? It must be the bad humors, must be the bad air. Clear, it's getting dark and then light. Clearly these things are revolving around us, right? So you can't fault us for doing this. But once the scientific method was really developed, and this happens in the sort of middle of the 17th century, you fast forward a couple hundred years and we now start coming up with this idea of doing experiments. And this becomes very, very important. In fact, it becomes the cornerstone of medicine 2.0.

• 1:41:39Peter Attia?

  And these experiments, which everyone has heard of called randomized controlled experiments, have an area where they work really well, but they have blind spots. So they work really well when the interventions are simple and when the outcomes are going to occur relatively quickly. So a good example of a randomized control trial is, you know, does giving kids, you know, this vaccine for measles prevent measles? And, you know, even that's too complicated. Let's take something simpler. Like, does using this antibiotic when you have an ear infection reduce the risk of perforated eardrums and long-term complications?

• 1:42:21Peter Attia?

  You would take a bunch of kids and you would randomize some of them to the antibiotic and some of them to a placebo, and you would follow them and you would very quickly see that there's a difference. And because they've been randomized, you've eliminated the bias. This is the magic of randomization. It takes out bias. We otherwise can't eliminate bias fully. Randomized control trials don't work very well in nutrition because the intervention is way too complicated. It's very difficult to tell a group of people to go and do something nutrition-wise and have them be perfectly compliant for five years and come back and compare it to another group of people. We can talk about some examples of where that's worked, but nevertheless, it's challenging. There's that time course.

• 1:43:02Peter Attia?

  So even with the best of intentions, the randomized controlled experiment has a problem, which is it's only giving you average information. So you put N people into the system, they're all different. You run an intervention and you get an average outcome. That's valuable information at the population level. It's not very valuable information at the individual level. Any individual that went into the computation of that average could be quite distinct. There's quite a variance to that. So bringing this back to cancer screening, the real issue with cancer screening is the

• 1:43:47Peter Attia?

  technologies that are typically debated all have strengths and weaknesses, all have limitations, all have blind spots. And if you look at this in a very simple way, and you factor in dollars, you might make the case that, you know, the only way it's justified to catch a cancer is if it saves money in the long run. And that's kind of true in a way, but it's based on a couple of problems that I'm not really here to write about. So I'm only here to write about the individual, I'm not here to write about the policy. And the reason being is I think the policy side is broken.

• 1:44:32Peter Attia?

  So we have artificial costs associated with healthcare in the United States. So none of the dollars that we talk about in the US are real dollars. It's just funny money. They're made up numbers. And it's gotten a lot worse in the past 12 years. So 12 years, the US government made a deal with the devil. And the deal was, you promote the Affordable Care Act, we will never negotiate with you on price again, to the drug companies. So we just pay much more for that. Furthermore, we have this two-tiered system of for-profit, not-for-profit in healthcare.

• 1:45:15Peter Attia?

  So all of a sudden, unlike everybody else, we have a for-profit healthcare system, which just drives up cost remarkably. So, you know, that's a whole separate discussion, which I'm not interested in at the moment. I'm actually asking the question, what should you do, what should your wife do to maximize their odds of not getting cancer, or if you get cancer, beating it? So in that situation, we have to stack screening modalities. So let's take breast cancer as one example, and then we'll take prostate as another example, and use those two, because they're, those are the second and third leading causes of cancer death. So it's lung, Breast and prostate, colon, pancreatic. Those are the top five.

• 1:45:59Peter Attia?

  Those five cancers are responsible for more than 50% of cancer deaths in the United States. So the standard, you know, thinking on breast cancer historically has been mammography. And a mammogram is a decent test, but it's not a great test because no single test is a great test. A mammogram has like a roughly 90% sensitivity and 85% specificity. So sensitivity means how likely is it to see cancer if cancer is present? So the answer is about 90%. The 85% specificity means how likely is it to say no cancer is there if indeed no cancer is there? 85%. That might sound okay.

• 1:46:42Jocko Willink?

  It doesn't sound okay to me at all, bro, honestly.

• 1:46:44Peter Attia?

  Yeah, it doesn't because when you start to factor in the relatively low prevalence of cancer, which might be one in 10, your positive predictive value and your negative predictive value are horrible. So this is how mammography got a bad rap. And this is why some people say, well, you know, mammography is like, yeah, you should do it, but you know, we don't need to do it that often. Or, you know, you've got all these reasons for not doing it. Or, and, and what I would say is, yeah, mammography is really good at some types of cancer. It's good in women typically post-menopause because post-menopause, their breast tissue is much less glandular. So it's easier for the X-ray to see. It's also better when cancers have some degree of calcification in them.

• 1:47:28Peter Attia?

  But it's not good for glandular, glandular breast tissue. It's not great if the cancer doesn't have any calcification in it. So instead of just thinking about mammography, we should be thinking about how do you combine mammography with either ultrasound or MRI, which are far more sensitive. Now, again, a lot of people are just going to say, who's going to pay for that? Well, I'd argue that's where we should be spending money. We shouldn't be spending money on drugs that we're going to put people on when they have metastatic cancer for cycle after cycle after cycle after cycle. It's much better to spend the money right now when you treat something that's very small. Similarly, for prostate cancer, I mean, the PSA test has basically become persona non grata.

• 1:48:11Peter Attia?

  So basically the, the, the thinking today is there is no official recommendation on prostate cancer screening, despite the fact that it's the second leading cause of cancer death in men. There is no actual recommendation on screening. And the reason is, people say the PSA test is neither sensitive nor specific enough. And that's true. It's, and in particular on the specificity, it has very low specificity. But that's if you take it in isolation. In other words, if you say, "Look, we're only gonna care, we're only gonna trigger, you know, an awareness if a guy's PSA is over four." And if you do that, you're gonna be doing a lot of unnecessary biopsies. You're also gonna miss quite a few prostate cancers. And I just think of that as like, I don't know, paint by numbers.

• 1:48:56Peter Attia?

  Right, like, yeah, paint by numbers sucks. Like, if you wanna be a real artist, you can't have lines that you color in with numbers. Like, you have to go beyond that. And to do that, for example, you should be looking at the velocity of PSA. So, not just looking at, so if you check a guy's PSA every year, you should be not just looking at the number, but what's the rate of change? If that is over .45 per year, that's, even if the absolute numbers are low, that's a reason to be concerned. Secondly, you should be looking at PSA density. So, not just looking at the PSA, but dividing the PSA by the size of the prostate. So, you're looking at how much PSA is coming out per unit size of prostate. And the bigger that number, the higher the concern. And if you have any man that's high risk, and there are lots of different things

• 1:49:39Peter Attia?

  that easily would tell you somebody's high risk, you should be doing other tests, such as a 4K test. And if any of those other things trigger, you would do a prostate MRI. And if you do all of these things, you could say, "Oh, well, gosh, the cost is a little bit higher." Yeah, but it's a fraction of the cost and the morbidity that comes with missing that and waiting until that cancer has spread to the bone. Because against, once prostate cancer has spread to the bones, it, there's no going back, there is no effective treatment. It's a terminal condition. So, all of these things come down to just understanding the basics of the following observation, which is, every cancer that gets treated at an early stage, when compared to the same cancer being treated at a late stage, even when they use the exact same drugs,

• 1:50:24Peter Attia?

  has a dramatically different survival profile. And we don't need very, very fancy drugs to treat these early-stage cancers.

• 1:50:32Jocko Willink?

  So does the hospitals just run the numbers and think, well, we got 100 patients. If we give them all, all this screening, that's going to cost more than what it's going to cost to give.

• 1:50:44Peter Attia?

  It's not the hospitals, it's the payer. So, you know, it's, it's a really complicated system, our system is. And, um, you know, it's funny, we were talking about this before the podcast started, that I'll never write another book again. And that's largely true because there's only two conditions on which I would ever write a book again. One is I'd have to have enough time to do it, and that's not going to happen for like a decade. And two, there would have to be a topic I'd be willing to go deep enough into to spend five years doing it. One of the few topics that would at least trigger that is this topic, right? Which is, and I don't know if I could ever do it, right? Like I just, I don't know if I could in just five years wrap my head around this if I totally immersed

• 1:51:23Peter Attia?

  myself. But how would you structurally fix our system? And one element of that problem is the, you have the wrong people owning the risk, right? Like, we should actually own the risk for our lives. We would make better decisions. You want someone with skin in the game owning the risk. Hospitals should not be profiting off disease care. Like, there's all these things that are totally broken, but it's, it's, it's the payer that's making the calculation that's saying, look, I mean, we, you know, we don't want to do these things.

• 1:51:59Jocko Willink?

  And the payers primarily the insurance companies?

• 1:52:01Peter Attia?

  Mm hmm. Or the employer. So it depends on the size. So with, usually for a company more than 50 people, the employer is the insurance company. So, you know, if you're, if you're, you know, if you're General Motors, you are insuring your employees. You do it through someone that's like, looks like an insurance company. You do it through Aetna or Blue Cross or whatever, but, but you're the one that's footing the bill and you're the one that's, you're the actuary, basically.

• 1:52:26Jocko Willink?

  So, but they're doing what I said, which is they got 100 people or whatever that number is, and they run the numbers and say, look, it'll cost this much money for all this different screening, or we just roll the dice and usually the dice come up that we'll lose a couple of people.

• 1:52:41Peter Attia?

  Or they just look at lousy studies, right? Like there was a study that got so much attention last year by all of the anti-screening advocates. And it was a study done in the New England Journal of Medicine. So again, very prestigious journal. It might've been JAMA, but I think it was the New England Journal of Medicine. And it was a study done in Europe. And it was testing the hypothesis, which is, hey, what's the efficacy of colonoscopy for colon cancer screening? Now, I mean, I don't know how many pages in this book I devote to the reasons why colonoscopy is one of the most important tool we have because of those five top cancers that kill, colon cancer is the only one that we could completely prevent, meaning it's the only one that we can definitively look at and stop in its tracks.

• 1:53:20Jocko Willink?

  Yeah, you say that, so every, every colon cancer starts as a polyp.

• 1:53:25Peter Attia?

  That's right.

• 1:53:26Jocko Willink?

  And you can see the polyps and you can get rid of them.

• 1:53:28Peter Attia?

  That's right.

• 1:53:28Jocko Willink?

  This is like just the facts.

• 1:53:30Peter Attia?

  Yep.

• 1:53:30Jocko Willink?

  So here's this opportunity, this is a, this is a cancer you could basically eliminate.

• 1:53:34Peter Attia?

  That's right. You could eliminate that. I can't say that for breast completely, or prostate, or lung, or pancreatic. Those are more complicated cancers. Obviously, not smoking would get rid of 85% of lung cancer, so that's a given. But 15% of lung cancers are coming in non-smokers. And if you took all the smokers out of lung cancer and just looked at the non-smokers and never smokers, lung cancer would still be the seventh leading cause of cancer death. That's how devastating it is.

• 1:54:00Jocko Willink?

  Damn.

• 1:54:01Peter Attia?

  So back to this question. So, so this study, and I believe it was done in a Scandinavian country, but I'm blanking on exactly which one, if, in fact, it was in Scandinavia, was a 10-year study that if you read the headline, you would come away thinking, yeah, it's not worth doing colonoscopy. Because the headline was, in the group that was randomized to get a colonoscopy versus the group that was randomized not to, the reduction in colon cancer was only, I'm gonna sort of, I've written about this briefly, but I'm gonna butcher it. It was small. It was like a couple of percent. And so the argument put forth by the anti-screening advocate would be, all those colonoscopies, the cost of doing those wasn't worth saving a couple of percent of people from getting colon cancer. But

• 1:54:46Peter Attia?

  again, here's where you have to be a good consumer of science. You cannot just rely on the headline. You have to look finer. Okay, so the first thing is, the study was very poorly done. The study tested taking a group of people and telling them to do nothing, and telling a group of people and recommending they get a colonoscopy in the next 10 years. Now, I don't remember the number, but it was less than 40% of the people who were told to get a colonoscopy actually did get one colonoscopy in that 10-year window of time. So to me, a more interesting study, if you're really trying, so in other words, all that study told us that if you tell people to get a colonoscopy in 10 years, and it might have been less, it might have been like, it might have been 25% of the people

• 1:55:31Peter Attia?

  actually did it, one in 10 years, yeah, you're not going to make that much of a difference.

• 1:55:36Jocko Willink?

  Yeah, because, because in the book, you say, it should be, it's not once every 10 years, so this, this thing can progress, what, what do you recommend in the book, every two, three years, something like that?

• 1:55:44Peter Attia?

  There's no definitive answer to this, because no one can do the full math on how long it truly takes for a polyp to develop, but in our practice, we're typically looking about every three years for modest risk, normal risk individuals, higher risk individuals, so someone who gets a colonoscopy and you find a sessile polyp, which is a higher risk polyp, or someone who gets a colonoscopy and they didn't have a complete bowel prep, so you, the endoscopist couldn't visualize the complete colon, we're going to repeat that in a year. But let's just say, all things go well, all systems are go, you go and have a colonoscopy, they pull off a couple of podunculated polyps that turn out to be nothing, yeah, we'd recommend two to three year repeat, as aggressive as that sounds. But again,

• 1:56:25Jocko Willink?

  in this experiment, they did 10 years, we recommend you get it, and then they actually use this as a reason to not get colonoscopies.

• 1:56:36Peter Attia?

  That's right.

• 1:56:36Jocko Willink?

  That's insane. How does it, how does somebody publish something like that?

• 1:56:40Peter Attia?

  Well, again, you know, it's, people would look at that and say, I mean, it was a big randomized controlled trial. But again, there's a big confusion. I mean, I think even in the medical establishment, there's a very big confusion between what is efficacy, which tests how well something works if done perfectly, versus effectiveness, how well something works based on how you're told to do it. Both of those things are important, they're not the same. You have to know which one you're testing.

• 1:57:13Jocko Willink?

  Okay, so there's cancer. Damn. And I'm thinking, as I, as I am going through this, and as we're doing this podcast, I realized like I would, I would have been much better off to have laid out kind of the way you lay the book out. And I didn't do that. So I apologize because you hit these topics, you know, and the next one that you get to is Alzheimer's. You say this Alzheimer's disease is perhaps the most difficult, most intractable of the horseman diseases. And you talk, that's what the book, that's another main theme of the book. Tell us the horseman diseases, the four horsemen.

• 1:57:51Peter Attia?

  Yeah, these are the, the main four diseases that, that are the result of chronic death, the chronic diseases. So cardiovascular disease, cancer, neurodegenerative disease and dementia. And then the fourth one is kind of the foundational one, which is all of those metabolic diseases, like non-alcoholic liver disease and type 2 diabetes.

• 1:58:06Jocko Willink?

  Yep. So you hit these, and at this point in the book, you're talking about the, the most intractable of the horseman diseases. We have a much more limited understanding of how and why it begins and how to slow or prevent it than we do atherosclerosis. How do I say that freaking word?

• 1:58:22Peter Attia?

  Atherosclerosis.

• 1:58:23Jocko Willink?

  Yeah, that. Unlike with cancer, we currently have no way to treat it once symptoms begin. And unlike type 2 diabetes and metabolic dysfunction, it does not appear to be readily reversible, although the jury's still out on that. This is why, almost without exception, my patients fear dementia more than any other consequence of aging, including death. They would rather die from cancer or heart disease than lose their minds, their very selves.

• 1:58:54Jocko Willink?

  I had, I watched a, a close friend of mine, actually a couple of close friends of mine, their father, um, got Alzheimer's and it was way more rapid than I envisioned. And he was a very active, very physically healthy individual. And this came on very quickly. And it was horrible. Um, he was angry. He was confused. He was violent.

• 1:59:32Jocko Willink?

  This is horrifying. And, and another important lesson that was passed on to, or I passed this on to everyone is, they didn't try and get him into a home until he was too far gone mentally, where it could not be explained to him what was happening. He didn't accept it. You know, you can go and if you can make that transition while you're more mentally aware of what's going on and you make the decision and now you are in a home.

• 2:00:03Jocko Willink?

  But like good family is trying to do, you know, we don't want to take you, we don't want to put you in there. You know, you stay out here and he didn't want to go in, right? And by the time they got him in, he got kicked out.

• 2:00:16Jocko Willink?

  Got kicked out of the home, like he was too, too violent. Um, it was aw- it was absolutely awful. The only blessing in all this is that he did die, he, he died relatively quickly after it got really bad.

• 2:00:33Jocko Willink?

  The, the, the weird thing about this is,

• 2:00:38Jocko Willink?

  like you, you say, we, we lose our minds in their very selves.

• 2:00:44Jocko Willink?

  Who are we?

• 2:00:48Jocko Willink?

  Like who are you? Who am I? What makes me me? And if I behave a certain way, when, when am I not me anymore?

• 2:00:58Peter Attia?

  Yeah, it's, it's an interesting question. And again, it's a human question, right? It's, um, I don't, I don't think we can, I don't think we can think about this through the lens of any other animal.

• 2:01:12Peter Attia?

  You know, uh, a meditator would say, we are not our thoughts, right? I mean, I think that, that would be, that would be one of the tenets of, of mindfulness-based meditation is learning to create distance between our thoughts.

• 2:01:26Peter Attia?

  But, you know, on some level we are, right? I mean, I think on some level we are, um, we are.

• 2:01:34Peter Attia?

  We are our consciousness, we are our thoughts. I think those two, I don't, I don't think those two are mutually exclusive, I guess is what I'm saying. I think we, I think we can, I think it's very valuable to be detached from our thoughts. And it's very important to understand that they are things that pass through our minds. And that, that, but, but at the same time, you know, there are certain things about me that would cease to make me me if it, if they didn't exist.

• 2:02:03Jocko Willink?

  I had a woman on this podcast, a friend of mine. Her name is Sarah Wilkinson. Her husband was a SEAL, elite SEAL, great reputation. And she, they got married, well, you know, when he, I think they got married actually before he was in SEAL training. And then she spent his, spent her, his career with him. And he, he, he killed himself while he was on active duty. Um, and what she said was the guy she married was not the guy that killed himself. Like it was a different person. And look, what was it? It was PTSD, it was explosive breaching, like all those things that the brain gets exposed to.

• 2:02:47Jocko Willink?

  And that's why I've been, I've been thinking a lot about that idea lately is, you know, what makes you you and well, at what point are you not you anymore? And I guess there's a lot of second and third order effects that go into that, you know? Do you say, hey, if I no longer remember these things and I'm not me anymore, then put me in a home. Let me, you know, put me on, put me out, out to pasture. The, uh, the Alzheimer's disease, the way it's described in the book, when it's like, uh, it sounds like spider webs kind of in the brain. Is that what it is? That's what it appears to be?

• 2:03:29Peter Attia?

  Yeah, I mean, it's basically-

• 2:03:30Jocko Willink?

  Use the word dental. You like di- That's the word used. There's a word dental to describe what the brain looks like.

• 2:03:37Peter Attia?

  Well, there's um-

• 2:03:39Jocko Willink?

  I was thinking of floss. That's the only thing.

• 2:03:40Peter Attia?

  You know, there are these proteins that get folded. Um, and amyloid is this is the protein that's most associated with with Alzheimer's disease. And if if this amyloid protein gets misfolded, uh, inside the inside the neurons, it's uh, it's an inflammatory process. And then you get these other types of neuro uh, fibulary tangles uh, called tau. And they're kind of these structural tangles around the neurons. So, so there's very much a physical process that's actually happening in the cells that are destroying the cells.

• 2:04:20Peter Attia?

  And um, one of the challenges is that we don't have a direct way to measure those um, in an early stage. Now, as of right now, we do have some pretty interesting advances where there are certain blood tests that can look for things that correlate very well with those findings. Both the amyloid uh, and the tau. So, we are just now starting to do this type of stuff where we can use a blood test. Or if you're willing to be a little bit more aggressive, you could use a lumbar puncture. So do a spinal tap on somebody and look at the cerebral spinal fluid. We don't do that in clinical practice, but they do that in research studies.

• 2:05:03Peter Attia?

  And you can identify beta amyloid and tau in people who are still normal. Um, and we can use, and you might say, well, what's the value in that?

• 2:05:15Jocko Willink?

  I was gonna say, can you do anything with that?

• 2:05:16Peter Attia?

  Yeah, I think the value in that is we can, we can start to reverse that. And we are seeing that. Uh, now again, this is still too early to tell because it hasn't been, you know, studied in a large, rigorous fashion. So anecdotally, all I can tell you is we do see that making positive changes. And there's, you know, we can list what those changes are. Can take people who are preclinical. So either they don't have any signs of cognitive impairment or they only have mild signs uh, called MCI um, of cognitive impairment. And we can pull those people back. What I don't think we can do is take people in Frank dementia and make a difference.

• 2:05:58Jocko Willink?

  Well, speaking of what we can do about these things, and I'll give myself a little reprieve here in saying that this next part of the book that you write, part three of the book, is the basically what we can do about it, part of the book. And you go through a section talking about thinking tactically versus thinking strategically, which is a great thing to put in a book, especially from my military perspective. Strategically, obviously, the big picture of what we're trying to accomplish overall, and tactically, how do we actually make these things happen? And you say this in Medicine 3.0, which I think we've described now, and I apologize for not describing that more clearly out of the gate. This is us trying to prevent things from happening, Medicine 3.0.

• 2:06:39Jocko Willink?

  We have five tactical domains that we can address in order to alter someone's health. The first is exercise, which I consider to be the far most potent dominant in, sorry, potent domain in terms of its impact on both lifespan and health span. Of course, exercise is not just one thing, so I break it down into components of aerobic efficiency, maximum aerobic output, VO2 max, strength, and stability, all of which we'll discuss in more detail. Next is diet or nutrition, or as I prefer to call it nutritional biochemistry. The third domain is sleep, which has gone unappreciated by Medicine 2.0 until relatively recently.

• 2:07:21Jocko Willink?

  The fourth domain encompasses a set of tools and techniques to manage and improve emotional health. Our fifth and final domain consists of various drugs, supplements, and hormones that doctors learn about in medical school and beyond. I lump these into one bucket called exogenous molecules, meaning molecules we ingest from outside the body. And the beautiful thing about those is we can control them. All those different things, we have some level of control over, which is awesome. Chapter 11. Exercise, the most powerful longevity drug. I never won a fight in the ring, I always won in preparation. Muhammad Ali.

• 2:08:04Jocko Willink?

  This gives good background here. Several years ago, my friend John Griffin pinged me with a question about how he should be exercising. Should he be doing more cardio or more weights? What did I think? I'm really confused by all the contradictory stuff I'm seeing out there, he wrote. Behind his seemingly simple question, I heard a plea for help. John is a smart guy with an incisive mind, and yet he was even he was frustrated by all the conflicting advice from experts, touting this or that workout as the sure path to perfect health. He couldn't figure out what he needed to be doing in the gym or why. This is before I'd gotten back into full-time practice of medicine. At the time, I was immersed in the world of nutrition research, which, if anything, is more confounding than exercise science, rife with contradictory findings and passionately held dogmas backed by flimsy data. Are eggs bad or

• 2:08:48Jocko Willink?

  good? What about coffee? It was driving me nuts, too. I remember those days. I started typing out a reply and kept on writing. By the time I hit send, I had written close to 2,000 words, way more than he asked for. The poor guy just wanted a quick answer, not a memo. I didn't stop there either. I later expanded that email to a 10,000-word manifesto on longevity, which eventually grew into the book you're holding in your hands. Clearly, something about John's question triggered me. It's not that I was a passionate devotee of strength or training over endurance, or vice versa. I'd done plenty of both. I was reacting to the binary nature of his question. In case you haven't figured it out by now, I'm not fond of the way we reduce these complex, nuanced, vitally important questions down to as simple either ors. Cardio

• 2:09:33Jocko Willink?

  or weights? Low carb or plant-based? Olive oil or beef tallow? I don't know. Must we really make take sides? The problem, and we shall see this again in the nutrition chapters, is that we have this need to turn everything into a kind of religious war over which is the one true church. Some experts insist that strength training is superior to cardio, while an equal number assert the opposite. The debate is as endless as it is pointless, sacrificing science on the altar of advocacy.

• 2:10:08Jocko Willink?

  The problem is that we are looking at these hugely important domains of life, exercise, but also nutrition through far too narrow a lens. It's not about which side of the gym you prefer. It's so much more essential than that. More than any other tactical domain we discuss in this book, exercise has the greatest power to determine how you will live out the rest of your life. There are reams of data supporting the notion that even a fairly minimal amount of exercise can lengthen your life by several years. It delays the onset of chronic diseases pretty much across the board, but it also amazingly of is amazingly effective at extending and improving health span. Not only does it reverse a physical decline, which I suppose is somewhat obvious, but it can slow or reverse cognitive decline as well.

• 2:10:52Jocko Willink?

  So if you adopt only one new set of habits based on reading this book, it must be in the realm of exercise. If you currently exercise, you will likely want to rethink or and modify your program. And if exercise is not part of your life at the moment, you are not alone. Seventy percent of the US population is like you. Now is the time to change that right now. Even a little bit of daily activity is much better than nothing. Going from zero weekly exercise to just 90 minutes per week can reduce your risk from dying from all causes by 14%. It's very hard to find a drug that can do that. Thus, my answer to questions like the one my friend John Griffin asked me is yes and yes.

• 2:11:35Jocko Willink?

  Yes, you should be doing more cardio and yes, you should be lifting more weights. Yes. I was so stoked when I was reading this part of the book because I finally felt like I was doing something good. Because I work out very religiously and that that was awesome. So.

• 2:11:53Peter Attia?

  I should have had you read that chapter.

• 2:11:56Jocko Willink?

  Oh, yeah, yeah.

• 2:11:57Peter Attia?

  Like, don't you think a guest reading? How did we not think of that?

• 2:12:00Jocko Willink?

  That would have been cool. Yeah, that would have been cool.

• 2:12:02Peter Attia?

  A guest reading by Jocko.

• 2:12:04Jocko Willink?

  Yeah, I could have thrown in this little chapter here. I would have had to get somebody to help me, you know, put the phonetic pronunciation for some of the words.

• 2:12:14Jocko Willink?

  What I was thinking, so, so that was weird. Seventy seven percent of people that don't exercise. I am so, if you would have asked me that question, I would have said it was probably got to be at least 15 or 20% of people in America that don't exercise. Like, that's how, that's how much, I mean, obviously, I own a gym. I do jujitsu. I do CrossFit, like everything that I'm doing, I'm around people that work out. And people that come up and talk to me, all over the world, they all work out. So 70%, that's crazy. Uh, what with your patients? Is there anything that stops your patients from exercising?

• 2:12:55Jocko Willink?

  When you get that patient, that's like, you give them the program and three months later, he's like, well, you know, next month, I'm really gonna start for real, cuz he hasn't done anything yet. What's the, what holds him back?

• 2:13:07Peter Attia?

  Yeah, I think there are, there are probably a number of things. So there's probably a subset of people who genuinely don't enjoy it.

• 2:13:17Peter Attia?

  And I try to be sympathetic to that because I acknowledge that I genuinely do enjoy it. Now, what's not clear to me is, do I enjoy it because I just started it at such a young age? And it's always been a part of my life? And I've done it enough to appreciate the short-term and long-term benefits of it.

• 2:13:41Peter Attia?

  You know, one of the things I try to explain to people is that

• 2:13:46Peter Attia?

  all of these things that we're talking about, but let's use exercise cuz I think it's the most important, have an advantage over them that saving for retirement does not. So it's not like rocket science that you would tell somebody when they get out of college and start their first job. Like, you gotta, you gotta put some money away, right? You gotta save money for, for when you're, you know, gonna retire and, and

• 2:14:13Peter Attia?

  that, you know, there's value in that and we understand that.

• 2:14:17Peter Attia?

  But we should also acknowledge that when you ask somebody to do that, there is no short-term gain that comes from that. So if you're making a thousand bucks a week and you wanna set aside 150 bucks a week, there's lots of long-term gain to that. But let's be clear, you get nothing in the short-term for doing that. You're just $150 lighter every week. It's 150 bucks you could be spending on anything and you are not. But almost everybody would agree that there's value in doing this. With exercise,

• 2:14:51Peter Attia?

  I can point them to all the long-term data and I can make a more compelling case for this than I can for anything else. Again, I can't restate this enough, right? Like, is it better to be fit than to not smoke? Yes. Is it better to be fit than to not be obese, not have diabetes, not have high blood pressure? Nothing compares to extreme fitness in terms of lifespan with with respect to all-cause mortality and health span. I can give them all of that. That's like saying you can save that $150 a week and I'm going to give you the greatest rate of return. I have an investment vehicle that's going to give you the greatest

• 2:15:30Peter Attia?

  rate of return such that that $150 a week is going to be $10 million in 40 years. That would require a great rate of return. But, but I can say that, guess what? You also get something in the short term. Yeah, you do. Like, you get something every single day that you do it. And that's why I mean by exercise is this really potent drug and we can't replicate it because it's not just one molecule. It's doing so much every single time you pound it, right? You're getting an endorphin raise, you're getting an immediate response to your vascular system, it's changing your energy levels, it's allowing you to do things here and now that make you better.

• 2:16:10Peter Attia?

  There's a psychological component when you do something that is difficult in the gym or on the track or in the pool or wherever you choose to get your exercise and you develop a sense of fortitude. Again, saying any of these things to your audience is dumb, right? It's sort of like, what's the expression? It's like telling- Singing to the choir. Yeah, singing to the choir or saying something about the Pope, right? So, so I don't need to go through all of that. But, but if someone's never done it and they've never experienced the short-term benefits, the inertia can be really hard. So, so again, I think this is an argument for, I think, why we want kids to be active. I think it's very important that kids are active because I think this is a very important lifelong

• 2:16:55Peter Attia?

  skill. And so, again, I, you know, I'm sure you've been asked these questions, like if you could, you know- Change one thing in the, in the, in the, in the world today, what would it be with respect to, you know, your particular issue? And I think for me, the one thing I would probably change is institute a much more rigorous process of physical education and exercise from, from, from basically the time kids are born. So it's just take all those movements that kids do perfectly, which they do, they're all perfect when they're born, and just never let that go away. And everything should be built around movement. Everything, education should be built around movement.

• 2:17:32Jocko Willink?

  Isn't that crazy? Gone in a complete opposite direction. Like, they don't, they have schools with no PE now. And, and when they do have PE, it's like, nothing. Uh, no, it's funny, you were saying this, I don't need to tell your audiences, but you actually, when I wrote Discipline Equals Freedom Field Manual, I sent you, speaking of chapters, I sent you the chapter on physical fitness. And I was like, hey, I got, and on diet. I was like, hey, man, here's what I'm, here's what I'm putting out. How am I doing? And you were like, freaking good to go. Cause which meant I basically had already been listening to you for a while. So, so, uh, that's cool. But, oh, I was gonna say, oh, I was gonna say this. I, this reminded me. You talk about like putting money in the bank physically. I remember when I was gonna join the Navy. And I was like, damn, you

• 2:18:15Jocko Willink?

  know, this is like 20 years is a long time. But I remember thinking to me as a 17 year old, hey, when I, when I join, I'm gonna be in such good physical shape that when I get out, I'll still be like, good to go. And I was right. Like, it teaches you a lot about physical fitness and it becomes a physical culture of life. Is there anything? So if you get one of these clients of yours, one of your patients, by the way, you have a practice where you help people with longevity. Again, I'm skipping all kinds of stuff today. When you have someone that doesn't want to exercise, have you found anything that helps them? And I have to preemptively say this.

• 2:18:59Jocko Willink?

  People ask me all the time, like, well, how does someone get through SEAL training? And some people say, like, you know, you've got to have something like really meaningful. The fact of the matter is, there's guys that like have a girlfriend that dumped them in high school. I'm going to show her I'm going to be a SEAL and they make it. There's someone else that, you know, told his dad that I'm going to do this and that's enough. There's like, and there's someone else that's like, oh, they told me I couldn't do it at the recruiting station. So I'm going to do it just to prove them wrong. There's, and there's some people like, oh, I just want to serve my country. I want, people have an infinite number of reasons that they just make it through this program. And it doesn't really matter, doesn't really matter which one you have. Some people you, I, I see people on like, uh, online will comment like, you'll never make it through.

• 2:19:44Jocko Willink?

  If you don't have the why, or if you, and I'm like, bro, you don't know. This dude just like wants to prove his older brother wrong and he makes it. Like that stuff happens. Have you figured out a way to coerce that out of people? So they understand the value that they'll get if they freaking exercise 90 minutes a week?

• 2:20:03Peter Attia?

  Yeah, it's a combination of things and it's different for everybody. But I definitely do a little bit of carrot and a little bit of stick. So the stick is usually showing them what the end looks like without it.

• 2:20:14Jocko Willink?

  Damn, it's going straight scared straight.

• 2:20:16Peter Attia?

  Well, it's, it's, it's marginal decade reality, right? It's like, okay, so let's, let's talk about the inevitability of decline.

• 2:20:24Jocko Willink?

  Well, I don't know what you told Leif Babin, but I called him today and he was like, he's like breathing hard. And I'm like, oh, what's going on? He's like, I'm just getting, finish up a workout. I was like, oh, I'm getting ready to record with Peter Attia right now. And he goes, yeah, that's why I'm here right now. We're talking about that marginal decade, man. I'm, I got my, I'm not on the path right now, which is funny, you know? I've been, he's been hanging out with me for freaking 17 years, but it wasn't until he looked at his marginal decade from you. Where he's like, I better get my ass in the gym. So there you go. Good job.

• 2:20:51Peter Attia?

  Yeah. And, and look, part of it is we're all victims of what works for us. And for me, that's a very motivating thing. Like it's really motivating for me to think about that last decade. I'm now old enough that some of the things that used to motivate me don't. Vanity motivates me less. Okay. I'm going to be honest, like the first time I stepped foot in a gym, it was. For a totally different set of reasons than the reason I lift weights today. You wanted them guns. Yeah, you didn't want to be this grony kid anymore, right? You wanted to show everybody how strong you were, how tough you were. And sort of, none of that stuff means to me today what it did then. So now I have a different point of view. But I will say this, look, that's the stick part.

• 2:21:35Peter Attia?

  The carrot part is, and this has come with more years doing this, is realizing that I just want someone to get a win. Because once they get a win, they're going to get addicted to the win. So when I start with that patient who's doing nothing, I don't, I hate when they say, Peter, what do you do? Because I'm like, wrong question. Like, for me to tell you what I do is just going to make you feel worse and make you feel like this is not achievable. So let's forget that. Who cares what I do? I've been doing this since I was a fetus, basically. What do we want you to do?

• 2:22:15Peter Attia?

  And I will say something like, hey, if we can get you working out three hours a week. Well, actually, I take a step back and I go, how many hours are you willing to give me of your time? And they might say 90 minutes, and they might say three hours, and they might say five hours, whatever it is. But let's just say they say three hours. I say, great. And I point them to the data and I say, look, with a three hour, if you gave me three hours of your time and I could do whatever I wanted with you during that period of time, and I promise we're not going to hurt you, right? We're going to take this incrementally. You know, this is how much we're going to extend your life potentially, and we're talking about years. And this is the difference in quality of life. So I get them to buy into that.

• 2:22:57Peter Attia?

  Okay, then I say, all right, here's the formula. Half of that time, we're going to do cardio. Half of that time, we're going to do strength training. And what does the cardio look like? I show them what it's going to look like. And it's not crushing. We're just not there to crush anybody. They don't have any aerobic base at this point. So all I want them doing is really easy peasy stuff. And it's just about habit building as much as it is about the stuff. And it's like, hey, like, this is a great time for you to listen to podcasts, listen to audiobooks, listen to music, whatever it is. In the weight room, we're not, I don't care what you do. If you're someone who wants to go to a gym and work out on a bunch of machines because they don't look intimidating, that's great. But if you want to do something a little more complicated, let's just get you carrying things.

• 2:23:42Peter Attia?

  Can you, you know, and again, it's a bit more nuanced because I want to make sure they can do it safely and all these other things. But it's like, what do step ups on a box look like? What does carrying look like? So they might have this idea that they're walking into a CrossFit gym and they're going to be doing cleans and they're going to be squatting and deadlifting. It's like, no, no, you're not going to be doing any of that stuff anytime soon. And, and, and I think if people give you three to six months of that, I'm still waiting for someone who at the end of that period of time says, I don't feel better. And if they, as long as, as long as you get there, you're, you're, you're home run.

• 2:24:17Jocko Willink?

  Then you're good.

• 2:24:18Peter Attia?

  Yeah.

• 2:24:19Jocko Willink?

  The chapter goes, I mean, the chapter's all kinds of good detail in there. Zone two, VO2 max strength training, grip strength, concentric and eccentric loading. You cover all kinds of stuff in there with, in a, in clear language that helps people understand what they need to do. So go get the book. Next section here is the gospel of stability. Chapter 13. Relearning how to move to prevent injury. This is like a journey that you had to go on. And what does it mean to you? When you, when you want to explain to people, what is, what do you mean by the gospel of stability?

• 2:24:58Peter Attia?

  Yeah. I mean, this is a, I think it's one of the most complicated chapters in the book and it was definitely the hardest one to write from a technical standpoint because I think stability is something people kind of understand, but it doesn't really have a great definition. I mean, I define it in there in the, you know, the best ways I can, but I think the easiest way to think about it is, you know, a stable body is a body that transmits force to the outside world without dissipation of force and energy leak. And it's one to which force can be applied without internal collapse and dissipation of, of energy or injury. So, um, you know, just an example, thinking about that, right? Like,

• 2:25:39Peter Attia?

  You know, if you're walking up a flight of stairs and or you're carrying something heavy up a hill and your knees hurt, or you're walking down a hill and your knees hurt, that's that's an energy dissipation, right? And you can you can really go through what's the path of force from the point of contact, which virtually every time we're making contact with the outside world, it's our hands and our feet that are doing the contact. And how is that force moving from your hand or from your feet into the center of your body? Because that's where it's always going, right? So you're, you know, your feet are transmitting force through your ankles, your knees, your hips into your pelvis, etc. And, you know,

• 2:26:19Peter Attia?

  stability really comes down to, you know, creating an exoskeleton that allows that force to be transmitted safely. So the injuries that we have, many of which are chronic, but even the acute ones are usually acute on chronic weaknesses. So, you know, when somebody tears their ACL, that wouldn't necessarily have happened. You know, if you took 10 people and exposed them to that same force at that same moment, maybe seven of them would have torn their ACL, three of them wouldn't have. And and a lot of that can be attributed to different types of strength. So stability in the knee, for example, lateral strength

• 2:27:00Peter Attia?

  in the knee. Stability within the back explains a lot of why people have, you know, as I did, lower back injuries and why, you know, failure to generate sufficient intra-abdominal pressure can lead to energy leak. So to me, this concept of stability goes so hand in hand with strength because a big part of health span is not just being strong and having, you know, good cardio-respiratory fitness, it's also being free of injury, it's being relatively pain free. And I think that a very important part of this journey for me personally has been learning how to manage the sins of my youth from an injury perspective.

• 2:27:43Jocko Willink?

  I I often get asked about like, you know, this kind of stuff, especially with Jiu-Jitsu people. They're like, oh, you know, you what injuries have you had? And I'm like,

• 2:27:55Jocko Willink?

  I'm pretty good to go. You know, I'm pretty good to go. And I think the reason that I'm pretty good to go, again, knock on wood, thousand times, is because I I work out and I work out religiously. So I think that when you, you know, you put your foot down, you put your arm down and you get injured because that's what happens. We we have a friend that just tore his ACL, like, just taking a step li- literally like he's doing jujitsu, but he wasn't getting heel hooked. He wasn't no, nothing dynamic. He was taking a step. He's actually taking a step backwards, felt a tweak, falls down on the mat, like, holding his knee, torn ACL from nothing. Scary, but I feel like working

• 2:28:39Jocko Willink?

  out, lifting, squatting, doing pull ups, doing dips. I feel like those things, I feel like I I feel like I have pretty good stability. I need, I need, at this juncture, I need to work on my flexibility again. I you, I worked on my flexibility several years ago, and I got flexible and I felt good about it. And then I, I'm the worst. I'm the worst.

• 2:29:01Peter Attia?

  What, what, like, give me an example of something that is, is suboptimal for you?

• 2:29:04Jocko Willink?

  My shoulders are really, really inflexible right now. They're really inflexible and I, and I've lost a lot of mobility in them. I've just started getting it back, started proactively doing the stretches that I did for, I just, I just shoulder that hurt me one time. This was probably 15 years ago, maybe even longer than that. Yeah, it's probably 15 or 20 years ago. Had a shoulder that was constantly hurting, constantly hurting, constantly hurting. And finally, I did like religious stretching and the pain went away and the mobility increased and it felt great. So I'm gonna go through that protocol again and get it back. But those are the kind of things where I know,

• 2:29:46Jocko Willink?

  and and another thing you know, I had to, you know, Burt Soren, Soren from Sorenx? Anyways, I have his.

• 2:29:52Peter Attia?

  Oh, Bill's Gym.

• 2:29:53Jocko Willink?

  Yep, it's Bill's Gym. Built, built my gym, but we were having a conversation and. It's really easy to have an exercise that you, for whatever reason, can't do for whatever period of time. For instance, a pull-up, right? You could say, oh, I hurt my shoulder, can't do a pull-up. It's very easy to never do a pull-up again in your life. And that's not good. So what I told him is like, I don't even, whatever, I try and keep the exercises that I've been able to do before and continually try and maintain them. And if for some reason, like I, I, I got a, I got an arm injury by Dean Lister,

• 2:30:37Jocko Willink?

  my friend, my coach, he's showing a jujitsu move. He's never hurt me while we were training in 20 something years. He was showing a move and like really hurt my arm. And so for six or seven months, I couldn't do an overhead squat. Because I just could not, you know, you gotta kind of lock out your arms on an overhead squat. I could not do it. And when I finally could extend my arms again, I could, I could, I just didn't have the strength anymore. And I could see, I was like, oh, that's what happens to people. What happens to people is they go, well, I guess that's gone. And I said to myself, I will not submit to this. I will, give me the PVC pipe, we're, let's start again. Let's go.

• 2:31:22Jocko Willink?

  And slowly started building that strength back. So I think that's what happens and I, and I know we've got a section in here about, or maybe we already covered the section, but you talk about the fact that you, you see people get derailed. Matter of fact, one, one of the stories you tell in here is one of your friend's moms. She was healthy, doing well, she fell, broke hip, femur, something. And then all of a sudden, you can't work in the garden, you can't walk around anymore, and everything falls apart. That's why, here's one great, here's some great piece of advice. I don't know if you have this in here. This is from me, because I get asked this question all the time. I hurt my arm, I hurt my back, I hurt my whatever, I'm sick. What should I do?

• 2:32:06Jocko Willink?

  And this is such a good answer, I'm gonna give it to you. Do what you can. You do what you can. Look, you used to be able to do 20 pull-ups and now you can only do a negative? And only on one arm right now because your shoulders hurt in your other arm? Cool, do what you can. Oh, you can't run anymore because you got your knees tweaked? Cool. But you can go on the hand bike? Cool, do what you can. And then try and get back, try and aggressively go back, not too aggressively, but go back and retake those exercises. I was, I was building a house. And while I was building a house, I was living in another house.

• 2:32:46Jocko Willink?

  My house that I was living in had a garage where I put my garage gym with whatever, seven-foot ceilings. I couldn't do muscle-ups in those. And I didn't think much about it, it wasn't like I was injured or anything, I just, oh, you know? And it took 18 months to build a house, so for 18 months, I wasn't really doing muscle-ups. Didn't really think about it, again, you just couldn't go up that high, so it just wasn't doing it, didn't think about it. I was really excited, got back to my new house. Had my, I have, I have 20-foot ceilings in my garage now. So like I can do muscles, rope climbs, everything. But I did that first muscle-up workout and I was like, oh, oh. You got weak in this.

• 2:33:31Jocko Willink?

  But look, I did dips the whole time, I did pulls the whole time, but I got weak. And then I just had to rebuild. That's the good thing, is if you've had to rebuild before from an injury, you realize that you can rebuild. You had the shoulder surgery.

• 2:33:46Peter Attia?

  Yeah, so I had, I tore my labrum probably for the first time in boxing. Anytime you, once you dislocate or sublux your shoulder, you're gonna damage that labrum. And so I had multiple subluxations in my teenage years. And then swimming, you know, as an extreme distance swimmer, that sort of made things worse. So by about... 2012, it was sufficiently bad that I knew surgery, you know, I knew I was gonna need surgery, but I met, you know, some really good folks who rehabbed me to the point where I was doing awesome. So in 2020, when we came to Austin, I, you know, met this awesome, well, actually, I'd met him many years before, but he happened to be in Austin, he was an

• 2:34:30Peter Attia?

  orthopedic surgeon that split his time between New York and Austin, named Alton Barron. And I went to see Alton, having a little shoulder pain. And he said, well, let's do another MRI. It's been, you know, eight years since your last one. And it's like, yeah, it's horrible. Like, dude, you're, you don't have a labrum. It's just, it's all hanging off there. And more importantly, that explains your symptoms, right? The MRI by itself doesn't actually tell you the whole story. It's, let me examine you and see where your pain is. And he's like, yeah, I mean, luckily, you do so much other stuff, like your rotator cuff is in amazing shape. It's so strong, but your rotator cuff is stabilizing your shoulder. And not your labrum, your labrum is what should be holding that in place. So I said, so do I, do you think I need surgery now? He goes, no, I wouldn't, I wouldn't do

• 2:35:15Peter Attia?

  it until you can't take it anymore. Like, let's see how far you can milk this. And I was like, great. And then finally, in one day, in 2022, January 2022, I was, I was driving my car at the racetrack, and there was just something about the way I was getting in and out of the car that day that just finally tipped it over the edge. And to make a long story short, we were like, yep, okay, now it's time to do the surgery. So we did the surgery in March of 22. And I actually put a video up on Instagram of him examining me under anesthesia on the table, because that's the only time he could ever fully demonstrate how loose the shoulder was, because I had to be under general anesthesia for the rotator cuff to relax. And it's one of the most gruesome videos you'll ever see. It's like, I'm sitting up, intubated.

• 2:36:00Jocko Willink?

  Oh, I remember this.

• 2:36:01Peter Attia?

  Yeah, yeah, yeah. And he's just going, and I mean, it's like, he demonstrates, like, if there was any doubt that you needed this surgery, we just erase that doubt. So I have the surgery and it's so funny to hear you talk about, you know, what you just said because these are all my fears, right? It's like, you know, grip strength is such an important part of my existence. Like so much of what I do is predicated on being able to carry things, being able to hang, being able to do pull-ups. You know, the dead hang is one of my favorite tests. It's a, it's not a regular part of my training, but it's a test set. Twice a month, I will do a dead hang for time. And that's something we do with our patients. And, you know, my goal was to get to five minutes. You know,

• 2:36:46Peter Attia?

  five minutes is generally considered the gold standard. Like if you can dead hang for five minutes, you're, you're really special. I'd never got there, but I was at like four, four minutes and 36 seconds or something. How big of a bar? Um, probably like a, oh, oh, you know, I do it on a 45, like a regular, like Olympic bar. So a little skinny bar. Yeah. Um, so I put that up on the pull-up bar. Can it rotate while it's there? It doesn't. Okay. Yeah, it's, it's sort of locked in. Cool, cool.

• 2:37:17Peter Attia?

  My wife, by the way, first time she ever did a dead hang, went 308. Damn. Like, that's ridiculous. For anybody, but for a woman, that's really strong. Um, so I knew that post-surgery, like it was going to be, and again, not, this is not true for every shoulder surgery, but because of the, because of the nature of mine, I knew it was going to be six months before I could deadlift. I knew it was going to be six months before I could carry anything very heavy. So I knew how much my grip strength was going to decline. So I did as much as I could around it, right? So it's funny, the day after surgery, I was in the gym in a sling doing leg extensions and leg curls. And within three days, I was even able to do this other machine where you strap a

• 2:37:58Peter Attia?

  belt to your waist and you do like, you know, sort of like deadlifts, but without holding the bar. So it's

• 2:38:06Peter Attia?

  But I'll tell you what, here we are today, 15 months post-surgery, I still can't get to four and a half minutes. Like, and I'm working at it. But that's, like, I tell this story to say, when you lose it, it can take a while to get it back. And why this matters is, the most important rule of working out is, don't injure yourself doing it. Because, once you get to a certain age, any time on the sidelines is gonna just make it harder and harder to get back. So, you know, you alluded to the broken hip story, right? I mean, these statistics

• 2:38:46Peter Attia?

  are so important to understand for two reasons. One is, so let's just state the stats. Once you're 65 and up, if you fall and break your hip or femur, depending on the study, there's a 15 to 30% chance you're dead in a year. The one-year mortality of a broken hip or femur for those aged 65 and up is 15 to 30%. What's equally tragic in my mind is, of the 70 to 85% of people who don't actually die, half of them will have a full level reduction in mobility. Meaning, if they were able to walk easily before, they

• 2:39:28Peter Attia?

  will require a cane for the rest of their lives. If they were walking with a cane before, they will go to a walker. If they were in a walker before, they will go to a wheelchair. That's called a full reduction in functionality.

• 2:39:40Jocko Willink?

  What if someone's a freaking stud, and they're 72 years old, and they break their femur doing jiu-jitsu?

• 2:39:48Peter Attia?

  They're more likely to survive than someone who's not, right? Because, I mean, again, there's a lot of acute things that can go wrong. You know, you can have a fat embolism, you can have a, you know, a pulmonary embolism. There's a lot of stuff that can go wrong in the perioperative phase. But a big part of why those people die, if they don't die immediately, it's the inactivity. It's, you know, once you reach a certain age, it can take six months to 12 months to put on the amount of muscle you'd lose from 10 days of inactivity.

• 2:40:22Peter Attia?

  Think about that for a second, right? Like 10 days of inactivity is not a lot for someone who gets injured if.

• 2:40:28Jocko Willink?

  Yeah, that's like you, oh, you went on vacation and decided, oh, you know what? I'm just gonna relax and you didn't work out.

• 2:40:34Peter Attia?

  Well, it's funny you say that. I mean, this is one of the things we talk about a lot with our patients is we've got a lot of patients and at the end of a year, they're not making gains. And what we're realizing is, you know, you're in Ibiza for a month. Like you undid all the work you did. Now, again, you're not killing it for those 11 months, but you're doing good enough for 11 months. But you just undid it in a month.

• 2:40:54Jocko Willink?

  What is that? What is that when you're 23?

• 2:40:58Peter Attia?

  Um, I don't know, but it wouldn't be as dramatic.

• 2:41:01Jocko Willink?

  It seemed like when I was 23, just nothing mattered. It was just, it was just like, nothing mattered. Just do whatever. You're still, it's gonna crush.

• 2:41:08Peter Attia?

  Yeah, yeah, yeah. But, but you know, the, the experiments that are done are done in, you know, 60, 65 year olds. And as you get older, you become more anabolic resistant. Meaning literally, it is harder to experience anabolic function. You require more protein to make the same amount of muscle.

• 2:41:26Jocko Willink?

  Good, more steak. Let's go.

• 2:41:30Peter Attia?

  So.

• 2:41:30Jocko Willink?

  You can, you hear how much denial there is over here on my side of the table? Like, I'm like, hey, the guy I was talking about earlier, that won't happen to me. That's me all day long. That's my attitude. It's freaking jacked up. Or it's really cool. I don't know. What do you think, Kerry?

• 2:41:46Speaker 02

  I think it's good to go. More steak, more milk, more jiu jitsu. Just keep it rolling now.

• 2:41:52Jocko Willink?

  So you, again, the chapter, go ahead.

• 2:41:55Peter Attia?

  Oh, no, I was gonna ask you, tell me, tell me a little bit about, I mean, jiu jitsu fascinates me. I don't do it. I've never done it. My boys both do it. They love it. I'm so happy to see them doing it. It seems especially the younger one still, you know, you just have a hard time getting his attention sometimes. But, but the older one who's eight, like, it really is the thing he loves. I can really see him doing this as, as his thing. He loves it in a way that he didn't love any other thing he tried.

• 2:42:22Jocko Willink?

  Yes.

• 2:42:24Peter Attia?

  And so, you know, like, do kids get injured doing this? I mean, like, what are the, what are the, what are the things that a parent needs to understand as their kid is doing jiu jitsu?

• 2:42:33Jocko Willink?

  Kid's gonna get injured in jiu jitsu, same likelihood, soccer, basketball, whatever else.

• 2:42:39Peter Attia?

  What, what are the main injuries? Are they head injuries? Are they shoulder injuries? Knee injuries?

• 2:42:44Jocko Willink?

  Knees, shoulders.

• 2:42:47Jocko Willink?

  Elbows, just sort of like they're playing basketball.

• 2:42:50Peter Attia?

  Kids more resilient.

• 2:42:51Jocko Willink?

  Kids are freaking thousand times more resilient. Kids, honestly, my kids didn't get hurt doing jiu jitsu. Like, they were doing jiu jitsu seven days a week from the ages of zero. No, from the ages of five to like, for the girls, five to 12. And for my son, five until current time. And

• 2:43:16Jocko Willink?

  they never had any kind of serious injury. My daughter that did gymnastics got injuries from gymnastics. My daughter that did ballet got way worse injuries. Ballet is crazy. So I don't think there's like huge, for kids, I think it's great.

• 2:43:34Peter Attia?

  And what about the opposite end of the spectrum? Like, what are the oldest people you have coming into the gym?

• 2:43:38Jocko Willink?

  Sixty? Yep.

• 2:43:40Peter Attia?

  But no one in their seventies and eighties?

• 2:43:43Jocko Willink?

  There's people that, there's people that compete at 70. They have a masters division at 70 and up. It's definitely, you know, depends on the person. You can do it. I mean, Elio Gracie, the founder of Gracie Jiu Jitsu, he was doing jiu jitsu and rolling until, you know, he was in his eighties, nineties, still doing it. So you can do it. I think it can be a lifelong sport. I think it could be a lifelong sport as much as, as much as tennis or golf or, you know, people play pickup basketball. I mean, it just depends on what you do with yourself. And if you let those little movements slip away and you don't say to yourself, hey, I'm gonna get that movement back. You know, if you don't do that, it's gonna go, if you don't, if you don't use it, you're gonna lose it.

• 2:44:27Jocko Willink?

  That's, that's an accurate statement. So I, the other thing that's great about jiu jitsu is, you know, they're gonna get cardiovascular work. They're gonna get strength training, they're gonna get flexibility, all from one big thing. So that's kind of nice, too. Not to mention, they'll never get, they'll never get beat up. At least not in school by someone their own age, right? Can there be a 16 year old when they're 12? Yeah, but generally speaking, 16 year olds don't beat up 12 year olds. Like generally speaking. They might bully them, they might push them around, but you usually have peer or near peer bullying situations. And so, so they're not gonna get bullied, which is amazing. They're gonna be able to protect other people.

• 2:45:11Jocko Willink?

  And what's interesting, they generally speaking will not become bullies. Because they understand what physical confrontation does to people and they don't like it. And they recognize that it's not a way to get power over people. So it's beneficial across the board, across the board, freaking awesome.

• 2:45:33Jocko Willink?

  Do you have an occasional like catastrophic injury in jujitsu?

• 2:45:39Peter Attia?

  Yep.

• 2:45:40Jocko Willink?

  Competition?

• 2:45:41Peter Attia?

  Yep.

• 2:45:42Jocko Willink?

  With kids competition, they generally, hopefully have referees that will stop the match. If you know, a kid gets in an arm lock and he's not tapping, because little kids, they won't tap. They wanna win so bad, they won't tap.

• 2:45:57Peter Attia?

  Wow.

• 2:45:57Jocko Willink?

  And so a good ref will stop the match. You win, you know, the other kid wins, sorry. You, you shouldn't have got caught in that position. I always coached and ref like that. Hey, I don't care if you weren't gonna tap, you were caught in that position, you, you lose. But, but they also are pretty safe, the way they do it in terms of they don't allow certain submission holds at certain ages, because you don't have the maturity to tap out. There's moves in jujitsu, there's a move called the heel hook. Which is putting torsion on the ankle, but what it ends up doing is it's very strange, it's very different than other submission holds, because it doesn't hurt until it, until it injures you.

• 2:46:41Jocko Willink?

  So you can see a lot of people, they don't wanna tap, they don't wanna tap, they don't wanna tap.

• 2:46:46Peter Attia?

  And they don't wanna tap, they, they know they're in the heel hook?

• 2:46:49Jocko Willink?

  They know they're in the heel hook, generally.

• 2:46:50Peter Attia?

  But they're just thinking, I can get out of this?

• 2:46:51Jocko Willink?

  I can get out, I can get out.

• 2:46:52Peter Attia?

  Can you get out of it?

• 2:46:54Jocko Willink?

  You can, yes, you can, you can get out of some heel hooks and that's what they're trying to do. And I always, we, you know, we as instructors, instructors in general are always saying, hey, listen, this doesn't hurt. On arm lock, it hurts before you're injured. A, a, a choke, you just go to sleep. A straight knee lock, it hurts before you're injured. But the heel hook, I mean, you tell me, you're the doctor, like you don't have nerves inside your knee by your ACL. That's telling you there's pressure there, right? That's just there. And what would the purpose of being there being nerves in there? I guess there wouldn't be any, so.

• 2:47:31Speaker 02

  And, and the heel hook manipulates the, the knee, but it's the, the pressure's coming from the heel and the foot.

• 2:47:38Jocko Willink?

  Right.

• 2:47:39Speaker 02

  So with like any straight arm lock or anything like that, the pressure's directly on the joint that you're manipulating. This one's like, you know, the, the next one in the chain that's actually getting the, the pressure and the damage.

• 2:47:50Jocko Willink?

  Yeah, there was just, uh, my kids just sent me a video of someone getting heel hooked. And luckily for the person that didn't tap, you could see that it broke their tib fib. It just broke the bones, which is great because then you find, you know, you get four weeks later, it's stronger than it was. You know, that ACL is lifelong you're dealing with.

• 2:48:08Speaker 02

  Yeah.

• 2:48:09Jocko Willink?

  So yes, jujitsu, safe and beautiful for your children. The most important thing you can give children, even more important than love.

• 2:48:17Jocko Willink?

  Uh, you've got a whole chapter about that stuff, stability. You go into nutrition here and you kick it off with, you say potato, I say nutritional biochemistry.

• 2:48:29Jocko Willink?

  Which is classic, then you got a, a quote from Feynman in here. Religion is a culture of faith. Science is a culture of doubt.

• 2:48:40Jocko Willink?

  Very important to understand. And you tell a story and here, I'm not going to read it, but it's the same story that I freaking had with my wife who used to be like, you're not allowed to talk about nutrition with my friends. And this was in the, I guess it was in the two thousands where I was pretty fired up about nutrition. And of course my wife's friends would, would go crazy at the table with me. You know, what do you know? Oh, you're giving your kids poison? That's cool. That was how I'd open up the conversation.

• 2:49:09Jocko Willink?

  And then you say this.

• 2:49:14Jocko Willink?

  Actually, you say, "I am no longer a dogmatic advocate of any particular way of eating, such as a ketogenic diet or any form of fasting. It took me a long time to figure this out, but the fundamental assumption underlying the diet wars and most nutrition research, that there is one perfect diet that works best for every single person, is absolutely incorrect. More than anything, I owe this lesson to my patients, whose struggles have taught me a humility about nutrition that I never could have learned from reading scientific papers alone." So that's what you figured out. People are different.

• 2:49:48Peter Attia?

  Hmm, and again, perfection can often be the enemy of good. And, and so, we, we want to be careful that we don't lose sight of what is known and what is speculated, and what's a first order term versus a fifth order term. And I think what's abundantly clear are the first order terms.

• 2:50:15Jocko Willink?

  Give me an example.

• 2:50:17Peter Attia?

  Don't be overnourished and don't be undernourished. Consume sufficient enough protein to support the anabolic activity of muscle. Uh, derive sufficient micronutrients from your food, vitamins, minerals, things like that. Avoid toxins in food. That's about it.

• 2:50:42Jocko Willink?

  So good advice. I, I had a friend here at, at this gym, and he was, got pretty chunky. We might go so far as to say he got fat.

• 2:50:52Peter Attia?

  He was overnourished.

• 2:50:53Jocko Willink?

  He was overnourished, and then, you know, six months later, he's back to his kind of fighting weight, and I said, "Bro, you don't even cut some serious weight, huh?" And I said, "Yeah, yeah, I did." I said, "What'd you, what, like, what'd you do?" He said, "I stopped eating like an asshole." And I was like, "Everybody, that's, that's probably a great diet. Stop eating like an asshole." Cause we all know what that means. And you don't have to read a freaking book, or be a scientist to know what eating like an asshole. Donut asshole. We could go down the list, like, "How much spaghetti can you possibly eat?" "I can eat it all, if I'm an asshole." To myself.

• 2:51:31Jocko Willink?

  Um, yeah, it's, I found it very helpful that you are explaining to people. And then you go, you go into... You know, you talk about everything in this chapter. And, and you hit the dietary.

• 2:51:48Peter Attia?

  Yeah, I mean, that's kind of the, that's kind of the irony of this. I wrote two chapters on nutrition. It's a 17 chapter book. Exercise gets three chapters. That's insane. Nutrition gets two. Everything else gets one. And, um, you know, there was a part of me that wanted to do a very glib chapter on nutrition, which would have been a paragraph, basically just stating the kind of stuff we're talking about.

• 2:52:08Jocko Willink?

  Don't eat like an asshole.

• 2:52:09Peter Attia?

  Yeah, it's like, look, be an energy ballast, get enough protein, avoid the toxins, get the right. But, but of course I go into the detail, right? Which is, you have to be able to answer three questions about yourself or anybody else. If you're in the business of trying to treat this. And, and again, it's really easy to get the answers to these three questions. Are you over nourished or under nourished? Are you adequately muscled or under muscled? Are you metabolically healthy or not? When you know the answer to that question, then it's just a matter of understanding. Do you need to increase intake, decrease intake, maintain intake? Go up or down on protein? And what do you need to do with exercise, sleep and all the other things that factor into that? Vis a vis metabolic health.

• 2:52:53Peter Attia?

  For most people, the answer is you need to eat less. You need more protein. So you need less total calories. You need more protein calories. And that's what brings it full circle to strategy versus tactics. Right? So there are basically three strategies to reduce energy intake. Dietary restriction, calorie restriction, time restriction. So once you identify your strategy, then you can get into all the tactics. And the, the tactics is where the religion happens.

• 2:53:24Jocko Willink?

  People get crazy.

• 2:53:25Peter Attia?

  It's unbelievable.

• 2:53:27Jocko Willink?

  You were kind of crazy.

• 2:53:28Peter Attia?

  Yeah.

• 2:53:29Jocko Willink?

  Bro, you were doing, I, I went out to dinner with you in New York. It was like you, me, Tim, like just a, a bunch of dudes and we were out having a good time.

• 2:53:39Peter Attia?

  I was like, I still remember the restaurant.

• 2:53:41Jocko Willink?

  Yeah, it was freaking delicious, but you wouldn't know.

• 2:53:44Peter Attia?

  I would not.

• 2:53:45Jocko Willink?

  Because you sat there with an empty plate in front of you. Cause you were in the middle of a four day fast.

• 2:53:50Peter Attia?

  Five, five, five days into a seven day fast or something. Yeah.

• 2:53:55Jocko Willink?

  Oh, that was awesome. I that you really missed out that night. That steak I got was amazing.

• 2:54:00Peter Attia?

  I've been back since.

• 2:54:01Jocko Willink?

  Okay, right on. You tripled down.

• 2:54:05Jocko Willink?

  So, look, again, I just have a note here that says, get the book because this is a textbook. This is going to help you do an assessment. It's going to help you answer those questions and then guide you in a direction of which of these strategies and tactics you can utilize to sort your nutrition out.

• 2:54:23Jocko Willink?

  The next section is the awakening.

• 2:54:27Peter Attia?

  Your favorite section.

• 2:54:28Jocko Willink?

  Yeah, and you know what? I figured this was gonna happen. So I broke out my book, Discipline Equals Freedom Field Manual. And here's what it says. Sleep is a necessity. Humans need sleep. Failure to get enough sleep has serious side effects. Lack of sleep can cause negative hormonal changes, interfere with the metabolizing of glucose, increase blood pressure, and suppress the immune system. Less sleep also means less human growth hormone in your body, which means less muscle mass and weaker bones. Mentally, the brain is impacted as the ability to pay attention and concentrate begins to diminish and problem solving and basic reasoning become less acute. Furthermore, over an extended period, there are psychological effects like paranoia and even hallucinations. So, that's me.

• 2:55:12Peter Attia?

  You're on it. You got it.

• 2:55:14Jocko Willink?

  That's me. I wrote that. Now, you know, like, I don't know, people think, I wake up early. I've always waked up early. I've always woken up early. And people think I don't believe in sleep or that you need sleep, and I'm not like that. I actually understand that people need sleep. And quite frankly, other people need more sleep than I do. That's just the way it is. I'm not bragging. I've been like that my whole life. I don't need a lot of sleep, and that's the way it is. But I've never told anyone like, hey, you need to sleep less. I've never told anybody that. Let me confirm. I don't think I've ever told anybody that. I've never told anybody, hey, you need to sleep less.

• 2:55:56Jocko Willink?

  And you go into some pretty great detail in this book about sleep. And it actually, you know, I'll just read this section, old man blood. Scary as it can be in some situations, the short-term harm done by a night or three of poor sleep pales in comparison to the damage that we do to ourselves if this situation continues. Kirk Parsley, who's been on this podcast, observed this when he was a physician to the SEALs. He was also a SEAL. Outwardly, these men appeared to be prime physical specimens, finely honed in their rigorous training, but when Parsley analyzed their blood tests, he was shocked. Many of these young guys had the hormone levels and inflammatory markers

• 2:56:37Jocko Willink?

  of men several decades older than them. "Old man blood," Parsley called it. Because their training exercises and missions often began at odd hours of the night and required them to stay awake for 24 hours or more, at a stretch, they were chronically sleep deprived, their natural sleep-wake cycles utterly disrupted. When Kirk told me the story, I experienced a jolt of recognition, too. I, too, had had "old man blood" during my not-thin Peter Phase, and this is an earlier part of the book, where you were not in good, you were in good shape, swimming, freaking to Catalina Island, but you were also a metabolic disaster and not looking as lean as you should, according to your wife, who said, "You should try to be a little..." What'd she say?

• 2:57:22Peter Attia?

  Less not thin.

• 2:57:23Jocko Willink?

  A little less not thin. With elevated insulin, high triglycerides, and a testosterone level in the bottom 5% of men in the United States, I'd always attributed my poor health and hormone imbalance to the point of my, at that point, to my lousy diet and diet alone, but I had also spent at least a decade in a state of severe sleep deprivation in residency and afterward. Belatedly, I realized that not sleeping had actually caught up to me as well. It was probably even evident in my face. Studies have found that people who sleep less chronically tend to have older-looking, flabbier skin than people their same age who sleep more. Now I recognize that sleep, diet, and risk of long-term diseases are all intimately connected to each other. Knowing what I do now, I would bet that a few months

• 2:58:07Jocko Willink?

  of perfect sleep could have fixed 80% of my problems back then, even on a crappy diet.

• 2:58:16Peter Attia?

  Sleep. And I, you know, just to make sure people understand why I make such a bold statement there. Because I was exercising 28 hours a week.

• 2:58:25Jocko Willink?

  Yeah.

• 2:58:25Peter Attia?

  In other words, I look back at that and say, how is it that with so much exercise, I was still, you know, in the state I was in? And I think that there are extreme cases with extreme sleep deprivation, where, you know, because the old saying, the old adage is, can you out exercise a bad diet? And the traditional thinking is no. The truth of it is, you could, if you can exercise enough. Like, when I was growing up, I could clearly out exercise a bad diet because I had the world's worst diet and I was probably 6% body fat and fit as a fit. Like, I mean, I looked like a specimen.

• 2:58:59Jocko Willink?

  And you also had freaking like high testosterone.

• 2:59:01Peter Attia?

  Of course, absolutely. So there's clearly a scenario where you can't. But the difference is, like, I couldn't exercise that much today if my life depended on it. You know, I mean, I asked this question of a couple of our mutual friends, right, who were former SEALs who live in Austin now. And one night we were having dinner, this was probably like a year or two ago, and I was like, okay, I get from having talked to enough of you guys that like, getting through BUDs is mostly here. Like, you know, I get that. Well, you guys are no more mentally, you guys are probably at least as mentally strong today as you were then. Could you get through BUDs today? And every one of them said no. And the reason is, they said, we don't physically recover the way we used to.

• 2:59:45Peter Attia?

  Like, we couldn't do that volume of suffering today in our late 40s and early 50s. And so that's why I just think the strategy of, I'm going to out exercise my bad diet, like, that strategy will not work beyond a certain age, and that age is pretty young. Sleep introduces another wrinkle to that, which is really bad sleep and really bad diet. There's no, there's no out exercising that at any point either.

• 3:00:11Jocko Willink?

  Yeah, I think when, uh, when it comes to females going through SEAL training, I think one of the things that's going to be very problematic is the ability to recover. Quickly enough because they just don't have like the testosterone. The I don't think they have the hormones to to recover because you are getting a beat down. You are getting annihilated and it's hard for.

• 3:00:36Peter Attia?

  Bud's is six months, right?

• 3:00:37Jocko Willink?

  Six months. Yeah. And what I think would happen is I think that what would happen was if you took an extremely fit person, which I had a actually was Leif. Leif and I were having a discussion, this discussion as a matter of fact, and Tia Claire Toomey, who's a CrossFit champion. I mean, just incredible specimen of a woman, just badass. And I was saying, I said, you know, I mean, you take someone like Tia Claire, I mean, I said, she got, she can deadlift more than me. And he's like, no, she can't. And I was like, bro, she's, she's like a professional athlete. Of course she can, blah, blah, blah. And um, and um, and he's like, no, there's no way. And I'm like, I bet she can. He's like, I bet she can't.

• 3:01:18Jocko Willink?

  And we looked it up and her, her deadlift, I think it was, you know, four oh five, you know, which is freaking outstanding for a girl. But for a man, that's pretty normal.

• 3:01:29Peter Attia?

  Right.

• 3:01:29Jocko Willink?

  Right. It's pretty normal. But so, so, but it's still like, so she's in the, she's in the ballpark, right? She's in the ballpark. But if you, um, I think what would happen with a female in SEAL training is that like they give you the weekends to recover, but you're barely recovered on Monday morning, barely. And then you you go another week and you have to recover again and again and again. And I think what would happen is

• 3:01:57Peter Attia?

  Is Bud's the worst of it?

• 3:01:59Jocko Willink?

  As far as.

• 3:02:00Peter Attia?

  As far as the physical, uh, demand and the, the, the recovery or lack.

• 3:02:05Jocko Willink?

  No, it's not.

• 3:02:06Peter Attia?

  It's not. Wow.

• 3:02:07Jocko Willink?

  It's not because you'll go overseas and you'll be in some situation where you'll be getting crappy nutrition and even worse sleep or just as bad sleep and you'll be nervous and like, it's going to be worse. It's going to be worse. Uh, so that's what I think would happen is I think, I think they would need recovery time. And they just wouldn't have, they wouldn't be able to keep up over, they probably, they'd probably be in the top. 20% on the runs and swims in the first week, they'd be in the top 40% in the runs and swims in the second week, they'd be in the bottom 50% in the third and fourth week and then and then they just would continue to go down.

• 3:02:41Peter Attia?

  And what was the at the at the worst of your training, I assume hell week was the biggest sleep deprivation you've ever experienced in a in a in a training, not in not in real life?

• 3:02:49Jocko Willink?

  Yep, it is.

• 3:02:50Peter Attia?

  And is hell week 30 years ago the same as hell week today in terms of sleep deprivation?

• 3:02:55Jocko Willink?

  Pretty damn close.

• 3:02:55Peter Attia?

  Okay.

• 3:02:56Jocko Willink?

  Yeah, yeah, it's it's for for, yes, it's the same, it's the same. They'll sleep, they sleep a couple hours and usually why they put you to sleep is to get people to quit because on, you know, you've been awake for Sunday and then Monday and then Tuesday and then they'll come and say like, hey, listen, we just got in trouble with the commanding officer and he says we've been too hard on you guys and he's now told us that you guys need to you guys are going to get six hours of sleep and you have to get dry, so go put on dry clothes and you guys will see you in six hours. And then you're like, oh, you put on dry clothes and you crawl into bed and then 20 minutes later, an hour later, or 40 minutes later, they're in there with Boren, sending you right back to surf zone, a bunch of people like, I'm out, dude, I'm not getting back into this game.

• 3:03:40Jocko Willink?

  So, and they do that a couple of times, they do that or something like that. So that's why they let you sleep. They let you sleep so that you have to wake up and go back into hell. So that's a transitional period that some people don't make it through.

• 3:03:54Peter Attia?

  How much use is there of stimulants?

• 3:03:57Jocko Willink?

  What kind of stimulants?

• 3:03:59Peter Attia?

  Modafinil, you know, Ritalin, things like that.

• 3:04:04Jocko Willink?

  None.

• 3:04:05Peter Attia?

  Do they check guys for that or like, I mean, in your day and age, those things weren't popular, but today, those are very popular drugs that any high school kid could get a hold of. Do you have any idea if they're?

• 3:04:15Jocko Willink?

  They drug test the shit out of these kids.

• 3:04:16Peter Attia?

  They do, so you're getting drug tested during hell week?

• 3:04:19Jocko Willink?

  I don't know if they drug test them during hell week, but certainly after hell week and prior to hell week, you're you're getting drug tested a lot.

• 3:04:28Peter Attia?

  How much do you eat during hell week?

• 3:04:29Jocko Willink?

  As much as you want. You eat a ton, well, yeah, you eat a ton, you eat a ton.

• 3:04:33Peter Attia?

  So you're not limited on nutrition?

• 3:04:35Jocko Willink?

  Nope.

• 3:04:36Peter Attia?

  You're you're basically, and then. Coffee, you gonna have coffee?

• 3:04:42Jocko Willink?

  I don't know. I didn't, I didn't drink coffee. I still don't drink coffee. And I don't know if you could drink coffee. I don't think you can. I don't think you can drink coffee during hell week. I don't know.

• 3:04:52Peter Attia?

  By the way, there must be a real difference between if you get your, if you're doing your hell week in January versus August.

• 3:04:58Jocko Willink?

  There's a big difference.

• 3:04:59Peter Attia?

  Is the dropout rate significantly higher in January?

• 3:05:01Jocko Willink?

  It's higher. It's higher for sure. I mean, it's, you know, the deal in San Diego, it can be thirty seven degrees. You know, can be thirty seven degrees. The interesting thing is, what is it? In the winter hell weeks, the, the cold, so you'll get more quitters. In summer hell weeks, they'll get more chafing and more swelling. And more disease. But more people will make it. Cause cold is a.

• 3:05:25Peter Attia?

  What month did you do it?

• 3:05:27Jocko Willink?

  Ah, April, May. Spring, I think May. Late May. And here, here's the other thing, like when you're, when it's winter time, they check the water temperature. They put you in that water until someone's getting hypothermia.

• 3:05:40Peter Attia?

  Oh, so you'll spend less time in the water in January.

• 3:05:43Jocko Willink?

  Hundred percent. So that means in the winter time, you're running more. You're doing more and some for, depending on who you are. Cause some people, you know, that did cross country, they don't care if they run. They'll run all day. Some people that did water polo, they'd rather swim. There's some people, when you go to a pool evolution, it's, it's a rest for them. I was very comfortable in the water. Any of the pool, not the swims, but not tying pool comp. Well, I failed pool comp, but uh, life saving, those kinds of things, drown proofing, I was, they were like a break for me. Some people were absolutely horrified of those things. Uh, some people, you know, you take a kid that ran cross country in college, he's doing a four mile timed run. There's no doubt that he's gonna pass and he's gonna be fine.

• 3:06:25Jocko Willink?

  Uh, guy that swam in college or played water polo, he's gonna pass those swims really easily. So people, depending on what your strengths are, you'll have some time where it's, you'll get a little reprieve. But they'll find your weakness too. Cause no one is good. Well, just about no one is good at everything. And even, and you will get some studs. You'll get some freaking guys that are complete and utter studs and occasionally they make it and sometimes they quit. Sometimes they quit because they lost something for the first time. You know, they never lost a race before and that's too much for them. They never failed pool comp like I did. You know, I'd failed all kinds of stuff in my life. So I failed pool comp. I was like, cool. What do I need to do to fix it?

• 3:07:03Jocko Willink?

  But the sleep deprivation thing. You know, some people have bad hallucinations and stuff and I didn't really have. I had like one hallucination, you know, as we were paddling our boat and I looked across the ocean. I found I saw a traffic light and I was like, and I knew it. I was like, well, there's we're in the ocean. So there's no traffic light. I'm just hallucinating and it wasn't that big of a deal. I recovered from hell week pretty quickly. And like I said, I've always been, I'm, I'm very functional without sleep as well. Very functional, like when I hear Matt Walker and he'll say, you know, if you've had less than five hours of sleep. You cannot, you're basically it's equivalent of four beers or it's equivalent of whatever.

• 3:07:47Jocko Willink?

  That is just not true with me. It's and it's not true with many of my friends too. It's not true with many of my friends or at least a decent amount of my friends. I, I just went out to, I, I was, I did an event in Las Vegas, got on a red eye. Slept two hours on the red eye, arrived at my next gig and was speaking and interacting and answering questions. For eight hours.

• 3:08:16Jocko Willink?

  Like literally no factor, literally no factor. And, and so I don't know. I think there's some, a little bit of exaggeration or something with that, or I don't know. Am I wrong?

• 3:08:28Peter Attia?

  I mean, I don't know exactly what the stats are. I kind of forget, but it's, um. I don't think it's four beers. I think it's.

• 3:08:37Peter Attia?

  Is it four hours is equal to a blood alcohol of? Point oh eight? Maybe that sounds about right.

• 3:08:44Jocko Willink?

  Yeah.

• 3:08:45Peter Attia?

  But yeah, there's no doubt. There has to be, there has to be personal.

• 3:08:47Jocko Willink?

  I'll tell you what, you get some alcohol, I'm a different man.

• 3:08:51Jocko Willink?

  You want to see some changes, bro? And it give me no sleep, lack of sleep. It's going to be, get some, get me on the sauce, get me on the fire water and I'll, you'll meet a different Jocko all day.

• 3:09:01Peter Attia?

  When did you stop drinking?

• 3:09:02Jocko Willink?

  Basically when I retired. So that was in 2010 and I didn't like.

• 3:09:07Peter Attia?

  Yeah, there wasn't like.

• 3:09:08Jocko Willink?

  Yeah, just all of a sudden I wasn't hanging around with a bunch of my friends anymore. And I, I just stopped and then I looked up and I was like, well, no point in doing that anymore. I mean. And I, well, at the World Cup, I had a, I had a Guinness, you know, I, I don't, I don't like the taste of alcohol anymore at all. I don't have any desire for it. And man, I've seen it just destroy so many people that I just can't, I can't get on board. I can't give money to that industry. I just can't do it. I'm, I'm, I'm, I'm becoming more and more anti-alcohol every, you know, every moment of my life now. And, and look, I, I've been kind of giving the caveat that, you know, I had a lot of fun and bonded with the guys and I've started to just like,

• 3:09:50Jocko Willink?

  kind of, kind of think about that too and think, well, how much fun would I have been having if I wasn't drinking? What if I wasn't doing that? What would I have been doing? What did I miss out on? So I'm even starting to revoke that caveat a little bit as I get older. And, and, and, you know, the culture was very strong for alcohol in the whole military and it was even stronger in the SEAL teams and you're a frog man, that's what we're doing. And I was like, cool, that's what we're doing. I'm here, I'm here to be a frog man. Let's go. That's what we're doing. I'm in and I'm gonna do it hard. So watch this. But thankfully, I, you know, I always also, you know, some people have the, they say, oh, I have an addictive personality and it's almost

• 3:10:31Jocko Willink?

  like a humble brag. Um, like I have an addictive personality. I think you actually do have an addictive personality.

• 3:10:37Peter Attia?

  To some things.

• 3:10:38Jocko Willink?

  Yeah. I don't think I have it. Like, I'm like, okay, cool. I don't, yeah, I, I, I can stop doing something. Maybe jiu-jitsu is a little bit, but, but, you know, I go, I go times where I can't train and I don't freak out about it. So I don't think I have an addictive personality. And it scares me when I think about people that do have that. It scares me to think about what it must be like to want to drink alcohol or do whatever thing so badly that you can't control it. That's, that's very scary to me. I think I have a little bit of. I think I have a little bit of I like to be in control of what's happening. And which is weird because when it comes to leadership, I don't have that at all. I don't need to be in control.

• 3:11:21Jocko Willink?

  And everyone that works for me will tell you like, oh yeah, Jock was just like, he's crazy. He let me do whatever I want. Cause I had somebody say something to me about that, about me wanting to, you, you, you want to control stuff. I'm like, actually, I don't care. Talk to anyone that's ever worked for me. Unless they were an idiot and I had to micromanage them, which is a very small category of people. But most people they work for me, they're like doing whatever they want. And I'm giving them free rein and backing them up and supporting them. But for my personal life, I don't like to uh feel like I'm going to lose control or feel like I can't control something that's happening. So that's what scares me about the, it doesn't scare me, but the, the psychedelic. You know, voyages that people are going on.

• 3:12:04Jocko Willink?

  Because and the way I explained it to some of my friends that have been on these voyages and it's been very helpful for them. And I've said like, well, I feel like I'm driving down the road at eighty miles an hour in my vehicle. I, I don't think I need to stop, pull over to the side, take apart my engine, put it back together again and like, hope I got it right. Doesn't seem like a worthwhile risk to me. And I don't feel like I have, you know, that. I don't feel bad or feel good. I'm happy.

• 3:12:33Jocko Willink?

  So um, there, there's my, my thoughts, but sleep, back to sleep.

• 3:12:40Jocko Willink?

  The, the other thing is you can only, the short sleepers, the genetic short sleepers, which I don't know if I'm one, I don't, I don't really think I am. Cause it sounds like it's so rare that it could be impossible that I could be one. I used to think it was genetic because one of my kids is like the same way, doesn't need to sleep. One of my kids, my oldest daughter doesn't need to sleep. My middle daughter. Go pull her out of bed, you know, my wife, pull her out of bed. My son, somewhere in the middle. My youngest daughter, pull her out of bed. So I thought, okay, well, that makes sense. We've got different genes. Um, but then I hear how rare it is that you're actually really a short sleeper.

• 3:13:21Jocko Willink?

  I'm like, well, then it can't be me, but I can survive for sure on a pretty small amount of sleep. Without really much inhibition. And I don't think that's cool. In fact, I want, I want to sleep more. I want to, like, let's go.

• 3:13:36Jocko Willink?

  Uh, but to your point, which you explain in great detail in the book, there are all kinds of negative impacts to not sleeping enough.

• 3:13:47Jocko Willink?

  And you've got a section in here about, again, get the book, go get the book. Um, but, you know, don't drink alcohol, don't eat anything less than three hours before bedtime. Abstain from like electronics for at least one hour before bed, avoid doing anything anxiety producing or stimulating such as reading work email or God help you checking social media. Uh, for the folks that have access to a sauna or a hot tub, go get in that before bed. Room should be cool, ideally in the mid sixties.

• 3:14:20Jocko Willink?

  I hate to sound like one of those people that I, I guess I am now, but I have a sauna. And I have a, a bed cooler thing and that bed cooler thing is legit.

• 3:14:29Peter Attia?

  Yeah, it's amazing.

• 3:14:30Jocko Willink?

  It's freaking legit. It, and when I had, it's cold. And so like, I don't really have like the crazy sweat nightmares anymore. I guess they're more in Arctic environments, but it works out good.

• 3:14:46Jocko Willink?

  Give yourself enough time to sleep. You call it sleep or scientists call it sleep opportunity. Fix your wake up time, don't deviate it from it, even on the weekends.

• 3:14:55Peter Attia?

  This is where I feel really lucky because my boys, especially the middle one, he's like, I mean, this kid is on a clock. He cannot sleep past six AM.

• 3:15:05Jocko Willink?

  Yep.

• 3:15:05Peter Attia?

  So we don't sleep past six AM.

• 3:15:07Jocko Willink?

  You don't.

• 3:15:08Peter Attia?

  Doesn't matter if it's a holiday, doesn't matter if it's a weekday, doesn't matter if it's a weekend. It's, we're always up at six and uh, there's something good about that, right? You, you, you don't get into what's called social jet lag, which is when people try to, you know, short change their sleep during the week and then make up for it on the weekends. It doesn't work that way.

• 3:15:27Jocko Willink?

  Yeah, or you, or you do the opposite. This is what I've always advised people, oh, it's Friday night, so I'm gonna go out a little later, I'll sleep in. Okay, so now you wake up at eight and now it comes to 10 o'clock at night, you're not tired.

• 3:15:40Peter Attia?

  That's right.

• 3:15:40Jocko Willink?

  Cause you had more sleep, so you stay up until midnight and now you next sleep until 10. And now you can't go to sleep until one o'clock in the morning and now you're, you're getting up uh, early on Monday and it sucks, so. So there you go.

• 3:15:54Jocko Willink?

  Get your sleep, everybody, from me.

• 3:15:58Jocko Willink?

  Get your sleep. Definitely from the doctor here, get your sleep. Chapter seventeen. Work in progress, the high price of ignoring emotional health. And this was the surprise chapter.

• 3:16:13Jocko Willink?

  On Tuesday, July 11th, 2017, at 5:45 PM, to be exact. I had received a call from Jill, my wife. She was in an ambulance with our infant son, son, Aratin, on the way to the hospital. For some reason, he had suddenly stopped breathing and fallen unconscious. His eyes were completely rolled back in their sockets, and he was lifeless and blue with no heartbeat. Only the quick reaction of our nanny had saved him. She rushed him to Jill, who is a nurse. Her instinct took over. She immediately put him on the floor and began performing CPR rhythmically, but carefully pressing her fingers on his tiny sternum. As the nanny frantically dialed 911, he was barely a month old. By the time the firefighters stormed into the house, about five minutes later,

• 3:16:58Jocko Willink?

  Aratin was breathing again, and his skin was turning from blue back to pink as oxygen returned to his body. The firemen were stunned. We never see these kids come back. They told Jill, to this day, we still don't know how or why it happened, but this is likely what occurs when baby dies, when babies die suddenly in their sleep. They choke for a moment on their own saliva, or some other insult occurs, and they and their very immature nervous systems fail to restart their breathing. When Jill called me from the ambulance, I was in New York in a taxi on 45th Street, on 54th Street, on my way to dinner. After she finished telling me what the story, I just said, without a shred of emotion, "Okay, call me when you get to the hospital, so I can talk to the doctors in the ICU."

• 3:17:44Jocko Willink?

  She got off the phone pretty quickly, and of course, it's obvious why she was upset. Our son had nearly died, and the right thing for me to say, the only thing to say, was that I was getting the next flight home.

• 3:17:56Jocko Willink?

  Jill stayed in the hospital with Aron alone for four days. She pleaded with me to come home. I called in daily to talk to the doctors and discuss each day's test results, but I stayed in New York with my important work. Aron's cardiac arrest happened on a Tuesday, but I did not come back home to San Diego until Friday of the following week, 10 days later. Even today, just thinking about what happened, I feel nauseous about my behavior. I can't believe I did that to my family. I can't believe what a blind, selfish, checked-out husband and father I was. And I know I may never fully forgive myself for it as long as I live. I must have been giving off a very troubled vibe during this period,

• 3:18:40Jocko Willink?

  because around then, my close friend, Paul Conti, a medical school classmate who is now a brilliant and very intuitive psychiatrist, began urging me to go to this place in Kentucky. I looked it up, and it seemed to be a place for addicts. "This doesn't make sense," I told him. "I'm not an addict." He explained to me, over several months of gentle discussion, that addiction can take many forms, not merely to drugs or alcohol. Often, he continued, "It's an outgrowth of some trauma that has happened in a person's past." Paul is an expert in trauma, and he saw that I displayed all the behavioral signs: anger, detachment, obsessiveness, a need to achieve that was fueled by insecurity.

• 3:19:25Jocko Willink?

  "I don't know what it was that happened, but you just have to trust me on this," he said. He was relentless. I agreed to go to Kentucky, but I was still looking for any excuse to get out of it. In early November, a woman from The Bridge, which is the rehab place in Kentucky, called to do my intake interview. It was a long, tedious conversation, and my patience finally expired when she asked, "Have you ever been subject to any kind of abuse?"

• 3:19:56Jocko Willink?

  I got so angry, I yelled, "Fuck you!" and hung up the phone. After this call, I decided to cancel my planned stay. What was wrong with these people asking such idiotic questions? That Thanksgiving weekend was still a blur. It's the only Thanksgiving in our life together when we didn't go to dinner with friends or family, or host one ourselves. We just stayed home alone. On Sunday night, Jill begged me to go to, again, to go to Kentucky. "I just can't go off the grid for that long," I said. "My patients need me, and you need me to help with the kids." This was total bullshit, and we both knew it. She replied point-blank, "You're of no help to me. In fact, you're hurting me and your kids very badly."

• 3:20:44Jocko Willink?

  Confronted with the brutal truth, I knew I had to go.

• 3:21:04Jocko Willink?

  So you go out to this place in Kentucky.

• 3:21:09Jocko Willink?

  You get out there, you are, you know, trying to

• 3:21:14Jocko Willink?

  keep a low profile. I thought it was funny that you had called out that you wanted a private room, you know, because you're so important and, you know, you're gonna get a roommate. I'm gonna fast-forward a little bit. After four or five days, I could no longer remain silent, which is what you had done for your first several days, there not telling anybody anything. They'd set aside almost an entire day when we were all supposed to tell our life stories from the beginning. We had an hour each, and we were supposed to prepare. So I was finally telling my life story for the first time to this group of perfect strangers. Not even Jill had heard the whole thing. But I was telling it in a way that was very matter-of-fact. "This happened when I was five, this happened when I was seven, and so on." Some of it was sexual, some of it was physical. "But it was not all bad," I explained.

• 3:21:59Jocko Willink?

  "These events, terrible as they were, had led me to take up boxing and martial arts at the age of 13. I got to punch bags and people, and that channeled my anger. I learned how to protect myself, but I also gained discipline and focus, qualities that proved invaluable. When around the age of 19, I pivoted from pugilism to mathematics. Terrible as it was, my past was also what set me on the path to becoming a doctor," I continued, growing somewhat defensive. Throughout college, I volunteered at a shelter for sexually abused teenagers. And I became close to many of them over four years, including one young woman who had been abused by her father. When she attempted suicide, one of my, one of many attempts, I went to the, to visit her in the hospital.

• 3:22:40Jocko Willink?

  I was a senior by then and I'd already applied to the top PhD programs in aerospace engineering, but I wasn't really sure it was my calling. Spending so much time in the hospital with her helped lead to the epiphany that I was meant to care for people, not solve equations. So you see, I concluded, parts of my past may have been bad, but in a way, they also ended up setting me on a course towards a better life. Some of the kids I grew up with and boxed with meanwhile were getting arrested for armed robbery and getting girls pregnant in high school and all kinds of other stuff. That could have easily been me. So in a way, I said, "My abuse may have actually saved my life. I don't really even need to be here."

• 3:23:19Jocko Willink?

  Right then, one of our therapists, Julie Vincent, cut me off. "There are many rules at the bridge, and one of the most important ones was no minimizing. You are not allowed to minimize anything that someone else is saying and you're especially not allowed to minimize your own experiences." But she didn't flag me for that. Instead, she asked a simple question. "You were five years old when this happened first to you, right?" "That's right," I replied. "And your son Reese is almost five years old right now, right?" I nodded. "So you're saying it's okay that this happened to you and you were his age, but would you be okay with people doing that to Reese now?"

• 3:24:00Jocko Willink?

  Another rule at the bridge is you're not supposed to hand anyone Kleenex when they're crying. They're supposed to get up and fetch it themselves.

• 3:24:09Jocko Willink?

  Now it was my turn to stand up and walk over to the Kleenex box. It all came pouring out of me, and finally, I was able to embrace why I was there and begin the hard work of unpacking the last forty years of my life.

• 3:24:48Jocko Willink?

  When you're going to this place and you show up there.

• 3:24:53Jocko Willink?

  You know, they say like, uh, uh, someone that's going to SEAL training. When you, when you go there, you know, if you're going to quit or not, like deep inside, you actually know. Do you think you knew what was going to happen when you went to this place?

• 3:25:07Peter Attia?

  No.

• 3:25:13Peter Attia?

  No, I mean, I was just, I was just, I was just so angry, you know, I don't think. You know, I wasn't really there on my choice, you know, I mean.

• 3:25:23Peter Attia?

  If I didn't go, I was leaving the house, right? And never coming back. So. I think I just, you know, I just had so much anger that I, I wasn't thinking about anything other than. Just trying to get through the day. And this place is wonderfully awful, right? I mean, they deprive you of everything. They don't, you know, you don't, you don't have a phone. They take your books away. There's. I mean, I, I think I mentioned there, the only thing they let me indulge in was exercise. You know, I could get up at 4:30 and they had this janky little universal machine somewhere in the basement. That like, you know, I could go down and use and run in the woods. Like that was it, right? So, so.

• 3:26:08Peter Attia?

  Aside from that, you're stripped of every defense mechanism you have.

• 3:26:14Peter Attia?

  But no, I had no idea what I was in store for.

• 3:26:18Jocko Willink?

  Now, I've felt like talking about combat, which I've done. I mean, basically because I have a podcast and I, you know, I, I've said that when my friends have died. I've often been the guy that's giving the eulogy. As a matter of fact, I have a SOP now. If someone I know dies, I'm immediately writing because I don't know if I'm going to get the call or not, but I'm going to be ready.

• 3:26:44Jocko Willink?

  And I've found that to be very, I think that's very helpful.

• 3:26:50Jocko Willink?

  And so is this the first time where you were able to like express these things that you had gone through growing up?

• 3:26:58Peter Attia?

  Yeah, it's, it's, it's more than that, though, right? I think stating them as facts is not really the issue. It's understanding.

• 3:27:13Peter Attia?

  It's, it's not justifying them anymore, right? So I think, again, there, it wasn't like I didn't know this had happened. It wasn't like I blocked this out. It was that, you know, bad things happen to everybody and we come up with adaptations. This is a normal, healthy, important thing. If we don't adapt to bad things, we're hosed, right? Like, that's the end of our species. So, the only issue is, how many of those adaptations are positive? How many of those adaptations are negative? And what I don't think I ever appreciated was that all of the attributes of my personality that were positive and negative were actually quite linked.

• 3:27:58Peter Attia?

  And they all kind of stemmed from a coping strategy around these issues of my childhood. And I think the first sort of thing that I had to kind of realize in that moment was that the, you know, in this, this place in the, the bridge, they use a model, right? Where you have kind of, you know, you're born as a, as a young, healthy child and then you, you suffer some sort of insult. And they, they, they talk about this thing as the trauma tree, right? So the trauma tree has branches and roots. So the branches are the things you see. They're, they're above the ground, right?

• 3:28:40Peter Attia?

  So the branches are addiction, codependency, you know, all the things that we think of as, you know, habituated survival strategies. The roots are the things beneath the surface. That's the trauma. So that can be abuse, neglect, enmeshment, witnessing tragic events would be traumatic. And the thing to figure out is, how do we go from sort of the young, healthy child into an adaptive child into a maladaptive adult? And like, what does that transition look like? And what adaptations are serving you well and which ones aren't?

• 3:29:19Peter Attia?

  And I think that was really, you know, a big part of the takeaway, right? Which was, many of those adaptations have served me incredibly well. But some of them haven't. Some of them have been very destructive. And, you know, we were talking earlier about alcohol. Well, I feel very fortunate, but like you, I mean, I can't, I can't actually relate to somebody who drinks alcohol through addiction. So there's very different chemistry in people's brains. There are some people for whom ethanol triggers a pleasure center in them the way I can't relate to. So, you know, drugs, alcohol, gambling, these things have never resonated with me. Those aren't my addictions.

• 3:30:04Peter Attia?

  It just so happens that my addictions are very socially acceptable. I mean, work is a very socially acceptable addiction. Perfectionism is a very socially acceptable addiction. Anger can be tolerated, provided you can sort of keep it in check, which I mostly could. But again, you know, as the story you read at the outset displays, I mean, it can get to a point where you're so detached and you're so addicted to, you know, work and, you know, your own sort of narcissistic beliefs, that, you know, the destruction is just enormous

• 3:30:48Peter Attia?

  around, you know, to those who are closest to you. Again, it's not, it's not visible to the outside world, but it's, it's absolutely visible to the people closest to you.

• 3:31:03Jocko Willink?

  So you go here, you get, you get, I would say, from, from what you write in the book, it's sort of get, it moves you in the right direction.

• 3:31:13Peter Attia?

  It does, yeah. I leave early. I only stay for 14 days. And most people believed I needed to be there for six weeks. But I begged to go and they, they relent.

• 3:31:35Jocko Willink?

  Fast forward a little bit here.

• 3:31:39Jocko Willink?

  We're into covid times. 2020. As March bled into April, it became clear there was no end in sight.

• 3:31:49Jocko Willink?

  One day in late April 2020, I was on a routine morning call with my practice manager, when I couldn't take it anymore and started venting. "I've lost control," I told her. "I can't keep my patient's stories straight anymore." Was it patient X or patient Y who just last week told me about his daughter's struggle at school? Was it patient A or patient B whom I needed to reach out to that evening about an issue she was having? She tried to soothe me, saying I was doing the best I could under the circumstances and that our patients were grateful, but the more she talked, the angrier I got. And just like that, I spun into a radical, self-destructive episode, one like I've never experienced before or since. Even remembering it now is terrifying. I threw a table across our living room.

• 3:32:34Jocko Willink?

  I tore my t-shirt to pieces. I screamed in rage and pain. My wife begged me to leave the house for fear I would harm her or the kids. I thought about driving myself into a bridge abutment or some other structure fast enough that I'd be killed.

• 3:32:51Jocko Willink?

  I was convinced that I was broken, defective.

• 3:32:55Jocko Willink?

  When they autopsied my brain, they would discover just how screwed up I was. I was beyond fixing. Nothing could make it right. I ended up holed up in a motel, on the phone with Paul, Esther and Terry. They insisted that I needed to go back to a place like the bridge. Now, true to form, I stubbornly disagreed, claiming that I could fix this with just a little more time and support. If only I could get home and get some rest. After pleading with them for 48 hours, I finally relented. In the middle of the night, I drove myself to Phoenix, Arizona, to be admitted into a place called Psychological Counseling Services, or PCS. Terry had been telling me about PCS for nearly a year. He said it was a place that worked miracles, healing wounds that seemed beyond permanent.

• 3:33:41Jocko Willink?

  I asked how he could be so sure. He said I just needed to trust him.

• 3:33:50Jocko Willink?

  So you had out there, fast forward a little bit on my second day. I was assigned to write a list of forty-seven affirmations representing one positive statement about myself for each year of my life. I made it to about five or six before I got completely stuck. For days and days, I couldn't come up with anything good to say about myself. My perfectionism and my shame did not permit me to believe anything nice about myself. I just couldn't do it. Finally, on the nineteenth day, a blistering hot Wednesday morning, it happened. One of my therapists, Marcus, was pushing deeper and deeper into a story I had told him earlier about how I had stopped wanting to celebrate my birthdays when I was about seven. In fact, I revealed, "I would keep my birthday a secret until well into my twenties."

• 3:34:33Jocko Willink?

  His question made it clear that this was not something a healthy child would do, and it likely masked something more deeply wrong. He just kept digging and would not let it go. That recognition pushed me into an emotional freefall. It had been two and a half years in the making, but I finally was able to let go and accept the truth about my past and how it had shaped me without any excuses or rationalizations. All that I had become, good and bad, was in response to what I experienced. It wasn't simply the big T traumas either. We uncovered many, many more little T traumas, hidden in the cracks that had affected me even more profoundly. I hadn't been protected. I hadn't felt safe. My trust had been broken by people who were close to me. I felt abandoned.

• 3:35:18Jocko Willink?

  All of that had manifested itself as my own self-loathing as an adult. I had become my own worst enemy, and I hadn't deserved any of it. This was the key insight. That little sweet boy did not deserve any of it, and he was still with me. Once I had accepted all of this, it was easy to write out the forty-seven affirmations.

• 3:36:03Jocko Willink?

  So when you're going through this with these people, with these therapists,

• 3:36:09Jocko Willink?

  what's, what's, what happens? What's going on? Like, I literally don't know what this looks like. Like, explain it to me if I've never seen a boxing match before. What is going on with these therapists? I know we get it, you get into the dialectical behavior therapy, DBT. What does this look like?

• 3:36:27Peter Attia?

  Well, PCS is set up as about 80% individual therapy, about 20% group therapy. You're doing therapy from 7:00 in the morning till 7:00 at night, every day. 30 minutes for lunch, basically. Seven days a week. Most people go there for one week. I was there for three, so I was there for 21 straight days.

• 3:36:56Peter Attia?

  Which meant I went through, I went with three different groups. So I, I basically did the same thing effectively, but with three different groups of people. But I had the same individual therapists, so we were kind of going deeper and deeper and deeper. And again, you know, I didn't want to stay for three weeks, but I also knew from the last time, like, I'm gonna surrender a little bit on this one, and I'm gonna, I'm gonna stay as long as they tell me I need to stay this time. And so at the end of that second week, I really thought I was there.

• 3:37:27Peter Attia?

  And then my friend Paul called me the night before I was supposed to leave and said,

• 3:37:33Peter Attia?

  "We think you need another week." And I was like, "I can't do another week of this." Like, I just can't do any more of this. And...

• 3:37:44Peter Attia?

  You know, he just said like, you gotta trust me. And I did. And it, and it made sense because of what happened in that last week. Like that, you know, there's the, there's a quote in there about, you know, the stone cutter hitting the stone, right? And it's like, on that hundred and first, you know, hit, the stone breaks. And it looks like, well, he did nothing for the first hundred. No, the first hundred were just as essential to that one. So even though I think kind of everything really came together for me on that 19th day, it goes back to two and a half years earlier in Kentucky and all the work that had happened in that two and a half year period of time. But it really, it just, it

• 3:38:28Peter Attia?

  really came together on that one, one that moment. And, and through, you know, Marcus' real probing. And, and it was more into the little t stuff, truthfully, right? It wasn't into the big, obvious stuff at this point.

• 3:38:41Jocko Willink?

  What's a little t look like?

• 3:38:43Peter Attia?

  Yeah, I mean, it's, it's, you know, it's, it's, in my case, I think it was more around

• 3:38:50Peter Attia?

  not, not, not having a dad around, probably was, was the most formative thing that I had just never assumed mattered. I just didn't think that that meant anything. And I, I think I finally came to accept the fact that you can't use a totally rational brain of a 40 year old to try to explain what a two year old, a three year old, a four year old, five year old experience. They don't process things that way. And I think once I came to understand that, I just stopped making any excuses. You know, I think there was always still some lingering excuses. And they were really standing in the way

• 3:39:31Peter Attia?

  of doing this, this kind of work that needed to be done.

• 3:39:36Jocko Willink?

  So would an excuse be, well, I get mad, but this is the way I was treated well as a kid. So that's just the way I am. Is that the type of excuse we're talking about?

• 3:39:47Peter Attia?

  No, I mean, no. So, so an excuse, I mean, yes, that could be, but that would, so it would more be.

• 3:39:55Peter Attia?

  Hey, you know, I might not have had this kind of attention as a kid, but it doesn't matter because, you know, I wasn't getting beat to a pulp every single day. Like, there was always sort of a way like, it wasn't that bad. It what, you know, um, or another excuse could be,

• 3:40:17Peter Attia?

  um, and so that that's an excuse towards what's happening to you. Another excuse could be like,

• 3:40:24Peter Attia?

  you know, I have a horrible temper, but like, I don't hit my wife or my kids. So therefore, it has no effect on them. Right? Like, yeah, they see me like screaming at a driver or pulling a guy out of his car and almost killing him. But I mean, like, I'm not hurting them and not realizing, of course, how, you know, illogical that is.

• 3:40:44Jocko Willink?

  This is, I guess it's because COVID was going on, but like, I remember exactly when this was happening because you and I were talking all the time, like, um, yeah. And it's weird for me because, like, seemed normal. And you, you, you told me, like, I can't remember if you told me before or after you, you, you went. I don't remember if you told me, hey, I'm going somewhere, or if you told me after I just got back from somewhere. But I remember you indicating that you had gone and you said, you said something along the lines of like, hey, I'm not addicted to anything, but I need to get some shit sorted out type thing. That's the thing. And I was like,

• 3:41:26Jocko Willink?

  okay, cool. Um, but I, the reason I'm saying that is because from just to, just to your point that from the outside, I didn't have any, like, look, did I think like, Peter gets pretty pissed when he, you know, misses a shot, whatever. Sure. But, you know, whatever. I didn't think that was a, any kind of like, deep issue, you know? Um, so from my perspective, again, to be aware of your friends and pay more attention so that you can help out is a good thing to do. And obviously, in the veteran world, we need to do that. But clearly, it's not just veterans that go through trauma, big T trauma, little T trauma, whatever, and might

• 3:42:11Jocko Willink?

  need some freaking support sometimes. And who knows, like,

• 3:42:18Jocko Willink?

  You know, like to talk a little bit about, you know, if you see someone that's doing this kind of stuff, like losing their temper, or they're, they're doing things that you think, that's a little weird. That seems a little strange. Like, just to be like, dude, what's going on? Are you good? I don't know. I feel like a bad friend. You know, to not maybe just be a little bit more proactive.

• 3:42:43Peter Attia?

  Yeah, I mean, I, I don't know. I mean, look, I think, you know, Paul Conti was able to see that because he's literally one of the smartest psychiatrists on the face of the earth. Like, I, I just don't know that a normal smart, a normal otherwise smart person could, could sort of put those patterns together. So, I, I, you know, I, I just feel lucky that, that, you know. And again, Paul, I remember him saying this, he's like, you just live your life like a trauma victim. And I was like, what the hell are you talking about? I'm not a trauma victim. And he goes, okay, but I'm just, I'm just telling you, you like, you walk like a duck, you quack like a duck, it's possible you're a duck.

• 3:43:27Jocko Willink?

  You're like a functional alcoholic, but you're a functional trauma. Cause you're freaking highly functional. I mean, damn. You know, like, you're just kicking ass across the, in, in so many different aspects of life for extended period of time. You know, like, hard to see. How often are you around Paul Conti?

• 3:43:46Peter Attia?

  Quite a lot, right? Because Paul and I shared an office in New York. Um, so Paul, I probably saw Paul more than any friend, you know, during like a five year period of, you know, 2015 to 2020. And, but, but again, he knew me in med school. Like, he's, he's known me forever. He, he understands.

• 3:44:11Peter Attia?

  Yeah, he just understood the perfectionism, the rage, the constant need to prove myself. And again, I think it's, I'm not here to suggest that like striving isn't good or any of these other things like that. That's not, that's not the point here, right? The point is, at what point do these things become maladaptive, right? And you could take someone else who's working just as hard as me, who's, you know, just as committed to excellent work, but it's not coming from this place of insecurity. It's coming from a place of love, and it could be a totally different experience, and it's not destroying their life. I mean, the point here is, it was destroying my life. That's the point. That's the only thing that matters, is, and that's why, again, this chapter is not written as like, you need

• 3:44:52Peter Attia?

  to do this. It's not a you need to do this. It's, this is a story that I hope lets you examine yourself. Because there is no question in my life that I was, like, there was just a trail of body bags around me.

• 3:45:09Jocko Willink?

  If you wouldn't have gone and gotten this help, where you, you're getting divorced, your wife wasn't going to see you anymore, she was going to get custody of the kids, you were going to get pissed off, you were going to stop working so much, everything's going to fall apart. That's the trajectory we were on?

• 3:45:22Peter Attia?

  I mean, I don't think I would be alive today. Because shame is really the problem here, right? Shame is the, shame is the thing that that kind of underpins all of this stuff, right? And that's, so every time you make a mistake, at least in my case, every time I would make a mistake, I would hammer myself harder for it, right? Like, so for example, let's go back to when I come home from that trip, 11 days or 10 days after my son is almost dead. Do you think I'm acting better or worse as a result of that? Like, the logical person would say, oh my God, you must have been bending over backwards to be a better husband after you were such a dick. But that's

• 3:46:06Peter Attia?

  the logical person. No, no. The reality of it is, you feel the shame for how you've behaved, so you come home and you act worse. Again, shame is an awful thing.

• 3:46:17Jocko Willink?

  How do you act worse? Like, what do you do?

• 3:46:19Peter Attia?

  You're just more aloof, more distant, more of a dick, more gruff, less helpful.

• 3:46:27Peter Attia?

  Probably went back on the road three, four, five days later.

• 3:46:32Jocko Willink?

  Are you in your mind thinking, well, I'm just like such a beast of a human that I just, this stuff doesn't faze me and I'm just carrying on?

• 3:46:40Peter Attia?

  I, you know, it's funny. I wish I knew, I wish I could go back and find out what lies that guy was telling himself. Prob- probably, um, your job is to provide, like your job is to be the financial provider, not to do, not provide any emotional support.

• 3:47:02Jocko Willink?

  So this, you, you, you explain this story. Um, you know, obviously, like I said, get the book, but what is a beautiful thing is it says this, uh, one section, it says, if you take nothing else from my story, take this. If I can change, you can change.

• 3:47:21Jocko Willink?

  And, you know, this is, you, you're talking about this specific kind of emotional side of it, but it's really all aspects of health and of life. And that idea right there, if I can change, you can change. And by the way, you have health issues earlier in the book. You have, uh, metabolic issues earlier in the book. You have opiate, uh, did you talk about opiate in this book? I don't know if you do.

• 3:47:50Peter Attia?

  No.

• 3:47:50Jocko Willink?

  Nope. But you talked about it last time you were on my podcast, like you have been through really bad spots in just about every aspect or potential way a person can be in bad spots. And yet you've figured out that you can change.

• 3:48:11Peter Attia?

  This, this one's the hardest. This was the only one I really thought couldn't be changed. Um, I always had confidence the others could change. I always felt like I could bend the arc in anything else. This was the only one where I was like, this is truly unchangeable. Um, I've, I've never had a stronger belief in my life, stronger than the belief in gravity, that I could not change this, this set of traits in myself. That these, these were hardwired into my motherboard at birth.

• 3:48:47Jocko Willink?

  When's the last time you lost your temper?

• 3:48:51Peter Attia?

  Well, never in a destructive way since 2020. Now, I won't like, let me be completely clear. Three days ago is the first time in three years I got mad at another driver. And honked at them and yelled at them.

• 3:49:08Jocko Willink?

  Was this in traffic or is this on the race course?

• 3:49:11Peter Attia?

  No, no, no, it was just, we just, it was a, I was at the airport in San Diego and I went to get the car and I'm driving back to get, pick up my family and a bus cut me off. And I was like, all right, so I pull out of the way. And then I go to go around them the other way and then the bus like almost smashed me into a wall. So I pull out and I'm like, I mean, I just got super pissed in that moment and

• 3:49:38Peter Attia?

  you know, I'm honk, I like literally laid on my horn for 30 seconds, right? Like, how do you not see a vehicle? You literally almost put me into the wall.

• 3:49:49Peter Attia?

  And that's the first time I've had like road rage in three years.

• 3:49:53Jocko Willink?

  And what was your debrief to yourself after that?

• 3:49:57Peter Attia?

  I went through kind of like, okay, what, what made, what, what else was, what else was really bothering you that day? Cause you've been cut off a thousand times in the last three years and you've never cared. So what is it about that day? And secondly,

• 3:50:10Jocko Willink?

  Did you figure that out?

• 3:50:13Peter Attia?

  Yes, I think this is the, this time really was almost really resulted in an accident. Like it's a, there's an asymmetry when a bus is almost cutting you off.

• 3:50:23Peter Attia?

  Also, this sounds dumb and I don't know if this justifies any of it, but in my mind, it's like, this was an airport bus at the airport. Like you should know your way around the airport. You shouldn't be weaving in and out of lanes with concrete on either side. Like there was sort of an expectation.

• 3:50:39Peter Attia?

  But regardless, it was on my mind, like for a couple of days. I was really like examining this and here's another thing I've learned, like you have to forgive yourself. Like I'm not, I'm not here to say I'm perfect. But I'm here to say that I'm not going to let one mistake spiral into 20. So there, you know, I say this to my patients all the time. Don't beat yourself up if you miss your workout for a day. But just don't miss it two days in a row. Just get back in the gym the next day. Don't worry about it. If you eat, if you, if you go on vacation and eat like crap, come back and start eating well. Don't let a mistake spiral into infinite mistakes. And so in many ways, it comes back to this idea of shame, right?

• 3:51:22Peter Attia?

  It's really tempting for me to just berate myself in shame because of my misbehavior. But instead it was like, you know what? That's like not a proud moment for me. Like, I'm not proud of the fact that I laid on the horn and yelled at someone who, by the way, doesn't hear me, but it doesn't matter. The point is like, I'm not proud of how I acted and I'm gonna do better next time. But just by doing that, I can do better next time. Right? That didn't, it didn't ruin, and I'll, I'll tell you what I was most proud of is about 30 seconds after that, I picked up my family. And I was totally fine. Whereas like three years ago, that would have ruined the day. I would, my wife would have gotten the car and I'd have been like, you wouldn't fucking believe what just happened. This fucking idiot, I'm gonna go find them.

• 3:52:08Peter Attia?

  But instead, like to this day, my wife might hear this podcast, but she would otherwise have no idea what just took place. So it's just like, we're done with that. So, you know, it's a little bit of a setback, but there's a victory.

• 3:52:20Jocko Willink?

  I know that you posted the other day after you

• 3:52:24Peter Attia?

  Dry fired my bow.

• 3:52:26Jocko Willink?

  And you're like, hey, I click on it. You start off with something like, this is progress. I was like, oh no. And then, and I was thinking the same thing. I was like, well, and then you explained it. You're like, hey, you know what? I, you know, it's really dumb and I just, you know, shouldn't do it. And you know what? It's okay.

• 3:52:43Peter Attia?

  Yeah. I mean, like I had, I dry fired a bow in April of 2021. It was the last time I dry fired a bow. And I mean, and I, that was after going through all of this and I did okay, but I had to go jump into an ice bath. Like that was the own, and I still screamed, I was so pissed when I broke it. But prior to that, when I dry fired a bow, like 2019,

• 3:53:11Peter Attia?

  I smashed the bow after. Like, so you know, people listening might not understand what happens. When you dry fire a bow, you've already broken the string, the cams and the limbs. Well, then I just broke the bow. I was like, I just, I'm gonna destroy this bow. Everything is gone. Um, so yeah, like I, I, I think that's like literally the thing. If you did say like, what are the three things you're most proud of in the last 12 months? I literally would put that on, on those, the top three.

• 3:53:42Jocko Willink?

  Dry firing their bow.

• 3:53:43Peter Attia?

  Dry firing a bow and within three minutes. First of all, not yelling, not screaming, not throwing anything. And within three minutes, being okay.

• 3:53:53Jocko Willink?

  It's so crazy that you're a freaking grown ass man. That's a doctor, uh, this look at your life. Incredible. And you do that kind of shit. It's like, oh, you did that kind of shit. It's like, it's kind of crazy, right? Isn't that kind of crazy?

• 3:54:12Peter Attia?

  Yes.

• 3:54:12Jocko Willink?

  It's so hard to like picture that. I have a friend named JP Denell. Do you know JP is? I know you do. But my friend JP Denell, he's in the SEAL teams with me. He was, um, very young when he worked for me. And

• 3:54:28Jocko Willink?

  like I, he is, you know, had a bad temper. And at one point I was like, hey, man, losing your temper is a weakness.

• 3:54:38Jocko Willink?

  And we broke it down, you know, like later. Cause we look at our dads, right? And you're like, oh, when, when my dad loses his temper, it's like a force. It's like a thing. It's like no one, no, all of a sudden he kind of be turns into like a weird Superman character. Because now everyone cows to cows down to his behavior and everyone gets out of the way. And it's just like, so you see that and you go, I'm going to, I'm going to get that superpower. And that was what JP grew up with. Like, oh, you know, that's a power. And I was like, hey, man, when, when you lose your temper, it's a weakness. And that impacted him because he never saw it that way. And, and I, I don't even remember when I figured that out.

• 3:55:21Jocko Willink?

  I don't really remember when I figured that out, but it was, I was in the SEAL teams and I, you know, probably saw some idiot officer freaking lose their temper and start yelling and screaming. And everyone in the platoon going, what an idiot. And I remember thinking, I will never do that. You will never see me lose control of my emotions. That's, that's, that's a bad thing. And then just never let that happen again. That's, that's like.

• 3:55:46Jocko Willink?

  I think Echo Charles has a similar story where Echo Charles realized at some point that losing your temper, he read it in a book, actually, he read it in a book that losing your temper was a sign of, you know, insecure, that's what it was for him, it was he, he read in a book that losing your temper was a sign of insecurity. And he's like, I'm never gonna lose my temper again. And, you know, I haven't seen Echo lose his temper in a long time. But that's just, yeah, it's just so weird to think about that and think about how negatively that can impact you. When you, when you, uh, you see your kids lose their temper, how do you, how do you help them see the, the, uh, the problems that

• 3:56:30Jocko Willink?

  it causes? And I guess, how old are they?

• 3:56:33Peter Attia?

  Uh, just turned six and will be nine at the end of the summer.

• 3:56:37Jocko Willink?

  And Olivia's already, what?

• 3:56:38Peter Attia?

  Fourteen.

• 3:56:39Jocko Willink?

  Fourteen. So she's good to go. Um, so yeah, six years old, they're kind of not quite there yet. But nine, it's like, if you're losing your temper at nine, we can start discussing how that's going to impact you. So do you have any conversations like that? What do you do when they lose their temper?

• 3:57:00Peter Attia?

  Yeah, I mean, look, it's, um, you know, one of the great questions you can ask a kid when they're misbehaving in general, after the fact is, how, how, how did that impact the outcome? Right? As opposed to just saying, don't do that. Right? It's like, okay, you, you made a choice to act a certain way. There were repercussions from how you acted. How did it work out for you? Um, and that, that's one lesson I've taken away. Another lesson that I think every parent knows is the most important thing to do when a kid is losing it, and this is not easy to do, but it is important thing to do, is to not lose it yourself.

• 3:57:40Jocko Willink?

  I get asked, uh, like what you, hey, how do you discipline your kids? What's your favorite way of discipline? Do you, you know, do you beat them? Do you make them do burpees? Do you whatever, you know, they got a bunch of, and, and I got asked that a while ago. And I was like, I can tell you my favorite form of discipline with children. My kids, my favorite form of discipline was asking them questions. Because when you say exactly what you did, like, hey, that make you feel better? How's it, how's that outcome? How'd that, how'd that help you? How's that make you look? What do you think everyone's thinking of you right now? That you laying on the floor crying when you're seven? Or you're storming off the field when you're 10? Or whatever the case may be. Asking questions is powerful discipline, disciplinary tool for children.

• 3:58:25Jocko Willink?

  Um, like I said, there's so much of this that you cover, which we didn't even touch on. We didn't cover the actual tools that you use, that you got taught to, to handle this. To, you have tools that you learned to utilize. Just like I could teach you how to shoot a bow. You got taught what to do when your temper starts to flare up? When you start feeling certain emotions? And it's all in the book and it's so worthwhile to read that for yourself and for your family and for everybody around you, that you can, there's tools that you can utilize to come, to overcome those things. Um, but you know what? I'm going to fast forward a bit and kind of close this thing out.

• 3:59:09Jocko Willink?

  I mean, we've been in here for, I think, approaching four hours. Uh, you write this. As my recovery progressed, I noticed my preoccupation with dying began to fade away and my quest for longevity no longer felt like a grim desperate task. Now the things I did every day felt welcome, necessary. I was enhancing my life and looking forward to the future. My journey to outlive finally had clarity, purpose and meaning. It brought me back to something my dear friend Rick Alias had told me. Rick had been one of the 155 passengers on US Airways flight that emergency landed in the Hudson River in January of 2009.

• 3:59:54Jocko Willink?

  As the plane was coming down, Rick and most of the other passengers were certain that they were going to die.

• 4:00:01Jocko Willink?

  Only the pilot's skill and more than a little luck prevent a disaster. If the plane had been going down, if the plane had been going a little faster, it would have broken apart on impact. A few miles per hour slower and the nose would have tipped forward and it would have sunk into the river. A handful of tiny factors like that made the difference between everyone on that plane living and many or most or all of them dying. That day changed Rick's outlook on longevity in a way that really resonates with me. All that time I had been obsessed about longevity for the wrong reason. I was not thinking about a long, healthy life ahead. Instead, I was mourning the past.

• 4:00:43Jocko Willink?

  I was trapped by the pain that my past had caused and was continuing to cause. I wanted to live longer, I think only because deep down I knew I needed more runway to try and make things right. But I was only looking backward, not forward. "I think people get old when they stop thinking about the future," Rick told me. "If you want to find someone's true age, listen to them." "If they talk about the past and they talk about all the things that happened and that they did, they've gotten old." "If they think about their dreams, their aspirations, what they're still looking forward to, they're young."

• 4:01:28Jocko Willink?

  Here's to staying young, even as we grow older. So, uh, that's the book. That's some good advice from the doctor.

• 4:01:45Jocko Willink?

  And you give away advice all the time. You're still doing that now. That's what you're doing now. What currently, what are you doing? Tell us what you're doing, where we can find you.

• 4:01:57Peter Attia?

  Well, my podcast, The Drive, still comes out every week. So that's, you know, continued to be a huge joy. We're about five years into that and I, we've come no closer to running out of topics to explore than we were five years ago. So I see no end in sight to that. And we have recently launched, well, we soft-launched it. It'll be kind of rolled out a little bit more this year, a product called Early, which is sort of a digital, I don't know how to describe it, other than kind of a masterclass of everything we do in the practice. So this is something that took us two years to build. And it's, it's,

• 4:02:39Peter Attia?

  it's truly the, this is all you need to know to do all this. And it, you know, it's, God, it's probably 30 hours of highly-produced video, plus tons of downloadable material and stuff like that. So we had a very limited release of it in April, where we put it out for four days, just to our subscribers. We're gonna have another release later this year, and then probably open it up to the public in the beginning of 2024.

• 4:03:02Jocko Willink?

  Because your practice, we've mentioned your practice, but your practice is helping people have better health span and lifespan.

• 4:03:08Peter Attia?

  Yeah, but it's super small, and it's effectively closed. I mean, at this point, it's sort of a friends and family.

• 4:03:15Jocko Willink?

  But this is a way for a normal person to say, alright, I read this book. Because look, what we covered, I barely dusted on anything that's in the book today. Like, it's freaking 410 pages of dense, awesome information. We barely touched on any of it. And once you get done with that book, you're gonna say to yourself, I need more. So, the podcast, you have a subscription version of the podcast as well?

• 4:03:39Peter Attia?

  That's right. So it's, one episode a month is dedicated to subscribers, called an AMA, and then, and then the show notes are for subscribers only. So yeah, we don't, we don't have any ads on our podcast. It's all subscriber.

• 4:03:53Jocko Willink?

  You're on Twitter?

• 4:03:54Peter Attia?

  Yeah, Instagram more.

• 4:03:56Jocko Willink?

  You're on Instagram the most. You're on, you have a YouTube channel?

• 4:03:59Peter Attia?

  Yep.

• 4:03:59Jocko Willink?

  You have a Facebook. They're all?

• 4:04:01Peter Attia?

  They're all Peter Attia, M.D.

• 4:04:02Jocko Willink?

  Peter Attia, M.D. He got it done. He got it done. I let...

• 4:04:06Peter Attia?

  Only because somebody had Peter Attia before I started.

• 4:04:08Jocko Willink?

  Oh, otherwise you...

• 4:04:09Peter Attia?

  Otherwise, I wouldn't have thought to put the M.D. on there. It seems a bit douchey, but...

• 4:04:14Jocko Willink?

  Well, luckily, there was no other Jocko Willink back when I got a hold of my stuff. But um.

• 4:04:20Peter Attia?

  Jocko Willink MD.

• 4:04:22Jocko Willink?

  Definitely, definitely not. That's for sure. Kerry.

• 4:04:26Speaker 02

  Sir.

• 4:04:27Jocko Willink?

  You got Echo's job right now. You got any questions?

• 4:04:29Speaker 02

  I got an echo question, actually.

• 4:04:31Jocko Willink?

  Oh, damn.

• 4:04:32Speaker 02

  So you you talked a lot in the book about sleep and, you know, the the effect that has on our ability to perform and things like that. I'm curious about your kind of opinion on mouth taping. Do you have an opinion?

• 4:04:47Peter Attia?

  I do, yeah.

• 4:04:47Speaker 02

  Okay.

• 4:04:48Peter Attia?

  Yeah. It's it's really, it's really important for people who are mouth breathers to to not be mouth breathers. So when you're breathing through your mouth,

• 4:04:58Peter Attia?

  be it awake or at sleep, I mean, you basically want to reserve mouth breathing only for when there is no other option, which should really only be when you're exercising strenuously. And so if you're sleeping and you're mouth breathing, it is sending a message to your brain that your energy requirements are significant and you're in a more sympathetic state. So your sympathetic nervous system ramps up, your parasympathetic nervous system goes down, your heart rate goes up, your heart rate variability goes down. So this is a physiological state you don't want to be in when you're trying to rest and recover. So again, once you address any structural issues that the person might have in their nose, being able to put on mouth tape for people is an awesome tool to teach them how to nasally breathe.

• 4:05:39Speaker 02

  Right on. And what are some of the benefits of nasal breathing? I I know there are some, I'm just not 100% sure what they are.

• 4:05:46Peter Attia?

  I mean, everything actually start, I write a lot about sort of how so much starts with the breath, right? So your breathing strategy, and there were basically two major breathing strategies. Your breathing strategy determines your center of mass, your center of mass determines how you how you kind of exist with gravity in in the world, right? So are you hunched over? Are you sitting up too much? Being in that high sympathetic, low parasympathetic state by itself is counterproductive to your health. So that's, that's really why you want to be nasally breathing.

• 4:06:20Speaker 02

  Got it. Cool. Yeah. JP Donnell and I both, we've been geeking out about the mouth tape. We both do it now when we sleep and it's, it's been crazy beneficial for me. I used to wake up with headaches a lot of times and because my mouth was like gaping open when I was sleeping, I guess. But it's, it's been super helpful.

• 4:06:37Peter Attia?

  Awesome.

• 4:06:37Jocko Willink?

  Yeah. I'm glad you, I'm glad you asked that question because that's the type of information that you can get from, from your podcast, from the Drive Podcast, from the book, from the newsletter that you send out, from everything. So I'm glad you, like legit, like that's, I'm glad you asked that because I spent all my time talking about death and hell and all this other stuff. So that's what I did, but that's not what you do for a living. That's just the stuff I wanted to talk to you about, you know, as, as my bro. Peter, you got any closing thoughts?

• 4:07:09Peter Attia?

  No, guys, this is, uh, it's a privilege to sit down and be able to go deep into this stuff.

• 4:07:16Jocko Willink?

  Well, uh, thanks for joining us once again. I can't believe it's been seven years or yeah, something like seven years since you came on this last time. Um, thanks for what you're doing.

• 4:07:26Peter Attia?

  Last time I was on, I was just starting to write this book, put it that way.

• 4:07:30Jocko Willink?

  Wow. Crazy. Uh, thanks for what you're doing for so many people. You give away so much information and everybody is, should be so appreciative of that. Thanks for your friendship over the years, man. Um, it's been very meaningful to me. Uh, but like your friend Rick said, after his exposure to death on that seemingly doomed plane, I like to think more about the things we will do in the future. Um, the hunting, the shooting, the driving.

• 4:08:03Peter Attia?

  And the mystery mission.

• 4:08:04Jocko Willink?

  The mystery mission, which I got for you, which is going to be so freaking awesome. Uh, I got.

• 4:08:11Jocko Willink?

  Peter's wife asked his friends to send a video with something, some request, some event that they were going to, that we would do with Peter individually, in the future, sometime in the future, in the next five years. And I couldn't think of anything, because what do you get, what do you do with Peter? Like, I was like, oh, we go hunting, oh, we go shooting, oh, there's a bunch of stuff. I was like, yeah, blah, blah, blah. No offense to people that said that, because it'll be awesome. But I got struck with a bolt of lightning of something that I know he could never guess. It's something that he's been preparing for his whole life, but that he doesn't need to prepare for, but it's something that he's never done before. If you can imagine all that.

• 4:08:51Peter Attia?

  And do you remember how you worded it in the video?

• 4:08:54Jocko Willink?

  What'd I say?

• 4:08:55Peter Attia?

  So you gotta remember, my wife, this is, she asked me, what do you want for your birthday? And I said, this is what I want. I don't want any presents, I don't want a party. I want, I want an experience with each of my friends. And, um, and so it's this two-hour video, right? Because, you know, every person's gonna talk for a few minutes. And it's amazing. And Jocko's is, "I will call you with a pack list and coordinates and a time to meet."

• 4:09:24Speaker 02

  Freaking morning order on this.

• 4:09:25Peter Attia?

  And, and by the way, he prefaced this with a beautiful, beautiful, a lot of really, you know, and, and the ask wasn't, what do you have to say to Peter? But a lot of people did that anyway, and it was very kind, and meant a lot to me. But after Jocko had one of the sweetest things to say, it was, "This is the gift. Pack list, coordinates, time. Be there."

• 4:09:48Jocko Willink?

  It's gonna be like, it's gonna probably be three, three days total, with maybe a day of travel on either side, or a half-day of travel, so. It's gonna be awesome. But that's what I like to think about, like your friend Rick advised. I like to think about what we're gonna do in the future. We're gonna do that, we're gonna do rock marches, we're gonna, we're gonna do a lot of cool stuff in the future. And I think, as much as we can, we will do our best to stay young and outlive. Thanks, bro.

• 4:10:19Peter Attia?

  Thank you.

• 4:10:21Jocko Willink?

  And with that, Peter Attia has left the building and well, freaking I legit, I'm glad you asked that question at the end because that's the kind of knowledge that he is freaking packed with and go listen to the first podcast. I mean, the guy's life has been, he's been overachievers all whole life. He just, he is brilliant and he's been focusing on this stuff for decades and, and he's willing just to give it away. So, and I didn't do the best job of like bringing forth that information. That's what the whole book is filled with. Get the audio book. Like, do you really want to hear me sit here and, and read the scientific

• 4:11:04Jocko Willink?

  parts of this book? I, I was like, well, I could do that or you can go get the audio book and listen to the doctor himself read it. That's what we did. I'm glad you asked that question. So people recognize how much information they can get from him, from his podcast, from this book, Outlive, The Science and Art of Longevity.

• 4:11:22Speaker 02

  Yeah. You got an opportunity. You got Peter Attia in the room, man.

• 4:11:26Jocko Willink?

  You're gonna ask him what's up.

• 4:11:27Speaker 02

  Something cooking on the brain.

• 4:11:28Jocko Willink?

  Yeah, you've been taping that mouth, been taping that mouth breather up.

• 4:11:31Speaker 02

  Yeah, bro, me, me and JP, Danelle, we've been geeking out about that, man. We, we both use the same like brand of tape or whatever. And it's been.

• 4:11:40Jocko Willink?

  We're getting your hostage tape on. That's what it is, right?

• 4:11:43Speaker 02

  Yeah, that's, that's the one we've both been using and it works, man. Not waking up all, you know, headaches and.

• 4:11:50Jocko Willink?

  Bro, I'm glad because for so many years I've been running around telling people, hey, quit being a mouth breather, right? Like, what's your problem?

• 4:11:55Speaker 02

  All this time.

• 4:11:56Jocko Willink?

  All this time. And I didn't know there was some scientific truth for it, right? But guess what? Doggo is right again, man. Quit mouth breathing, son.

• 4:12:04Speaker 02

  It's, there's.

• 4:12:05Jocko Willink?

  I'm glad you got that tape. I was wanting to tell you to get that tape, boy.

• 4:12:09Speaker 02

  Close that mouth, boy.

• 4:12:13Jocko Willink?

  Oh, there was a guy that was a mouth breather in the SEAL teams, but somehow his, his nickname wasn't mouth breather was fart sniffer. Because it kind of looked like he was kind of had his mouth open like he was kind of like trying to sniff that fart.

• 4:12:27Speaker 02

  Yeah.

• 4:12:28Jocko Willink?

  Pretty rough nickname on my homeboy, but no, that's the way it goes sometimes.

• 4:12:32Speaker 02

  It's crazy too. I, I catch myself closing like literally I'll, I'll be breathing through my nose more throughout the day too. And I'll just notice it like my, my mouth closed. I'm breathing through my nose. I, I don't know if that's, you know, a subconscious thing that's going on.

• 4:12:47Jocko Willink?

  Cause the damn improvement, bro.

• 4:12:50Jocko Willink?

  I feel like that bad friend now that didn't tell his buddy he had a bugger hanging out, you know, I should have been like, hey, bro, your mouth breathing all about me, man. Step back and shut your damn mouth. Shut your mouth, man. Shut your mouth.

• 4:13:02Speaker 02

  Well, your boy's on it. We're getting that taken care of.

• 4:13:05Jocko Willink?

  Right, right. There you go. Um, well, hey, that's one of the many ways we can try and become healthier, uh, and live healthier.

• 4:13:13Speaker 02

  Live.

• 4:13:14Jocko Willink?

  Longer, have a better health span, a better lifespan, all that stuff. So that's what we're doing. Need to get the right fuel in your system, by the way. You might as well go get that Jocko fuel.

• 4:13:23Speaker 02

  A hundred percent.

• 4:13:24Jocko Willink?

  Get that Jocko fuel hitter.

• 4:13:30Jocko Willink?

  What am I thinking about? I'm thinking about milk cause, cause that's one thing Peter was saying. You gotta up that protein. You gotta up the protein. You might as well just get that up that protein when it tastes good. And it's, what is that word? Satiating, right? It fills you up. Crack that milk and get it done. RTD style.

• 4:13:49Speaker 02

  All day.

• 4:13:50Jocko Willink?

  So RTD, if you're not in the industry, that means ready to drink. You can get, get some milk and just have it in your house. You can drink 30 grams of protein like a boss.

• 4:13:59Speaker 02

  Two, two minutes.

• 4:14:00Jocko Willink?

  Like a boss.

• 4:14:02Speaker 02

  It's amazing.

• 4:14:02Jocko Willink?

  Tasty. And you know what's crazy? It's so, it's filling. You feel, you feel good.

• 4:14:09Jocko Willink?

  So get some of that and and and look, I'm still old school with the pow pow. Get the mulk powder. Cause if you're feeling like you want a little bit more, you know, like if you want a full on meal, that's dessert.

• 4:14:21Speaker 02

  Milkshake action.

• 4:14:23Jocko Willink?

  You want milkshake action?

• 4:14:24Speaker 02

  Yeah.

• 4:14:24Jocko Willink?

  Yeah, go get yourself, get some of the powder. Um, joint warfare, super krill, krill oil, vitamin D3, we we got it all for you.

• 4:14:32Speaker 02

  Time war.

• 4:14:34Jocko Willink?

  Time war.

• 4:14:34Speaker 02

  You want longevity, bro. You want eyesight?

• 4:14:37Jocko Willink?

  Yeah. Get that.

• 4:14:40Speaker 02

  Get that time war.

• 4:14:41Jocko Willink?

  Get the time war. Time war is the subscriptions for time war is crazy right now because when you so when you go to jockofuel.com, you can you can get it. And then if you like it, you can subscribe to it. So right now, like, once people go on time war, they're just hitting that subscribe button. Just send that shit to me, boy. Send it to me.

• 4:14:59Speaker 02

  I was I was digging into the Jocko system the other day because I was tooling around on jocko fuel, you know, I'm getting some stuff. And yeah, I was looking, there's like the Jocko system and the ecosystem. And I was like digging around drawers. I was like, oh, okay. Got the full stack. Uh, there's go like in that system too. So all the all the cool things we just mentioned, they're all like listed in order in that in that stack. So easy access.

• 4:15:22Jocko Willink?

  Yeah, time war is one of them. I I told you this before, like, I will take time war until I die. Just the way that what you get out of it from a from a feeling good perspective to like the joints to the and the eyesight thing was crazy to me. The eyesight thing was crazy. My eyesight got legitimately better than like a must have been about to say, I have to look at what what the muster was because I that's when I noticed it. But it's crazy. So anyways, go to jockofuel.com, get yourself some of that. Uh, if you don't go to jockofuel.com, you can go to Wawa, you can hook it up at Wawa, bottom right corner of that shelf. They kind of we got we got to put the squeeze got put on us by the big imperialistic

• 4:16:06Jocko Willink?

  beverage companies. You know who they are and I need to name them. There's you know who they are, trust me. But they went paid millions of dollars to try and subdue the rebels.

• 4:16:17Jocko Willink?

  Try and take out the rebels. We're out there on what planet? We're on Hoth or some

• 4:16:22Speaker 02

  Tatooine.

• 4:16:22Jocko Willink?

  Tatooine, right? We're out there trying to be free, trying to offer people something that's actually good for them. They're trying to, they're trying to take us out with the Death Star.

• 4:16:29Speaker 02

  You, you can't deny performance. Jamie Cochran said that when she was on the podcast the, the other day, man. And, uh, that's where I think about our people clear shelves. Like you can't compete with that. You know, you, you can't buy that away from us.

• 4:16:44Jocko Willink?

  That's the way it goes down. Look, if not vitamin shop, GNC, uh, we're coming into APs. So all those military commissaries across the world, be able to get your supply, be able to get it. Hanaford Dash Stores in Maryland, Wake Forest Shop, right? HEB, HEB's represent all you've, all my people down in Tejas, just rolling in there and just getting after it. Thank you. Appreciate it. You, you got a full supply at HEB. We're sending it as fast as we can. Meyer up in the Midwest. Harris Teeter in there now. Lifetime Fitness in there. Shields, rolled into Shields, 300,000 square feet of just awesomeness. Go check that out. And they also have Jocko Fuel. They got everything

• 4:17:24Jocko Willink?

  you want, including Jocko Fuel. And, and by the way, we're in a bunch of little gyms, small gyms, jujitsu gyms, CrossFit gyms. We're in there. We're, we're the, we're the, we're the energy drink of CrossFit. So when you get done knocking out that Annie, knocking out that workout of the day, before you hit it, you can get that energy drink. After you hit it, you can get that milk header, get that protein in you. If you're, if you own one of those gyms, you want to sell Jocko Fuel, go to J or email J F sales at Jocko Fuel.com. We can hook it up.

• 4:17:58Speaker 02

  Get that wholesale account.

• 4:18:00Jocko Willink?

  That wholesale account rolling. OriginUSA.com. Uh, we just, we just launched workout gear.

• 4:18:07Jocko Willink?

  Hey, it took a while. I know. Trust me. I know. Trust me, I know. But to reestablish a supply chain of American-made materials so that we could cut and sew it here in America, took a little bit of extra time. Then to design it properly, get the right materials, it took some time. But we got it now. RTX, roll, train, execute, execute, execute. Uh, you can get that. You can get hunt gear. You can get your Jiu-Jitsu gear. You can get, you know what? Hoodies, bro. Are are hoodies American?

• 4:18:39Speaker 02

  Yes.

• 4:18:40Jocko Willink?

  Hundred percent, right? Where if you're in America, you wear a hoodie.

• 4:18:44Speaker 02

  Yes.

• 4:18:45Jocko Willink?

  Right? You're you have a hoodie. You probably got two. Get yourself one more. Get yourself an American-made Kilo hoodie.

• 4:18:52Speaker 02

  Get the Kilo.

• 4:18:53Jocko Willink?

  Get the Kilo hoodie. The if you're if you're in the northern part of the States, get the heavy, uh, but the Kilo everywhere else. But bro, you see, you you never lived in the northern part of the States.

• 4:19:03Speaker 02

  No.

• 4:19:04Jocko Willink?

  Cause in the summertime, in the fall, you don't need, you don't need that. You the heavies for the cold weather. You need that Kilo.

• 4:19:10Speaker 02

  That Kilo that's year round.

• 4:19:12Jocko Willink?

  Kilo hitter. And look, you live, this is what we were talking, just at a, at a, at a meeting with Origin and Jocko Fuel. And they're like, well, you know, it's, it's, we're not going to be selling many kilos right now, because it's the summertime. And I was like, bro, what are you talking about? What are you talking about? In California, you need to, you need a Kilo year round.

• 4:19:32Speaker 02

  Hundred percent.

• 4:19:32Jocko Willink?

  Year round.

• 4:19:33Speaker 02

  Back, back of the, back of the Jeep, I've got two key, like, two kilos, you know, after 7:00 PM, you throw that little guy on, you're good.

• 4:19:42Jocko Willink?

  But California, but but East Coast, same thing. You, I was in Maine, when I was growing up in Maine, the sun goes down, guess what? You need to put that Kilo on.

• 4:19:50Speaker 02

  That Kilo.

• 4:19:51Jocko Willink?

  That Kilo is a go-to piece of equipment that should be with you at all times. Now, listen, I'm not going to lie to you. I have a blue Kilo, I have a black Kilo. Blue Kilo is what I work out in the morning. Black kilos kind of the wear around. I have a cami. I have that raptor kilo. And look, do I wear it when I'm out in the woods? Yeah. Do I wear it when I'm also rolling down, down the streets? Hell, yeah.

• 4:20:16Speaker 02

  Do you wear it rolling into the podcast studio every day?

• 4:20:19Jocko Willink?

  Yes, yes, I do. And then I have, we have a zip up on now too. And I got one of those. What I found out about the cool about the full zip for travel, if you're traveling, you may want to have some variable warmth, right? So you unzip it. It may not sound like much, but you just unzip that bad boy and all of a sudden let that coolness in. Or a little chill, little chill coming through, little wind, no problem. Zip it up. We're good. Get that versatility with the kilo zip hoodie. Dude, I just invented that, right? Hey, if you get hot, unzip it. I'm over here smart.

• 4:20:54Speaker 02

  Very good technology.

• 4:20:56Jocko Willink?

  I'm giving Peter a T a run for his money on intel, on his intelligence. Cause I said, if you get hot, you can unzip your hoodie. Check it out. OriginUSA.com. Go get yourself an American made hoodie and wear it with pride. Help your, help the national security in this country and help your children live in a stable, free nation in the future. That's what we're doing. OriginUSA.com. There you go.

• 4:21:23Speaker 02

  Also got Jocko store, Jocko store.com.

• 4:21:26Jocko Willink?

  Damn, you had one job.

• 4:21:29Speaker 02

  Blew it.

• 4:21:32Jocko Willink?

  It would echo hears that right there, bro.

• 4:21:34Speaker 02

  Game over, man.

• 4:21:35Jocko Willink?

  What'd you say? Jocko, what? Let's give it a go. Let's give it a go. Here we go.

• 4:21:40Speaker 02

  Jocko store.com. We got rash guards, T-shirts, trucker hats, beanies, hoodies. We got the shirt locker subscription. Echo is putting out a shirt every month, new design every month. This is one of the earlier shirt locker ones. This is still one of my favorites though. We got the element D. And we got layers in, in every shirt. This one's got the zero, zero, four, 34 at the bottom. No big deal, but great subscription, new shirt.

• 4:22:06Jocko Willink?

  Layers.

• 4:22:07Speaker 02

  Layers. Getting deep in the layers.

• 4:22:10Jocko Willink?

  Layers. It's like the first time Echo said that, man. I was like, are you kidding me? And now we say it. It's, now everyone says it.

• 4:22:17Speaker 02

  It's so true.

• 4:22:18Jocko Willink?

  People talking about them layers. Actually, we gotta go back. I don't know who said that first. I might have said that first. Gotta watch the tape. Gotta go back to the tape, man. We'll check it out. Yeah. If you want to get some of those later, jocko store.com, subscribe to the podcast. Uh, so also subscribe to jocko underground.com. We got that going on and just in case all other forms of communication go down, we'll be there on the underground.

• 4:22:40Jocko Willink?

  Jocko underground.com. We got a YouTube channel. Subscribe to that. Origin USA YouTube channel, Jocko Fuel YouTube channel, Echelon Front. You've got some YouTube channels. You want some, you want to get some, you watch some videos, watch some good ones.

• 4:22:55Jocko Willink?

  Psychological Warfare on iTunes, flipsidecanvas.com Dakota Meyer, just making cool stuff for you to hang on your wall. Got some books, Outlive, The Science and Art of Longevity by Dr. Peter Attia. Just get that book. It's a textbook for you on how to be a better human. So there you go. I've also written a bunch of books. You know what they are. Final Spin, Leadership Strategy and Tactics, Code Warrior, or the Code, Devaluations of Protocols, Discipline Goes Freedom, Field Man. I mentioned it today, had to quote it today because I knew Peter T was going to come at me.

• 4:23:28Jocko Willink?

  He was going to come at me.

• 4:23:31Jocko Willink?

  Yeah. You gotta sleep. You gotta sleep. It's good for you. Tape that mouth, son. Tape that mouth, boy.

• 4:23:41Jocko Willink?

  Way of the Warrior, one, two, three, four, and five.

• 4:23:46Jocko Willink?

  Everywhere I go, those parents are thanking me because of what their kids are doing.

• 4:23:52Jocko Willink?

  So they're doing jujitsu, they're doing pull-ups, doing all the stuff that Peter T was talking about today. He talked about how you would change the way children are raised. His kids are warrior kids, by the way. Forgot to mention that today. But his kids are absolute warrior kids. He posted the other day doing the warrior kid workout. They're in the game, bro. Get the kids, you know that book. Mikey and the Dragons, About Face. Extreme Ownership, The Dichotomy of Leadership. It's all there. Echelon Front, we have Leadership Consultancy. We solve problems through leadership. That's what we do. Go to echelonfront.com for details. Next big event. Let's say we get the council, which is sold out. We got, we got a battlefield, August 8th through the 10th at Little Big Horn. I think there might be a couple tickets left.

• 4:24:37Jocko Willink?

  So if you want to come and check that out, come and check it out. We got a women's assembly run by Jamie Cochran, our chief operating officer. What'd she say? You just quoted her?

• 4:24:46Speaker 02

  Um.

• 4:24:47Jocko Willink?

  Can't deny performance.

• 4:24:48Speaker 02

  Yeah, yeah.

• 4:24:48Jocko Willink?

  There you go. Well, there you go. You want to learn about that activity? Go to the women's assembly. What's it called? The women's summit?

• 4:24:55Speaker 02

  Uh, so it's, it's the assembly now.

• 4:24:58Jocko Willink?

  Oh, okay.

• 4:24:58Speaker 02

  Yeah. So they, they had a, you know, a little name change, but the women's assembly, uh, it's a free, uh, live event that we host through the Extreme Ownership Academy.

• 4:25:09Jocko Willink?

  Got it. And the summit is an actual live event.

• 4:25:11Speaker 02

  The assembly. Yeah. The assembly will be the, the, the in-person event in Phoenix.

• 4:25:17Jocko Willink?

  Okay. It's September 14th and 16th, Phoenix, Arizona. So go check that out if you want. We also have online training, Extreme Ownership Academy.

• 4:25:27Jocko Willink?

  This is where you learn the jujitsu of life.

• 4:25:31Speaker 02

  A hundred percent.

• 4:25:31Jocko Willink?

  That's where you learn the jujitsu of life. And listen, if you don't understand jujitsu, let me explain it to you. A person that weighs a hundred and fifty pounds can beat a person that weighs two hundred and fifty pounds. That's what can happen with jujitsu. If you want to learn jujitsu of life, so you can outmaneuver, outthink, overcome problems, lead, go check out Extreme Ownership Academy, extremeownership.com.

• 4:25:56Speaker 02

  How, how, how much of, how much of your, um, career would you say was relationships based?

• 4:26:03Jocko Willink?

  Uh.

• 4:26:03Speaker 02

  Like in the teams, like percentage wise?

• 4:26:06Jocko Willink?

  Ninety-nine percent.

• 4:26:08Speaker 02

  Ninety-nine percent. Right on.

• 4:26:09Jocko Willink?

  Ninety-nine percent was relationship based. I, I, I, I will have to think about this. I never, as a matter of fact, I just got done saying this to a company. I never had to say, hey, like do what I told you to do, which is not relationship based. That's authoritarian based. That's rank based. Never had to do that. Never had to do that. Very seldom, and I can't think of any examples where my boss told me like, hey, shut up and do what I told you to do. No, because I had a good relationship with him. They wanted to know my opinion. They wanted to take lead from me. We were influencing each other. We were listening to each other, up, down, and across the chain of command. So you want to talk about how to get through life in a better way? Build good relationships.

• 4:26:53Jocko Willink?

  So we actually teach, because there's, this is, you can't, if I asked you like right now, hey, hey, Kerry, build me a 40-foot gaff-rigged schooner boat. Would you be able to do that? Negative. No, you don't know how. No. There's skills you would need. Yes, sir. It's the same thing with building relationships. There's skills that you need. There's things that you can do to build strong relationships. And when you build a strong relationship, you build a strong team. When you build a strong team, you get the results. So that's what we're doing. Go to extremeownership.com and learn how to build relationships, learn how to make decisions, learn how to get better, and learn how to lead. That's what we're doing.

• 4:27:36Jocko Willink?

  Also, if you want to help service members, active and retired, you want to help their families, want to help Gold Star families, check out Mark Lee's mom, Mama Lee. She's got a charity organization. If you want to donate or you want to get involved, go to AmericasMightyWarriors.org. She is doing all kinds of things to help our veterans. And also, don't forget about HeroesAndHorses.org. That right there is Micah Fink's organization. We just got a report in from the field. Did you get that report from the field? I did not. Okay. I probably should have related to you. Currently, Micah Fink, he just actually had a wrestling match with a bear, and he was about to submit it.

• 4:28:21Jocko Willink?

  When out of nowhere flew a bald eagle and the bear got scared and ran away. So we're still giving it to Micah undefeated.

• 4:28:31Speaker 02

  A hundred percent.

• 4:28:32Jocko Willink?

  Hundred percent undefeated in the field. He's out there getting after it. No, but seriously, Micah Fink doing awesome stuff, helping veterans, first responders, find themselves out in the wilderness. It's an awesome program. If you want to connect with us on the interwebs, Peter Attia is on Twitter, on the Gram, on YouTube and Facebook, all of them at Peter Attia M D. And for us, Kerry Hilton is at Kerry underscore Hilton. Didn't get that, didn't get it, huh?

• 4:28:58Speaker 02

  Still, still haven't gotten that one resolved.

• 4:29:00Jocko Willink?

  Didn't get that Kerry Hilton. Is there another Kerry Hilton out there? Somebody has that?

• 4:29:04Speaker 02

  There is, yeah. And yeah, I hit him up, trying, trying to say, hey, man.

• 4:29:08Jocko Willink?

  Oh, because he's not active?

• 4:29:09Speaker 02

  Negative. Yeah.

• 4:29:11Jocko Willink?

  Did he get it before like?

• 4:29:13Speaker 02

  Yeah, yeah, he's, he's had it for a long time. I, I first hit him up a couple of years back and was just like, hey, man, like if, you know, maybe we can work something out.

• 4:29:22Jocko Willink?

  Throw you a hundo, bro.

• 4:29:24Speaker 02

  No interest, zero interest in responding to Kate.

• 4:29:28Jocko Willink?

  Got some computer out there. I, that's Kerry. Kerry's at underscore Hilton. And I'm at Jocko Willink. Just watch out for the algorithm, man. Just, just please. And thanks to all the service men and women out there who are on the front lines of defense around the world, keeping us safe. Also, thanks to our police, law enforcement, firefighters, paramedics, E M Ts, dispatchers, correctional officers, border patrol, secret service, all first responders. Thank you for keeping us safe here at home and a special thank you right now in honor of Dr. Peter Attia. Thanks to all of you doctors, nurses, that's in honor of Peter's wife Jill,

• 4:30:07Jocko Willink?

  and all the healthcare professionals out there who support us in our darkest hours. And to anybody else out there and everybody else out there,

• 4:30:22Jocko Willink?

  just remember what Peter Tia said. If he can change, so can you.

• 4:30:31Jocko Willink?

  So can you, and that is so powerful. It's so true. Look, if you've been on the wrong path, if you've taken some hits, if you've been doing some things you shouldn't have been doing, if you're not as healthy or productive as you should have been, and maybe you haven't been the best mother, or the best father, or the best husband, or best wife, maybe you've been hyper emotional, or not emotional enough, and maybe you've been lazy, and gluttonous, and just generally freaking miserable.

• 4:31:03Jocko Willink?

  You don't have to be.

• 4:31:06Jocko Willink?

  You can't change overnight, but you can change. You can do it. But in order to change who you are, you have to change what you do, how you live, and that is something you do have full control over, and there's no better time to start than now.

• 4:31:26Jocko Willink?

  So put down that doughnut. Pick up that kettlebell.

• 4:31:33Jocko Willink?

  And get after it. And until next time, this is Kerry and Jocko, out.