#1 Longevity Expert: Surprising Daily Habits That Shorten Your Life | Dr. Peter Attia

Name: #1 Longevity Expert: Surprising Daily Habits That Shorten Your Life | Dr. Peter Attia
Uploaded: 2023-04-26T12:00:10.000Z
Duration: 4 h 36 min 6 s

General Approach to Health and Well-being

In this section, Peter and the speaker discuss the evolution of medicine from Medicine 1.0 to Medicine 2.0, which has doubled human life expectancy in a short period of time. However, they also discuss how life expectancy is now declining in many parts of the developed world.

Evolution of Medicine

Medicine 2.0 solved the problem of fast death caused by trauma and infections.

The scientific method, development of light microscope, and antibiotics/vaccines were pivotal moments that shifted medicine from 1.0 to 2.0.

These three things doubled human life expectancy in a very short period of time.

Current Issues with Health and Well-being

Life expectancy is not going up; it's slightly going down in many parts of the developed world.

Physicians don't have the training to inform patients on how to maintain normal weight, avoid type 2 diabetes, exercise regularly or sleep well.

Example for Medical Oncologist Training

In this section, Peter gives an example about how long it takes to become a medical oncologist compared to someone who knows that cancer patients need chemotherapy but doesn't know what kind or how much.

Medical Oncologist Training vs Common Knowledge

It takes five or six years after medical school to become a medical oncologist.

A person without any medical training would know that cancer patients need chemotherapy, but they wouldn't know what kind, how much, or other details.

The Importance of Lifestyle Medicine

In this section, the speakers discuss the importance of lifestyle medicine and how it can improve health outcomes.

The Need for Lifestyle Medicine

Physicians lack training in nutrition, sleep, exercise, and stress management.

Lifestyle medicine movements are challenging the status quo to update tools and education.

Pushback against lifestyle medicine often centers around the idea that telling patients to eat better and exercise more is obvious.

Exercise as a Longevity Intervention

Exercise may be the most potent longevity intervention that exists.

Hazard ratios associated with all-cause mortality show that exercise has a much greater impact than conditions like hypertension or smoking.

Hazard ratios communicate relative risk of one condition compared to another.

Metrics for Cardiovascular Fitness

Different metrics of cardiorespiratory fitness, strength, and muscle mass have a significant impact on lifespan.

Comparing VO2 max shows that those in the bottom 25% have significantly worse outcomes than those who are more fit.

Conclusion

Lifestyle medicine is an important field that challenges traditional medical practices. Exercise is a powerful tool for improving health outcomes and increasing lifespan. Metrics like VO2 max can help individuals understand their cardiovascular fitness levels.

The Importance of Strength and Fitness for Longevity

In this section, Peter discusses the significance of strength and fitness in comparison to disease conditions when it comes to all-cause mortality. He emphasizes that having a higher VO2 max, greater muscle mass, and greater strength are the most potent things we have at our disposal to live longer.

The Significance of Strength and Fitness

Going from the bottom 25th percentile to being slightly above average (50th to 75th percentile) in terms of strength and fitness has a hazard ratio difference of 2.75, which is more significant than having end-stage renal disease.

Measures of strength and fitness have a significantly wider difference in all-cause mortality compared to any disease condition known.

Having a higher VO2 max, greater muscle mass, and greater strength are hands down the most potent things we have at our disposal to live longer.

Lifespan vs Healthspan

In this section, Peter explains the difference between lifespan and healthspan. He emphasizes that longevity is not just about extending lifespan but also about improving healthspan.

Lifespan vs Healthspan

Longevity has two vectors: lifespan vector and health span vector.

Lifespan vector is binary - you are either alive or dead. It's about extending lifespan beyond what's already been done without focusing on magical numbers like living up to 150 or 200 years old.

Health span vector is analog - it declines slowly over time with three components: physical, cognitive, emotional; two out of three components are heavily age-dependent while one isn't age-dependent much at all.

The Four Horsemen of Aging

In this section, Peter introduces the concept of the four horsemen of aging. He explains that these are the key drivers of age-related decline and death.

The Four Horsemen of Aging

The four horsemen of aging are: inflammation, oxidation, glycation, and methylation.

These are the key drivers of age-related decline and death.

Inflammation is a response to injury or infection but chronic inflammation leads to disease.

Oxidation is a natural process in which oxygen molecules lose electrons but it can lead to damage if not controlled properly.

Glycation is when sugar molecules attach to proteins leading to damage over time.

Methylation is a process that regulates gene expression but it can also lead to changes in DNA structure over time.

The Four Horsemen of Health

In this section, the speaker discusses the four major health issues that cause most deaths in modern society.

The Four Horsemen

The first horseman is cancer, which includes various types such as breast and colon cancer.

The second horseman is neurodegenerative diseases such as Alzheimer's disease, Lewy Body dementia, Parkinson's disease, and other types of dementia.

The third horseman is metabolic diseases such as insulin resistance, non-alcoholic fatty liver disease (NAFLD), and type 2 diabetes.

The fourth horseman is a spectrum of diseases ranging from insulin resistance to type 2 diabetes. Although it does not directly take many lives, it indirectly amplifies the risk of the other three horsemen by typically about twofold.

Delaying Onset

While we cannot completely eliminate these health issues, we can delay their onset. Long-lived people or centenarians provide proof that delaying onset is possible. They get the same diseases as everyone else but about two decades later than others.

Problems with Medical System

In this section, the speaker discusses problems with the medical system and how doctors are trained to deal with patients.

Late Diagnosis

Doctors often report sub-optimal blood sugar levels as normal and do not take preemptive action until it's quite far advanced.

Unsatisfactory System

The medical system is unsatisfactory on many levels. Patients are often told that if they don't hear from the hospital, everything is okay. This is not satisfactory as things go wrong and get missed all the time.

Preemptive Action

Doctors should take preemptive action to prevent diseases such as type 2 diabetes and Alzheimer's disease. Dale Bredesen suggests that Alzheimer's disease may start in the brain 30 years before diagnosis.

Prevention and Delaying Onset of Atherosclerosis

In this section, the speaker discusses how prevention can help delay the onset of atherosclerosis and reduce the risk of cardiovascular disease.

The Importance of Prevention

Prevention is crucial in delaying the onset of atherosclerosis and reducing the risk of cardiovascular disease.

Understanding the pathogenesis of atherosclerosis is key to preventing it.

Risk factors for heart disease include smoking, high blood pressure, elevated apob, and metabolic disorders.

Time Horizon for Prevention

In the United States, prevention is viewed through a time horizon of 5 to 10 years.

Patients are typically not treated for primary prevention unless their 5 or 10-year risk is above some threshold (typically 5%).

Waiting until a person's risk is high before acting on it is like driving towards the edge of a cliff without hitting the brakes until you see it.

Failure to Appreciate Causality

There is often a failure to appreciate causality in medicine.

APO B has a significant effect on atherosclerosis but is not commonly tested in the UK.

Overall, understanding how to prevent and delay onset of diseases such as atherosclerosis can significantly reduce one's risk for developing cardiovascular disease. It's important to view prevention through an appropriate time horizon and appreciate causality when considering treatment options.

APO B Test and its Importance

In this section, the speaker discusses the importance of APO B test in measuring the concentration of lipoproteins that cause atherosclerosis.

APO B Test

The cost of APO B test is artificially inflated in the United States.

Non-HDL cholesterol is a poor man's substitute for APO B, which is covered by NHS.

APO B is a protein wrapped around all particles that cause atherosclerosis. Measuring its concentration directly measures the number of particles per unit volume of all lipoproteins.

APO B concentration is the most powerful predictor of any lipid or lipoprotein as it pertains to cardiovascular disease.

Causal Relationship between LDL and Atherosclerosis

In this section, the speaker establishes through epidemiologic studies that low density lipoprotein (LDL) or apob is causally related to atherosclerosis.

Causal Relationship between LDL and Atherosclerosis

Low density lipoprotein or apob is causally related to atherosclerosis based on epidemiologic studies, primary prevention studies, secondary prevention studies, and mendelian randomization.

Once you've established causality, you remove the causative agent. However, we don't take that approach in treating atherosclerosis which leads to it being the leading cause of death globally.

Delaying Onset of Atherosclerosis

In this section, the speaker discusses how atherosclerosis can be delayed significantly by reducing the level of LDL at an early age.

Delaying Onset of Atherosclerosis

Atherosclerosis is the leading cause of death globally. 19 million people die every year from atherosclerosis.

Based on the tools we have to delay its onset significantly, atherosclerosis not only shouldn't be the leading cause of death but it shouldn't even be in the top ten.

Lowering APO B as much as possible is important since the lower, the better.

Aggressively Lowering APOB

In this section, the speaker discusses how aggressively to lower APOB and what therapeutic interventions to use. The goal is to lower APOB without creating another problem.

Aggressive Use of Statins

Aggressive use of statins has a small but non-zero risk of increasing insulin resistance in some individuals.

Statins reduce the desired outcome (LDL-C), but increase glucose and insulin levels, pushing patients further towards metabolic health risks.

PCSK9 inhibitors, acetamide, and bentinoic acid are drugs that don't seem to come with any side effects.

Optimal Solutions for Reducing APOB

90-94% of people have no measurable discernible subjective or objective side effects to statins.

Other drugs like PCSK9 inhibitors, acetamide, and bentinoic acid are much cleaner drugs than statins.

The goal is to get APOB as low as possible without creating another problem.

Chronic Unresolved Inflammation

In this section, the speaker discusses chronic unresolved inflammation as one of the core root causes that increase the likelihood of atherosclerosis, cancer, neurodegenerative disease, and poor metabolic health.

Lifestyle Behaviors That Help Lower Chronic Inflammation

Adopting certain lifestyle behaviors can help lower chronic inflammation.

These lifestyle changes are likely to aggressively start reducing our risk of all four horsemen.

The Upsides and Downsides of Health Interventions

In this section, the speaker discusses how health interventions can have both positive and negative impacts on an individual's health. He uses examples such as caloric restriction and exercise to illustrate this point.

Caloric Restriction

Caloric restriction is one of two interventions that have been shown to extend life in virtually every model organism.

However, calorie restricting humans to 30% of their required caloric intake may not be a net positive in their life because it increases susceptibility to trauma and infectious diseases.

Calorie restriction also increases the risk of sarcopenia, which makes individuals more susceptible to accidental death from falling.

Exercise

Extreme exercise can lead to injury, which can negatively impact an individual's quality of life.

However, exercise has numerous cardiovascular and muscular benefits that are beneficial for overall health.

Whack-a-Mole Problem

There is no scenario where taking action to address one issue does not potentially impact another.

This problem is not limited to pharmaceutical drugs but applies generally in life.

Mitochondrial Function

Mitochondrial function is important for various reasons discussed in the book's exercise section.

Statins are known for impairing mitochondrial function, which can be problematic when using them as a pharmaceutical drug.

Managing Risk

Individuals need to take ownership of their health by understanding the risks associated with different interventions.

Practical steps include finding a balance between interventions and being aware of the potential risks associated with each.

The Nuanced Approach to Health

In this section, Peter and Rangan discuss the importance of taking a nuanced approach to health and avoiding binary thinking when it comes to tools like medication.

Avoiding Binary Thinking

Tools like medication should not be viewed as inherently good or bad.

The effectiveness of a tool depends on how it is used and whether it is appropriate for the individual.

Generic guidelines for health may not work for everyone, and different things work for different people.

Context Matters

There is no one-size-fits-all approach to optimal aging. Different choices work for different people.

Choices in life have trade-offs, and what works in one context may not work in another. For example, improving sleep may come at the cost of spending quality time with loved ones.

General Health Recommendations

Exercise, adequate sleep, and adequate protein consumption are almost universally recommended for good health. However, what constitutes "adequate" varies from person to person based on their personal history and needs.

Exercise has no upper bound in terms of benefit but must be pursued with consideration given to opportunity cost and injury risk.

The Opportunity Cost Argument

In this section, the speaker discusses the opportunity cost argument and how it applies to biohacking. He gives an example of a patient who wants to pursue hyperbaric oxygen therapy despite there being no evidence of its efficacy.

The Opportunity Cost of Time

Everyone has 168 hours in a week, regardless of economic means.

Pursuing unproven biohacks can come at a high opportunity cost in terms of time.

Instead of pursuing unproven biohacks, one could spend that time on activities with demonstrated benefits such as exercise or spending time with loved ones.

Example: Hyperbaric Oxygen Therapy

There is no evidence that hyperbaric oxygen therapy provides cognitive enhancement or zero protection.

Pursuing hyperbaric oxygen therapy would require 12 hours per week for little chance of success.

That time could be better spent on activities with demonstrated benefits.

The Cost of Time

In this section, the speaker discusses how everything in life has a cost and shares an example of a patient who was spending four hours per week trying to save money but was actually sacrificing his health and relationships.

Example: Saving Money vs. Health and Relationships

A patient was spending four hours per week trying to save money by going to different shops and driving out of town for cheaper petrol.

By redirecting that time towards activities like walking or spending time with family, he saw significant improvements in his health and relationships.

The patient realized that everything in life has a cost and that it's important to weigh the costs and benefits of our actions.

Conclusion

In this section, the speakers conclude their discussion on the opportunity cost argument and emphasize the importance of weighing the costs and benefits of our actions.

Pursuing unproven biohacks can come at a high opportunity cost in terms of time.

It's important to weigh the costs and benefits of our actions, as everything in life has a cost.

Redirecting time towards activities with demonstrated benefits can lead to significant improvements in health and relationships.

APO B and Cholesterol

In this section, the speaker discusses APO B and cholesterol levels, how to assess risk, and when to treat aggressively.

Assessing Risk with APO B

Non-HDL cholesterol is a better predictor of risk than LDL cholesterol.

Calculate non-HDL cholesterol by taking total cholesterol and subtracting out HDL cholesterol.

Young people should be at or below the 20th percentile for non-HDL cholesterol.

Someone with evidence of atherosclerosis should be treated as a very high-risk secondary prevention case.

Treating Aggressively

If someone has calcification on a CT angiogram or CT coronary CT, it's effectively secondary prevention.

It's important to treat early rather than waiting until there are signs of heart disease.

Triglyceride to HDL ratio is suggestive of insulin resistance but has no bearing on atherosclerosis risk.

The Importance of APO B in Lipid Risk Assessment

In this section, Peter Attia discusses the importance of APO B in lipid risk assessment and how it is a superior biomarker compared to other lipid biomarkers.

APO B as the Superior Biomarker

Normalizing for APO B eliminates the predictive value of HDL cholesterol, triglyceride, and total cholesterol.

In a hypothetical scenario where people were given an option to have one test to measure their risk of atherosclerosis, Peter Attia suggests that it should be APO B.

The literature overwhelmingly supports that APO B is the superior biomarker for lipid risk assessment.

However, if access to APO B is not available, knowing non-HDL cholesterol and LDL cholesterol levels are still important.

Managing Lipid Risk

Knowing non-HDL cholesterol and LDL cholesterol levels are important because they capture all lipid risks except for LP little a.

To manage elevated levels of APO B or non-HDL cholesterol, pharmaceutical interventions may be necessary.

Lifestyle interventions such as carbohydrate restriction can help reduce triglycerides which contribute to lipid risk.

Carbohydrate Restriction for Lowering Triglycerides

In this section, Peter Attia explains how carbohydrate restriction can help lower triglycerides but comes with an increase in fat consumption.

Lowering Triglycerides with Carbohydrate Restriction

Carbohydrate restriction is effective at lowering triglycerides quickly.

However, carbohydrate restriction often means increasing fat consumption which can be problematic for some individuals.

Saturated Fat and Triglycerides

In this section, the speakers discuss how saturated fat can increase cholesterol synthesis and impair LDL clearance from circulation via the liver. They also mention that carbohydrate restriction is effective in bringing down triglycerides.

Saturated Fat and Cholesterol

High degrees of saturated fat will impair LDL clearance from circulation via the liver.

Carbohydrate restriction is effective in bringing down triglycerides.

Low-Carb Diets and Health Risks

In this section, the speakers discuss how low-carb diets can affect health risks such as APO B or LDL cholesterol levels. They emphasize that causality matters when it comes to health risks.

Low-Carb Diets and Health Risks

Mainlining coconut oil or other forms of saturated fat can drive APO B up through the roof, making a person worse off than they were at the outset.

People who suggest ignoring LDL cholesterol levels while on a low-carb diet are playing a dangerous game of Russian Roulette. Causality matters when it comes to health risks.

Blood Pressure

In this section, the speakers discuss blood pressure as an important metric for monitoring one's health. They highlight its importance in detecting problems early on.

Importance of Blood Pressure Monitoring

Blood pressure is an important metric for monitoring one's health, especially since it can detect problems early on.

The speaker regrets not being able to go deeper into this topic in his book due to space limitations but argues that it is just as important as discussing APO B levels.

The Importance of Blood Pressure and Kidney Function in Preventing Dementia

In this section, the speaker discusses the importance of blood pressure and kidney function in preventing dementia and Alzheimer's disease.

Blood Pressure and Kidney Function

Elevated blood pressure can significantly impact kidney function, which becomes problematic for aging populations.

Compromised kidney function makes it less likely to live longer and more susceptible to toxins that would normally be filtered out by healthy kidneys.

Measuring blood pressure correctly is important, as automated cuffs may not provide accurate readings.

Patients are recommended to get a high-quality monitor and check their blood pressure twice a day according to protocol for at least two weeks.

Treating blood pressure with lifestyle changes or medication to better than 120 over 80 has significant benefits in preventing dementia.

Trackers and Personality Types

In this section, the speaker discusses trackers and how they can be helpful depending on personality types.

Trackers

Not everyone is pro-trackers; it often depends on personality type.

Some patients use trackers as a way of keeping them on track with lifestyle changes, while others become obsessed with checking their numbers multiple times a day.

Blood Pressure Monitoring

In this section, the speakers discuss the limitations of traditional blood pressure monitoring and the potential benefits of continuous blood pressure monitoring.

The Value of Tracking

Continuous blood pressure monitoring is more valuable than spot checking.

Tracking can be a valuable insight-generating tool for some people.

The debates between tracking and anti-tracking communities are often unhelpful and uninformed.

Limitations of Traditional Monitoring

Spot checking has many limitations, including only providing two points in time.

People don't know their blood pressure at night or during various activities throughout the day.

Continuous Blood Pressure Monitoring

24-hour ambulatory blood pressure monitors are currently the only way to monitor blood pressure continuously.

These monitors are cumbersome and not practical for everyday use.

There are devices that measure blood pressure optically off the back of the wrist that show promise.

CGMs as a Behavioral Tool

In this section, the speakers discuss how continuous glucose monitors (CGMs) can be used as a powerful behavioral tool.

The Power of CGMs

CGMs are one of the most powerful tools to change behavior in real-time.

They provide valuable insights into how food, exercise, stress, and sleep affect glucose levels.

Using CGMs as a Behavioral Tool

CGMs can help people understand how their behaviors impact their health outcomes.

They can motivate people to make positive changes by showing them immediate feedback on their actions.

Ambulatory Blood Pressure Monitors

In this section, the speakers discuss ambulatory blood pressure monitors (ABPMs), which are currently the only way to monitor blood pressure continuously.

How ABPMs Work

ABPMs are cuffs worn on the arm that cycle every 15 minutes to measure blood pressure continuously.

They are currently the only way to monitor blood pressure continuously.

Limitations of ABPMs

ABPMs are cumbersome and not practical for everyday use.

People who don't like being tracked may find them uncomfortable or inconvenient.

Optical Blood Pressure Monitors

In this section, the speakers discuss devices that measure blood pressure optically off the back of the wrist.

How Optical Blood Pressure Monitors Work

These devices use optical sensors to measure blood pressure off the back of the wrist.

They show promise as a more practical alternative to traditional ABPMs.

Potential Benefits of Optical Blood Pressure Monitors

Optical monitors could provide a more convenient and comfortable way to monitor blood pressure continuously.

They could help people better understand how their behaviors impact their health outcomes.

Blood Pressure and Cholesterol

In this section, the speakers discuss the importance of tracking blood pressure and cholesterol levels. They also talk about the target levels for blood pressure and how they have changed over time.

Importance of Tracking Blood Pressure

Knowing a patient's average blood pressure is more important than knowing their average blood glucose.

Non-invasive blood pressure trackers will likely be developed in the future.

Target Levels for Blood Pressure

The target for blood pressure has become more aggressive in recent years due to studies like the Sprint trial.

Symptoms matter a lot on the low end of blood pressure, but not as much on the high end.

Hypotension is a dangerous side effect of pharmacologic interventions for hypotension.

Lowering Cholesterol

Lowering cholesterol has no downside except for side effects from medication.

CNS growth during childhood occurs when cholesterol levels are lowest, so lowering cholesterol does not starve the brain.

Pharmacologic interventions should only be used after exercise, weight loss, and sleep improvements have been tried.

Problems with Blood Pressure Medications

In this section, the speakers discuss problems with using medications to treat high blood pressure, especially in elderly populations.

Problems with Blood Pressure Medications

Exercise, weight loss, and sleep improvements are better first-line agents to fix hypotension than pharmacologic interventions.

Elderly patients may experience dizziness or other side effects from even small doses of medication.

The threshold of risk depends on the potential downside of treatment.

Blood Pressure and Body Height

In this section, the speaker discusses how blood pressure is affected by body height and whether it should be treated differently in tall patients.

Considerations for Tall Patients

The speaker admits that he does not know the answer to whether blood pressure should be treated differently in tall patients.

One way to think about it is to consider the difference in height between a person's aortic valve and their brain vasculature, which is the most important perfusion part of the equation.

Another way is to compare the blood pressure of a giraffe with that of another large animal that doesn't have as much distance between ventricle and brain.

Personal Experience with Generic Advice

The speaker shares his experience with generic advice on running cadence, which didn't work for him due to his long legs.

Similarly, he mentions his slower swimming cadence, which was better suited for him despite being significantly lower than others'.

Movement Coach and Personalized Medicine

In this section, the speaker talks about his movement coach and how personalized medicine can help optimize efficiency.

Personal Movement Coach

The speaker mentions his movement coach Helen Hall who helps him optimize muscle sequencing and efficiency.

He gives an example of how generic advice on running cadence didn't work for him but working with Helen helped him find what worked best for him.

Personalized Medicine Approach

The speaker highlights similarities between himself and Pacer in terms of approach to medicine and personality traits.

He emphasizes the importance of personalized medicine and how generic advice can become problematic without context.

Understanding Kidney Function and Biomarkers

In this section, the speaker discusses the importance of using biomarkers to understand kidney function. They explain why systatin C is a superior biomarker compared to creatinine and how urinary protein can also be used as an indicator.

Importance of Systatin C

Systatin C is a superior biomarker for understanding kidney function.

Creatinine is not reliable due to its susceptibility to factors such as muscle mass and exercise status.

Tracking systatin C levels can help determine if estimated GFR based on Statin C is still high.

Urinary Protein as an Indicator

Urinary protein can be used as another indicator of kidney function.

It should be checked once a year along with systatin C levels.

Continuous Glucose Monitoring (CGM)

The speaker explains what CGM is, how it works, and why it's important for patients to understand how various factors impact their blood glucose levels.

What is CGM?

CGM stands for continuous glucose monitoring.

It's a device that samples interstitial fluids in subcutaneous tissue to indirectly measure glucose levels in the blood.

Importance of CGM

CGM provides real-time readings of blood glucose levels, which helps patients understand how various factors impact their blood glucose.

Understanding the relationship between average blood glucose and glucose variability is important for metabolic health.

All-Cause Mortality and Blood Glucose Levels

The speaker discusses the relationship between blood glucose levels and all-cause mortality, and how this can be used to determine metabolic health.

Blood Glucose Levels and Mortality

There is a monotonic decrease in all-cause mortality as average blood glucose goes down.

A hemoglobin A1c of 5.7% or 5.6% translates to approximately 120 milligrams per deciliter in our units.

Two people who have neither diabetes nor pre-diabetes with different blood glucose levels will have different risks of all-cause mortality.

The Advantages of Using a Calibrated CGM Over Hemoglobin A1c

In this section, the speaker discusses the advantages of using a calibrated continuous glucose monitor (CGM) over hemoglobin A1c for measuring average blood glucose and glucose variability.

Hemoglobin A1c Limitations

Hemoglobin A1c is inaccurate in scenarios where red blood cell life is not exactly as predicted by the assay.

Average blood glucose is imputed from hemoglobin A1c based on a belief that red blood cells live about 90 days.

Conditions that lead to shorter or longer residence time of red blood cells can result in artificially low or high estimates of average blood glucose.

Advantages of Calibrated CGM

Calibrated CGM is a far more accurate tool to measure average blood glucose and glucose variability than hemoglobin A1c.

Wearing a calibrated CGM allows for a better understanding of how various factors such as diet, sleep, exercise, and stress affect blood glucose levels.

CGM as a Behavioral Tool

In this section, the speaker discusses how wearing a Continuous Glucose Monitor (CGM) can be used as a behavioral tool to modify eating habits.

Wearing CGM and Behavioral Changes

Wearing a CGM can act as a behavioral tool to avoid consuming unhealthy foods.

The gamification aspect of seeing glucose levels rise after consuming unhealthy foods can motivate individuals to make healthier choices.

Opponents argue that wearing CGMs could promote disordered eating, but it is important to be mindful of who is prescribed the device.

Nuances in Medicine 3.0

In this section, the speaker talks about the importance of nuance in medicine 3.0 and how it applies to using CGMs as a tool for behavior modification.

Personal Journey with CGMs

The speaker wears a CGM for two weeks every three months or so and uses insights gained during that time to modify their behavior.

This approach may not work for everyone, but the speaker has found it helpful in modifying their own behavior.

Importance of Nuance in Medicine 3.0

Nuance is essential when prescribing treatments such as CGMs because they may not be suitable for everyone.

There is no one-size-fits-all solution when it comes to changing behavior, and what works for one person may not work for another.

Emotional Health and Longevity

In this section, the speaker discusses the role of emotional health in longevity and how it can impact behavior change.

Information vs. Behavior Change

Patients often make lifestyle changes but then revert back to old habits.

Emotional health and how individuals approach the world can impact their ability to maintain behavior changes.

Importance of Emotional Health

Emotional health is a key part of the conversation around health and longevity.

Managing conflicts and relationships can be crucial in maintaining healthy behaviors.

Differences in Medical Practice

In this section, the speakers discuss the differences in medical practice between private healthcare and national healthcare systems. They also talk about how access to testing affects medical practice.

Private vs National Healthcare

The speaker notes that he has had less access to testing due to working in a national healthcare system.

The other speaker notes that in the US, which is a private health insurance only system, there is no limit to testing.

However, the second speaker agrees that their system pays little attention to the problem of having fewer tools at one's disposal.

Relying on Human Tools

The first speaker notes that due to not having access to fancy tools, he has had to rely more on human tools such as interpersonal skills.

The second speaker finds this interesting and wonders how many physicians within the NHS recognize this and rely on these skills.

Perfectionism and Vulnerability

In this section, the speakers discuss perfectionism and vulnerability. They talk about how being vulnerable can be uncomfortable but also necessary for growth.

Perfectionism in Recovery

The second speaker notes that the first speaker has admitted to having perfectionist tendencies for much of his life.

However, the first speaker corrects him by saying he is a perfectionist in recovery and will always struggle with vulnerability.

Struggling with Vulnerability

The first speaker admits that being vulnerable is uncomfortable for him but acknowledges its importance.

He talks about struggling with letting people see his faults and acknowledging his own humanity to himself.

Reflections on Vulnerability

The second speaker asks the first speaker about his experience being vulnerable on large platforms and sharing personal things with hundreds of thousands of people.

The first speaker admits that it is uncomfortable but also realizes he is lucky to have the opportunity to share his experiences.

The Cost of Treatment and Paying it Forward

In this section, the speaker discusses the cost of their treatment and acknowledges that not everyone has access to the same resources. They express a desire to pay it forward by sharing their story and helping others.

Acknowledging Privilege

The speaker acknowledges that they have had access to resources that many people do not have.

They express a desire to use their privilege to help others.

Sharing Their Story

The speaker plans on writing a chapter in their book about their experiences with mental health.

They discuss how perfectionism is a growing problem and can be linked to social perfectionism and suicide.

The speaker describes themselves as a "perfectionist in recovery" and shares insights on how they are working through it.

They discuss how therapy has helped them reframe childhood situations and change how they show up in the world.

Changing Perspectives

The speaker believes that personality is not fixed and can be changed through certain practices.

They acknowledge the progress they have made in three years, particularly with shedding their destructive inner monologue.

Overcoming Negative Self-Talk

In this section, the speaker talks about how he was able to overcome negative self-talk and rewire his brain in six months. He shares an exercise that helped him change the negative voice in his head.

Exercise to Overcome Negative Self-Talk

The speaker had a negative voice in his head that was rooted in a daily deliberate behavior practice.

He was surprised that he could rewire his brain and get rid of the negative voice within six months.

The exercise involved imagining that your closest friend committed the act in which you failed instead of turning the rage inward.

For example, if you're having a bad day driving, imagine that your closest friend is the one driving poorly instead of getting angry at yourself.

Using Self-Talk to Overcome Negative Thoughts

In this section, the guest talks about how he used self-talk to overcome negative thoughts and perfectionism. He shares an exercise he did where he recorded himself talking to a friend as if they were in a situation where they performed poorly, and then sent the recording to his therapist.

Using Self-Talk to Overcome Negative Thoughts

The guest used self-talk to overcome negative thoughts and perfectionism.

He recorded himself talking to a friend as if they were in a situation where they performed poorly.

The exercise was similar to advice given by Kristen Neff on self-compassion, which is talking to yourself as if you were talking to your best friend or a young child.

Recording the message and sending it added an extra component of accountability.

The Power of Audible Self-Talk

In this section, the guest explains why audible self-talk is more powerful than just thinking positive thoughts. He also discusses how recording and sending the messages helped him rewrite his historical way of doing things.

The Power of Audible Self-Talk

Audible self-talk is more powerful than just thinking positive thoughts because it harnesses concentration through sound.

Recording and sending messages helped him rewrite his historical way of doing things by forcing him to overwrite negative thoughts with positive ones.

Using Accountability Partners for Positive Change

In this section, the hosts discuss whether people can use accountability partners for exercises like the one described by the guest. They explore potential problems with using a romantic partner and suggest using a friend instead.

Using Accountability Partners for Positive Change

The guest suggests that using a romantic partner as an accountability partner may introduce unnecessary strain on the relationship.

Using a friend as an accountability partner is not as ideal as using a therapist, but it can still be effective.

Having an accountability partner adds an extra component of motivation and encouragement to make positive changes.

Daily Practices for Emotional Health

In this section, the speaker discusses the importance of daily practices to maintain emotional health and shares his own recovery contract that includes red light, yellow light, and green light behaviors.

Recovery Contract

The recovery contract includes red light behaviors (things to avoid), yellow light behaviors (warning signs), and green light behaviors (daily practices).

Yellow light behaviors are important to identify in order to predict potential meltdowns.

Green light behaviors include exercise, widening distress tolerance window, spending time with family instead of over-exercising or working too much.

Performance-based activities were limited in the recovery contract to reduce stressors.

Other green light behaviors included therapy, journaling, and checking in with supportive friends.

Finding What Matters

In this section, the speakers discuss how everyone has different things that matter to them and how it is important to find what those things are. They also talk about the importance of finding a balance between discipline and compassion.

Importance of Finding What Matters

Everyone has different things that matter to them.

It's important to find what matters to you personally.

There is a balance between discipline and compassion.

Taking Action for Health and Longevity

In this section, the speakers discuss actionable steps for improving health and longevity. They emphasize the importance of getting data on your baseline metrics and using that information to make changes in areas where you are lacking.

Actionable Steps for Improving Health

Get data on your baseline metrics.

Use the data to figure out what changes you need to make.

Focus on areas where you are lacking, such as VO2 max or muscle mass/strength.

Introduction

In this section, the host thanks the guest for coming on the show and discusses his book.

Guest's Book

The guest has written a book that can help people make positive changes in their lives.

What and When to Eat for Longevity

This section discusses what and when to eat for longevity.

Effective Diet

The most effective diet ever promoted on the planet is discussed.

This diet protects our body against decay, disease, and the root causes of aging.

It is not only good for you but will also make you live longer.