Impact Theory with Tom Bilyeu – Why You Need to Protect Your Joints to Live to Be 100 with Peter Attia, M.D.

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Key Takeaways
  • Instead of trying to live forever, aim to live to be a “kick ass 100-year old”
  • If you’re over 40, think carefully about squatting and deadlifitng
    • Maybe deadlifting and squatting are an unnecessary risk for some who’s trying to be a kick ass 100 year old.”
    • Instead it might be better to focus on things like balance, and incorporate more single leg body weight exercises (described below)
  • Humans are innately bad at estimating risk
  • “I don’t think people understand that once you get beyond 1-2 drinks, how harmful it is on your liver”
    • “The pleasure people get, from drinking 4 shitty Budweisers, isn’t anything compared to the potential downside it’s causing in the long run”
  • The standard American diet is slowly killing people
  • Evaluate what you want to do in life only through the lens of how many years you have left on earth, and not at all through the lens of how many years you’ve already put into something
  • “Those of us who are the biggest jerks to others, are often jerks to ourselves”
Intro
  • Dr. Peter Attia (@PeterAttiaMD) is an expert in longevity, health span, and quality of life
  • He has a great podcast – check out some of the Podcast Notes
  • Check out his website
Is living forever possible?
  • “No, I don’t think it is possible, and I don’t see anything on the horizon that makes it possible.”
  • There’s life span, and then there’s health span – what good is it living to 100 if you can’t walk, and are cognitively impaired
  • Peter’s mission – “Be the most kick ass 100-year old that ever lived”‘
    • This might mean being 100, but having the body of someone who’s 60
    • Being 100 and still being able to…
      • Squat down
      • Carry your groceries
      • Lift a suitcase above your head
      • Pick up your great grandchildren
What can we do today, to help our chances of living to be healthy 100-year olds?
  • Take things from different disciplines (yoga, pilates, weight/strength training), and combine them, to find a routine that works well for you
  • Overall, we should be focused on the maintenance of muscle mass, joint integrity, flexibility, functional movement, and balance
    • “How many times does someone who’s 90 fall, because they lost their balance?” – Balance is more important than we think
    • “‘My balance is not what it was when I was 20”
      • Peter used to be able to do single leg pistol squats blind folded, for 20 reps on each leg – “I can’t do that once today with my eyes open”
  • Think of your training, as training for the Olympics, which is X number of years away (X =100-age) – Peter calls it the “100-year old Olympic games”
    • In these games you’d be able to do what was described above – squat down, carry your groceries etc.
  • “Today, if someone said I could no longer drive a race car, or shoot a bow and arrow, lift weights, or lay on the floor to play with my kids….if I had to give those things up, I’m not sure how much longer I’d want to stick around”
    • That’s why it’s so important to focus on health span – so you can do the activities you love, well into the later years of your life
Exercise
  • Deadlifting
    • Tom finds that if he doesn’t deadlift, he has lower back pain – not the reverse
      • “If I’m doing it once or twice a week, I feel bulletproof” – Tom
    • “Deadlifting and squatting reveal all of your errors in movement” – Peter
      • You can’t take bad form into those things, and not have it revealed 
  • Cardio
      • It’s really a muscle issue – it’s about how much your muscles can extract oxygen out of blood via aerobic metabolism
      • Endurance athletes have very high VO2 maxes
      • If you want to experience the VO2 max energy system – go run as hard as you possibly can for 4 minutes – it’s basically your maximal extraction, or utilization, of oxygen
Peter’s Exercise Routine
  • Peter’s been focusing on single leg exercises, rather than heavy deadlifts/squats
    • “I haven’t had more 155 lbs. on my back, in 6 weeks”
      • Why? – Maybe deadlifting and squatting are an unnecessary risk for some who’s trying to be a “kick ass 100 year old.”
      • “I’m one bad deadlift away from doing something stupid. I don’t know if I need to do them to be the best version of myself at 100.”
    • He’s been doing courtsy squats, lateral lunges, and single leg body weight squats with “meticulous form” focusing on really loading the glute rather than the quad (he doesn’t specify if these are pistol squats)
  • Military Press
    • “Is there a time and a place? – Absolutely. Does it have any role in my life? – Absolutely not.”
      • Peter says he doesn’t likes the way it loads the spine
    • He’s looking more for something that will give him 80% of the benefit of military presses, without the risk, such as:
      • Loaded activities below the shoulder line
      • Using more static loaded movements above the neck
        • “This gives me 80% of the benefit at 20% of the risk. That’s exactly the kind of compromise I’m willing to make. I don’t think we’re applying that level of risk/reward often enough to how we exercise”
Humans and Risk
  • “We are innately really really bad at estimating risk”
  • Tom asks Peter if he’s accurately assessing the risk associated with driving a race car (which Peter likes to do)
    • “I feel safer in a race car than I do in my street car”
      • Think about it – people are driving tired, while checking their phones, some people are drunk or high etc.
  • Alcohol
    • “I don’t think people understand that once you get beyond 1-2 drinks, how harmful it is on your liver”
      • At any dose, Tylenol is really hard on your liver as well – but because it doesn’t have a “good” feeling associated with it, we don’t take more than we should
    • “I’m amazed at how much people drink, even when there’s no apparent reason for it. There are too many blah reasons that people are drinking.”
      • “The pleasure people get, from drinking 4 shitty Budweisers, isn’t anything compared to the potential downside it’s causing in the long run”
    • Peter has a driving simulator at home, and he’s learned that even 1 drink compromises your driving ability when it matters
    • It’s an asymmetric risk/reward
  • Caloric Restriction and Fasting
    • The short term inconvenience/discomfort from fasting for 5 days for 1-4 times a year, is trivial compared to the potential benefit
    • Peter thinks a minimum of a 3 day water fast is necessary to start getting the benefits of autophagy (the cell eating itself), and mitophagy (the recycling of the mitochondria)
The Standard American Diet
  • Aka S.A.D. – what an appropriate abbreviation
  • “The S.A.D. has arrived at the absolute worst combination of macronutrients that you could possibly imagine. You couldn’t come up with a better way to confuse someone’s metabolism, than by combining fats and carbohydrates, in the way they are, with foods eaten on a SAD.”
  • What would Peter recommend to patients who come to him, who are obese, and following a S.A.D.?
    • Either time restrict your eating, or restrict what you eat (aka dietary restriction – just eating healthy basically)
    • He wouldn’t recommend someone just calorie restrict 100% of the time
      • “I think the data is pretty clear that this isn’t a winning strategy. There’s something about the cycling into, and out of, a catabolic vs. a anabolic state.”
        • What does this mean? – Basically, when you fast for a short period, and then eat, cells that are defective are cleared away, and then repopulated with healthy cells once you eat again
      • The worse the diet, the better the benefits of caloric restriction
        • “If you never eat anywhere but McDonald’s, caloric restriction will have a more positive effect for you, compared to if your baseline intake is a healthy diet”
Fasting and Autophagy
  • Peter is interested in researching blood marker profiles, that might indicate whether one is experiencing autophagy
    • Right now, we technically have no way of knowing if the body is undergoing autophagy
  • This blood test, once developed, would allow you to compare the autophagy levels associated with different fasting protocols
    • This would allow us to answer the question – Should we be fasting for 3 days each month? 7 days every 3 months? 14 days one time a year?
The Sunk Cost Fallacy
  • “I have been able to internalize something that I think is not innate to most people, which is the fallacy of sunk cost”
    • This has allowed him to switch gears fairly often – from starting out with a degree in engineering, to hopping over to medicine, to leaving medicine to become a consultant, then going into hard core research, and then finally back to medicine
      • When Peter left medicine after 10 years of med school + post graduate training, he got a lot of heat, and people told him to reconsider
        • He told these people – “I’m going to do something for the next 40 years;  I want it to be exactly what I want to do, and that’s way better to me than doing something I don’t really really want to do, because I’ve spent the last 10 years doing it.”
        • “That’s 10 years I can’t get back, but it’s still a fraction of the time that’s still in front of me.”
    • “I’ve been able to stand at any point in my life, and say ‘I want to do X. I’m going to evaluate that only through the lens of how many years I have left on earth, and not at all through the lens of what I’ve put into this.'”
    • “I think the days are long gone of doing one thing for your whole life. It’s no longer so ridiculous to have a career change every 5 years. If you’re not growing, if you’re not constantly being reminded of how much higher you have to climb, I suspect life becomes a lot less fun.”
What drives Peter?
  • “Unfortunately I think a lot of my drive is insecurity.”
  • “I find myself, on a daily basis, thinking ‘I hope people don’t find out how much I don’t know'”
    • For more about what drove Peter to think like this, check out David Foster Wallace’s commencement speech called This Is Water
  • “I don’t think two years ago I could have acknowledged what I can be much more brutally honest with myself about today”
    • Peter has always gone to therapy, and one of his therapists recently said something insightful – “Your entire life has been driven by 3 things that you do…3 tools that you have – emotional detachment, rage, and obsession”
      • Peter has gotten a lot of good stuff out of these tools, where things could have gone quite differently
      • But…these tools have run their course for Peter, and he now realizes he needs a new set of tools
    • He began asking himself – “What kind of person do I want to be in 5 years?”
      • Then just reverse engineer it – How would that person act today? How would they react in when facing a difficult situation today? – Go and be that person
What rules is Peter following today, so he can be the person he wants to be 5 years from now?
  • Show up every day – he goes to therapy regularly
  • Set yourself up to be around people who will never take your shit
    • Have patient people around you – you’ll make a lot of mistakes in your growth
  • Aim to be the best person you can be around those closest to you
    • Those closest to you, are the ones who see the worst of you
    • “If you can show up as the best version of you for those people, you will be a great version of you for everybody, including yourself”
  • “Those of us who are the biggest jerks to others, are often jerks to ourselves”
    • Really examine your self-talk when you make errors – notice how harsh it is
    • “I do think we suffer much more in our own heads, than we suffer in any other way”
What is one thing people could change, that would have the biggest impact on their health?
  • It depends on how you currently sleep, eat, exercise, and manage stress – the biggest impact, will be in the area where you’re lacking most
  • BUT if you were to ask the reverse – “A catastrophic interruption to which of the above, will have the greatest detriment on you?”
    • Sleep
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