#1108 - Peter Attia

Apr 24, 2018

Peter Attia is is the founder of Attia Medical, PC, a medical practice with offices in San Diego and New York City, focusing on the applied science of longevity.

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late and gentlemen how's everyone doing I'm decompressing this week but we got some good fucking podcast coming up one today I like it is a good one

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this is a smart motherfuker Zedge educated individual this episode of the podcast brought you by on it oh and nit we are a total human optimization company and we specialize in items and supplements and things and ideas that improve Human Performance that's what on it is all about I'm one of the owners of on it it is something that I deeply believe in and the philosophy of on it is best summed up by taking a look at the Onnit Academy link if you click on that link it's hundreds and hundreds of articles on exercise and diet and nutrition and exercise physiology and different workouts for your strength and conditioning routine is different to an Ace Ventura some people but it's what Aubrey Marcus the rest accrued on it and myself are all about just trying to do our best on this

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has any human being I've ever met to being a saint is just a fucking amazing beautiful person and when I say beautiful he's also gorilla doesn't have to be so nice he's huge heavyweight contender in Bellator in MMA and just the fucking sweetest person on the planet in the guys gotten malaria three times I'm going to the Congo through this podcast and through this promo that we've run we built several well so far

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for the pygmies in the Congo and I just I get a broken up thinking about it it's it's amazing that Justin does this and it's very very amazing to me that we've been able to raise thousands of dollars to help build these Wells you can also buy and sell Bitcoin with the cash app I love that about it because you don't have to buy a whole Bitcoin you can buy as little as a dollar and most buys and sells happen in seconds and you can keep the funds right in the app or you can cash out directly to your bank account at any time and could not be simpler so go get the cash out for free on the App Store or Google Play use the promo code Joe Rogan you'll get $5 and $5 will go to Justin runs fight for the Forgotten charity member Joe Rogan's only one word when we're together we're also brought to you by LegalZoom LegalZoom is a fantastic way for you to take care of legal issues online in the comfort of your own home or office on your time whenever you

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check out LegalZoom business legal plan at legalzoom.com now and get special savings when you enter Rogan at checkout LegalZoom where life meets legal legalzoom.com don't don't don't don't do well my guess today was recommended to me by the great and powerful choco Jocko willink if you know anything about Jocko I know anything about my appreciation with Choco Choco says someone is fucking awesome I bet they're fucking awesome and I was right I was fucking right brilliant guy he's a doctor he specializes in longevity but he's also been a Competitive Cyclist boxer he swam from fucking that we talked about at the beginning deposit podcast swim from Maui to Lanai

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back Jesus and not on a cruise ship either I can go on a cruise ship that wouldn't be nearly as impressed you know it started off kind of fun and then man we got into a Groove somewhere deep and we start talking about medicine and then you get to see his true Excellence which is really always fascinating to me when I'm talking to someone and they seem like a smart normal person and then they talk further and you know you're a fucking genius you're one of those sneaky genuses cuz he's a handsome sneaky genius really enjoy this conversation so please give it up for Peter attia

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The Joe Rogan Experience

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what's going on man you just tell me something that what is one of the most ridiculous things I've ever heard that you swam from Maui to Lanai right and you the one the only humans ever do that I'm told I was the first person to swim from Maui to Lanai and back but the one way is a pretty famous swim race that's done every year the first person to do it and go back fuck dude why'd you do that how long they got to do that it's a ridiculous proposition so I got into I decided in who's going to sound silly I read a book in January of 2004 about this woman named Penny Dean who still to this day holds the record for the fastest crossing of the Catalina Channel shows for me from Catalina Island to San Pedro to YouTube

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22 point point Vicente and she had done it in like 7 hours and 20 minutes and I was like that's amazing I was it as a crow flies it's 21 miles with the current it's a little longer and I was like you know I really want to do this but I got to learn how to swim first that sings That's 3 miles an hour swimming she is a Phenom Penny Dean had a stroke rate of 90 Strokes per minute which someone who doesn't swim but like to turn to have a hand hit the water every you know third of a 2/3 of a second is a remark I can't hold a Cadence of that for a hundred yards

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wow and she did it for 20 miles what a beast she's out of control freak me out I might be one sport where it's if you just look at the numbers I think women are better than men from Cuba to the United States fairly Advanced age yeah I mean she's of course got an amazing pedigree of swimming and that wasn't her first rodeo but I'm not a member of this community anymore but when I was it was one of our favorite topics of discussion I think I think opportunities or ideas to put forth were higher pain tolerance something about being you know evolving to be able to give birth just means they can tolerate pain a lot higher

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I think another thing I've heard is buoyancy you know women are naturally going to have more body fat with provides insulation when you do these swims you're not allowed any wetsuits or Aids of any sort so it's like your Speedo single latex cap and that's it and so you can have a little been in so I think women's hips because they going to have more fat on their hips date they had corrects one of the big boy and see if she's that we have in swimming we we we didn't evolve to swim we're horrible at it naturally because we swim like this we drag our gets through the water and if you think about the importance of aerodynamics in most of the things that we think about whether the archery your race car driving or cycling you know in water is that much more important cuz the density of water is you know thousands of times greater than air so swimming is just a hundred percent about avoiding drag

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wow so that will that totally makes sense I just have been fascinated forever with people that are capable of pushing their brain to do things that other people just don't think of possible like a you know Bigfoot 200 race or like any of those things but the swim one is particularly crazy because you can't stop right like if you're running an ultramarathon and just want to sit down for a couple minutes and just take a break you can do that but if you're swimming there's not a goddamn thing you do water is about as good as a kid but you can't touch the boat for the kayaker it's an immediate disqualification

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that's so crazy man that is such a wow so you heard about this woman doing and that's why I read this book and I was like I really want to do this at the time I was in my residency in Baltimore and I was like you know I really want to do this and I got to learn how to swim to do it so I start taking swimming lessons and then let me make it very long story short basically by about the summer of 2005 I entered my first swim race which is a 2 mile swim race in Lake Reston Virginia and I did it I was like oh my God I just swim 2 miles in the Open Water you know it's hard but I was like okay that's the proof-of-concept now you just got to figure out how to make it 20 25 miles and

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so I just you know went completely psycho and Ratchet up the training and and then in October of 2005 I did my first Catalina swim that's got to be a pretty good feeling that when you're done that you are capable of pushing yourself to what most people think is an impossible distance yeah I talk to I mean people you asked Mom I go why do you do this I would say that it in life velocity means very little acceleration means everything so what do I mean by that right like if you're going 650 miles an hour in an airplane you don't actually feel it you only feel when speed changes so I've always had this theory that emotionally that's also true like happiness is only interesting when it's juxtaposed with sadness and so the feeling of crawling on the shore after you've been swimming for 12 to 14 hours is amazed

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but what makes it especially amazing is that 6 hours earlier you thought you were going to die

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so you start these swims in the middle of the night to avoid the shipping traffic so that First Swim boat drops you off at Catalina Island it's midnight that's a Darkness you can't imagine why you can't even see LA from Catalina you have to swim for 6 hours before you even see the lights of Los Angeles yeah what do you see the stars and the phospho like bioluminescent organisms in the water that's worth the price of admission so every time your hand comes through the water you're pulling and ripping these little things and you're seeing the Sparks and you can't tell where the water ends in the sky starts in other words the stars in the bioluminescence looks like one cylinder for the first few hours at school but then you know that my first swim the water was incredibly rough I had only swim in the ocean for two weeks before the swim I did all my training and of swimming pool so

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and a lake on the East Coast so now I wish I wasn't used to how to keep the salt water out of my mouth so then I was like puking my guts out and then my yeah yeah yeah how does that work you just stop and pee and then keep swimming but then my tongue is really swollen from the salt water because again as I would learn later on I have we gone to do many more of these swims but what I learned is the importance of spinning the water out of your mouth very quickly so we not in a freshwater pool or like you get away with more than the ocean you swallowed at all while you're going to get sick as hell

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to all this stuff going on so by 5 in the morning even someone for 5 hours you're getting cold

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you're I mean in a frankly just physiologically like your cortisol levels are in 1/8 or you're just you feel horrible it's like it's a really bad feeling and you're not even halfway there and it's like you don't know if you can do it and Bubble Watch well if 6 hours later you're now crawling out of the water feeling like you've done this amazing thing that that's emotional acceleration that's like the greatest contrast

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I know what you sow mean I've never experienced that but I was explaining the other day to a friend of mine about this camping trip that we went on in Montana when it was like 9 degrees outside it's freezing cold stay out there for five six days and then when we finally got to a hotel room I took a shower and it was the most amazing shower I've ever experienced in my life and that's a small thing or think about the meal you had a similar situation now that you've done and how many of these are you done these crazy you swim races or Swim that means you have to do you go to the Federation that oversees that body of water and you say hey I want to do this and then you you know you go through all the channels to do it like they have to have an observer there and they you follow these official rules

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someone is actually completed it right in someone's there to make sure you didn't you know you did it correctly I don't know I probably done all in probably like a dozen of these but probably like 6 of them really long ones what's the longest

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well that's a good question what is there and back around Christmas time in the water because you rarely get to swim use in a straight line so the Maui Lanai one I wanted to go Maui Lanai Molokai Maui to do a triangle and that would have been 30 miles is a crow flies but we just you know boat captain wasn't willing to do it at night cuz the tiger sharks and during the day time we couldn't physiologically figure out how one could I suffer against those the Wind cuz the wind gets so brutal in the middle of the day so even the one that I did which was just there and back I ended up swimming for 12 hours because on the 1st way Crossing where there was no wind took me 4 hours and then it took 8 hours to get back because I was swimming like the hypotenuse of a triangle right like that

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it's going this way so I had to swim this way just to go in a straight line and I still can I almost missed Maui Jesus cries I almost got swept out to Molokai just because the current was about 1.7 not which is about as fast as I can swim maybe two nuts fuck

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that is a ridiculous thing man why you doing this is this is why I don't do it anymore it was certainly it was an amazing season of my life but I think once my daughter was born which was 10 years ago this summer that's when I I only probably did two of these after she was born because then the training just got so I just you got to live in the water if you want to do this for like you got to

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including the winter you know like you know even in San Diego where I live it's still you know 55 degrees in the water and you're going to spend 3-4 hours a day in the water freezing you know it's just too I was like you know I just don't have the the drive to spend 25 hours a week swimming

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what was the what was going on in San Diego in that guy got bit in half by shark couple years back there training for something yeah that's right I remember like it was yesterday so at the time I lived in San Francisco and this is actually just before I swam the Maui thing now that I think about it I was 10 years ago when the Maui thing in June of 06 by June of 08 so I'm doing all my training in a swimming pool up in San Francisco because I don't want to acclimate to very cold water actually want to be in warm water but I needed one long ocean swim like 14 or 15 miles is my like last training swim but came down to San Diego to do it and just by bad luck I came down a few days after that guy was killed

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now this was a guy I didn't know him but he was a triathlete training with a trap on group that they would go out and swim every morning and I know the beach exactly where it happened in Solana Beach and unfortunately like most people who get attacked by great whites they have a very

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did they always attack the same way which is below and behind stealth fight up in an ewe Retreat so they're trying to basically injure the price of their prey exsanguinates and then they take off and then they wait till you bleed out so they never saw the shark but you can tell from the bike parks it was actually had a friend who was on the beach and saw him when he came out and he was basically dead when you got to shore he didn't pee or blood the death of the problem is so in this case the shark had bit him and cut through his femoral arteries and veins and the salt water prevents you from having any hemostasis so it exacerbates the blood loss

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so that's generally how folks Parish when they're busy and luckily that commotion prevents the sharks from wanting to come back to work till 3 days later I go out and I'm swimming at that beach cuz I swim from my training swim was La Jolla up to Solana Beach and back and got to tell you like 3 days after a guy dies where your swimming it is it was about one of the most mentally challenging training swims to be like could you can't see like the water at that part of the beach is so murky you know you're only a couple hundred yards offshore that but you can barely see your hands when you're swimming and so you're just thinking

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sister day

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yeah I'm not interested in that is just something about sharks to their to me one of the most terrifying things we're so in apt in the water I mean even a person like you is a great swimmer what we are in comparison to what they are it's just your you're throwing yourself into the world of a super predator and to know that one just jacked a person just a few days before and you're out there swimming around

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yeah although I will say this you know when it's all said and done all of the close encounters I've had probably the scariest moment I've ever had in the water was doing a swim from Santa Rosa to Santa Barbara So Santa Rosa Island which is the second for this North Channel Island you got San Miguel Santa Rosa Santa Cruz and Anacapa represent the top 4 Channel Islands so we did this November swim it was night time thing against women from Santa Rosa Island to Santa Barbara and

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at about 5 in the morning maybe 6 in the morning you're just starting to get enough light where you can see and you're out there so you really have amazing visibility and I look down probably 40ft and I see this in normous thing swimming like this which is how sharks swim and I see the dorsal fin in the position that freaks me out and the Tails this way all of that is shark

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and I like you know like lift up out of the water kind of hyperventilate for a second and I'm thinking myself alright you got to make a judgement call here if that's really a great white you probably ought to get out of the water but if you the moment you are out of water that's it the storm is over like you just spent like months doing this like it's done

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so when I convinced myself and I think I'm right I think it was a dolphin on its side because of dominant side with its fin would it still think would be the same way and it could swim that way so in the end I just kept swimming but I mean not skipping the shit out of me will they have seen quite a few of them off the coast of Malibu there's no question that they are way more plentiful than we realize and talk to the fisherman like the fisherman will tell you they're like your golf Coronado I mean it's like there's non-stop great whites

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I freaking me out Peter the good news is they see us all the time and most the time they realize we're not what they want they want seals yet I guess they're making a mistake like a suit you can wear either Kevlar suit protect protect you from getting bitten in half this is so funny you bring this up I became obsessed with this thing called the

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what was it called Christ you put the thing on your ankle like you had like all about growth I need wrapping your icon had a tail like this long and I like four foot long thing and it was charged and it sends out an electrical impulse that disturbs the shit out of the Sharks the shark's nose is an organ that senses electricity to win a shark or it could be pitch-black you can be sick water and they can still scope you you know from hundreds of yards away based on the electrical activity of your heart and that organ is there no so this little thing I forgot what it was called Shark taser or some shit it puts out a signal that like tazes them and they don't want to get within like the world's first shark deterrent bands called the shark band worn on the wrist or ankle different name but to the one that I was going to get and did a ton of research into had a really long tail hanging off it and that became the pro

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easiest patented magnetic technology to repel sharks so the tail was a problem because of the drag no because it would sound silly but it would come up and Zapp you in the nuts became unbearable to practice swimming in this thing every 37 seconds you get zapped by the tail and I was just like as it says reduce the risk can I get some numbers please

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it also is a leash for your surfboard to you can use one of those to trap it to your strap it to your ankle but yeah I know it's going to come to me like in an hour I'll remember this silly thing was Jimmy Hoffa Catalina I know it's one of the best shark fishing places in the world have a friend of mine who told me that if you think about like wild places on Earth that are just over run with Predators terrifying like predator-prey activity Catalina Island is one of the top spots in the world what are you talking about he's like I'm telling you man the shark fishing off Catalina Island is fucking insane and then I watched television show just and I'll synchronicity a couple days later and it was these guys shark fishing off of Catalina was like what in the fuck I could have never guessed the catching makos mostly and it's actually my recollection cuz we swam

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around Catalina once as well the back side is way more aggressive in the front side the side that faces the Pacific sided rather go back where they were yeah it looked pretty nuts me they were bringing in these 15-foot sharks and then I was like what the fuck this is just floating around out there you know it's up I mean I guess of course they are I mean there's a lot of fish out there as well so I'm sure they had Alina is amazing and I never step foot on it except at the beginning or end of his swim until 5 years ago I went there for a vacation like actually just went to Avalon for you know three days

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I'm like it's not a place I could live a little you know too quiet but for 3 or 4 days it was amazing I think people hunt on Catalina the got huge Buffalo there is that what is this yeah so apparently there was a movie that was made their back in the twenties or something like that and let a bunch of Buffalo will they had a bunch of Buffalo yet for the movie and I guess they never Buffalo well there was one of the Channel Islands that they had actually turned into a bow hunting destination like they had brought in a bunch of deer I think they brought in Staggs in a bunch of weird exotic shit and they put them on this island I think they even had elk and then biologist just weren't having it there like this is just so out of whack and if so they had them eradicated the way it's pretty gruesome they just come down in the air and just leave the bodies yeah they just decided that they were too invasive species regardless of how valuable they might have been

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want to go there and eat them now they just decided just for the ecosystem alone just has no Predators there and then we're going to turn the fucking Island Wild Kingdom and bring wolves or something in there would be pretty God damn crazy magic there was an island go and I just had wolves and Elk running around on island just date that's an interesting perspective cell biologist look at it in terms of the entire ecosystem right they looking in terms of the plants the amount of waste Topeka waste these animals are leaving behind the fact that they're literally eating everything that they can on a Scion they're not supposed to be there and then they're competing with whatever things are native to that island and probably a thousand pound Elks not supposed to be on a fucking ions and this thing's just eating everything you can and they don't they don't have a winter either so it's just like the whole

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search Sun supposed to be there the Channel Islands themselves are kind of amazing I mean but most people know Catalina but you know there's 8 of them and not two of them you can't step foot on I think someone else and send Nicholas there military bases so we try to do is swim from San Nicholas back to Los Angeles this is a relay swim because it's like an 85 mile swim and I spent like 6 months researching it speaking to a bunch of naval officers I was like hey is there anyway we can officially to have to start a swimming have to do with a touch dry land and be out of the water and they're like yeah you can come on the island so in the end what we decided was we were just going to do a stealth Landing you know by the time they came down and screamed at us and shot it as we have been off the island but we got to send Nicholas that's real shark territory because that's where the elephant seals live and so when we got out there we can literally could not get too short because of the elephant seals

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like work with 200 yards offs and neck and nose after taking a full 2 days to get out there I'm in this place is really hard to get to cuz the water is brutal and you're not in a huge boat and yeah it looking at 5010 elephant seals that are just like licking their chops looking at you trying to get in the water what would they do with you I didn't want to find out but they're not predatory I don't think I did I think they're aggressive as hell did you see that video of the little girl that's sitting on a dock and a seal jumps up and grabs her in the ass and pull her into the water to see that Jamie I didn't think that seals ever did something like that before I don't know I did see a special once about how Dolphins could be kind of aggressive with each other like they could harm Cecile sitting there and this girl is sea lion actually list

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it comes up and they think the salon so cute

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but it I think it was probably looking for a handout and these people weren't giving it to her when she turns her butter

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she did

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yeah fuck that thing I be like I'll be right back

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fill that fucking puddle with lead in plants in the water eating fish and shit you know whatever then get ahold of them and stuff to feeding them under they have an issue in Boulder

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Boulder is there been Colorado beautiful as it gets right your man San Francisco I think Boulder is right up there but there's less people and everything you know about it was really healthy and active and hiking and stuff like that they don't allow hunting for mountain goats on the weekends because there are so many people hiking and don't do they don't want people killing these mountain goats in front of them cuz people freak out even though they have decided that they have to control the population until certain number of Makita but so many people go out there that these things aren't scared of people so it's created this really weird situation where if you are hunting them you're you're almost hunting something that's domesticated people feed them Cheetos so much so that a friend of mine was talking about it

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he was up there with his daughter his daughter open up a bag of Cheetos and the Goat walked right to a wild goat lives on the fucking Woods walked right up to his daughter and they were laugh and she opened up the bag of Cheetos and put it and he stopped his head in the bag of Cheetos he knew what to do and he's he's in his guy who was talking about this is a hunter and he's like this fucking goat has like Cheeto dust all over its face like it's the craziest thing its face is all red with Cheeto dust and it sitting there chewing the cheat like it's done it before and it's just probably eventually right yeah I was in Costa Rica is another similar situation and we are staying at this Four Seasons out there and the monkeys have got very custom to people being there and so they come by and they hang out and they were trying to get things from you and my daughter opened up a package of Oreos and the monkey just jumped onto this

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a couple feet away from her and and my wife was like I really don't think it's a good idea that we feed this thing Oreos and I said wow you know it's probably gonna get eaten by a fucking crocodile anyway it's food poisoning it is that what you're thinking it's not going to eat this every day so I could be normal part of its diet but we hand the monkey and Oreo it pops open the Oreo and starts chewing on the frosting like a little kid and they were like all this little fucker probably gets these things every week right so begs the question does he know how to do that because he's watched some human do it or are we in Nate ly wired to do that with Oreos I think he knows how to do it because someone's giving him Oreos so many times that he knows that's the good stuff the good stuff the middle

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let's just sell that in a paste in contrast it would because back to the contrast pure metal would be pretty gross nobody would buy it but if they sold those black cookies by themselves no one like those could what you eat the white stuff in my car at all you just stupid ass black cookie hits the sun cost at you in love or it looks it look at him open it up immediately open it up and start chewing that white stuff

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crazy we had there's a thing that is called a coatimundi have you ever heard of those it's it's related to the raccoon it's a weird animal that lives mostly in Central and South America and it has a northern range that extends into Arizona all the way up in a mace I think like it gets into the air is work it's cold but Arizona things the only state in the US that has it but is this weird-looking monkey raccoon thing that is so domesticated that we gave it some grapes

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we gave it some grapes and this little fucker there it is that weird little thing it came and sat what we had like a little patio area in the hotel room they came and sat down with us and so calm that it's at and went underneath one of the chairs and took a nap after we gave it some grapes like what we're hanging around with my daughters are running around making noise this thing's Just Chillin It was a total pet is a total pet

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apparently they hunt them in Arizona I mean after seeing this is it's like I don't think I can hunt that have to be pretty hungry to eat one of those are so cute little face weird little animal

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really interesting our relationship with animals is very odd when I get into close proximity San Diego then at least the part I live in in in or just one of those things once we got rid of mountain lions cuz nobody wants mountain lions around the coyotes run amok is that what it is I think about this the other day actually and he was saying that this probably only like in our neighborhood is really like to mountain lions left and the the coyotes just they've exploded there there's so many of them around like it doesn't bother me that much I mean I actually kind of like listen to them hell but you know if you get to get in your chicken coop

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yeah I had one till chickens just a few weeks ago it was on the roof of the chicken coop the way they jump is so stunning like they're So Graceful like I've never seen anything that moves like that in the wild the wave coyote does there was a 6-foot fence it's on the ground it jumps to the top of the 6-foot fence almost like it's it's under different gravity rules than us and touch of the top of the fence and then boom it's on the top of the chicken coop I mean in like a sec I haven't seen that that would be it's crazy I have video of one of them jumping my fence I caught one of them with the chicken in his mouth jumping the fence jump a 6-foot fence with a chicken in his mouth just jump touch the top of the fence with his front paws back Paws went over right behind it it was gone it's crazy

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but you know but they we need them we need them to kill the rabbits and rats and if we didn't we have a giant like here's what I tell my daughter cuz she she gets all stressed out that his coyotes in a rat walk around her house and I was like well first of all the pretty skittish of us and boy they keep those rodents under control you need them for that but there's a single state in every single City now every single City there's there's coyotes in Manhattan Banks they found them in abandoned buildings by a pass gas in the podcasting Dan Flores he's a wildlife historian it's fascinating there are really really unusual animal in that when you shoot one

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the yellow out here's a Swiss is coyotes in New York City New York City dude she can New York City New York City Police Department coyote running down the street where man they have a real problem with them in Chicago I thought I could Escape them when I'm in New York no you can't escape them anywhere there in all 50 states now they completely extended the range and the reason why they extended the range is because we we went after them we hunted the down you know they were able to eradicate Wolves and the way they were able to Raticate what was his they would kill the alpha and then they would take an animal like a horse they would shoot it and then they would fill it up with strychnine and so then they would rub the alpha the body of the alpha all over this this carcass of the horse and then the other wolves would come in smell that the alphabet in there and then they would eat the wolf or eat the horse rather and die and so they were able to do this and essentially use this method + shooting

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things like that to eradicate them from the West because of ranchers and cattle farmers

► 00:40:44

they've never even been able to do that with coyotes when you shoot a coyote if they do roll call like when you hear them if one of them is missing it sends the females it send some sort of a signal where their bodies produce more pups so if one's missing instead of having like 3 pop chill-out 6 so you make more coyotes when you kill them and they extend the range when you persecute them they just extend the range it's crazy animal they are wicked smart man they've been chewing at the roof of my chicken coop trying to get in I came outside the other night my dog I have at three dogs but one of them is a Golden Retriever and that dog has fucking zero instincts I mean it's it is just up it's a little human it's like it's like the little marshmallow it's just a he's fun to go running with his stuff he's a great dog sweetheart of a dog crate pet but like he's like what's going on over there

► 00:41:44

elderly chewing the shingles off the roof job outside you know it's it's it's very weird living in proximity with all these things because where I live you know we have a lot of hawks lot of owls lot of coyotes and occasionally a mountain lion FCI salt Bobcat what's which is pretty interesting

► 00:42:10

I've never seen one of those weird looking too weird looking thing to see one of our friend of mine I put it up on Instagram see if you find it it's fucking old is an old one on Instagram a friend of mine had a coyote or a bobcat break into her chicken coop and kill every one of your chickens and the coyote artist look at that fucking freaky bitch change the Bobcats hit the best searching skills of all time but look at that that's in my friends Chicken Coop she's a bunch of murder chickens scattered around it looking at things face fuck that

► 00:42:49

that look as fuck you yeah that look as fuck you lady yeah I killed your chickens while you have them outside so no Taco does how we got connected yeah yeah I was home so I was like one of my really close friends again even Kirk parsley who's also a Navy SEAL at former CEO and

► 00:43:21

Kirk said hey you got to meet my friend rockbass was just so you guys use how to make choco just have to experience Jocko we obviously connected pretty quickly and then I think this was before Jocko's book and his first first book I take him out and I said I got introduce you to my best friend by Tim Ferriss who obviously you know Tim and Customs always looking for you know great guest on a podcast and so I called him and I said look you got to just trust me on this one site unseen just have Jocko come to San Francisco next week just not going to say anything else it will be worth it and I had enough credit in the bank with him I've done it I've been successful on sight unseen recommendations but I think the Jocko from is the best one ever cuz he called me after you tell me about Jocko is still there and he's like

► 00:44:18

yep that was pretty intense yeah I sent him an email after that podcast might that's one of the best podcast I've ever heard my life and I made a post about it choco respond to the post and then I got Jocko on and then I and Tim convince Jocko to do his own podcast and now it's huge man is podcast I get text messages all the time from people thanking me for telling them to listen to it and then I get tweets from people thanking me for talking Jacqueline at doing it because it's just in this world you know in everything there's outliers in athletics is out but it comes to discipline and motivation and just just when you look at someone who just undeniable Jocko's one of those guys he's just undeniable he's he's a specimen he's definitely

► 00:45:07

authagraph yeah I met him a long time ago when he was training with Dean Lister and demons fighting in the UFC remember meeting them and I'm like what's that guy's deal I've got a whole lot of shit going on behind their eyes and I like I said some stuff you know during public it's pretty funny so

► 00:45:34

Jocko is in New York I just after his book came out and visit and I was like look I want to see some of my my my buddies who run headphones here because some of the water what Jacko does is they get his partner like they consult with with guys like this doing leadership stuff and so we went up to the offices of one of my friends who has this very famous hedge fund in his office is like on the 50th floor on Park and it's looking it's like a beautiful view down Park we're just sitting there in his office just shoot in the shed and I forgot how it came up but somehow we were just talking about like like how good is a sniper like what is it actually take and Emmett of course we were talking very specifically about I can put a blanket on his name Chris

► 00:46:23

the Bradley Cooper played him in ya Chris Kyle we talked cuz Chris Kyle had been part of jacko's team I forget which Seal Team maybe it was he when he was Seal Team 2 but

► 00:46:36

in fact I think Rocco said he goes you know yeah Chris was a part of my team for more of his kills in any of his other kills and so then we were like what set him apart I mean obviously any Navy SEAL snipers got to be amazing but Chris took it to another level what what was it and he and he said okay let me show you what it was so he said we walked over to the window and he goes okay see that guy in that hat over there like about a mile down the you know you can basically see if it's like a pink hat or something so yeah you guys okay if you're a sniper you got to be able to lay down not move and put your eye up against this thing and like look out at him and you can't if you ever take your eye off that you're going to lose the site so you got to be able to stay in that position and I'm moving to Amigos and I forgot the number was pochacco said the average Navy SEAL Sniper can stay in that position without moving I glued to the site for X number of minutes and I forget what the number was maybe like 15 minutes

► 00:47:36

he's like Chris could do that for two hours he could lay in that position not moving and not taking his eye off that thing with one eye shut for hours I need to know you just like you just had a different you just had a different gear and it was just an amazing thing that is like like like maybe three people in the world that would understand why that matters you know because just sharpshooting just being able to shoot something at a distance and long distance shooting is it's it's a big sport mean for in terms of target shooting I mean that there's guys that are out there that shooting 1500 yards and doing it competitively that's a crazy did it's amazing crazy distance but when you think about it you got a rifle it's on a rest you're sitting you either on a bench or you're prone or whatever it is you lying down most

► 00:48:36

time this is all of this it's this with your finger pull pull pull pull pull boom some people are way better at that just think of that coordinating your vision getting the reticle set on the target pulling that without movement the outliers are the people who can do that and go to think like when he break down physical movements right like you watch gymnastics routine Olympics like holy shit and it flips in the land and they stick and it's incredible

► 00:49:08

but now break it down to just a movement of your trigger finger pull pull pull pull pull up no movement you know I mean it's hard to like if you shoot pistols and you have dummy rounds you know like a lot of people then mix in dummy round so that they find out that they're jerking the trigger yeah and when you see like I was watching a video with Tim Kennedy and Tim Kennedy was a shooting at the range and he's he's pulling Pang bang bang and it goes quick and he goes it didn't go off Target it didn't move it was it was no punch to it you got a fucking practice forever just to be able to do that just to not anticipate The Recoil of the gun and you just controlling the mind me a fascinating thing to me

► 00:50:08

I don't like they want to go hunting

► 00:50:18

let's get your rifle because I could teach you how to shoot a rifle we could we could get someone if we could sight in your rifle go to the range outside and then in a hundred yards get you a good accurate rifle and then all you have to do is kind of keep it together a rifle we get into a hundred yards of a wild pig you're going to be able to kill this thing or a hundred percent you got years before you going to be able to shoot that thing with a bow I mean fucking year first in the bow is like my wife said this to me a while ago she said of all the things you do she's like archery seems to be the only one where even if you don't have a good day you're still happy like if I if I if I'm on the racetrack and I'm driving a race car or if I'm you know swimming or whatever and I just have a bad day like I don't I'm just not firing on all cylinders like it and I just kind of pisses me off there's something about archery we're even if I'm not having a good day like

► 00:51:12

maybe it's an extension of what you're talking about with the trigger finger so for me I got to charge because of Tim and the story that the thing that he told me which obviously fragrances but yeah the thing that he told me that immediately made me be like I want to do this was just anything that requires that match Perfection just seems great and he was like yeah you don't take a shot unless you can kill the animal like that you might take one shot in 2 days like it's got to be a kill shot in the kill shots got to look like X Y and Z and I was like oh that's like you got to be dialed in so it was his idea back tension you know it was sort of like wow you pick me up perfect shot like it's all in the rhomboids you know it's all back here and you've got to be able to do as you said you going to completely be able to eliminate any anticipation any of this business and so I think that I think of archery from is almost like a meditation and give you read like I'm talking in the way they can Sam Harris would talk about sort of Consciousness and the way you are so high

► 00:52:12

aware of what you're doing that yes you can daydream in your mind can wander but if you actually start to imagine the sensations of every part of archery in many ways it feels like meditating so I think that's why I'm just like

► 00:52:26

you know what I never really thought about it with shooting a rifle sound have much experience with guns but I'm guessing it's it's very similar but as you said like the the the difference between the good in the great and that is less obvious you know at a distance yeah I think off hand shooting a rifle and shooting a bow I bet I bet I'm just as accurate at 60 yards is the average person is a sniper but the average person with a rifle you can be pretty fucking accurate you know you can't off of bench so there's there's some similarities there's like there's a similarity to having the you have to have perfect technique you have to have the right stance you have to make sure that you know everything's locked in and your your structure is correct but I agree with you that I think it's some sort of a meditation I also think there's something to hitting a Target that is in our DNA that's connected to hunt

► 00:53:26

that's connected to survival that's connected to in the thousands of years that people through arrows and fucking what is that what is that thing called what's that thing called that they atlatl thing yeah I thought I said atlatl right yeah that's like Advanced spear-throwing thing and then archery and just I think when a person would hit a deer they knew their tribe was going to eat for a so there's a slight charge and you get a small amount of that juice when you hit a Target I'm sure there's going to be dopamine secreted when you send me to do that it's the greatest feeling in the world that doesn't make sense does it make somebody there's a fucking set like Jamie laughs at me cuz I'll hit the bullseye from 45 yards and I'm like you get this little

► 00:54:24

get a little little burst man I just like the whole experience even this sound so sometimes like when my veins get holes in them like sometimes you put a Broadhead through her or you put like a field tip through another one in now obviously sometimes if you trash the vein the air doesn't work but like usually just a single hole in a vein will produce a sound that is the greatest sound you've ever heard when that Arrow leaves the whistle yeah and broadheads invented broadheads they whistle so animals give me around so that whole experience of like the perfect release you know either when you surprise yourself like I've been so I switched over to this Carter Revolution release sure about the back tension release yes it's the most pure back entrance better than the honey cuz the honey you could still cheat a little bit you know if you were getting lazy you could you guest list but the evolution there is no cheating

► 00:55:24

patient yeah yeah I noticed that are you rambling about boring the shit out of me I was trying to explain to Alexander Gustafsson who's in here the other day and he's a hunter to Hudson in Sweden you can't bowhunt it's not legal and he wanted to learn how to shoot a bow and was explaining that I put my finger on this trigger my finger sits on the trigger I use a card or two I use a while First Choice in the name of the reason I go I put my finger on the trigger but I never squeeze it the squeezing is all done with my back cuz I pull then it got just goes off and look at see his head is like why why would my counter-intuitive but once I got into a Tim actually sent me this book on back tension and then I just devoured it I mean it was sorta like the reading the penny Dean book you know is Tim doing the salon now

► 00:56:24

not as much as he should be but and because he's been on bowhunting course that's what got me into it about 2 years ago he was getting ready to go to a trip to a 5-day trip in Colorado and he called me and said

► 00:56:46

hey I want to talk with you about like some training and some nutrition to like get ready for this is going to be kind of an extreme whole deal you know you're at altitude you're running around like crazy you got to be able to like thanks Sprint and then be totally relaxed and so he's like you know can you help me think about how to train with a nutrition would be in and I said okay to tell me more about what the demands are and the more he told me the more I was like why am I not doing this this sounds awesome awesome video of of of the so he took I mean probably the only took one shot in like the whole 5-day trip and was a perfect what did he kill

► 00:57:25

there's a huge burden I can't remember what it was like yeah yeah I was like a bird on the ground like some huge ass bird but it wasn't a turkey it was like I remember what it was but the shot he was like you know it's one of those things where was like cuz you know all my practice is on stationary targets right so it's a totally new dimension when it's like the things doing this also is flying it was it was like kind of like either running on the ground or about to fly or something anybody hit in motion and he was a great shot you should have fucking Eagle definitely wasn't yeah I was reading something about the goose problem about how the goose population has exploded because of a farm lands and that they literally don't don't know what to do with the the certain population of

► 00:58:25

different kinds of geese are flying into this country from Canada it's funny you say that I was in Toronto 3 weeks ago that was wrong from and though I don't go off in and we were I was with my brother and we up taking the kids to some place and sure enough like we're walking from like one area to the other end these geese come up and they kind of start posturing and I'm thinking the fuck my brother's like moving like one of their eggs sounds like why he's like oh yeah and they're big. Pretty big jobs like turn up let's just keep walking don't make eye contact but you can cook them so fuck them get out of here God damn Keys yeah there's a there's a certain type of geese at they call rib eye in the sky

► 00:59:18

cuz they have a delicious red meat to them what is that called which fucking God damn it but they're very plentiful in Texas yeah they hunting in Texas and they they literally stew meat like is it called it looks like a ribeye it's crazy sandhill crane sandhill crane that's what it is you don't know he's a fucking wizard with the Google man with Google everyone is a wizard but Jamie's and extra wizard he's really good I've had friends that say it might be the most delicious meat in the world made it taste like a like a like a wahoo ribeye and it's flying around and you can shoot like fucking 10 add a crazy like my friends that hunt these things and you know they're fun they're mostly in Texas I don't know where they are but my friends who hunted them on to them in Texas

► 01:00:18

sure they fly all across the country but if he has a crane it's not a goose yeah I've never been but I've only been bird hunting twice I went once with Anthony Bourdain first TV show we hunted pheasants and he shot one then we cooked and ate it that was fun I shot it one and missed and I shot a turkey once which is pretty interesting wild turkeys very good very delicious but

► 01:00:44

you know it some when I I like mammals I like eating mammals prefer I prefer red meat is better for you I think it's more nutritious it's more exhilarating the something about the the meat itself just taste better now though I haven't met too many foods I don't like I'm sure you must have a voracious appetite I mean I do but nothing like what I used to being II fast pretty much everyday like I'm doing 16 hours what you doing I split my time between New York and California when I'm in New York it's absolutely one meal a day no ifs ands or buts cuz it's just the schedule is such that you know I'm seeing patients in the morning and afternoon I don't want to do I want to waste time to eat what are you doctoring that's a good question I mean I trained as a surgeon and did cancer surgery but I have my practice is based on longevity so it's

► 01:01:44

how do you apply nutrition exercise sleep Stress Management Endocrinology lipidology supplements hormones all that stuff I got to use engineer how to make somebody live longer is is my clinical interest so yes or New York I eat one meal a day so it's busy like a 22 hour fasting window and then I'm feeding within a 2-hour window wow when I'm here I mean yesterday and today it's the same like you know today is it's been kind of a busy day then I won't eat till dinner tonight but my short fast would be 16 hours where I would eat I'll be a short one for me really should you got to get in touch with your evolutionary I have this discussion with a friend this morning cuz he was saying to me he can't do 16 hours I was on my side you just told them you got to understand if if our ancestors couldn't function when they were hungry we wouldn't be here so it's not just that start

► 01:02:44

short term adaptation to starvation is is necessary to be beneficial in other words you know during these short periods of deprivation of food you know we get just a little bit more epinephrine and norepinephrine we just get a little bit sharper a little bit better I can't even I can't even remember this like you three meals a day it's been so long

► 01:03:09

I mean I've been doing crazy shit for 10 years nutritional wise like I meant spent three years in ketosis where was having a one day I was in ketosis for 3 years lots of fasting but I think intermittent fasting or time restricted feeding probably at least 5 years and what it is for people listening what are the benefits of that well I mean really technical we have to be clear that I think a lot of the benefits are overstated then a lot of the benefits are things that we've only studied an animal so there's a guy named Sachin Panda at the Salk Institute in San Diego who's I think one of the world's experts on time restricted feeding but

► 01:03:49

every sample of 16 hour fast in a mouse produces unbelievable results if you take a group of you know certain types of Mysore strains of rats are the rodents and you in a 24-hour period. Deprive them of any nutrients for 16 hours but then for 8 hours let them eat whatever the hell they want they can't gain weight so in the end in the reason we think is that it once you give a long enough. Of time when the animal can ramp up it's like the enzymes in the liver that are responsible for fat oxidation States we become fat burn I hate that term fat burning machine is so overused but they say that if we just become unbelievably efficient if a metabolising fat so be careful that when we extrapolate that cuz you and I have a very different metabolism in Emmaus like 16 hour fast the mouse is much longer than it is to us so I don't know if those benefits would extend also it's not entirely clear the timer circuit feeding will produce the longevity benefit that we see and other

► 01:04:49

sort of fasting or fasting-mimicking types of diets so for me what it comes down to is I mean honestly it's just an easier way it gives me a much more Liberty with what I eat during my feeding window I don't have to be nearly as restrictive when I'm feeding if I have that. Off it just just in terms of like my physiologic response secondly there's a convenience thing like I kind of hate being Tethered to eat I like knowing that if I get into a pants like I don't have to eat right now I'm sitting on the airplane and they're serving dogshit I don't have to eat I can wait another 5 hours until I eat

► 01:05:28

I also just feel much more steady in my energy levels I I kind of vaguely remember like 10 years ago when I was kind of like eating a normal diet how

► 01:05:39

I always had this low in energy after lunch like there is the post-lunch pre-dinner I just don't feel good like not that I feel bad but like I'm not sharp I'm not in my a game and I don't even know what that feels like anymore which is not to say feel great all the time but I definitely don't have that vacillating energy level most carbs for my diet you know when I have a friend of mine who talked his trainer about that the trainer's like you're crazy eat bread eat pasta don't listen to him like no don't listen to him like just just Google it that's that's fucking terrible for you if you want to eat carbohydrates get it from fruits you know get it from natural sources but you just if you have a trainer to tell me to eat bread get a new fucking Trainor cuz it's just it's not what you mean is nothing wrong with me if you want to occasionally and in small doses but when I eliminated most that stuff for my diet I felt the exact same thing I felt that mid-day nap desire go away

► 01:06:39

and they just the fogginess about like you at the end of the day like I'm fucking tired and then have to drink cup of coffee to get ramp back up again and it's just like never-ending cycle of having this insulin Spike and then crash and that is that's from carbohydrates it's from refined carbohydrates and you know having too much fucking sugar in your body and everybody does it so this will be funny for your so Google my name and just put like Peter attia fat and you'll see a picture of me when I was a swimmer cuz all this time we were talking about me swimming you're assuming like I'm a fit dude I was a fit but fat dude totally fat and say you got you got a little punch on you I don't know but there's another picture after I swim across Lake Tahoe go to that that one right there yet

► 01:07:37

gobble got there fella but it's definitely you know probably what maybe 30 pounds have your body no body fat was much greater and will you eating three or four bottles of Powerade a day cuz you're training all day and you know every post workout was a carb refeed and so your answer to this vicious glycogen dependent State there's so many folks out there that are living their life that don't even understand there's a process they're going through they just think this is eating and exercise this is what happens but it's not your body look if you shut up shut that off push it away enter into a completely different food source just change the way you eat your body

► 01:08:37

change and that that just that concept people that sounds like horseshit it sounds like what are you saying that you are offering some miracle cure you're saying you will change the dimension of life you operate in it will change cuz you won't be the same person you want that like who you are is dependent upon a lot of things but one of them is how much energy you have and how you feel you crashing you change the way you eat you change the energy you have to change the way you feel it'll change your behavioral change your choices will change your Ambitions will change your potential so many things that will change but there's an interesting question which I've I've I spend some time thinking about and I've sort of accepted the fact that we might not know the answer which is when I was growing up I was exercising like crazy not as much as I was when I was swimming but I mean sorry more than I was when I was swimming but I ate like I had the world's worst diet growing up

► 01:09:37

so I would eat breakfast was a bowl of like a box of cereal so I take like one of these Tupperware bowls that was this big and fill it with a full box of each day I would have just the box of Cocoa Puffs or whatever I would start the day with and then lunch was a full loaf of bread which would 7 sandwiches plus a plate of fries plus a big tub of like the ktulu jug of orange juice 6 hours a day so I would need to run 10 miles in the morning in the gym you know boxing like you know what that's just like I mean it's ridiculously energy expending but the point is I had a hard time holding my weight and I was a middleweight 160 walked around at 158 who walks around below their fight weight so you know my waist was 28 inches I was 24 and a half percent body fat and I was eating anything and everything you could put in front of me and then something happened in medical school where that shit just stopped

► 01:10:36

and I wasn't even eating his badly at the time but all of a sudden the metabolic adaptation just vanished and you know I mean I wish someone who could study this meaning you would have to take a group of individuals and do muscle and fat biopsies over their course of their life or at least during this window when we think this is happening and I think for many of my patients were just even friends like it seems that this happens kind of in your 30s if you're a guy for women is it harder for me to tell because I think pregnancy can interfere with this so sometimes we get rid of ask you to answer but if I had to hypothesize I think that we go from having a lot of lipoprotein lipase on muscle cells and not much on fat cells to the reverse so when I was 16 and Invincible my muscles had a lot of this enzyme LPL on it that could just absolutely take whatever I was throwing at them and

► 01:11:36

turn it into energy for the muscle where is when that LPL exists on a fat cell you're basically just going to store more fat and now why that would happen over time I mean to guess reasons but I'd love to know if that's the case because I still can't really figure out like why is it today I am so carbohydrate sensitive when there was a day when I could eat

► 01:11:58

did I was probably eating seven or eight thousand calories a day of which 80% were probably carbohydrates when I was growing up and was lean and mean did you expect to crash involved in the it like post afternoon crash post-lunch crash a good question back then I don't think I did that much back in the day which would also speak to the idea of better fuel partitioning fuel partitioning meeting is for the technical term for where your body knows to go to XS Energy in are you going to glycogen are you going to the fat and then where are you storing energy so I so I suspect that was just better at fuel partitioning as a kid which I'm sure most of us were anyway it's kind of course the real question the reason we care about this is like what could you do about it right like what

► 01:12:47

Jeffrey Campbell bike that's probably one of the reasons why testosterone as as as testosterone goes down you're going to get fatter all things equal and part of the reason is testosterone upregulate LPL and hormone sensitive lipase and all these other enzymes in the direction of making you leaner versus fatter so but I just don't think that that's enough of that you know I think there's something else that's going on it's triggering that decline Sophie you with this 22 hour window of not eating what do you think the benefits are other than your energy and slight spikes in norepinephrine and some other hormones well I don't think there's sufficient evidence at this point in time that time restricted feeding is going to impact my longevity so I think that's the big claim and it's the big play what is the what is the what are they saying can I think the claim would be fasting mimicry which could be you know like what's a valter Longo talks about where you do a 5-day hypo

► 01:13:47

diet of 752000 calories a day for 5 days followed by 25 days of AD libitum feeding meeting eat whatever the hell you want in terms of total caloric content you know the claim is well that's going to enhance longevity and or if you know doing a 16-8 or 18 6 is going to enhance life span so just to take a step back I am only aware of

► 01:14:12

three things that have Universal extended life span across all model organism so if you think if I call you Carrie it's right if you go from yeast to worms to flies to mammals the only things that uniformly extend life or almost uniformly is caloric restriction and or dietary restriction so total reduction in calories during the lifetime and or reduction of certain subsets of those calories so there's a super famous experiment that was done I see if anyone's interested I wrote about it it's on my blog somewhere but it's basically this the best experiment ever done a caloric restriction was between monkeys and there's a group at the NIH in a group at the University of Wisconsin and was like a 19-year experiment or something like that so you could really study the impact of caloric restriction over these things and that experiment showed us that caloric restriction extended life span if you had a really shity diet and it did not extend life span if you had a really good diet counter-intuitive but it also spoke

► 01:15:12

to the idea that dietary restriction probably matters other words if you're eating a regular diet of McDonalds everyday and then we put your counterpart eating 70% of McDonalds everyday that's going to move the needle but in the Wisconsin and it in the NIH experiment when you took the monkeys they were eating kind of it wasn't there natural food but it was less horrible food the clerk restriction did not extend life span so that threw a wrench and everyone's understanding of caloric restriction and there are certain strains of mice that also don't seem to be enhanced in terms of Life Span meaning just time on on Earth but for the most part nutrient deprivation pretty ubiquitously extends life the second thing that uniformly extends life across this is a drug called rapamycin which is kind of like My Favorite Drug in the whole world I mean meaning it's like I think the most important drug in in terms of this space not necessarily because it's a drug that will all

► 01:16:12

taking though I do believe that is the case but more importantly because of what it's taught us about the nutrient sensing pathway and its Target which is this protein called tour the target of rapamycin or M Torres you probably heard of it as mechanistic Target of rapamycin and rapamycin inhibits that now it's a bit complicated because there's two variants of it there's something called mtor complex 1 and mtor complex to and if you take rapamycin day in and day out everyday which for example transplant patients do it's an immune suppressant that doesn't seem to really extend life span but you take it in a pulsatile way you selectively get this end torque one inhibition without the m42 inhibition that seems to produce longevity big time at work how would you take it selectively

► 01:16:57

well this is one of my main clinical interests and because I obviously I'm waiting for the day when I can start taking it and ultimately you know feel that it's safe enough that I can give it to patients if I'm extrapolating from all of the best data out there so that's looking at the work that's come out of your getting David sabatini's lab David's a guy at MIT he's a professor he's actually the guy that when he was a medical student I'm doing his PhD in 1994 actually discovered how rapamycin Works in mammals he's actually guy that coined mechanistic Target of rapamycin M to work as a name and so now whatever we are almost 25 years later you know he's still running the PowerHouse lab that understands that so if you look at all of the literature that's coming out of their lab

► 01:17:45

coupled with a guy named Matt K Berlin at the University of Washington who's doing rapamycin studies and dogs

► 01:17:52

along with the work done by someone named Joan manic who was at the time at Novartis is now a company called restore Bayou and a few other people my intuition is that somewhere between 2 to 6 mg every 5 to 7 days is probably the sweet spot but you know am I confident enough in that to say that we should all be taking it not yet there's a couple things that like I want to be able to measure before we do that but you know in the animal data the steps remarkable if you look at Matt Carolyn's dog data it's remarkable what are they doing with the dog you know this right I mean if you if you look at outside of euthanasia or accidents how dogs die if it's he died of cancer and hard and they get dilated cardiomyopathy with a different type of heart disease in humans get they don't get a through sclerotic disease they get heart failure there at the hearts just get too too too big in the rejection fraction which is the amount of blood the percentage of blood that leaves The ventricle

► 01:18:52

chamber with every contraction that number goes down bad things happen in perspective you and I sitting here couple of normal fit dudes we probably have a resting ejection fraction of 60% and if like we went out there and like killed it and work as hard as we could at Peak we might get that up to 85% ejection fraction so once the ejection fraction gets below 30% you know a person starts to become very symptomatic well Matt took these dogs that had low ejection fractions to begin with and I forgot what the exact number was but it might have been like below 40% below 30% put them on a mice in for 12 weeks and in just 12 weeks sign absolute 10% improvements or not didn't that means not going from 3233 that's one from 30 to 40% EF Improvement

► 01:19:44

just as hard to measure an affection 12 weeks of a drug and certainly you're not going to be able to measure a longevity impact over that so much of the study that's being done with this is looking a surrogate markers that we assume would portend longevity so Matt's work focusing on the ejection fraction manix work was focus on immune response what you're going to do this was a turning point for me this was like December of 2014 was like when everything in my professional World shifted in terms of my interest towards like rapamycin is the thing I want to know everything about because when I was at surgical resident you know we used to give rapamycin out like it was cotton candy to all the transplant patients it was an amazing drug that revolutionized transplant physiology because it had far fewer side effects in massive doses of Prednisone and things that we used to have to give patients now you could give them much less prednisone and you could give them rapamycin or cousins of rapamycin like FKA

► 01:20:44

506 you doing with that stuff is your suppressing immune systems of the body is rejecting organ exactly now when the you do that does that leave them susceptible to illness or disease does in person taking for longevity that's the million-dollar question and so I think into in a moment I want I'll tell you the story of how rapamycin came to because I think it's the most interesting story in biology certainly in the last 25 30 years but when it was approved in 1999 by the FDA it was for this indication it was an immune suppressant it was 10 years before anybody figure it out. Oh wait this could also extend life and there and you had this Paradox which was with you and suppressant extend life I mean everybody acknowledges that immunity is a cork you know element of health and so in December of 2014 I finished almost Christmas Day if I remember thinking this is like the best present I've ever got Mannix group publish this

► 01:21:44

paper which they did in a group of about 300 and 2065 year olds ish so they put them into four groups there's a placebo group there was a group that got and it wasn't actually rapamycin it was ever a everolimus which is an analog a rep Myspace to the same drug it was a group that got one every single day 5 milligrams once a week 20 mg once a week they did this for something like 8 to 12 weeks and then they washed out meaning they got nothing for 8 to 12 weeks and then they were hit with a flu vaccine and then a scientist measured the immune response doing these really complicated Ashley's where you look at T cell function

► 01:22:23

so relative to the placebo paradoxically all groups and I said paradoxically because even the group that got one once a day also an increase in immunity which is a good thing but the 5 and 20 group saw an even bigger response the people who just got 5 once a week or 20 once a week so not even bigger response but the group that took 21 so we had more side effects and the biggest side effect of rapamycin acutely is he's awful awful mouth sores called after Seltzer's they're nasty they're brutal I used to get them all the time just from I think sleep deprivation or anything of something is weakening my immune system so it's an internal sword not a not like a cold sore no no no it's like it's a really nasty type of canker sore yet so once I had one so bad that I was like as soon as in residency and I was like it was just driving me nuts so I went to the or and I got a bunch of Lidocaine which is a local anesthetic and I wanted to the call room and I just

► 01:23:23

my tongue and just injected like lidocaine in it when I did that somebody walked in and I've got like blood dripping down for my mouth and I'm going to need Lynn my mouth and they're like it's not what you think I wear lidocaine I like dude deviated septum fixed and they shove the lidocaine up there you know it's it's it's par stuff and the rest of the day I just felt like shaky and just weird and then I realized oh this is like a almost like a cocaine type thing like it's supposed to know why we have lidocaine cuz of cocaine to my heart because he was the original he was the founding surgeon at Johns Hopkins and one of the original Four Horsemen so the four main Physicians that basically have shaped medicine in this country all started out at Hopkins Osler

► 01:24:23

medicine Hopkins and surgery and then two other guys Walsh and I'm blank Gun Kelly was the third one and he basically figure it out cuz you got to remember like there was a day when surgery was staggeringly barbaric like prior to Ether surgery was like alright can you hold them down like a gum get getting drunk gag them and like we're going to do our thing right crazy so the exact dates anymore but it was too late 1800s when up at Massachusetts General Hospital I forget the name of who it was but someone basically came up with either so either became the first form of anesthetic but you know you were knocking people out well it was you know fast forward probably 20-30 years when Halstead figured out that this thing called cocaine could provide local anesthetic so he began experimenting with like crazy and of course in the process became

► 01:25:23

but Peyton Lee addicted to it so you this entire generation of Surgeons at Hopkins from that early era that were completely Coke addicted so Halsted and all of his first generation of residence and then of course from that we got lidocaine bupivacaine all of these things that don't have the same properties but to this day cocaine is still use and it must be don't realize it but cocaine is a schedule 2 drug meaning it actually has a metapopulation like heroin which is schedule 1 in the DEA marijuana that's right but the cocaine is schedule 2 and it is still used in some ENT surgery cuz it has some favorable properties over even like Hannah bupivacaine for nasal surgery did you know that they still use coca leaves for flavor in Coca-Cola the actual extract the cocaine from that use the coca leaves in the cocaine goes to Medical cocoa tea for my first time this summer like real bad like brought up from

► 01:26:23

great but could not get enough of that stuff you can shut the fuk up on it though cuz it's a weird sort of hi it's a very strange thing it's very talkative sort of high I thought it was just everything about it was like just don't you believe she's ever done that like in Peru or no no apparently it's really interesting it's like a coffee sort of thing and it's got flavonoids It's actually probably healthy for you I just love plants and Jen we think of the coca leaves as producing cocaine cocaine we think of is inherently negative but the delete itself like if you just don't extract it actually really good even like thinking about the difference between eating fruit versus eating Oreos is pretty good at regulating how fast this sucks when the case of fruit like how quickly does fructose hit your liver there's a sort of Governor built into it if you're on raspberries like could

► 01:27:23

get non-alcoholic fatty liver disease from eating enough raspberries yeah probably but it's like a giant gallon of orange juice everyday most people think of fresh-squeezed orange juice as being off your eating healthy look at you over there with your fresh squeezed orange juice and super healthy you just drinking a big ol glass of sugar are you literally your body doesn't know the difference between that and Coca-Cola very little difference between the two of us got some other stuff in there caffeine but other than that just the sugar itself yeah your liver would have a hard time telling the difference so crazy most people would think a glass of orange juice at breakfast is a healthy choice glass should have a Mountain Dew yeah the dosage of 1/5 and then 20 so so they

► 01:28:23

that study remember reading that and thinking okay if it's if you looked at that study you realize if you're going to be in the placebo the one-a-day the five once a week of the 20 once we could 5 once a week was the way to go because you got all the benefit of 20 more benefits than one and the fewest side effects and how long is this study that was an 8-week intervention with an 8-week washout was enough to see the enhanced immunity do you think that a longer-term study is necessary to see like what are not allowed adapts yeah absolutely I mean all the stuff is in its infancy now my my check is total right now wrapping license off patent rights of the drug was approved in 99 by the FDA but this is after an unbelievable amazing story of like how he almost got lost forever like you know so there is no economically incentive for a company to you know figure out how to do this thing with rapamycin

► 01:29:23

and even everolimus I think ultimately Novartis I'm saying this with no actual knowledge other than just my own speculation but I suspect Novartis was like well you know we're not going to play this game just with everolimus and that's I think why I probably spun into this other company restore bio2 to sort of combine it with other agents but at an end of one level what I'm kind of interested in doing is using myself as a guinea pig to start to measure the benefits of it because my hypothesis is three things have to be true if rapamycin is working I could be wrong but but this is my hypothesis and this is what I test with with with with other scientists if you were taking rapamycin at the right dose so assume you're not getting all the nasty side effects for not getting the mouth sores and stuff like that three things have to get better one your glucose metabolism should at least get no worse but potentially better I suspect it's a function of where you start

► 01:30:23

so there is one doctor in New York who has like a rapamycin practice I think he's in

► 01:30:29

please in the Bronx actually

► 01:30:32

and I talked to him a bunch and when he

► 01:30:35

when he started it himself he said like the improvements were remarkable just in terms of glucose metabolism but I think he was starting at a pretty bad spot but if you were I took it we might not notice much getting better but we definitely should not get worse so that's easy to measure clinically you do as an oral glucose tolerance test would give you that answer but two things should get significantly better the first is immune function should get better not worse there's no clinical way to measure that but we do know how to measure it I mean it when I was doing my postdoc it was in an Immunology lab like I know how to do that ass a I just don't have like a million dollars worth of equipment to measure it what is the difference in the dosage even in the high end at 20 vs which would give someone if they got a kidney transplant to 3 milligrams everyday okay so it's quite a bit different it is and it's different on two levels because you know when you're giving it everyday at a lower dose Houston still end up producing tissue

► 01:31:35

that might even be comprable to wear that person was getting with the spike of 20 and in general this isn't always true but in general and pharmacology side effects of the result of a certain side effects of the result of an ater dose and certain side effects of the results of the peak dose so with every drug you kind of have to understand this a little bit but going back to the Trap am I standing of the third thing that has to be true in my opinion I could be full of shit but I think the third thing it has to be true if you're taking the right those is you need to see an uptick in a tapa G and so just as if you get this process where the body cells start eating themselves so it's kind of like a programmed cell death although technically we reserve that term for something called a pop ptosis but when you're fasting what's why would fasting produce a benefit I mean I mean I think the most logical explanation is if any has the top a g so the body basically has to prioritize in the absence of nutrients the underperforming cells are

► 01:32:35

we told each yourself and you know we can recycle some of your components maybe this mitochondria's worth saving this Golgi apparatus is worth saving and then we selectively when we refeed repopulate the better ourselves and in many ways I think rapamycin can do that in a pill so the problem is we don't have a blood test to measure a tapa G sew-in in the in the lab when you measure a tapa G you need muscle biopsies were typically even just sacrifice the animals this is becoming very hot areas of the Nobel Prize in medicine and Physiology was awarded for the genetic basically the elucidation of the genetic regulation of at apogee in a ship 2016 so it's very recent a year-and-a-half ago this with a Nobel Prize was awarded for but what I'm hoping is that we can develop a signature for a top of you with a blood test so I believe that you should be able to look at someone's blood and look at all of it you know it might have a little mix all of the small molecules all of the proteome and Usher

► 01:33:35

signature it should look different from the way we look when were you know fast it or redness or a fully fed otherwise would you just take a sample the muscle tissue like punch something out and I mean I'm willing to do it all and I probably will we're just trying to get what's called an IRB and institutional review board so to do these kinds of studies in humans even if I'm the only subject and it's just like I don't care what you do to me 10 things we still have to get an IRB so we're working on getting an end of one IR be so that we can take muscle biopsies fat biopsies for me blood test and then start to actually look for that signature what did Barry and where you got it from like we would you want to get some more than one I probably have to talk to people who have a lot of experience doing this with animals but it actually wouldn't surprise me if I were going to do it I would just start in the legs because the muscles in the legs tend to be the harbinger of what's going on in the body so forgetful one of the first sign

► 01:34:35

diabetes like a decade before you get diabetes one thing that if you're actually doing this kind of testing in people it you'll notice glucose insulin resistance in the muscles of the legs so what's the legs start to get insulin resistant you're on a Glide path the bad things happening I'm fast first of all from years of martial arts but also because over the last year or so I've been doing a lot of running and it's one of the only muscle groups that I can work out everyday I can I can run Hills everyday and I'm not sore like that that's not even possible for any of the group I mean I can kind of do that with boxing you can hit the bag and if it's far as like running hills is essentially like Plyometrics like you're pushing your entire weight up and then you catching the other way I can pushing it out there you can't do that I mean

► 01:35:35

wrong but it's nothing like the amount of endurance that you have in your legs to be an adaptation that you've had as well I mean when I was a Competitive Cyclist I mean there were definitely days when I would especially when we did like multi-day events like there were days when it's just like you're beating it's like everybody else is riding together you're riding alone today the fatigue level though is significantly different than it different than it would be if you were doing something with your arms everyday your ability to recover you have more options especially if you really have good proprioception but you know I actually think if you took so you know how you have both positive and negative motion concentric eccentric motion of a weight if you are willing to do away with the negative

► 01:36:30

you can lift heavy every single day so there's this guy name Ryan un-freakin'-believable baby. I'm just dropping the way and I was like that seems weird to me so when I was a cyclist this was my training and it was all put together by this guy named Ryan Flaherty who introduced knows another one of my sight unseen introductions to Tim for a podcast a great podcast with Ryan Flaherty on and he's like on the guru of speed Heat this is a guy who likes single-handedly I should say single-handedly I mean he's on the shoulders of many other people have done great work but but it has really done an amazing job of figuring out how to make people run fast and it's a very long story and I mean he does such a great job on the podcast I won't go into a bit but for the purpose of this discussion

► 01:37:20

one of our interest was he could we translate everything you've learned about sprinting into cycling and his biggest observation was the following if he took a hundred Runners and line them up and new like before they ran new house how hard they could hit a force plate treadmill he could predict the order in which they finish the race 2/4 play treadmill as its name suggests a treadmill it's a special treadmill where measures the force that you hit and that the higher that number divided by your body weight that became what he described as mass specific force that number if you rank order it is the order in which people would finish the Run how to make sense if you think about it write the harder you can hit the ground relative to your own wait the higher you go and the higher you go the longer you travel with each stride so Usain Bolt has the highest ever fourth plate measurement calculation and it's I forgot what his ratio is

► 01:38:20

I want to say he's like 6.9 or 7 times more Force than his body weight every time he hits freaking staggering about his next question is when he was working at USA Track his next question was could you train this and other words like okay if Joe Runza you know 4.9 40 and we want to get that down to a 4 5 cannot be done and it turned out the answer was categorically yes you have to do two things you have to get stronger and you have to get lighter so how do you do that and that's when he came up with this idea of we do Hex bar deadlift we lift really heavy so you're only doing fives for his threes or to never more than 5 wraps and so you'll do 5 sets every single day and you'll pick it so some days it'll be 5 sets of 3 some days it's 5 sets of 5 whatever it is and you're out there very well prescribed like you know at what percentage of your one-rep max you're doing these at

► 01:39:19

and it's off drop top drop top drop so you're never getting the actin myosin filament to tear pass cuz that's what's happening in the negative is the acting in the the acting is coming off the myosin and that is pretty a micro tear in the muscle and that's what the muscle rebuilt that's why we get larger when we lift weights but when you drop it you unload the muscle when you're relaxing it so the muscles not going to get bigger so you're getting all the benefits all the strength which is primarily around the type 2B muscle fiber and without the without the size so anyway we went out last Ryan he could we do this in cycling we did this experiment which was he kind of came up this is for me and two other guys who were very good cyclist like I was like I'm a popper but these guys were like cat one cat to Collegiate cyclist cyclist but they were like my training Partners so we did this thing where we did the same routine that he had the sprinters doing it's a bit more complicated than I describe because you're also juxtaposing the

► 01:40:18

positive only with something called a post activation potentiation which you you have already experienced this but I don't know if you've ever tried to do Plyometrics after deadlifting but it seems counterintuitive that you'd be able to do more but you can really yeah it has to be a heavy deadlift terms of numbers or more so your highest streak jump is going to come after you've done like you have three sets of three at you know 95% of your one-rep max 3 sets of 3 dropping or using e-center no definitely absolutely yeah and so we would superset the Plyometrics with the deadlifts and you would do this everyday and to Ryan you know he where he runs a training camp where he has typically the top 10 college prospects every year just before the NFL combine come down and I mean the changes he makes in their time of Johnny Manziel was one of them so obviously Johnny Manziel is obviously

► 01:41:18

you know not panned out in the pros but most people kind of forgot how good an athlete he was and when he showed up to Camp I forget what his time was but I want to say it was about I don't know you probably look this up for me you know it was three tenths slower than what he ultimately ran at the combine and he I think he had the fastest per second fastest quarterback time at the Combine after just 12 weeks of doing it was unbelievable how fast you can get these guys to run I saw something the other day that I've never seen before it's an Ecentric bike it it changes back and forth her second person to tell me about this yesterday in fact now that I think about it it was eccentric and concentric but it if it alternates really weird it the forces move it and you're resisting the movement East Centric I forgot what it's called but like someone sent me this like hey this thing's amazing I was like it's a bike

► 01:42:18

fuck you talking about and it look different than that the one I saw was all so different it was a trick yeah yeah that's what I saw to Ecentric yeah you're spelling it wrong

► 01:42:32

oh it says just Centric oh okay

► 01:42:35

eccentric exercise bike try that

► 01:42:41

but it's the thing is it it alternated between eccentric and concentric it wasn't just the one with the red on the top row looks like it what is that pediatric ear ear, I thought it was full of kids well whatever I wish I had saved it cuz I was like I'm never buying this but you know it just looked interesting new methods of stimulating the body and tricking it into doing things and I guess that's essentially what a lot of people the way a lot of people think of intermittent fasting your kind of stimulating the body or hacking it working it you know. I wonder if you know one of the things that Ryan and I talked about was could we ever adopt his training system to swimming and in and running and cycling it's primarily going to be quads and glutes have to be the muscles to do it which any growth of fire at such a weight

► 01:43:40

men without having to do the negative as well so we couldn't really kind of figure out how to do it and so we adopted part of his technique to swimming which was the actual training routine meaning one of the big misconceptions if you're trying to go fast is that you need to still train slow but the reality of it is like you know if you're trying to run a marathon at you know call it a pace of 215 eunos world-class marathon runner there's not a lot of benefit to be spending much time running at a pace slower than that is the American Marathon ever won the Boston Marathon 3 years ago so amazing marathoner I think he's the only person to have won the New York Marathon the Boston Marathon end to have won an Olympic medal in Marathon he won the silver medal in the 2004 Athens games but when he won the Boston Marathon he was like 38 years old which in

► 01:44:40

parlance is like you guys will be a hundred and he had not really had a great race in the previous few years so he had been effectively written off in the sport and Ryan. She help train them and all they did was a flight AS principal of sprinting into Marathon running which was alright man if you want to win the Boston Marathon you need to be able to travel like 4 in further with every step you take taking the same number of steps at the same Cadence that you currently run and made you know Ryan did the math and said that means you're forced number has to go from where it is now which I think is 1.7 meaning he could only deadlift 1.7 * his body weight you forget that it's like 2.6 or something and so when Med train for the Boston Marathon he was

► 01:45:25

focusing heavily on these deadlifts and doing much shorter faster runs and you know I mean if you watch the video of his Boston Marathon when it's incredible like you know he just takes off and like leaves everybody behind him in there like yeah there's no way he'll be able to keep that up for let him go and I couldn't write him in

► 01:45:46

you think it's going to be a little break too but that's the big we talked about the other day some guy got really close to what you say he hit Jamie like 2:06 or something I think someone's got closer to the Giant in Germany last year go even closer was 202 or something along those lines and you think that this sort of method is what they're using

► 01:46:05

so I don't know if I'm allowed to talk about this stuff. Don't worry no one's listening everything has to be perfect right meaning you have to have the perfect athlete trained to peek at the right time you need the right humidity like everything has to fire on all cylinders but just as there was nothing physiologically special about a four-minute mile and Rodger Bannister broke it it was more of a psychological barrier you know I'm not suggesting for a moment that this will be easy but you know we're going to get there I mean like this can happen that is incredible if you think about how fast are running to run 26 miles in 2 hours to minutes dagger I don't think people understand like what

► 01:46:58

I mean I was never a great run or I could I was about a 250 Marathon 205 marathon when I was a boxer but never trained as a running like it was just I just ran so much and I was pretty fast but like when I think about how hard I would have to run to bust out a 2:50 to 2:55 and 2 sink like was there any chance I could have ever got that down to a 2:30

► 01:47:22

it's a that is such an enormous change in Pace it's could have done that regardless of all the training tricks in the world

► 01:47:35

well I know Matt personally I can't speak to what the other guys do but I think a lot of those guys are frankly in the state of where I was when they were younger meaning like they can probably get away with a lot more if you look at the physics of most of these guys there

► 01:47:52

they're perfectly built like I'm talking to leave love on the talk about like anyone who runs a marathon but if you don't like the people who going to win the marathons

► 01:47:59

they are basically all engine and then chassis in the right place but lately all they come down to write I mean they are in Norma's cardiovascular system very strong quads and glutes and then everything else is very tiny ants like is literally the size of their lawn you actually look at 12 I mean it's all relative but when you look at their frame their thorax is going to be larger and is it expanded because of the training I think so I mean Accentra never know cause and effect sometimes you could argue like maybe these guys were maybe the people who are drawn to those sports are the ones that are you wanting to be a leak in those Sports already had a genetic predisposition that sort of my feeling is it's a bit of both I think what Lance had that was pretty unique even amongst the world's best which is what he competed with of course I think his lactate threshold was a lot higher than most

► 01:48:59

genetically yeah and then of course you know I mean I know it's such a controversial topic although my view is I think that every single cyclists at least from 1991 till 2011 was on highly highly you know augmented programs so you know that Lance won seven of those years in the in that context just tells me that he was you know training harder and being more specific to the right and what people don't understand is like I mean Lance only take for One race a year like everything that that team u.s. postal did was geared for that one race and also when you really look at how much doping they did it while she wasn't that much like

► 01:49:45

you know when they were blood transfusion it might have been two units over the course of a race I'm not saying that that wouldn't help it would help a lot but that's nothing compared to what people were doing just a few years before Lance came along so Lance one I think his first one in 99 the guy who won before that in 98 was Marco pantoni before that was going to be on ulric in 97 and before that was going to be horn Reese if you want Reese's nickname was mr. 60 because his hematocrit was always over 60

► 01:50:14

that's freaking still have that guy didn't die of a stroke I don't know yeah Lance never had a crit over 50 to my knowledge they would basically always titrate with bow and or hemoglobin up to 50 which was the trigger so you know but but I think and again I've never I don't know Lance at all so I certainly don't know anything about him be on like the little bit that I had read over time but I do think his lactate tolerance was remarkable meaning you know we measure lactating athlete swimmers in cyclist when they're you know trying to figure out what their performance is and as far as I can tell there was seem to be these two phenotypes there's the one phenotype where people can tolerate staggeringly high amounts of lactate and Anna going to set lock tape her say that is causing the pain that you're experiencing it's the hydrogen ion that accompanies the lactate so lactic acid be a sad part of that is a hydrogen ion and that's actually was poisoning the muscle and preventing the muscle

► 01:51:14

I'm having this effortless actin myosin a que no contract release etcetera but we use lactated a proxy cuz we're lactate is high the hydrogen ion is high and there are some people who can just holler 8 Pike incredible doses I used to work with Olympic swimmers and I mean they were just a couple of these guys like they could actually be standing with a lactate of 24 made it when I was competing if I had a Lactaid about 16 or 17 I couldn't be standing like that was just too much pain like I was on the floor but I was over 17 I was puking

► 01:51:48

and I saw dudes I could stand there a 24 V I got one of my good friends he he he wanted a gold and a silver medal in the Sydney Olympics and retired from swimming in 2004 then came back to swim Masters so and was like yeah she was trying to make a comeback to make the 2012 Olympic team and when he was training for that like I would poke him between races and I saw him get out of a 402 the individual medley race which is the hardest swim race of them all the 400 IM is I mean you might as well just shoot yourself it's so painful he got out of that how to lactate of 18 two minutes later not too much later maybe 7 is there a jump on the blocks and 100 breast race you know came out of the lactating 21 I kind of thing so they were those guys and then I think at the other end of the spectrum

► 01:52:35

the word on the street is guys like Michael Phelps are at the opposite end of that where they are so efficient at shuttling lactic acid out of the cell back to the liver where this thing called the Cori cycle actually turns lactate back into glucose that they never have high levels of lactate now again all of this is sort of working no speculation cuz I know I think they were very hush-hush about phelps's numbers but I heard from reliable and reasonable sources that he would rarely have a Lactaid of 8.0 including when he's breaking World Records which for me at 8.00 can like that's fine but for you he was so efficient at getting rid of it that you could set the world record in the 400 IM and have like to date

► 01:53:22

there certainly a plausible mechanism by which I could be what's fascinating that this could potentially I'll be engineered right that like 3 use of crisper or something else he could take all these various facets of performance-enhancing modalities extend a person's ability and so many different ways and create a super person become cheating in the same way like would we would we have to have someone like Phelps who has his genetic predisposition to getting rid of lactose Lactaid and you take someone like me probably has none of that and you know you juice me up to his level is that cheating I mean who are so critical of Lance Armstrong say cuz cuz on the one hand but you'll have camps it's a look it's a great equalizer like why don't you just let everybody dope and just a steroid argument with anime as well

► 01:54:22

wait which is I think having done these Sports and nowhere near the high-level that those guys do it I just know how destructive they are like the Tour de France is the most unhealthy thing on the face of the Earth I've heard that it's healthy it's due to Tour de France on steroids than it is to do it off stairwell absofuckinglutly when those guys finish the Tour de France they are osteopenic mean their bone density has a row did their muscle have lost so much muscle mass mean it is a devastating grueling event. Nothing's going to completely ameliorate that but like if we think that like watching these guys kill themselves riding 6 hours a day hitting Peak thresholds if you know 6 watts per kilogram if we think there's anything physiologically reasonable doubt that we're out the fucking lunch but is that the point I mean isn't that the point is that you can push your mind to do something your body absolutely doesn't want to do so you should be rewarded for for that these guys are in A League of Their Own I mean professional cyclist

► 01:55:22

the toughest athletes out there I mean obviously every athlete at the peak of their game is remarkable and and no disrespect to like the best running back in the NFL but like you can't even compare that to what a guy does for workload for sure for just the pain absolute Shear discomfort in the physiologic torture and the duration of and all these other things will you see it in their faces to those guys like when they were tired they look like they're 10 years older than they are lost all of the fat butt lot of them you know if you don't have fat in your face I mean you age we automatically they just look exhausted too I mean it looks like it's just drain them like they forced to live 30 years inside of 10 guess what everybody's allowed to use whatever amount of EPO blood testosterone to be at the 80th percentile of what we consider normal so everybody's allowed to walk around with a haemoglobin 14.7 or up to 14.7 or 15

► 01:56:22

people to use certain amount but I also think like that the testing on this stuff is so like it's so JV now there's this idea called the biological passport that was introduced many years ago was basically said luck we're going to develop a signature for every person and now if you deviate much from your signature will that'll be the trigger and the argument Again by certain people I think Daniel Coyle argued this a lot in one of his books that he wrote ripping apart Lance was the reason isn't that the reason doping is unfair it's cuz everybody does that argument doesn't hold water is because if you're a person who naturally lives at a hematocrit of 47 you're only getting a slight Improvement going from 47 to 50 if you're a person who naturally lives at 43 you going from 43 to 50 you got much bigger advantage

► 01:57:13

to which I say yeah but what about Truman or relative basis but an absolute level if everybody's walking around with a hematocrit of 48 to 50 they still have the same oxygen-carrying capacity does level the playing field the concern though isn't it I would believe the concern is you don't want people to think that the only way to do this for is to take drugs absolutely and it's also worth putting in in mind that this is hurting my pet peeve with this whole drug and Sport thing is like I mean

► 01:57:46

a person I don't really give a shit I mean I had bigger things I care about them like how many steroids Barry Bonds took to hit all those home runs but what really does chap my ass is when people don't actually understand how steroids work right like it bugs the shit out of me when people assume that if you take steroids you will have you know you will hit that many you know home runs or you will run this faster lift this much the only thing that steroid is doing is enabling you to recover faster from the brutal work that it takes to actually do those things so you know all the eat if I if I shot myself full of epo East person Icarus right Brian did growth hormone testosterone in Epo I mean

► 01:58:37

you saw the end of the day he he finished worse the second year round because what his bike ran out of people don't realize like one little thing makes all the difference from a performance standpoint yeah he probably would have been a little bit better but it's not because the drugs were in him per say it's because the drugs that were in him allowed to train more so the reason he was a fitter Rider the second year was because his Watts percula were higher because of how much more he trained the drugs enabled them to train that much harder yeah that's what it does it allows you to train harder so you recover better so you have more output correct we don't want young kids to think that the only way to do this to start taking steroids and fuck up your endocrine system and that's of course after we also want to keep in mind like it almost requires like a broader discussion which is like why do we care well we care in Combat Sports because it allows you to inflict more damage under there no I'm saying like why would why do it let's just say I'm not a professional athlete

► 01:59:37

why do I actually care how fast I run or how fast I ride or any of these other things well because you want to brag about it some major weight right so maybe there in lies the problem I mean I mean you know what I stopped cycling competitively I think a big part of it was I just realized that performance and Longevity stopped being collinear they started to become somewhat orthogonal they started to deviate in other words the things that I was doing that were enhancing my performance and I'm not even talking about drugs I'm just talking training why's it seem to come at the expense of what I believe was going to make me live longer so specifically that the thing I care most about was cardiovascular health now the incidence of atrial fibrillation in highly-trained athletes is 10 times higher than that of non-athletes

► 02:00:30

so I guess a little counterintuitive rise like why would people who have such an amazingly fit cardiovascular systems have 10 times the risk of this horrible condition called atrial fibrillation what you got many people have it but not young you're not supposed to have that when you're 40 and it's usually associated with cardiovascular disease and yet people are you know showing up with these me I have four patients who have had to get ablation for atrial fibrillation what is an ablation ablation is a procedure where they stick a catheter up through the femoral artery birth in the van and then they burn pieces of the heart specifically around the pulmonary veins and they basically are trying to burn away and create remove the ability of the electrical system to move in this way so it was basically happening with with this type of athlete's heart is when your heart is constantly being exposed to that high stretch high ejection fraction low

► 02:01:30

you're basically stretching out the electrical system for the electoral system of the heart runs within its muscles soon as you stretch it out a certain group of people and we don't know why certain people are susceptible in certain or not but they just develop this this dysrhythmia so your soldering the motherboard as it were that right you're like creating new lines to block that they're the connection that's fucking crazy yes someone about it someone said once and I don't know if it's true maybe you would be able to have some inside that there that there's a concept that your entire life you have a certain amount of heartbeats

► 02:02:09

so make sense of course I've heard it many times I don't know if that's correct that's fuck it scary I don't I don't I don't tend to agree with that because I can't compare one beat to the other I mean you you can't you know it's hard for me to say that you know in 80 to 90% ejection fraction beat under incredible load is the same as the beat that I'm like it is beat per beat the same as the BET experience and I'm sleeping in my heart's rating you know what I was getting at 40 beats per minute I think maybe there's a directional truth to that but I I feel like when you're talking about human longevity it's a game of inches and that is like something is probably directionally true within a mile

► 02:02:53

now when you're talking about human longevity and you email and you are thinking about all these different things that you could do to extend how much of that is supplementation and do you supplement like are you are you a person who takes colloidal minerals or are you a person that is interested in antioxidants like what what do you do in terms of that so my view on longevity is bitching it's the hardest problem there is until you got to have every like I'm agnostic about what the approaches so I want to understand everything that you can do with respective you know food drugs supplement hormones and to be clear the only difference between a drug and a supplement is one's regulated in one is not but you know I have patience it'll say things I called you no doctor I don't want to take that drug I'd rather do it naturally can I do it and it sort of like well okay you don't want to take a Statin but you do want to take red yeast rice well they both inhibit hmg-coa reductase

► 02:03:53

is the enzyme that catalyzes the first step of cholesterol synthesis you're willing to take one that you buy in a drugstore that's totally unregulated and you're not willing to buy the one that comes from a drug company where the FDA has their foot up the ass of the company making it to make sure it's perfect. Just text me as a false equivalence so I only say that to just say like I think everything should be on the table and then I question should be how do you decide what to do so right there actually a bunch of supplements that I take but I don't have kind of a one-size-fits-all approach to it because I think you've got to be able to kind of measure what's going on in a person get a baseline figured out so you know I mean my guess is you had a million people on the show that can talk your ears off about you know which people judge people to take methylated vitamins versus which should and then if you have this MTHFR mutation versus this one should you be taking this versus that I think all those things are valid some of the stuff that I find even more interesting is actually a lot less sexy and I don't have a good answer for it but

► 02:04:51

you're looking at for example vitamin D levels so you need to see a huge disparity in the vitamin D levels people have and it begs the question to all people run

► 02:05:02

effectively the same vitamin D level and is that a function of not just their own individual like how much sun they're getting but more importantly like potentially genetically where they're from so I'm starting to feel like people who have northern European blood might actually run better at a lower vitamin D level than people like me who you know come from places near the equator where maybe I just evolved to see more sunlight and have more vitamin D what's your ancestry. My parents are both from Egypt so and the rains like when you look at a Laboratory test when you check somebody's vitamin D like the range that's offered is 32 a hundred is optimal

► 02:05:45

yeah I'm like that's that's probably not the range you know this is why person think the Rangers right 4260 but I also measure something on parathyroid hormone that allows me to further titrate that range and stuff like that this it's really obvious really clear that there's so much data to go through that it's worth we're learning this and it this is It's amount I want to say it's at its infancy but if we look back at Thousand Years now we will most certainly say their understanding of this science is at its infancy yeah for sure I mean the issue is how do you make sense of a problem to solve a problem which is Unstoppable in in the reason I say that is the following

► 02:06:26

you know

► 02:06:27

you have what I call kind of the medicine 1.0 World which was I Define that is everything that took place before Francis Bacon you can probably tell me when that was I'm going to guess Francis Bacon is like 1650 to 1670 or something like that but that was basically the first person to come along and codify the scientific method so anything that came along before the Scientific Method may have been correct meaning the things that we're certainly done back then that proved helpful but they weren't grounded in a principle of Science in other words you know even a blind squirrel is going to find nut sometimes

► 02:07:07

and then we basically threw your following the carpet United DD elucidation of a scientific method the development of Statistics to actually make sense of data we then got into the sweet spot where I think we are now which is medicine 2.0 and to me medicine 2.0 is really good at solving problems that are amenable to relatively short simple clinical trials and there has been no better example in the space than infectious diseases so like if you think about the unbelievable Improvement in human longevity that has come from antibiotics antiviral therapy for HIV I mean numbered 30 years ago HIV was a lethal no-questions-asked lethal condition today it's a chronic disease for virtually every patient with HIV it's a chronic disease today meaning you will die with HIV not from HIV that is when you consider how shity we are at addressing other chronic diseases like heart disease cancer Alzheimer

► 02:08:07


► 02:08:10

the problem is if you want to know the answer should I eat this way or that way should I exercise this way or that way should I take this drug or that drug with this supplement of that supplement to live longer we can never know the answer in humans cuz there is no clinical trial that can answer that question and we can do that experiment and everything that's not human but we've already learned the hard way that what happens in not humans doesn't necessarily extrapolate to humans and we can do things to be Slicker about it you know when you study rhesus monkeys for 20 years it's certainly more interesting than studying mice for one year

► 02:08:46

but in the end you know they're still animals in captivity they're still not in the same environment in all these things so my view on this topic is the only way to go to this kind of medicine 3.0 is you got to have kind of strategy around how you think about it and so many ways that's that's if that's what I spend most of my time dealing with is what is a strategy for longevity that becomes a scaffolding upon which you anchor every new piece of data cuz I mean I know things today from a data standpoint I didn't know 10 years ago and to your point even in 5 years will look back at stuff we're doing today and thank God we have more data is that still the right thing to do and so that strategy to me is is her to fundamentally based on three bodies of literature and that the first is like what did we learn from centenarians so the people who naturally live to a hundred they have the advantage or that body of literature has the advantage of being based on humans that has the disadvantage

► 02:09:45

but not being experimental so we you know like we don't know like what cause and effect was and then secondly if you look at all of the animal literature or non-human literature where you can actually do the experiments what's common there and then if you look at the underlying the molecular mechanisms so if you I feel like if you tie those three together you come up with a general scaffolding for what it means to live longer and live healthier then we can try to look at one thing at a time and say hey vitamin D yay or nay antioxidant yay or nay so it's it's just got to be very time-consuming for you by the research team that's when I started as practiced about 3 years ago I realized like I was losing the battle my ability to sit down and read scientific papers was like shrinking so I hired an analyst you know why he had worked with me in the past was amazing I brought him over full time to do this then another one that I mean now I have four

► 02:10:45

full-time analyst and I mean as this practice grows and or you know whatever I have the revenue to justify it like I'll have 10 endless one day and this practice and even that's not enough I mean approximately 100,000 papers are published every month on PubMed she's so I think it's like three papers and minute when you think about the amount of human achievement that we've experienced Just In Our Lifetime in that regard like how many people are working on understanding just a mechanisms of the human body in this date is just piling up as we speak to the problem is the signal-to-noise ratio is almost zero so I would say conservatively 90% if not 99% of that is completely useless absolutely I'm actually wrote about this one's too when a paper comes out if it is never cited again meaning for the remainder of time no one ever even goes back to reference that paper you could probably

► 02:11:45

the case that that paper is not relevant and if you then further strip Out Auto citations meaning the only time it's ever excited is when the author then goes back in sights his or her own paper something like 70 or 80% of patient of papers never get cited outside of an auto citation again this is because they're not relevant or does it possible to get lots lost in the shuffle like some of them might be worth something probably possible but I would bet it is much much more the former than the ladder and then on top of it a lot of stuff comes out and then years later you realize it was wrong you know or it was and that's more often the case that it was wrong through an honest mistake then wrong through a dishonest mistake that there's still a lot of wrong through dishonest mistakes that's coming out there as well so how much of his date is forcing you or causing you to alter your own patterns

► 02:12:37

well we we believe internally that probably 100 papers a month enter the literature that are relevant to what we do meaning it mean some of the literature that comes out like you know the Rheumatology literature might be relevant to them but that's not what I do so that's why when I say I want to see why it looks like it's you got his first while it's finding those papers to so how you do that like what we subscribe to a whole bunch of services that basically pre-filter a bunch of shit for us and then we have a system where we go by kind of pulling that stuff so you get those three a day and then they bring them to you how do you have the time though so I was like I was driving and I was like dude I'm the fucking bottleneck and I hate it but I'm now the bottleneck friend cuz the analysts are now turning out stuff faster than I can even provide ancillary feedback

► 02:13:37

cuz my job is like you know it you know you hire great people who are smarter than you and like you just got them you just point him in the right direction so what we mostly do is create programs where we're going out and looking for new knowledge so for example one of the questions that is tormenting me right now cuz I still don't know the answer is is there any benefit to taking human growth hormone from a longevity perspective food clearly a performance benefit growth hormone is probably the single most abused drug in all of sports there's no question about that but is there a way to take it where it makes you live longer I've never prescribed growth hormone to a patient because frankly I'm not yet confident that I know the answer to that question but I feel like it's worth knowing right cuz I can certainly make it to Leah logic argument for why growth hormone to be helpful but I can also make it to logic argument for why can be harmful and so

► 02:14:29

like many things your knee-jerk reaction to something can often be wrong and my knee-jerk reaction to growth hormone has historically been cause cancer

► 02:14:39

because why will growth hormone tells your liver to make igf insulin-like growth factor and a two-thirds of tumors seem to thrive on igf so ostensibly you would think wild growth hormone can't be right but then one of my analyst Bob Kaplan pointed out to me a year ago was like you know if he doesn't thinking about this and he's like giving how ubiquitous growth hormone isn't Sports and how long it's been ubiquitous in sports like I mean this was the drug that turned around u.s. Olympic athletes in the late 70s early 80s music where's the body count like where are all of these people dying of cancer from all these years of Staggering growth hormone use

► 02:15:18

I don't really see it we went back and look at literature and then we found that the data on growth hormone and igf are not nearly as straightforward as people that made it out to be in fact there's actually for you not that I don't want to see this but at least you'll see what I'm talking about if this is percentile so higher and this is igf level right so igf level most people are listening to this actually the overall mortality curve

► 02:15:54

for igf and growth hormone is like a J curve meaning low igf really high mortality

► 02:16:04

yes as you go from about the 70th her 80th percentile up to the 90th percentile was just slight increase in mortality but this is not what you would think of like you would sort of if you were just reading the headlines you would think it looks like this so you there's a Sweet Spot Not only that if you dis is overall mortality what if you parse this out by disease well that's when it gets really interesting so cancers curve looks like this

► 02:16:30

very similar yes but Alzheimer's curve looks like this heart disease curve looks like this

► 02:16:39

so describe that to people that are listening so what that means is so for example Alzheimer's disease and heart disease have an almost monotonic reduction in risk as igf gets higher and higher and higher it's only cancer that seems to have that uptick where risk starts to actually rise once you cross past the call at 70th percentile and so when you integrate all of these cards together that's why you see this slight now again this is epidemiology so one has to take this with a grain of salt but this is it to me when I saw this graph which Bob put together I don't know while ago I was like wait a minute this doesn't jive with my preconceived notion of like growth hormone is bad this warrants Way for their exploration and so what that basically turned into is now an enormous internal project that will take it probably a year to complete and will constantly be updated like we did this already with testosterone 2 years ago we put together like a 40-page white paper on the topic and then at least once every two weeks

► 02:17:39

it gets updated every time a new paper comes out basically asking the question like his testosterone replacement beneficial or harmful and under what situation should it be considered versus not an emotionally and that's hard to do because for reasons I'm not entirely clear on basically everyone's kind of just emotional about this stuff will their emotional about steroids because of all the Press about Barry Bonds and you know all the different baseball players that got caught what is it is it is it the cheating aspect of it I think people consider taking any kind of hormone whether it's growth hormone or testosterone as cheating even if you're talking about older people that take it like I was looking at one of those ads you know they have those ads for hormone replacement is really old looking for life

► 02:18:39

and my friend was like God that can't be healthy I'm like what the fuck are you talking about look at him what do you think of seven-year-old due to supposed to look like they're supposed to be knocking on death's door that guy looks like he could fuck his way through a building full of teenage girls 20 year old 21 or 19 he looks like a man who's really fit and healthy with an old guy's head is weird and I was like eating out if it's not healthy then what is it if that's not healthy like always going to die cancer going to die of a heart attack he's going to die. You'll get his head how much time would you give him I gave you a if I gave you a bet okay we have a Million Dollar Bet give you an over under 10 years how many how many years are going to give this guy you can give them 20 can you give them certain removing the over-under you said they only had a 10-year window on that site you get you get a chance

► 02:19:39

I'll take over on the 10-year okay to give them impossible to know I can't because I got was family history of course your parents will tell me more about how long you live and what you look like 70 in America is basically death's door I think today as well so it's a complicated question actually which is actually prompts another analysis in the 10-year range what is the average life expectancy of a man and a woman today in the United States and I mean someone's going to correct me so I feel like it doesn't matter what I say I think it's 79 and 81 respectively for a man and a woman today but the more interesting question is this one which is what year were you born 67 in 1967 what was the annual life expectancy or the average life expectancy of a man and a woman and we could look that

► 02:20:39

but I'm guessing it would have been at sea life expectancies than going up at 23.6% per year we could back out that kegger and let's just say for shits and giggles like the number was 60 in 69 or 73 or something like that I promise you you were going to live longer than that what was it 6767 all right now would I take the bet that you're going to live longer than 67 even though that was the median life expectancy the year you were born hell yeah I'll take that all day long and so what we're actually putting this is it just a dumb analysis would even know why we're doing the same as we just do dumb shit has no bearing but what I want to do is create a graph of actual life expectancy as realized vs. projected life expectancy in the year of birth my hypothesis is that is always a positive number what I want to know is what's the derivative on it is it increasing or decreasing so I think that science is accelerating

► 02:21:39

longevity and that that's one of my proof points is that we are constantly under estimating how long we can live now on the other end of that Spectrum I am not one of these futuris who thinks like there's immortality out there you know I would be if right now I could sign a piece of paper that would say Peter you willing to commit to a lifespan right now so you're willing to acknowledge that if there's some major breakthrough you'll miss out on it but I guarantee you this duration what would you take right now if I said Joe you can be a hundred and and be fully functional at a hundred so when you're a hundred you're going to be like you're going to be like a fit 60 year old at a hundred so you're still working out you're still shooting pretty good yeah it would you take it in other words you're willing to bet that by the time we get there because when it's over it's over anywhere

► 02:22:33

I mean to me I think most people have a greater sense of confidence about where technology goes now that I think it really only been a handful of Step function changes in one job so you know the reduction of infant mortality was huge like once we actually figured out how the fuck to deliver babies and not kill mom's like I was a big deal that had a step function Improvement in human longevity the next one was really sanitation like once we figured out that like don't shit where you drink huge Improvement in human mortality it for granted alright I'm in the third one was basically germ Theory you know starting with Lister and going all the way to Fleming when we figure it out like you know

► 02:23:19

if you if you cut open a cadaver and then go and deliver a baby that's bad cuz there were these microscopic things that none of us anticipate we haven't had a step function Improvement in mortality in nearly a hundred years

► 02:23:33

so what's next I think there are a couple of potentials for that but what I don't know is if like they're going to happen in my lifetime in your lifetime but I want to buy the optionality to stick around for it by Juvenile this incremental little shit he believes three plus papers a day the options are increasing its it just seems to me that it's there's a trend right the trend is as you as you're saying there is an increase of of longevity that's not a huge increase for a better understanding of the human body is that's that seems to be pretty radically improving it's especially turn the nutrition nutrition absorption the mechanisms behind nutrition

► 02:24:16

on some level you had on some level I still feel like we're in the Dark Ages cuz you recognize the potential let you know that. Because I think Russian I think I'm just humbled by how hard it is to actually take care of people like I I think took I was about I'm about as good a responder is you're going to have to carbohydrate reduction so doing something as simple as just not eating carbs and not even sugar like completely change my health I mean at 40 if you compare the 40 year-old me to the 30 year old me

► 02:24:48

like a 40 year old is like literally twice as healthy as the 30 year old me and that was through something as simple conceptually simple as making this radical dietary shift by what standards are you saying that you're twice as healthy 40 then third I will do you know 45 and butt what what is the mean of old would be my lipid levels what would be my triglyceride levels how much body fat do I have what's my VO2 max like all of those metrics like everything is just so much better at 40 nnn so

► 02:25:26

ice but yet I've seen a lot of patients where you take the carbs out of your diet doesn't matter you know you you you that you make them fast you do this you got anything you just can't fix some of the underlying metabolic problems like what kind of problems you know I think some people are just so insulin resistant that it becomes really hard to fix them without doing Draconian stuff I mean I have one patient who he's really now I think going to him anyways become the poster child for he's actually the toughest case I've ever had and why he's such an amazing guy is he was actually able to do something that's really hard to do which is stick to something with complete Blind Faith in Me even when it didn't feel good even when I knew it would take a long time to see the results so he he's five foot eight ways to 2:35 at the start to 58235 metabolic syndrome huge amount of fatty liver disease not that

► 02:26:26

occupation my practice most my patients are going to be on healthy people who want to like you know want this immortality thing but this is someone who doesn't fit that description probably 70 years old

► 02:26:40

unlike me to for drugs for blood pressure tenderizer heavy for a 7 year old and he just had a hip replacement give me sleep couldn't walk to everything was and we had tried carbohydrate restricting him before it just didn't work and part of it was I don't know how he just was hard for him to stick to it and both of us so I just sent him look man I want to try something completely fucking extreme and I want to try for 6 months every 5 days and for me every month you're going to spend the first 5 days eating 500 calories a day of a ketogenic diet and it's basically just going to be like vegetables oil like it's you really were a bunch of salad and then for the next 25 days you're going to do a Time restricted ketogenic diet where you're only going to eat in that 8-hour window

► 02:27:27

and then you're going to repeat that every month for 6 months and he was like I won't be able to do it and I was like I know I know it seems crazy I think you will be able to do it cuz remember all that time that you're not eating your body's going to have to start eating itself and until you'll be alright and when they're giving you grossly over simplified version of what we did but it was much more complicated than that there's a bunch of other stuff that we had to do to manage it as well

► 02:27:53

well I mean he just sent me I mean we were in touch all the way along so it was clear that this was working but it was just kind of amazing to get a picture from him two weeks ago as we just passed that 6-month Mark he was a buck seventy-five whoa what's 60 lb in 6 months holy shit his liver this is interesting but not nearly as interesting to me is the fact that his transaminases which are the enzymes that deliver makes in response to how much fat is accumulating in a normal is like less than 40 he was like in the hundreds and you know the ultrasound showed it was just a bunch of fat and it doesn't drink alcohol so we knew it was fatty liver non-alcoholic fatty liver disease you know now he's in the twenties and thirties blood pressure when you got the promise he was metabolically broken so I'll come back to why I felt like this was a necessary intervention despite how it Tony and it was

► 02:28:50

he's on a treadmill 30 minutes a day now you couldn't walk before me to take 60 pounds off when you say treadmill you mean walk in that you walked on the treadmill now so it's just it's basically reprogram them and and and so the reason I have occasionally pulled that trick out although it hasn't always worked is based on this case study I read that's very famous I'm sure some I might be someone in the show he's talked about it but it was paper was published in either the early seventies or late sixties it was the longest ever medically supervised fast does this guy who weighed somewhere between 3 lb he did a 382 day inpatient medical fast where he had only water and minerals at the end of that some like 382 days he was down from college 402a Buck 65 this paper was published 7 years later he weighed like a buck seventy about 75 the crazy thing about that

► 02:29:50

so he didn't have that problem that a lot of people have when they lose a lot of weight would have all this extra skin his skin went along with his body City exactly I would like to know I would like to know if he had stretch marks when it's Frank you know what's funny I've never tried to figure out like what ever came of that patient I can't imagine he'd be alive now though I know he was young at the time but the part that interested me was that he didn't regain all the wait 7 years later and that's suggested that there was a like who's a reprogram old he got the blue screen of death on the computer did the hard reset you got to be a new person again cuz I'm not of the camp that thinks like that guy got to be 400 pounds just cuz he was a glutton in a sloth like something fundamentally broke in that dude and what broke was he basically lost the ability to partition fuel correctly could food play a role in that absolutely certain if you eat enough shit that can

► 02:30:50

but I think it's more complicated than that I think it could be epigenetic if not outright genetic but probably more epigenetic

► 02:30:59

and so I'm interested in this idea of how do you reset people and again this is all kind of long-winded way of saying like one of the advantages of practicing medicine is you get to you you say humble cuz every time you think you're smart and you're like I got this shit figured out but you don't there's like some patient who's got a problem that you can't figure out and it just drives you nuts but you realize like I mean even just today I was talking to a friend of mine he's not a patient but I mean my guy he's just going through like this devastating Health situation he's been he has seen every doctor he's been to Mass General he's been to Stanford you've been to Hopkins you think of the best hospitals in this country they can't fucking come close to figure out what's wrong with this guy

► 02:31:41

and so is bad is that is for him I think that level of humidity is actually good for the profession it's good or what is going on with him that they can't figure out having these horrible neurologic symptoms where he gets these fasciculations and muscle weakness and obviously the big concern about 6 months ago when this started was he he was presenting like he had Lou Gehrig's Disease which you know obviously is about as bad as fat as you can have luckily that has been ruled out and they've done a million muscle biopsies and all these other things but they don't know what's going on cuz he altered is Diane is taking no we don't know what's going on that's it is certainly far outside of my area of expertise I mean what we talked about today was look man all we really need you doing is fixing your symptoms at this point in other words there's understanding what's causing this pain and managing the symptoms around it I think the smartest people in the country have figured out they have no goddamn clue what's going on let's now figure out how to manage your symptoms to your energy levels your mood all the time things done for that

► 02:32:42

well I told him today I was like later I'm going to send you a kit we're going to do a certain blood test on you in a certain urine test on you and I want to just figure out what's going on with your for hormone systems Bailey for hormone systems play a pretty big role in how we feel and adjusting those doesn't I'm not convincing this really makes you live longer but I can't really make you live better so I want a kind of understand I suspect he's not firing on all cylinders on that Dimension whether it's a result of whatever is going on that nobody can figure out or not but I'd rather focus on something that I think we can fix the change in diet thing with that guy where he went in fasted for 360 plus days what did he eat when he got back on food grade question I do not know the answer now it might be that that just I don't recall that being in the paper

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if it wasn't I don't know if anybody did the follow-up but that's to me that's interesting question to you got his life back right like she was a young man he was so I think I believe I remember that as well I think I would like to find out what he's eating now to keep his weight at the same level I mean he must just be so thankful first of all we might be like mean I have friends that are pretty overweight and one that died pretty recently who was really big and he just had this feeling when he would meet people and we talked about it a little bit it was just obese and I was just this thing or you're just all look at this enormous fat guy and then to go from that to go there's a guy there's normal guy that's just a guy 168-pound normal no difference between us I know we we love to have to beat up on fat people we love to turn it into a character defect but I got to tell you virtually every

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that person that I know that I've taken care of they are not disproportionately eating more than their peers and some cases yes but not unbalanced that the problem is that they simply do everything in correctly metabolically you know so the body is functioning correctly and I think certainly not exercising makes things worse or there lots of predisposing factors but at the end of the day what's happening is

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when you and I eat like let's let's take a meal of it but like if you had pancakes bacon and scrambled eggs that would be like a really good mix of bed be a third carbs 1/3 protein 1/3 fat that's like a shit ton of nutrient right if you are I ate that it probably wouldn't be that good for us but like we need a let's say we just finished a workout or something like we're going to partition such that that glycogen will first and foremost go to replace the muscle and liver stores of glycogen because we have bigger muscles that are mussels and more insulin sensitive we can actually disproportionately put more glycogen into our muscles into the leg muscles cuz you'll have done that run up the hills right and and then furthermore when we want to recruit energy again will have the ability to actually go back and get fat ass but you know in other words break down fat at lower ATP demands then necessarily always going to glycogen some other words we partition fuel in a smarter way and these patients I mean you can measure this clinically using something called rer and of course do another blood test

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like they just they just they can't break down their own fat so their body is essentially broken in that regard and that can be fixed with with diet it's a hard problem because the way I explain to people is clinically I'm not interested in weight loss right I mean that's just not I'm much more interested in longevity and yes sometimes weight loss comes with that but I like if I ever get stuck doing your weight loss like that I'm doing the wrong thing for my interest but the way I say to people when they want to lose weight is look you don't want to lose weight you want to lose fat butt supposed to be very clear on are semantics it weight is irrelevant right unless you're a cyclist or some athlete For Whom the actual scale mean something but for 4 people like us it's you want to lose fat not weight and then when you say you want to lose fat what does that mean in English

► 02:36:51

well do you want fewer Fat's house or do you want to eat fat cell to be smaller those are totally different questions if you want your fat cells have liposuction but we know that that doesn't fix you metabolically so if you want fewer for if you want to be less fat you have to have smaller fat cells now if that sell conceptually has two inputs and one output so now I say let's reframe the question you got a room with a hundred people in it you want fewer people in the room what has to happen more people have to leave the room and enter the room so similarly if you have a fat cell and you wanted to be less fat you got to get more fat out of it than entries it and the fact that exits the cell exit Fiat process called lipolysis and the inputs to a fat cell or something called the novo lipogenesis which is turning carbohydrates into fat and rias aerification which is turning fat like in a free fatty acid into a triglyceride back into a fat cell each of those three doors is controlled by hormones

► 02:37:47

and so the purpose of nutrition or fasting or exercise or drugs or hormones are all these things is to manipulate those hormones in the direction of what I come negative fat flux or what would be referred to in the literature is fat balance negative fat balance and the hormones that drive that are many insulin hormone sensitive lipase testosterone estrogen cortisol being the five most important in my opinion maybe someone will disagree with that but I think those are the five that rule the roost and so you know how do you manipulate those well insulin seems to be the most important of the five and there's no better way to lower insulin and to not eat

► 02:38:28

so the first thing that happened to that dude who went 382 days without anything but water and minerals is he basically had very low insulin levels in fact once he got into raging ketosis which he got into by about day 7 his insulin came up only to prevent him from going into ketoacidosis which was what would happen if he had no insulin response he was a type 1 diabetic he would have died of ketoacidosis because he wouldn't have had the insulin to regulate the uptick of ketones but if you are I did this because we have a normal pancreas we would actually make just enough insulin to suppress ketogenesis and keep that beta-hydroxybutyrate level in the neighborhood of probably 7 or 8 mm alert as opposed to getting north of 12 to 15 which is when you get into trouble

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so you know how do you manipulate insulin nutrition is the first way if you can't fast the next best thing is to reduce carbohydrates carbohydrates obviously you're the most intelligent make a food other protein can be quite insulinogenic as well it has a different response and then that's when you start to think about these other things you know I've seen patients where they just can't lose weight and I watch what they're doing in there doing everything right they just can't lose weight but then you noticed their cortisol levels through the roof

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hard to get rid of fat when you have hot lots of cortisol cortisol is a very anabolic hormone too fat and a very catabolic hormone to muscle which is the exact opposite of what we want to stop. Of course is the exact opposite testosterone is catabolic to Fat Butt anabolic to muscle and then of course you know women have a harder time because once women go through menopause they lose all the estrogen and all the testosterone and so now they lose two hormones to play a very important role in regulating this so for these people that are having the issue with the cortisol levels that's exacerbated by stress and yes so stress actually exacerbates your weight gain absolutely

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and it is literally the same time gain more weight because of stress absolutely again hormones are what's a driving fuel partitioning you know you're responsible for what you put in your mouth but in many ways at that point like the hormones take over and decide where it's going

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wow that's fast and you yourself what what's your diet like me and you you told me you only eat once a day but yeah I'm one one meal a day or sometimes two meals a day how many calories you take in

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you don't know where near what I used to I just don't train that much anymore I mean I kind of lift 3 days a week and then I I ride like a stationary bike like a Peloton or I prefer this thing called a wahoo kickr where you actually put your bike kind of thought you got three or four times a week I would guess when I sit down to throw down it's probably 3000 calories is I'm a fucking pig like I'm kind of disgusted like I I can eat a lot it's it's gross I got gross people out how much I think of you real yeah I know I have an eating disorder really I think I have disordered eating yeah seems like you just enjoy it because you do it once a day I stress eat I I do get a joke like I don't get a dopamine high from gambling or you know alcoholic

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like those things are not things that I can abused like when I'm really in a shity place in life like I buy soothe and punish myself with food people do so you can relate and as a thin man you know when you're talking to people that are large and have the same issue it's completely understand what these people are going through at least in as much as what the is the is the physiologic desire for I mean obviously they will experience something even worse because there's the act like I can like look I don't have ABS on I don't have veins in my arms anymore I used to when I was in the ketogenic diet and I was 7% body fat I was completely ripped I'm not ripped anymore you know relative to that that kind of bugs me but like nobody really knows that I'm going to be really gives the shit so I can still like look like a super healthy dude a super lien dude even if I'm not but oh my God like when when shit's going wrong like I want to eat some of the worst

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foods that have ever been created when you're not feeling it's tired like if I'm tired like if I'm coming home from a gig in at 2 in the morning it's very difficult for me to drive past Wendy's you know I want to go to Wendy's and get with a renal that could be either turn to sugar or salt in times of fatigue a lot of times it can be out you know they don't have the right level of free cortisol at that moment in time will power issue is if I could just get home I'll cook something healthy and then I have Victory you know cuz if I get home I know I've got healthy food at home I eat something really good and it's just as good but there's something about also is like you doing something you know you shouldn't do there's a little weird little charge that interesting I mean I guess it's different for different people I think for me if I'm really going to be brutally honest about it I think it's that I liked I sometimes just want to punish me

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self and I'm like you know like eating bad food is like when you're bad you eat bad food to give yourself a cheat day

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you know I don't not really I mean I think these days and you know you could kids so you know what I mean cheat day is just present themselves often enough where are the reasons and unfortunately I think for me the cheat meals are a lot of times cleaning up the kids play or something like that you know like I just I really like shittyfood like I like macaroni and cheese I just for if they don't eat their macaroni and cheese I got to eat it my kids asked me to make them peanut butter and jelly till the day and they don't choose crossy good fucking fantastic special glass of milk please Crush shouldn't go I thought about all the bread with peanut butter and jelly I ate in those cross I basically the fucking sandwich it's like I'm pretending I'm just eating a little cried a lot I'm worse than you do don't know what the situation out of

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gracious I would have liked God the peanut butter no jam and dip the crust in there in like and then I would have made it to him I'm just happy that I didn't eat a sandwich I'm of my own as well as their crust cuz I probably couldn't once once the fucking Gates were open one some out there making spaghetti and meatballs I got all right let's get some fucking ice cream in this mix too and I will let some already fucking off so what do you what do you eat when you sit down for a 3000 calorie meal in control of the meal which I usually am and I'm super boring dude so it's I like to have a salad and a bowl that's larger than my head so I was referred as a manly Bowl that's the definition of a manly ball just got to be like a staggering amount of salad and my salad is the same every freaking day it's romaine lettuce it's you know Tomatoes mushrooms cucumbers carrots and in the dressing is just extra virgin olive oil freshly squeezed lemon salt and pepper pretty bland salad in that sense but I mean I can eat that all day everyday and then it's a sir

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protein and I usually cycle through salmon pork steak you know some gamey meat like whatever I just sort of cycle through that and then I usually have some sort of starchy vegetable to go with it so potato rice you know lately the last couple of weeks I've been skipping the starch and just mainlining extra salad and extra protein but you know but that's insane that's what I'm in San Diego where I have control over what I eat more than New York and never eat in my apartment like I just never cooked so I always go out and there it's a little less regulated so may I just love Indian food I love Persian food I love food that unfortunately is you know got more carbs in it then I'm probably suited for but I try to modify so like last week I had them Bob was actually one of my my head unless he was in Boston he came down to New York for a couple days we were doing some work and we were

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for he loves Indian I live in and we went out for it to you in one night and who hadn't eaten all day so we ordered I think

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seven or eight entrees and the waiters like you know

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you guys know you ordered 7 or 8 entrees I really gay I we got it we got it we're good and so you know we saw to skip the non or maybe had one non to split instead of normally I would have had like four nouns and only had one bowl of rice but still out carbs it is more of it than I did and he's way more Jack than me so he can get away with eating way more non than me but yeah that night I mean also those sauces are like so fatty like I'm sure that was a 4000 calorie throw down pretty good about is when I'm done I'm done so that's everything about time restricted feeding that I think I get away with more because like when I go back to my apartment I will rarely have another bite and when I wake up in the morning it's like black coffee you know I'm not sneaking little shit in throughout the day like where is if I'm not fasting it's just too easy for me to just like snip snap

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my office like I shared my office in New York I share with another doctor who is his office like that's going to sublet an office there but I've never seen more shit in my life like in the stuff patients bring for him to eat and patience bring him there's an endless barrage of bad food to eat it's like good bad food Oreos that actually wouldn't tempt me despite the monkey home cook brownie yeah exactly get the name of

► 02:49:04

I can't remember the name of some of these bakeries up there but but yeah there's like some ridiculous shit that shows up and every once in awhile like I'm like okay the fast is breaking it for today but as long as you do it with moderation you think you're okay in moderation so the problem is once I start like it's usually the wheels come off the bus pretty quick do you try to mitigate that with exercise like do you say that I I went off the rails story so let's hit the gym and go hard it's less that it's usually I anticipated and so like so so last week A buddy of mine went to see the David Bowie exhibit did you see if I wear the Brooklyn no are you boyfriend at all yeah Brooklyn Museum it is a couple weeks ago but I was only there for 2 days for the UFC now to show out there

► 02:49:59

so pregnant by Shel Silverstein at 11 p.m. and they just didn't have the heart to tell me so I was there till midnight before they finally came in like escorted me out of the building I like sir we close an hour ago I was like damn sorry man so what is it all of his music all of its done put the headphones on you and your throat push the button to hear the thing it doesn't work that way like whatever you stand near you get the music associated with that plus or minus a narrative is necessary but it was like I've never said I think they had everyone it was epic so anyway that night I knew we were going to go out for a killer dinner before in Brooklyn before we went to the show

► 02:50:53

and so normally I exercise in the morning but that day I was like look I will your muscles will be a little bit more insulin sensitive if you can exercise about 30 minutes before you eat that's probably about the sweet spot so if I were to ride at like 8 in the morning and then not even till 7 at night I mean it I would still eventually get the glycogen there but it wouldn't be quite as easy little Carly with more insulin so in that case I just modified my day and was like you know made my schedule such that I could ride at 5 p.m. in anticipation of that and I also wrote a little longer and a little harder just you know like that's really crush this session so that you know I can go and enjoy dinner a little bit more will it sounds like you enjoy a lot of things you have a lot going on you got your medical practice you have me all these different things he participated in as far as a boxing and swimming and cycling

► 02:51:45

what jazz is you up now like what do you like how do you know you always have a mind that requires a lot of stimulation like what what keeps you going I mean I think I think this longevity thing is the perfect combination of all of my previous lives in terms of professional live so when I used to be an engineer and then I when I went into surgery and then I left that and went into a management consulting and was a hundred like had nothing to do with medicine for several years I've just worked in credit risk modeling and so many ways like when you combine medicine with engineering with risk management that is what longevity is all about like if you want to take the practitioners you know the roll up your sleeves approach that that's what it is I think that scratches that itch but but I think for me like I have to be sort of mastering something so that's where archery and race car driving today become just total obsessions in like when we were talking earlier it's like yeah

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want to spend 3 days you know taking 10 shots when I could be spending you know three days taking 300 shots in my backyard like in the end I think

► 02:52:56

what I really just obsess over is trying to get better at something and the nice thing when you start things late in life like I didn't get my racing license till 3 years ago and I only picked up archery 2 years ago new year ago like when you suck so much like the opportunity to get better is awesome so I think the bigger itch for me is not intellectual I think it's like tinkering it's like figuring out how to do shit better share a similar interest in things I suck at and that's what one of things that was so compelling to me about archery when did you start

► 02:53:33

2013 I think about why I bought a bow before that but I didn't really use it 2013 I think is right when I got pretty serious about it and John Dudley on your show Once then you couple times wasn't on I mean that shot through the handle of the Kettlebell was a hundred yards I think was a little more but yeah yeah that is that's one of my favorite things in the world he's helped me a lot he's a remarkable archery coach and just a great person to to Super 8 at once on Instagram like they bumped into each other in an airport and so like I saw Jocko like two days later we had coffee one day to be clear chucklehead T I had coffee. Cause a t guy but I was like to I can't believe you know John Dudley goes I don't know I may just grab me in the airport and I was like dude I wouldn't there's a shot to I want to see this was a lighted Nock

► 02:54:33

good people to have any idea how crazy I cannot fathom what I've seen him he's a dick Eula shit he's a bad mother fucker when it comes to archery that's for sure and he's helped me tremendously does he live he lives in Iowa he moved to Iowa just so we can kill big giant deer cuz he literally bought a farm in Iowa but a giant chunk of land and raises it for he has he does do some farming but essentially what he does is raises deer doesn't raise them know what there's no fence right makes it very good favorable feed everybody there I just I mean when I bought my bow like I just sort of you know when to the arch like Performance Archery in San Diego

► 02:55:33

great and then I'm right you know got all my kid and my setup in there if I call right you got to go to knock on like you got to just watch this dude's videos and he's the best and in terms of the average person who's interested in and he's got a great podcast about it knock on podcast but he gets so geeky and Technical and his descriptions in his understanding of it and then he constantly obsesses about form and structure and you know archery it to me that my histories of martial artist it really good jobs with me it makes sense cuz you could do that you could muscle things and do them wrong and develop bad habits and you'll never reach your full potential or you could do things correctly and be very very disciplined and focused and understand the what why you're doing something and then really actually reach your full potential is really no other way and with archery it specifically it's so satisfying like eyes were saying before when you dupe

► 02:56:33

it off and you know you do execute that perfect shot with your rhomboids and the Hand goes over the back shoulder and you watch that Arrow Shunk go right into that Bullseye like I have my daughter come out and do the slo-mo shot at me from behind I got like a hundred of these dumb things on my phone and it's just that I can watch them all day to live his elbow position to the height of the elbow to Elbow has to be in line with the arrow and on sometimes people are pulling but they're pulling in their elbows up here instead of way back here and now I think that's a good point about certain things right 02 to me the other thing I like about our tree and and race car driving is you have to learn some emotional disappoint you can't get pissed off and work your way through either of those things you can start to get pissed off on the bike and it can actually charge you which is not to say that cycling doesn't have technique in it but it plays a much smaller role in

► 02:57:33

the girl Factor can out trumpet but you can't go your way out of a shity shot and you cannot get in a car if you start getting pissed you're done you're absolutely done something to be said for a lot of things I think pool is one of them gas a big one golf but yeah we just did 3 hours believe it or not I don't believe that

► 02:57:58

crazy places the time-warp really is but I really appreciate this conversation I was really fun so thank you if people want to get ahold of you on Twitter give me your Twitter address website all that stuff jfp tortilla MD

► 02:58:18

thank you everyone for tuning in to the motherfukin so hope you guys enjoyed as much as I did I feel like I could do about a hundred podcast with that dude I want to think on it oh and nit use the code word Rogan save 10% off any and all supplements I also want to thank the cash app download it for free in the app store or Google Play and use the promo code Joe Rogan one word you will get $5 and $5 will go to our friend Justin wrens fight for the Forgotten charity to build Wells for the pygmies in the Congo and thank you also to LegalZoom checkout legal zooms business legal plan at legalzoom.com now and get special savings when you enter Rogan at checkout LegalZoom where life meets legal legalzoom.com

► 02:59:13

all right girl who works tomorrow we have dr. Matthew Walker he's asleep specialist that should be interesting I'm very much looking for that so that'll be tomorrow until then enjoy your time thank you for everything and I appreciate you people to know we're alright bye bye