Conversation with Dr. Peter Attia — The Pillars of Healthspan and Longevity

Dr. Peter Attia, the founder of Early Medical and the author of the #1 New York Times Bestseller, Outlive: The Science and Art of Longevity, joins Scott to discuss how to live a healthier life, specifically from a physical, cognitive, and emotional perspective. Scott opens with his thoughts on Google losing an antitrust case, why Macy’s is up for sale, and why higher education institutions need to draw a line. Algebra of Happiness: when not to make decisions. P. S. You can access Scott’s free brand strategy course for mobile at profgcourse.com/pod. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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

• 0:01Scott Galloway?

  Support for the show comes from Northwest Registered Agent. Your business identity is everything that makes your business legitimate and professional. With Northwest Registered Agent, you don't just form a business, you start a complete foundation built for privacy, credibility, and growth. That includes registered agent service, a business address, operating agreement, domain, website, professional email, phone number, and built-in privacy. In other words, your home address, personal email, and phone number stay private. Don't pay hundreds or thousands of dollars for what you can get from Northwest for free. Visit northwestregisteredagent.com/profgfree and start using free resources to build something amazing. Get more with Northwest Registered Agent at northwestregisteredagent.com/profgfree.

• 0:48Speaker 01

  If your best finance people are doing expense reports, chasing receipts, or spending time on month-end close, it's time to get Brex AF, agentic finance that eliminates that work before it starts. Learn more at brex.com/AF.

• 1:07Scott Galloway?

  Episode 279, 279 is the area code serving Sacramento. 1979, ESPN launched, becoming the first 24-hour cable network dedicated to sports. And the McDonald's Happy Meal debuted in the United States. True story, I saw this ridiculously hot guy spank his little boy after he threw his fries on the ground. So I threw my fries on the ground. Come here daddy. That's right. Go, go, go!

• 1:43Scott Galloway?

  Didn't see that coming. Welcome to the 279th episode of the Prop G Pod. In today's episode, we speak with Dr. Peter Attia, who's already regretting being a guest on this show, if he actually listens to it. I'm a narcissist, I listen to all the shows I'm on, and Dr. Attia strikes me as a little bit of a person with a big ego, in addition to being very smart. In addition to being very smart and having a big impact, I'm already trying to put those words back in my mouth, the founder of Early Medical and the author of the number one New York Times bestseller, Outlive: The Science and Art of Longevity. I've been following Dr. Attia for a while, and I am thrilled to have him on the show. There's sort of, whenever I read anything, I'm hoping to get one big insight that I'll hold on to.

• 2:23Scott Galloway?

  And the insight I gleaned from Dr. Attia and his work is that it's not about longevity, it's about the quality of your life. And something he said really impacted me, and that is, people decide that, okay, I'll trade off, I'll treat my body like shit in exchange for living to 85 instead of 90. That's not the trade off. The trade off is what do you want the quality of your life to be from 65 to 85? Do you want it to be, you know, you're able to hang out with your grandkids and able to go to the beach and play sports and be active and feel good? Or do you want to have, you know, toes and fingers start to get cut off because of diabetes? It was a little much. Anyways, that really struck

• 3:02Scott Galloway?

  me and something I have done my whole life since the age of, I started when I was 13, but got serious about it when I was 18. I've worked out four times a week for the last 40 years. And it is the only thing standing between me and total fucking depression. Seriously. Like, the only reason the sun comes up for me at all, like it does in England for a good, I don't know, three, three and a half hours. I want to speak to the manager. Anyways, enough about me. Let's move on to the news. The Epic news, an epic decision from the courts. Google lost an antitrust lawsuit against Epic Games. Epic has been after Apple and Google since 2020, claiming that these firms unfairly profit off of app developers. And by the way, I think it was absolutely the case. They have a monopoly

• 3:46Scott Galloway?

  on the Google Play Store and the App Store. And then, once you download something from the app, any transaction done through the app, they get a 15 to 30% commission on, meaning that any app that might compete at some point with Google or Apple's verticals, whether it's music or streaming, is at an unfair, impossible disadvantage. That's what you call abuse of your monopoly power. To make some waves, Epic told its users to make in-app purchases directly with them instead of using the App Store or Google Play. The tech giants then removed Epic from their platforms and thus Epic retaliated with lawsuits. In sum, Epic or anyone else in tech has no choice because to not be in play or in the

• 4:28Scott Galloway?

  App Store, specifically the App Store, is to be, is to set up your store on Mars. An App Store is actually kind of the 10-ton gorilla in the space because while I think the share is somewhat, I don't know if it's equivalent, something like 90% of the revenue that flows through in apps flows through iOS. Why? Because iOS users have all the money. Why? Because iOS users represent the billion wealthiest people on the planet. If you want to discourage someone from having sex with you, and I've used this joke over and over, but I think it's true, just talk about your Android phone. Apple actually managed to win the lawsuit back in 2021, or that is defend the accusations. And that trial was decided by a judge, not a jury. But the jury for the Google trial unanimously determined that Google's App Store violates antitrust laws and the firm has maintained monopoly abuse.

• 5:12Scott Galloway?

  The Wall Street Journal reported from the hearing that Google's Play Store made around $12 billion in operating profits in 2021. Think about that, with margins more than 70%. Just that business alone, a $12 billion business with 70 points of margin. So what is that? That's about an $8 or $9 billion EBITDA business or gross profits business. That's a $100 billion business right there, making it one of the most valuable businesses in the world just on its own. And a judge will decide remedies next year. Remedies, geez, remedies. Remedies could be a penalty, could be demand that they lower the fees, or it could be even worse, it could be that they ask that they be broken up or they spin it. This is really, really interesting.

• 5:54Scott Galloway?

  And also, it kind of pulls the finger out of the dike, if you will, and that is it'll give a lot of other judges the confidence to start ruling against Google and Apple around their monopoly abuse as it relates to their App Store and their other, other businesses. I think this is big. And what does it represent? Does it represent a change in the law? No, I think it represents a change in the zeitgeist. And that is, people love Apple and they love Google. But they are kind of having an overdue immune reaction and a gag reflex against big tech, recognizing that these organizations, in fact, aren't that innovative, or when they are innovative, it's around capturing more and more profits oftentimes unfairly. And what I would argue is that Google is probably a better example of a lack of innovation

• 6:38Scott Galloway?

  that comes from monopoly power. And what I would query you is to say, how has Google, in your eyes, really changed in the last 10 years? Really, the majority of the innovation around what is the largest toll booth in the world, about $150, $180 billion, a business called Search, is their ability to monetize it further. Remember way back in the day when the top two search returns were shaded dark blue? It was meant to say, hey, this is a paid-for ad. And then Google said, well, do we really need to give people a heads up? Because when you know it, when people know that this isn't the best place to find the information you requested, but a place they're getting paid to put in front of you, that you're less inclined to click on it. So let's make it lighter blue, lighter blue.

• 7:19Scott Galloway?

  Oh, no blue at all. And let's focus the majority of our innovation around how we take you to a place we can further monetize. This is the definition of monopoly abuse. And it doesn't mean you're a monopoly just because you're big. You can be a $150 billion company, and the scale might be good for consumers. Now, if that's the case, and this is what Google argues, all of those searches, all of those capital, result in a level of signal liquidity in capital such that they can reinvest in the product and make it better for everybody. There's a term for that: utility. Florida Power and Light makes a correct argument that it only makes sense to have one power station and one grid, because these things are really expensive. And if we all rally around one power grid in Florida, it

• 8:04Scott Galloway?

  can produce and provide and distribute electricity for Florida homes at a lower rate. Okay, fair enough. But if we are going to let you engage in monopoly practice, then you are a utility, and we get to regulate you. And people elected or appointed by elected officials in Florida get to sit at the offices of Florida Power and Light and say, you know what? It appears that you- You are raising the rates on low income homes. It appears that you are raising rates faster than inflation without without reinvesting those proceeds in additional capital or infrastructure capital investments that would make electricity more available or more broadly available. And we don't have a problem with you making money.

• 8:46Scott Galloway?

  We like that people can buy bonds and buy your stock and make money and put it in the retirement account. But we're not going to let you raise prices faster than inflation just because you own, you have a monopoly. Cable companies are effectively regulated monopolies. And they've made this argument forever that there shouldn't be more than one or two cable companies in a region because then no one could make the requisite capital investments to put a cable or run a cable through the ground into everyone's home. And it's been an amazing business for them. What Google and Apple have been able to do is not only develop monopolies, but have absolutely no regulation whatsoever. And I think people, whether it's their daughter being depressed or they see what happens in terms of election misinformation or vaccine misinformation, have decided, you know what, these companies have just gotten too damn powerful.

• 9:29Scott Galloway?

  And I think in general, when you have a jury trial here, you're gonna, you're gonna lose. Probably the most underreported business story of the week. And that is the epic case of Epic versus Google found in favor of Epic.

• 9:46Scott Galloway?

  Okay, what else is happening? An investor group is looking to take Macy's private for $5.8 billion. The group includes Ark House Management, a real estate investment firm, and Brigade Capital Management, which specializes in credit investment strategies. These firms want to acquire Macy's for $21 a share, which is a 32% premium to where the stock closed before the bid. Macy's stock has been trading up 20% following the news. It's down 32% over the past five years. JP Morgan analysts estimate that Macy's total real estate value is about 8.5 billion or $31 per share. That was what I noticed here was that the investor group included Ark House Management, a real estate investment firm. So something that gets overlooked in the strategy of a company and the outcomes of a company are its shareholder base.

• 10:30Scott Galloway?

  So for example, are the good folks at HBO stupid? Did they just not see Netflix coming? No, they're smart, they're very smart. The problem is they were owned by a company called Time Warner that was owned by shareholders that wanted a dividend and wanted profitability. And their shareholders took up or down the stock based on profits, whereas Netflix shareholders took up or down the stock based on growth. So Netflix was given license or permission by their shareholders to effectively invest ahead of the curve. If they got a dollar in revenue, they were allowed to invest a buck fifty, whereas Time Warner, when it got a dollar from HBO subscription fees, was allowed to reinvest eighty cents, putting them at a untenable position. And Jeff Bukas, the CEO of Time Warner, recognized this dynamic and said, unless shareholders are willing

• 11:14Scott Galloway?

  to go down seventy or eighty percent for a little while, such that I can take us into negative profitability and make the requisite investments to compete with Netflix, we should sell. And that's what he did. And he doesn't get enough credit. When Rupert Murdoch and Jeff Bukas sell assets at the same time, specifically Fox Studios and Time Warner, you don't want to be on the other side of that trade. They were the two biggest brains, or are the two biggest brains, in the media business. But effectively, your shareholders are a key component of your strategy. And the problem with Macy's over the last twenty years is they get a new CEO who decides, no, this is a good concept, and we can make money again, and we can grow again. And they start injecting Botox and doing freakish things to the poor corpus that is Macy's. This company is a grown-up, or the investor

• 11:59Scott Galloway?

  group is basically going to start selling off pieces and organs and limbs. They're going to start looking at real estate, and Macy's has a ton of underlying real estate, and say, look, does the Cleveland Macy's make any money, and what is the underlying real estate worth? And if it's not making money, but the real estate in the best neighborhood in Cleveland, which they purchased forty years ago, has gone up in value seven or tenfold, guess what, folks? We're going to sell it to someone else. Maybe to a Lululemon. Maybe to a Lululemon, or a Kava, or, I don't know, what's a hot concept? What's doing really? Or a dispensary. Don't know if they do THC in Cleveland. If I lived in Cleveland, I would be doing a lot of edibles. It would be edible leave-land for me. Anyways, point

• 12:42Scott Galloway?

  is, this is a group of people who are saying, we're going to come in and be the adults around the room, and we're going to cut costs like crazy. We're going to do hardcore analysis, get our pencils out, and decide what is the best use of this real estate. And it may not be putting a department store on top of it. In sum, in sum, you have to decide where the company is in the life cycle and manage it that way.

• 13:05Scott Galloway?

  One last story before we get on to our conversation with Dr. Peter Attia. There's obviously been a lot going on with the higher education space. The big news is that Penn's president Liz McGill resigned after weeks of controversy and criticism surrounding her comments with respect to free speech and antisemitism on the Penn campus. The tipping point, in my view, I actually think what they said was not that bad. If they were to say that we defer to the Constitution or the First Amendment of free speech, by the way, they have no obligation to. These are private campuses. These are private organizations. But if they said, "That's our role model," then fine. I think that is defensible. Here's the problem, though. That line, which they seem to have for a lot of vulnerable groups, they put out graphs

• 13:49Scott Galloway?

  and very long thoughtful emails around microaggressions. I remember at NYU getting an email from my department chair outlining what I didn't recognize for microaggressions and saying that if you engage in these microaggressions, that it could lead to punishment or even dismissal. So it seems as if the management at these universities has no trouble finding their testicles when it comes to certain vulnerable groups and where, you know, there should be a line and is a line, and they enforce those lines vigorously. Larry Sumner, the president of Harvard, was effectively fired because in an academic setting, he dared to question that there might be a difference between women and men in terms of their performance in the workplace based on genetic factors.

• 14:33Scott Galloway?

  And he was effectively ashamed and fired for that. And yet, when it comes to antisemitic speech, they've decided there's context and nuance. But it wasn't even that. What she said, if she in fact did in fact decide, "Okay, we're gonna have a line and it's gonna be total free speech," then fine. The problem is, it's not a line at these universities. It's a plaid. And that is, the line depends upon who is the vulnerable group. And this all comes back to the same thing, in my view. And that is, in the United States, we are wrestling with and coming to grips with the fact that there have been a lot of special interest groups that have been oppressed. And I think a lot of people on campus, administrators, leadership and students, go on the hunt for fake oppressors. They're angry that laws have been passed, that these are no longer the norms. They're angry that many of the perpetrators of this oppression

• 15:18Scott Galloway?

  are dead. But we're angry about this and we want to be seen as virtuous and as warriors, so we're going to go on the hunt for fake oppressors. And what a shorthand for oppressor in our society, especially among young people. Simply put, and this will trigger a lot of people, how rich and how white you are. And there's no one richer and whiter than Israelis. And as a result, the line is different around anti-Semitic content. In my view, it is the last acceptable form of hatred, specifically white hatred. And we have raised a generation of people under the age of 40 who see Israel as the bad guys, in part because of Israel's boneheaded, dipshitted moves around Palestinians. They're inhuman treatment of them, and I'll say that, inhuman. But at the same time, it has gone way too

• 16:02Scott Galloway?

  far, and there are two standards. But even more than that, in addition to not having a line and having a plaid, the reason why President McGill was fired was because their attitude and the way they handled that hearing embodied almost every negative stereotype of leadership at elite universities. And that is, they came across as arrogant assholes. It was as if they said, who is this Republican idiot from Long Island? We should not take her seriously. They kept saying things like, it's context-dependent. Well, what the fuck does that mean? In exactly what context is it okay? Is it not harassment to call for the genocide of Jews? What context does that not constitute as harassment? I don't believe

• 16:45Scott Galloway?

  the presidents of Harvard or MIT are going to be dismissed. The president of Harvard has only been in her job six months, and it seems like the faculty is rallying around her. But this may be, in fact, peak higher education. And that is, going back to our roots, when I was in school in the 80s, the leadership of universities were administrators and operators, there to teach you hard skills such that you could develop economic security for you and your family. And instead, they have decided that their self-importance and self-aggrandizement leads them to put out very thoughtful, long-winded issues or statements on political issues that tend to be 99% very, very far left. And I think half of America is regurgitating on it. And even some folks on the left are saying, this has gone way

• 17:29Scott Galloway?

  too far. And we have packed-

• 17:33Scott Galloway?

  Pack these universities with departments that have absolutely no measurable outcome. Diversity, equity, inclusion, ethics, sustainability, ESG. Well, guess what? Here's the way you get diversity. You cut tuition, you stop hiring formerly important people to think big thoughts with no measurable accountability such that you can lower tuition and get more trans kids, more LGBTQ kids, more non-white kids. We don't need to decide who gets in, what is right and what is wrong about the world. We need more, specifically more kids from more backgrounds who can engage in what is the ultimate cure for obesity, depression, economic hardship, more likely to get married, less likely to have a heart attack, and that is higher education. The leadership of these universities should be

• 18:18Scott Galloway?

  the hosts and the sponsors of critics, but not the critics themselves. It is all total self-absorption. For God's sakes, have a line, not a plaid. We'll be right back for our conversation with Dr. Peter Attia. Support for the show comes from Nutraful, the number one dermatologist-recommended hair growth supplement brand used by over 1.5 million people. With age comes knowledge, patience, and for some, hair loss. Didn't say it was all good things. And for those who want to do something about it, there's Nutraful. Nutraful has formulas built for men at different life stages. They have Nutraful Men for Guys Age 18 to 49, plus the new Nutraful Men 50 and Older. That's the first product of its kind specifically

• 19:01Scott Galloway?

  for men over 50. You can now address the key root causes of thinning wherever you are in life. Grow visibly thicker, fuller hair in just three to six months. Start Nutraful today and make the hat optional. Visit nutraful.com and enter promo code PROP G for $10 off your first month's subscription and free shipping. Find out why Nutraful is the best-selling hair growth supplement brand at nutraful.com, spelled N-U-T-R-A-F-O-L dot com, promo code PROP G. That's nutraful.com promo code PROP G.

• 19:38Scott Galloway?

  Support for the show comes from Upwork. Trying to scale your business? At some point, you're probably going to hit a point where you need some help. Sometimes, the best way to break through that is bringing in the right talent at the right time. Upwork can help. Upwork is a one-stop platform where you can find, hire, and pay expert freelancers across more than 125 categories. Whether you need specialized skills for a single project or extra support to keep up with demand, it's easy to connect with experienced professionals, review their work, and find the right fit. You can move faster without taking on the commitment of full-time hires. And for businesses that need the very best talent, Upwork Business Plus provides access to the top 1% of freelancers on the platform. AI-powered matching connects you with qualified candidates in under six hours, cutting down the time spent searching.

• 20:21Scott Galloway?

  Upwork also takes care of contracts, payments, and other administrative tasks, so you can spend less time managing logistics and more time focused on what's next. Visit upwork.com/profg right now and post your job for free. That's upwork.com/profg to connect with top talent ready to help your business grow. That's U.P.W.O.R.K. com/profg. Upwork.com/profg.

• 20:58Scott Galloway?

  Welcome back. Here's our conversation with Dr. Peter Attia, founder of Early Medical and the author of Outlive: The Science and Art of Longevity. Dr. Attia, where does this podcast find you?

• 21:09Speaker 02

  I'm at home in Austin.

• 21:10Scott Galloway?

  So, let's bust right into it. Can you walk us through your notion of longevity, specifically as it relates to lifespan and health span? You talk a lot about health span, which speaks to quality of life. Can you break down the physical, cognitive, and emotional components to... I don't want to say prolonging life, but enhancing life? Would that be a better way to say it?

• 21:30Speaker 03

  Yeah, I think so, but but also I think what I would argue is that lifespan becomes sort of an indirect benefit of pursuing health span. If you pursue health span correctly. Now, of course, one could take that to all sorts of extremes and say, well, my emotional health is predicated on, you know, exclusively being, you know, with strippers on a golf course doing cocaine, and that's going to enhance the quality of my life. You know, at that extreme, yeah, it probably will shorten your life. But if you took a more rounded approach to improving cognitive life, physical life and physical performance and emotional health, yeah, you're not only going to live a better life, but I think you're probably going to live, you know, five to 10 years longer through the mechanism of reducing the onset of chronic disease.

• 22:15Speaker 03

  You know, I think cognitive health, people sort of understand what that is by examining what the disease states look like. So the disease states, which would be the diseases of dementia, Alzheimer's disease, vascular dementia, Lewy body dementia. These are basically conditions that deprive a person of, you know, some elements of, and it varies by the different type of dementia, but processing speed, typically short-term memory, executive function, things of that nature. So we all know, I mean, as bright as you are today, Scott, you know, I'm sure you are not the man you were in your in your mid twenties in terms of processing speed and just how facile you were. And so that doesn't mean that you have a disease. It simply means that as we age, those processes will slow.

• 22:58Speaker 03

  But there are things we can do to reduce that rate of decline. And then the same is true on the physical side. Your strength goes down, flexibility goes down, balance, speed, power, all of those things will decline with age, and they peak at different points along the way. So power, of course, is probably the first thing that we lose. That tends to peak in our early twenties, whereas strength peaks later. But the more we can preserve those things, the more robust we'll be in our final decades of life. And then the third one is this emotional health piece, which is actually the one that is not age tethered. The first two clearly are. But you know, the emotional health piece really speaks to many things that you know,

• 23:39Speaker 03

  constitute happiness, connectivity, relational health, and those things need not decline with age. Sometimes they do, but they don't have to. So taken together, all of these things are kind of how I define health span as opposed to the traditional medical definition of health span, which is the period of life in which you are free from disability and disease.

• 24:00Speaker 02

  Can you stack rank the tools of longevity, starting with exercise, which I know you believe is the most important one, or that's how I've interpreted your stuff. Can you, can you give us a set of the toolkit?

• 24:11Speaker 03

  Yeah, I guess I would rattle them off without ranking them to start, but start with exercise, nutrition, sleep, all the tools around emotional health. And because there's so many of them, I kind of bucket them into one. And then the last one is the molecules. So drugs, hormones, supplements, anything that you take exogenously.

• 24:27Speaker 02

  So give us, if you will, assume somebody doesn't have the resources, the time, or the discipline to be in the top 90% of any, much less all of those. Tell me what you think or the hacks are in terms, starting with exercise, whether it's avoiding doing certain things, or certain, you know, certain investment in key things that do a great job. Imagine that I want to be the Old Navy of longevity and lifespan, and that is Old Navy has got to $1 billion faster than any retailer ever. And the algorithm or the strategy was genius, and that is we're going to be 80% of the gap for 50% of the price. How do I get 80% of what would be an elite athlete, or someone great who's really healthy for 50% of the

• 25:12Speaker 02

  investment? And maybe that's not possible, but, but let's see if we can do it.

• 25:16Speaker 03

  No, it completely is. So, so the Pareto principle follows everything in health as well. It helps the listener to understand what it takes to be at the top 1%. So I think that, you know, if you want to be at the top 1%, you're going to have to do a lot of things. And can you do half of those things and get 80% of the benefit? You can. So what would that look like? I think from an exercise perspective, and by the way, everything is going to assume you're starting out at average health. So if you're starting out at a huge Deficit to that, you know, you're going to have to then potentially double down on a few things at the expense of others to get yourself out of a gap. For example, if a person has a significant injury that completely impairs their ability to do anything, you know, they're

• 26:00Speaker 03

  going to have to do probably more than the 50% to fix that. But let's just assume we're talking about median health individual goes after the problem. From an exercise perspective, I think three hours of cardio training a week, two to three hours of cardio training per week, while not enough to get you on the podium at the local, you know, 10K is still enough to get you really significant benefits. At three hours, if you're doing two and a half of those at very low intensity, but in a very specific area, we call zone two. So hard enough that you can talk if you need to, but not so hard that you can't. That would be kind of that. So if you did maybe

• 26:45Speaker 03

  two and a half hours there and then half an hour of much more challenging intervals where you can really only hold the pace for about four minutes and you need about four minutes to recover. So going through, you know, four or five sets of those once a week. On the strength side, I think doing three full body workouts with resistance, you know, with using more than your body weight, three times a week, 45 to 60 minutes. I would call that kind of like 50th percentile input that would probably still, if done correctly. And that's the devil in the detail there. Of course, you have to be paying attention to where you are cardiovascularly in terms of energy output. I think that still delivers 80% of the results for most people.

• 27:29Speaker 02

  So just to press pause on that, I rode crew in college and it was such a traumatizing experience that I decided I'd never wanted my heart rate above 100 for 30 years. I just decided I'm never going to do cardio again. But now I do row on a machine on an ERG or a C2, whatever you call it. But I only, I do it three times a week and I go 2,000 meters in about eight minutes.

• 27:51Speaker 03

  Yeah, I was gonna say, how quick did you used to go? I bet you used to go six minutes and 30 seconds for 2K, right?

• 27:57Speaker 02

  Oh, I used to be, you know, I used to be a vein with a little bit of muscle wrapped around it. I mean, I could go really hard. And not only that, what I have found as I've gotten older is my mental toughness. I wouldn't say, it's not my mental toughness has declined. I just don't want to go there. I just, you know, I used to be, there was something that was drilled into me as a young man, where I would go do insane workouts. But yeah, now I'm just like, I just want to be really cooked and out of breath. But if I, if I'm 813 versus 751, I don't care. Whereas before I'd be like, I gotta be below seven minutes. Evaluate that, and that's only 24 minutes a week. What are your thoughts about that kind of intensity versus the two or three hours you were talking about?

• 28:37Speaker 03

  Yeah, I think that's great. I think there's no escaping the need for building an aerobic base. Again, if you said to me, Peter, give me the 10% effort, then yes, I would direct you towards something like that, right? You know, so there are, you know, types of intervals known as Tabata intervals, which are interestingly enough, not named after the guy who invented them. Basically, they go as hard as they can go for 20 seconds. They take 10 seconds to recover and you do that eight times for a total of four minutes. And these types of workouts are touted as a really efficient way to boost fitness. And I think for the time spent, they clearly are. But we shouldn't confuse those with the best way to improve fitness.

• 29:17Speaker 03

  And so, again, if you said to me, Peter, I'm only willing to spend 24 hours a week doing fitness, I would say that your three 2K sets a week are exceptional because you're doing upper and lower body. I mean, I rode for one year and I can attest to just how remarkable it is. And I still occasionally will get on the ERG for a 2K set. And there's probably no better bang for your buck. But if you're saying, okay, Peter, I want to go to the next level, then I would say, great. Let's space that out and do some 10K sets at a lower intensity. So, you know, instead of Of averaging two minutes for 500, which is what you're holding there.

• 29:56Speaker 03

  Let's take it to 220 per 500 meter and build that aerobic energy system where lactate is not getting above a certain threshold. And you're really expanding your muscles capacity to oxidize fat, which is essentially the sine qua non of a very healthy system.

• 30:15Speaker 02

  I've been working out three to four times a week for 40 years and I track trends. The perception or how the media or our evolution of what is good for you. When I was working out with weights, you were seen as someone who was just vain and might be inclined to be Arnold Schwarzenegger and take steroids. And it was for vanity. It wasn't for health. And the way I perceived the change is that weightlifting or resistance training has been vastly underrated and it's kind of getting its time in the sun. What are your thoughts?

• 30:45Speaker 03

  I think that's correct. I do think it's a little misguided when folks try to pit one against the other, weights versus cardio, cardio versus weights. Obviously my answer to that is both. That's sort of like saying food versus water. You know, it's sort of a silly discussion, but you're absolutely correct that when you look at the aging population, what most stands out is how much we see what's called sarcopenia, which is defined as basically a function, a loss of muscle mass that, you know, puts a person at a true functional deficit. That really accelerates in the eighth decade of life. So around 75, on average,

• 31:27Speaker 03

  a person, male or female, essentially falls off a cliff in terms of how much muscle they lose. And it becomes very difficult to get that back. It's not impossible. I've seen people who don't start training until they're at that point in their life. But clearly the best strategy is to develop as much what's called physiologic headroom long before then. So, you know, people your age and my age should be thinking about how do I build up a high enough reservoir of muscle mass? So that when that gravity of sarcopenia starts pulling me down, I'm at least starting at a much higher place.

• 32:02Speaker 02

  So I'd love to know, I'll give you, and by the way, we should have disclosed that these podcasts are just an excuse for me to talk about me. I try to have these hacks. I'm on the road a lot and I'd love to know your hacks for road work. I'm on, I'm only on the road about a hundred days a year now. It used to be 200 pre-COVID and I decided to change my life for, you know, relationships and just mental wellbeing, but I'm on the road a lot. And my, kind of my hack is I'll be in the hotel room and about in 14 to 16 minutes, I can do 25 burpees, 100 pushups, 150 leg bends, and then if I'm motivated, I'll cash out with another 25 burpees.

• 32:41Speaker 02

  And that's my like 16 minute, get my heart going, get some resistance, get some, you know, get my muscles hurting a little bit. It can, A, what do you think of that? And B, is there something, if someone's on the road and just has a hotel room and their body weight and wants to like log a couple such that, you know, they don't fall too much before they get back into the routine, what is your advice?

• 33:05Speaker 03

  Maybe a question to clarify before I respond, are you limited in that scenario by time? Or by being at a hotel that doesn't have a gym of some sort?

• 33:17Speaker 02

  It's mental deficiency and that is I wake up, for me, I wake up and think, I need to work out, I need to work out. And I find, life gets in the way and then I find excuses not to, and the clock goes fast and I end up, I got 20 minutes before a business dinner and that's it. And usually the hotels I stay at do have gyms. I just don't have the discipline to carve out always, you know, the hour to get, get the right clothes, get down there. You know, I find there's a lot of transition leakage. So I like doing workouts where I'm literally, I can be in my pajamas or just out of the shower, you know, just before I get in the shower. And that's one of the things I love about, and this is obviously benefits the wealthy.

• 33:55Speaker 02

  You know, home gym is just so powerful because I find that 60% of the time commitment is getting there and back and getting to your locker and all that bullshit. But anyways, no excuse other than I'm just lazy.

• 34:06Speaker 03

  So it sounds to me like it's less about the not having the gym. It's more about the activation energy to leave your room is the bigger hurdle, which is, is fine. I think you gotta know thyself, but the only point I was going to make for folks listening is I'm very deliberate about travel. I don't have to do it as much as you anymore, although I used to. You know, it's probably one of the first things I would discuss with a new person coming into my life as an assistant, which is how much does my travel revolve around gym quality? Right? So it's like, if I'm going to New York, nothing matters to me more than the quality of the gym at the hotel. I don't even care if I have to, you know, spend an extra 20 minutes commuting to and from a meeting. I absolutely care. So I have, in many cities, I have the gym that is

• 34:51Speaker 03

  the gym for me. But let's go back to you. So, so totally valid. And I think this is a bit of a know thyself, right? So you know yourself and you're like, look, I'm totally willing to do 20 minutes of something in my room. But if I try to branch out more than that, there's a risk nothing will happen. I think what you're doing is great. If I were going to add one thing to it, I would probably add some sort of a jumping lunge exercise or a jumping squat, because everything you're doing is, you're getting cardio fantastic on the burpees, you're obviously getting the pushups in, you could sort of do some core work, like some planks. But if you threw in, and it's hard for me to explain this, because we're not in person, but there's kind of a

• 35:33Speaker 03

  jumping lunge, jumping squat sequence that I like to do called mega legs, where it's like, you know, 20 jumping squats, 20 jumping split squats, 20 jumping squats, that kind of thing, where your, your legs actually get fried and your cardio system gets fried. And the whole set takes like a total of two and a half minutes. So that's probably the only thing that's kind of missing in yours would be sort of a more leg fatigue component. The other thing you could do Scott would be some wall sits. So you could do a wall sit at the very beginning and then a wall sit at the very end. Again, you're talking about a couple of minutes on each end, not adding tons of space, but also doing an enormous isometric load.

• 36:11Speaker 02

  So a lot of young people listen to the podcast. I think a lot of them are stuck. They do some, not enough, or they're worried about starting. What are your sort of mental hacks or apps or tricks to just get started?

• 36:23Speaker 03

  You know, I think this is not an area that I'm an expert in, but luckily there are so many experts out there. And I think most of them would point to the same thing. And the few times that I am trying to change a behavior, I generally try to adhere to this principle, which is if it's an additive behavior, so exercise is an additive behavior. Usually food is a subtractive behavior. If it's an additive behavior, I start with a very small goal where participation is all that matters. Meaning like, let's use the exercise. So if a person says, right now, I don't exercise one bit. I want to get to the point where I'm doing 30 minutes of something six days a week.

• 37:03Speaker 03

  I would say, okay, how about starting with five minutes a day, three days a week? How about, can you just get into the act of getting out of your house, walk around the block for five minutes and come back? And I'm not going to pretend that you're getting much benefit from that. You aren't, let's be clear. But what you are doing is developing a new habit, which is this is how I walk away from my computer. This is how I go outside, as you talked about. It's the transitions that are hard. And by the way, once you start getting to the point where you can take five, you know, or three, five minute walks a week, it's really easy to expand both the frequency and the duration. And then even what it is that you are doing, i.e. going from maybe walking to running.

• 37:43Speaker 03

  On the subtractive behaviors, even though I don't think that's necessarily what you asked, but we might as well address it. I think it all comes down to environment. And food would be the most obvious, right? So if you're saying like, I'm eating too much, fill in the blank. I think you have to accept the fact that some of us maybe have the capacity for willpower all of the time. But most of us, myself included, do not. So, you know, I would say you surround yourself by the foods that are the right choices. And that requires much less willpower. You only need to exert willpower when you're at the store buying it. And, you know, there's some tricks, like don't do that when you're hungry. Don't, don't walk down the middle of the grocery store aisle, only stay on the perimeter, right?

• 38:27Speaker 03

  So exert all of your willpower for the week and the 30 minutes it takes to stock your fridge and pantry. But then you're kind of surrounded by healthy food. It makes it a lot easier. So those are kind of like two. Call it behavioral approaches to addressing these problems.

• 38:45Speaker 02

  Let's talk about sleep, sleep for a younger person and then sleep for people our age. What are, talk about the importance of it. I mean, something it's really people I think talk about a less than, I think of the three legs of the stool is nutrition, exercise and sleep. And I would say sleep gets the least amount of attention. Talk about sleep hygiene.

• 39:04Speaker 03

  Yeah, sleeps, I agree with you. I think it's, if your sleep is really, really disrupted, it's very hard to succeed, even if the other two are doing well. I guess because I'm an old guy now, I'm probably a bit out of touch with what the challenges are for a young person. But I suspect it's probably more around kind of social stuff that, you know, has you wanting to maybe stay up a lot later. You know, we know that on average, younger people drink more alcohol than older people. And therefore, we, you know, and we certainly know the impact of alcohol on sleep. It's, it's surprisingly bad, despite the fact that it kind of makes you feel a bit drowsy and you think, well, that's probably helping me sleep.

• 39:47Speaker 03

  It's completely dysregulating REM sleep in particular. Not to mention it also, especially if you're, as you get older, it's going to make you more and more likely to need to wake up to pee at night. Because alcohol inhibits a hormone called vasopressin, which is an anti-diuretic hormone. I think the other problem that is, I would guess, a little more prevalent with younger people is something called social jet lag. So our bodies really need a circadian rhythm. And one of my good friends, Andrew Huberman, has talked a lot about the importance of kind of being exposed to light as the sun is coming up and as it is going down and how those two interactions kind of help normalize and anchor your circadian rhythm.

• 40:30Speaker 03

  Well, imagine if, you know, you have a job during the week and, you know, you're sort of forced into regular hours, but on the weekends you shift those by three or four hours because, you know, you're partying or whatever. That's no different than if every weekend you took a trip, you know, from where I live to Hawaii. Right. And you can imagine how disruptive that is, your sleep. I'm sure with your travel, you can appreciate the effect that jet lag has on sleep quality and how long it takes to normalize. But imagine if you're doing that every single weekend. And that's sort of what social jet lag is. I think for older people, food and alcohol also become a little bit of an issue. But I also think that, and this may be true of younger people as well.

• 41:13Speaker 03

  I just think that our sleep hygiene is also negatively impacted by our inability to kind of detach from work and problems as we get closer to bed. So I think it's very quick and easy to demonize the phone per se as this evil thing that hurts our sleep. And there's a lot of truth to that. But I think the most important thing that the phone is doing to get in the way of our sleep isn't even the light that it emits. It's the information that it emits and how that can be really distressing. And so, you know, it's one of the most important things I've done in the past couple of years is got two phones. And one of them, which is the work phone, that is where all the distress shows up. That's the one that has social media, email. That's the one anybody can text me on.

• 41:58Speaker 03

  I'm kind of putting that phone away at eight P M. And I have another phone that is my kids call my bat phone, which basically, I don't know what it has on it. I mean, it has the app to control the T V and two other dumb things. It has music and podcasts. And that phone is the one that if I need, if I'm going to touch a phone in the evening, it's that phone. It's a simple hack, but it creates a lot of distance between me and things that are potentially distressful before I go to bed. And I think that that can sort of lead into ruminative patterns, which are destructive for sleep also.

• 42:30Speaker 02

  So let's go back to the eighty fifty rule around nutrition. If someone said, all right, I want to get to eighty percent with fifty percent of the effort. What are some best practices around nutrition?

• 42:39Speaker 03

  Yeah, nutrition's a tough one because in many ways, you really have to think about what are you willing to sacrifice? So, so two people can come to the eighty fifty rule very differently. Everybody's going to have to make some form of restrictive concession. And the question then comes down to. What is the one that is most easy for you to sustain? So for some people, that concession is going to be around some element of the diet that they're going to restrict. We call that dietary restriction. So some people are going to say, well, look, I'm willing to give up a certain set of foods.

• 43:21Speaker 03

  I'm, you know, I'm willing to go on a low fat diet, or a low carb diet, or a paleo diet, or a vegan diet. But I'm going to give up a subset of the entire suite of foods. And the more restrictive you make that, the more you're going to be able to regulate your energy balance. And where energy balance goes, so too does metabolic health. So if you think about it, if you took any single ingredient food and said, that's the only thing I'm going to eat. I would be hard pressed to think you could think of a food that wouldn't end up, you know, regulating your body weight, right? Like if you went on the all potato diet, or the all steak diet, or the, you know, fill in the blank, all this diet.

• 44:01Speaker 03

  Again, I'm being a bit facetious because you're going to run into some nutritional deficits. But from an energy balance standpoint, it's almost impossible to overeat. Other people would come along and say, no, no, no, no, I don't want to do that. I want to be restrictive around when I eat. Right? So I had dinner with a couple of friends a couple of nights ago. And one of these guys, he's a buddy, and he only eats one meal a day. That's, you know, and I've done that for a couple of years as well. For him, it's a great way to not have to care at all about what he's eating in that one meal. He's like, I'm going to order as much as I want, or whatever I want. Because basically in this one meal, I can largely contain myself to, you know, what I'm eating. And, um, and that's how he kind of maintains his energy balance. And then there's other people who want to be much more prescriptive.

• 44:46Speaker 03

  And, you know, so for example, if you look at bodybuilders and people who are really, really needing to be perfectly regulated in how much they eat. These people are tracking everything that they eat and being really restrictive around that in terms of quantity. But they're giving themselves the flexibility to eat what they want and when they want, provided they stay within a quantity map. And we call that sort of caloric restriction. So whether it be calorie restriction, time restriction, or dietary restriction. I think a person's going to need to adopt at least one of those to some extent. And the which one you adopt, I think should be the one that you can most readily stick to.

• 45:27Speaker 02

  Okay, so let's go on to, I want to talk a little bit about mental health. And again, I'll come back to me. I suffer from anger and depression. And that's the bad news. The good news is I've gotten older, I recognize it and I can kind of move in on it. And I have this acronym for my, my means of addressing it. And I call it SCAFA, S C A F A. And it stands for first sweat. I find immediately if I feel myself going to a dark place and I have certain metrics where I can recognize I'm going dark, I immediately force myself to sweat a great deal and exercise a lot. And it's, that's really hard for me because when I'm feeling down, that's like the last thing I want to do, but I need to reset the system and sweat. C for clean. I try and eat at home, not out.

• 46:11Speaker 02

  I find if I eat out, I just eat a lot of salt and fat and shit that makes the food taste good. A is for abstinence. I don't do alcohol or edibles. I'm like, whatever's going on in my brain, when it goes there, it's probably better just without that shit. F is for family. And I know that's some virtue signaling, but I do generally feel a little bit more grounded. And my kids are so awful sometimes, they, they force me to get out of my head and not be thinking about me and that I'm not feeling well. And then A affection, being around my boys, being in the physical presence of my dogs, having my dogs literally on me as I'm watching TV. I find that that mammalia, that touch is very restorative for me. Where do I have this right? What else should I, should I be thinking about in terms of my own mental health?

• 46:55Speaker 03

  Well, again, you know, Scott, I don't, I don't pretend to have any real domain expertise here. So the only thing I would say is look, if that is working, that sounds fantastic. There's certainly nothing there that you've said that doesn't sound healthy. Are there other things that one could consider? Absolutely. Right? So one could consider therapy as well. In my experience, you want to have therapy as an ongoing thing and not just a crisis thing. And that allows it to be more effective during the crisis. So I've had a particularly difficult seven months for reasons I'm still sort of trying to understand. And I find it really interesting as I look back.

• 47:36Speaker 03

  Because I can kind of reflect and say, wow, there was this six month period where everything seemed really good. And then there was this six month period where you were in such an awful place and you were so dysthymic. But it was really nice for me to be able to have that discussion with people who had known me for years and who I speak with every week, and therefore they have a perspective I might be missing. So that's not something that necessarily can help a person today if they're having this for the first time. But that could be an encouragement to take mental health more seriously as a proactive health step, not just a reactive step. I think another thing for me that is really productive is journaling.

• 48:18Speaker 03

  And I, I, I'm not a regular journaler. In other words, I don't say every day I have to journal. But when I am in a place that is suboptimal, which I find myself in quite often, the pen really helps. I don't know that everybody's like that, but I think there are some of us who process information when they can write it down and it forces us to think through things a little bit. So those would be just a couple of other things that one could add to the list. I also think for me personally, being outdoors is a wildly important part of getting better. So regardless of the circumstances, I'm always trying to be outside every day.

• 49:01Speaker 03

  But in, in particular, when I'm struggling, like I do this thing called rucking that I love. And it's a, you know, so walking around with a heavy backpack, huge form of therapy.

• 49:14Scott Galloway?

  We'll be right back.

• 49:18Scott Galloway?

  Support for the show comes from Vanta. As AI adoption grows, so does your company's security risks and requirements. New frameworks, audits and vendors keep piling on, but your team isn't getting any bigger. Most compliance tools promise automation, but you're really stuck doing all the work by hand, chasing screenshots, validating controls, and playing catch-up when audit season comes around again. Vanta works differently. The regentech trust platform is built to scale with you, not slow you down. With over 1,400 automated tests across 400-plus integrations, Vanta collects evidence and monitors your controls year-round, cutting your audit prep by 82%. Plus, you can access the Vanta agent everywhere you work, whether your team is in Vanta every day or living in tools including Claude or Cursor. Want proof?

• 50:03Scott Galloway?

  Over 16,000 fast-growing companies like Ramp, Ryder, and Harvey save time and resources while scaling fast with Vanta. Learn more at vanta.com/profg and get $1,000 off. That's spelled V-A-N-T-A dot com slash profg for $1,000 off.

• 50:25Speaker 04

  Your heart can tell you a lot about your health. Apple Watch Series 12 measures your heart rate every five seconds with the most accurate heart rate sensing in wearable. So your vitals app, now with heart rate variability, can tell you when something is off. And your readiness score can let you know when to rest and when to push. Hear the story in every heartbeat with Apple Watch Series 12. The features described are for wellness purposes only and not for medical use. iPhone 11 or later required. Based on Apple conducted study of heart rate accuracy, August 2026. Visit apple.com slash apple watch series 12.

• 50:57Scott Galloway?

  And you, I mean, you're pretty transparent around your own struggles with mental health in your book. How does it manifest in your life? Like, from the outside, Peter? You look like you're just killing it. You look like, if this guy can't be happy... I mean, you look as if your life is just... I'm seeing you everywhere. You look like you're in amazing shape. From an outsider's standpoint, it looks like you've just got it... You're just doing so well. What are your own means of identifying when you're struggling? And do you have any immediate go-tos?

• 51:30Speaker 03

  Yeah, there are lots of signs. This is a very important part, I think, of therapy is understanding what the yellow light behaviors are, as we call them. So what are the warning signs that things are brewing that I have to start paying attention to? And this has probably been the single most important change in my life in the last five years is I used to really worry, Scott, that I was just the space shuttle challenger, or, you know, just a disaster that was going to happen with no warning, because disasters were happening, right? Every, you know, couple of years, there would be an enormous meltdown that was just, you know, would basically nearly ruin my life and that of anyone within the vicinity.

• 52:16Speaker 02

  But let's just press pause there. A financial meltdown, lashing out at people important to you, going into a dark place?

• 52:24Speaker 03

  Yeah, fortunately, not financial. It could usually be some incredibly self-destructive behavior that would harm many people. It could be an unbelievable lash out that, like, I mean, literally like road rage that could almost result in me killing somebody physically. It could be an incredible professional blow up. So just, you know, things that are really kind of, I think, sort of

• 52:54Speaker 02

  Rooted in anger.

• 52:56Speaker 03

  Yeah, at least four, if not six sigma events with respect to really destructive behavior. And I began to just sort of accept the narrative that I'm like Mount Vesuvius, like you don't know when that thing's going to go off. Like, it's just, it's an awful thing, and it's really bad for these poor people down there, but like, don't live near a volcano. I don't know what to tell you, right? And I, over time, and with an insane amount of therapy, began to realize that that's actually a false narrative. That's not true at all. The warning signs are all over the place. I just wasn't looking for them. I wasn't attuned to them. And there were six months of smoke coming out of that

• 53:38Speaker 03

  volcano. And there were six months of small cracks that were moving, and the ground was slightly shaking. I just didn't have the instrument to pick those up. And if I did, it's actually better than a volcano. Because the answer isn't move everybody away and let it erupt. The answer is no, let's fix the root of the problem and prevent the eruption. And so that's where I really tend to spend a lot of my time now is on focusing on that. And by the way, I think a big part of that is accepting the fact that dysthymia and anhedonia are not horrible. They're not horrible feelings. They're there to tell us something, right? If you feel this way, there's a reason.

• 54:22Speaker 03

  Emotions are not accidents. They are forcing you to confront a why. And that's, that insight has been one of the most important insights in my life. Because I no longer spiral deeper into the despair when I'm feeling the despair. Now I say, why am I feeling this way? Where is the disconnect? And it's usually a disconnect between something in my behavior and something in my values. So there's a way I want to live and there's a way I am living. And if those are not collinear, I start to feel bad. And now I'm able to reconcile that quicker.

• 55:06Speaker 03

  Not immediately, but now I can say, oh, you're feeling bad because you're actually working too hard right now. And you're not spending as much time with your family as you want to. And that is the thing that is gnawing away at you. And that's what's making you irritable with everybody right now. And realizing it when it's just that is a lot easier than absolutely blowing up and ravaging everything in your life.

• 55:32Speaker 02

  What are your observations around addiction? Or being on this hamster wheel around money for young people that are successful? Like, have you thought through your own, your own ability to try and balance that tension and the impact it has on you and the people around you?

• 55:48Speaker 03

  I think about this a lot, and I do think that most of us are addicts. The question is, what are we addicted to? And I tend to not worry so much about what the label is. What I tend to really ask myself is, is the behavior adaptive?

• 56:07Speaker 03

  Or is it, you know, sort of bleeding into maladaptive? And I think to answer that question, again, you have to really have a clear sense of what your values are. And believe me, like, there's nobody that hates the word values in a sort of corporate sense more than I do. I think that's just such hokey nonsense. What I mean is, and it can be substituted for any other words, is like, what is your eulogy gonna say? Right? That's, that's really more what I'm referring to. And I've been to too many funerals, and I've thought deeply about this, and I came to the realization, probably later in life than I wish, that I don't think I care what anybody thinks of me beyond my family

• 56:48Speaker 03

  and my friends. And the good news is, the more I practice that, the easier it is. Now, I've had to make some concessions around that. Meaning, like, if I sat there and scrolled through Twitter to see what people said about me, I wouldn't be able to live that way. But I will tell you this, I don't know the last time I looked at a comment about me on Twitter. It's been nine to 12. It's probably been a year. There could be people telling me I'm the greatest person in the world on Twitter. I wouldn't know it. And there's obviously lots of people telling me I'm the worst person on Twitter. So, so, you know, not reading comments, not looking in the mirror effectively, is probably a valuable way to do that. And

• 57:30Speaker 03

  kind of realizing like, who matters to me and who doesn't? And on the work front, I think this is, this is challenging, because a person in your situation can easily say, when confronted with, hey, do you think you might be doing this a little too much? Well, what do you want me to do? Do nothing? And the truth of it is, no, that's not it at all. And I think work is really important, regardless of how much money you have. Like, having a purpose really matters. And for many people, that sense of purpose is tied to a job, not for all people, right? For some people, it can be tied to, to something

• 58:11Speaker 03

  that isn't earning money. But for many of us, it is. And I think the real challenge there is playing that game of, at the end of my life, will I be looking back wishing I dialed this down or up? And I struggle with this more than anything. So this is still the greatest struggle of my life. And I think it's a big part of You know, the past six months for me personally has been thinking of why do I work so hard when none of this really matters in the grand scheme of things, right? Like my, this is a very remarkable period of time when my kids are still young. And like, why, why would I even consider missing a day of this?

• 58:56Speaker 02

  How old are your kids?

• 58:57Speaker 03

  Fifteen, nine and six.

• 58:59Speaker 02

  Okay, so you still have some golden years left.

• 59:03Speaker 02

  I have to bring this up because I'm fascinated by it. I wrote a post that got a lot of attention and I basically said that GLP-1 will be bigger than GPT-4. And when I think about, Milken says 1.7 trillion dollars a year in obesity-related costs. When I see the research that this isn't an appetite suppressant, it's a craving suppressant. I think we may have found scaffolding for our instincts that brings our instincts up to institutional production. And 42% of America obese, 70% obese or overweight, 70% of America isn't anything.

• 59:38Speaker 02

  And I'm just sort of blown away. I mean, the economic incentives to just get, keep us getting fatter and fatter seems so extraordinary to me. And if we can go thinner and thinner, the impact on the economy is going to be enormous. So one, I don't know if you've thought about the economic impact to me just seems staggering. And two, I know that you have highlighted that there's no free lunch here, that there is some downside. So one, do you buy the notion that this is going to have as big an impact as at least I hypothesize? And two, talk about the trade-offs of a GLP-1 drug.

• 1:00:15Speaker 03

  Well, you know, I thought about it a lot, Scott, after I heard the episode of Real Time. And because I hadn't thought of it in those terms, and I think as an economist, that's an interesting way to think about it, right? Which is, look, we can really quantify the cost of weight, right? Like, we can, we can actually quantify that. And by extension, we certainly have enough clinical trial data to look at both semaglutide and terzepatide and talk about their impact on weight. So I actually think there's a clear consideration. And I think one thing that you didn't consider in the analysis was the cost of the drug. So we have to ask the question right now. When you factor in the cost of buying the drug at the current prices,

• 1:00:57Speaker 03

  assuming these companies don't dramatically lower the prices, how does that change the calculus? So I don't know if you've done that yet, but the problem with these drugs today is they are comically expensive. I mean, they make PCSK9 inhibitors look like Tic Tacs. You know, at some point, that cost is borne either by the system, when the insurance company pays for it, and then everybody is subsidizing it, or the individual. And I do wonder if at the moment, we're just seeing the tip of the spear, where the wealthy can afford it, because it's a rounding error for the wealthy to spend probably, God, it's probably $16,000 a year is the cost of this drug. So, you know, for a wealthy person, that's a pittance.

• 1:01:39Speaker 03

  But the moment you say, no, no, that needs to be borne by insurance, which, you know, is really only paying for that at the most extreme levels of obesity or type 2 diabetes. How would you trickle that down to 70% of the population? Is basically my question. And how does that change the calculation? Then you get into the trade offs, which is in my, if I was guessing, I would say that there are trade offs to every drug or most drugs. And the question becomes at what threshold do you draw the line where cost, physical cost, harm exceeds benefit? So we can easily talk about the people for whom Ozempic or trisepotide makes sense.

• 1:02:24Speaker 03

  Meaning, yeah, maybe there's a small risk of increased in, you know, an increase in cancer down the line. Or the one thing that I've talked about a lot is we see every patient that's been on it has their heart rate go up 10 beats per minute. I mean, across the board. Don't know what that's from. I assume that's a change in sympathetic and parasympathetic tone, but it's in the wrong direction. So it's hard to believe that that's long term healthy. But it's also potentially not as bad compared to the long term harm of a person carrying 70 extra pounds. But at what point does that trade off flip in the other direction? And, you know, I don't know what that is yet, and we're not going to know that until there's more data. You then had touched on the issue, which has been reported, although I haven't seen clinical trials demonstrating this yet.

• 1:03:08Speaker 03

  I've seen this only as reports, which is that the effect. Probably of the GLP one, but it could be the GIP as well is is on the on the regulation of pleasure. And therefore, if it's turning down pleasure, whether it be from food or some other molecule such as alcohol, then, you know, we've potentially hit on something even bigger and more important than just an obesity drug. So I think all of this is to say, it's early days and I just hope that people out there are willing to invest in the right kind of studies to answer these questions. Again, some of them that we can be answering in short term studies like the behavioral

• 1:03:50Speaker 03

  stuff, but some of which are only going to be done over long term studies where we can really look at safety and other consequences. And then lastly, I think the economic model of this is just still a little bit broken. I think that the US drug pricing model is a badly broken system. And I could go on for hours about that, but I but I think we're going to have to address that. Just to put that in perspective, by the way, for people listening who don't, these numbers sound a bit funny. You know, I don't think there's another developed nation, you might know this guy. I don't think there's another developed nation out there that spends more than about $10,000 per person per year in total healthcare. And if there is, it's not going to be that much more, right?

• 1:04:35Speaker 03

  It might be that it's, you know, $12,000 per year per person, but I'm pretty sure every other developed nation from Canada to Norway is under at or below $10,000 per person per year in total healthcare cost. So when you have a drug that costs 16,000 plus dollars that you're going to need to be on for the rest of your life, because we know, as sure as God made little green apples, when you come off this drug, the weight comes back. We have to figure out that part of the equation as well.

• 1:05:05Speaker 02

  The best way to describe healthcare in America is how I think some people describe San Francisco, bad but expensive. You've been very generous with your time. Last question. As someone who's you've been successful, what advice would you have to your 25 year old self?

• 1:05:24Speaker 03

  It's tough. I don't know that my 25 year old self would have listened to anything the 50 year old is saying, but if I could have really convinced him and maybe put him on some MDMA and got him in a really empathetic state, I would have said now is a good time to start figuring out yourself. Don't wait until there's a crisis. So be proactive in your approach to emotional and mental health, just as you have been at the time I had been very proactive with respect to my health in all other ways. And I think it's very cliche and it's not for everybody, but I really believe there's something to be said for being a father. And I can't imagine what my life would be like if I didn't have a

• 1:06:08Speaker 03

  family. And again, it just sounds like such a dumb thing to say because it's so cliche. But I think if you're a dad, you would agree with this. So maybe those listening to this who aren't would find it silly. There is nothing I have accomplished in my life or will accomplish in my life that I am going to be more proud of when it's over than my family, because I know how hard it has been and how unnatural it has been at times and how much sacrifice it takes, and yet how rewarding it is. So I know that the trends are that people are having less kids and you know, people are more reluctant to start families. But I would say that it is the most rewarding thing that I can imagine doing.

• 1:06:53Speaker 02

  Dr. Peter Attia is the founder of Early Medical, a medical practice with the goal of lengthening patients lifespan and simultaneously improving their health span. He previously spent two years at the National Institutes of Health as a surgical oncology fellow at the National Cancer Institute, where his research focused on immune based therapies for melanoma. He's also the host of The Drive and the author of the number one New York Times bestseller, Outlive: The Science and Art of Longevity. He joins us from Austin. Doctor, as you are going through that analysis of the trade offs in your life and wondering whether it's worth it, you do need to add in

• 1:07:27Scott Galloway?

  On the credit side, you're having an enormously positive impact on people. I think a lot of young people are thinking about health earlier that wouldn't have otherwise had they not seen your content. You're so outstanding at distilling down this information and people look at you and they want to be you. So I hope that you, I hope that's part of your calculus and we really appreciate your time today.

• 1:07:47Speaker 02

  Thank you so much, Scott. It's been a great honor to sit with you.

• 1:07:59Scott Galloway?

  Algebra of Happiness, When Not to Make Decisions. I have a friend. I invested in his company. He's a super impressive executive, has made a shit ton of money, built one of the most iconic products in the world of tech. And when all of this broke out in the Middle East, he immediately got on a plane to Israel and his part is called up in the reserves and is having a lot of personal issues and sat down with me and I said to him, look, whatever you do right now, don't make any decisions. You just got so much external stimuli, you got so much shit in your life. Don't make decisions around where you live, don't make decisions around your job, don't make decisions or big decisions, I say, about who you're married to or not married to. Don't make any big decisions.

• 1:08:43Scott Galloway?

  I am struggling right now, or on a regular basis, maybe once or twice a year, I get depressed. And that's the bad news. The good news is I can feel it, I can recognize it, I know how to get out of it. But, but, when I am in that space, when I'm going dark, as I call it, I do a few things. One, I stop all THC and all alcohol, I exercise a lot, I eat clean, I eat at home, I try and be around my boys a lot, I find that's very restorative. But what I do not do is I don't make any decisions, any important decisions, because you might, you are making them through a fucked up lens called being in a weird place in your life. There are certain decisions around relationships, around jobs, around where you live that are so important that you need to be clear-headed.

• 1:09:28Scott Galloway?

  You might end up making the same decision, but for God's sakes, you don't want to look back and think, I made the wrong decision and had a real negative impact on my life and the lives of others because I wasn't seeing clearly. It is really hard to read the label from inside of the bottle. But when you don't feel like you're in a place of calm where you can make good decisions... Then don't. Don't make the decision. Put it off. Put it off and try and err on the side of generosity. Don't lash out. Don't say things about the relationship that you might regret. Just take it down a notch. Take the temperature down. There's a time to make decisions. There is also a time when not to make decisions.

• 1:10:11Scott Galloway?

  This episode was produced by Caroline Shageran. Jennifer Sanchez is our associate producer and Drew Burrows is our technical director. Thank you for listening to the Prop G Pod from the Vox Media Podcast Network. We will catch you on Saturday for No Mercy, No Malice, as read by George Hahn, and on Monday with our weekly market show.

• 1:10:35Scott Galloway?

  Woohoo. Woohoo. I dropped my fries on the floor. Come here, you tall drink of lemonade. Spank the dog. Spank the dog.

• 1:10:46Speaker 05

  Support for the show comes from Delta Airlines. Every athlete at the top of their game knows that greatness isn't just a destination. It's a grueling, lifelong journey. It's built on early mornings, silent sacrifices, and an unwavering drive to outclimb the achievements of yesterday. That is the journey of a WNBA athlete, and Delta is there every step of the way. Delta is proud to host these competitors, providing charter flights for every WNBA team to elevate their travel experience and champion equity on every leg of their trip. Keep climbing with Delta Airlines, the official airline of the WNBA.

• 1:11:31Speaker 06

  They're running a cover two defense. But you're running to get game day deals on Uber Eats. Keep everyone at tonight's watch party fed with deals from your go-to restaurants or stock up with deals on your favorite snacks and groceries. Whatever the occasion, get game day deals on Uber Eats all season long. It's not football without food. Uber Eats. Order now. Terms apply. Product availability varies by region. See app for details.