Kind: captions
Language: en
Peter AA welcome back to the show thank
you back for having me Tom absolutely my
pleasure uh let me ask what is it about
Modern Life that is suddenly shortening
life
expectancy well I mean I think it's an
interesting question right because most
of what's in Modern Life has actually
increased life expectancy um but I think
what you're referring to is over the
past uh five to 10 years in the modern
world in the developed World we've seen
kind of a slight plateau uh and not just
a plateau to but actually a downtick for
the past five or six years even outside
of Co so if you take Co out of it is it
true that we are living shorter uh the
answer is yes but it's it's a bit of a
statistical issue um here's what it is
uh men who are aged 30 to 60 are dying
at too high a rate and it is now
dragging down average life
expectancy so just as 300 years ago
average life expectancy was really short
a big part of the drag was that too many
women and babies were dying during child
birth and when that happens you just
drag down the whole population average
so what's happening today is too many
men call it age 20 to 60 are dying uh
and the most common cause of death
that's increasing that are what we call
deaths of Despair so that's suicides and
overdoses and um that is having a
significant enough drag now on on
average life expectancy of people in the
United States unfortunately I can't
speak to this in other countries I'm not
as familiar with the data in Europe or
Australia um but I can tell you that in
the United States that's what's
happening okay yikes uh that actually
oddly enough I try to predict the
answers before I ask the questions uh
that isn't the answer I was expecting so
um suicide and overdose okay so take
some swags here as somebody who's
thought a lot about mental health it was
in your book um
what is going on where where are we
disconnecting in the way especially men
are living their life in modernity which
has brought us so many amazing things
but to your point something has tipped
if you had to aggregate some of the
biggest factors what are they so at the
risk of just disclosing that this is not
an area where I consider myself an
expert so now I'm speaking hopefully
less as an expert and more just as a a
kind of consumer of information and and
someone who lens to experts I think what
I would say is um there's there's been a
little bit of isolation of men um
there's been a little bit of um a sense
that you know maybe men are becoming
less connected to their sense of purpose
um and as such this is
producing uh you know behaviors in men
that are ultimately harmful right so so
one of the things that would result from
everything I just said is basically a
need to sort of mask pain and in many
ways um if you think about the rise in
the use of opioids as an example which
is the biggest driver of what I just
said a second ago so opioid use is the
biggest driver of uh what we call
accidental poisoning or accidental
overdose um and that's been by far the
largest group of deaths that have risen
in um in in the entire category of
accidental deaths right so it's not that
more people are d in car accidents right
it's deliberate self harm suicide and
then unintended self harm which is uh
overdose although you could argue that
that's slow suicide or what someone like
Paul kti has called
parasuicide paru so what yeah meaning a
behaviors that are kind of adjacent to
Suicide so so you know you asked the
question through the lens of modernity
um I think mity has been with us for a
while I don't know if there's something
from a technology perspective that's
making that worse so for example we know
I think with I think a reasonable degree
of certainty that social media has some
harm on mental health and a lot has been
written about its negative effect in
particular on adolescent girls them
being more susceptible maybe even than
adolescent boys or men and women who
were out of adolescence um but there is
clearly something else that's going on
um with with with men probably again
with respect to purpose uh would be my
best guess that that is um leading to
some sort of pain that's resulting in
some sort of compensatory numbing
strategy um that that at least I think
plays a partial role in
this let me ask a question that'll get
at us the same topic but from an angle
that um maybe deeper into your
wheelhouse so if we were to take modern
medicine and we may need to Define what
I mean by that but I'll finish the
question first if we were to take modern
medicine back say 5,000 years and so hey
if you're out chucking Spears and uh you
know getting the antelope and dragging
it back and you get an infection we can
take care of that um if we brought that
apparatus but otherwise their lifestyle
did not change do you think we would
increase life expectancy beyond what it
is for Gen Z right now yeah so let me
make sure I understand your question
you're saying Peter um let's take
everything that modern medicine has to
offer medicine 2.0 specifically yes
let's take medicine 2.0 back to 3000
BC um make no other change uh which is a
complicated thing to imagine because
that also means you have to bring
electricity back and you have there's a
lot of things you have to bring back so
it's it's but let's just play it as a
thought experiment somehow you just
transport like alien doctors and
Medicine back to 3000 BC um yeah it's
interesting right because going back to
that point in time our life expectancy
was shy of 40 but as I said there were
largely three things that resulted in
such a drag on uh life expectancy the
first is the one I already alluded to so
uh infant mortality was enormous I don't
remember exactly the numbers of like one
out of every X number of babies and it
was a small number like maybe one out of
every four or five babies born the
mother Andor baby die Jesus full stop
now this is not that hard to believe for
anybody who's watched their you know if
you're listening to this and you're guy
if you've watched your wife go through
childbirth you can totally appreciate
this like my wife would have not
survived the birth of our daughter if
not for modern medicine absolutely full
stop so we would have lost both of them
for sure so you have a you have you have
a huge amount of humility for what
medicine has done to make child birth
safe secondly you have infections so you
know it was very easy to get an
infection and without any sort of
antibiotic you you didn't get too many
shots on goal there and then lastly
trauma so you know you got a big cut on
you you fell you broke a leg you broke a
hip you're done so those three things
alone basically wiped out our species
but not not to the point where we
couldn't procreate again enough of us
were able to still pass on our genes
before we died but life expectancy was
probably in the high 30s right there
were probably people who lived beyond
that if they managed to escape all of
those things but they you know we
weren't dying of chronic disease so I
guess what your question is getting at
is is is there something else in the
modern world that is so toxic that
despite all of the advantages of modern
medicine it's killing us and I think the
answer has to be yes right um so is the
amount of stress we're under beneficial
probably not it's probably a bit
maladaptive for many people especially
people who are you know on on you know
at the at the high end of it right
stress is kind of like an inverted
u-shape relationship between performance
and stress so low low low levels stress
are not very helpful they don't actually
we we we don't have the motivation to do
anything so you have to have some stress
some drive but for for any of us at some
point that becomes really unproductive
and you start to you know kind of spiral
in in your response to stress you you
can't even multitask anymore um and
sometimes that is all self-imposed and
sometimes that is imposed by the world
around you right you have too many
things in your life you know you you you
got a job you you're working three jobs
to try to pay this and you're you know
you you have this bill that's due and
and all of those things are very
stressful and they're purely external
and then other times you could be in
your shoes right where you're an
entrepreneur you don't have to worry
about paying bills but yet you're
imposing a ton of stress on yourself
because of who you are and your desire
to do something that um is above and
beyond what you're doing today so um I
think modernity enables a lot of that
because basically it changes what we
have to optimize for so 5,000 years ago
we were really only optimizing for a few
things we had to find shelter we had to
find food we had to procreate and we had
to be safe those were about that was
really it there really wasn't a lot of
self-actualization going on at least we
don't have really much evidence that it
was that probably started a little bit
later on um but 5,000 years ago it's not
really clear that there was much of that
going on certainly 10,000 years ago I
would I think I'd be comfortable saying
there was none of that going on or at
least not enough of that that it
mattered basically natural selection was
the force that was driving us yeah that
that is the lens through which I look at
a lot of this is what would have been
selected for so um when talking to
people in a modern context so my life is
divided into entrepreneurship and
mindset so I get people that come to me
with mindset stuff and a lot of times
I'm like this is just a
maladaptive response to the modern world
where the very first time this occurred
to me was at awareness Technologies the
first company that I got involved with
and I remember thinking dude some people
just need to be chased by a lion like
the the way that they are approaching
their lives is so bizarre that they're
uh majoring and minor things and when
you don't have to worry about your
survival when you um aren't looking left
and right and being like yo I need you
to keep me from getting eaten by
something you can afford to isolate
which then has all these knock on
effects but it isn't maybe immediately
apparent that this is going to be
problematic um you don't have already
made meaning and purpose because when
you have a child and you're like yo I
have to make sure this thing lives and
everything is trying to kill it um all
of the sudden you're you're having to
manufacture this stuff yep now I am a
hyper responder to the modern world so
for me I'm a city bther not a forest
bather like uh I love building things I
love being around a lot of people and
yet thoroughly enjoy isolation so it's
like I I am just built for this moment
uh however I have the what I can feel
like are evolutionarily planted
algorithms running in my brain that are
saying if you don't do these things
you're going to feel profoundly um ill
at ease and so I've had to think a lot
about okay why would I need meaning and
purpose that's the big one right so why
would I continue to need meaning and
purpose I have all the money in the
world I never have to work again like I
should be on easy street but I was the
most paranoid at my most successful
because I realized so I uh my last day
of quest was a Monday and my first day
at impact theory was Tuesday because I
knew time off is not going to be the
thing that I need to lean into it's
going to be meaning and purpose and why
am I doing all of this and so having to
map out what those
evolutionary um algorithms are that are
running in my brain to keep me from
making mistakes became incredibly
important so one of them and this is the
lens that I view you you really affected
my vision of you for sure uh and how I
should be thinking about health in our
last episode where you got me to stop
thinking as much about diet and more
about
exercise how much do you think that
plays into this how much of this is a
problem with being sedentary sitting and
watching Netflix playing video games
which you know I love but I I always
want to know what's what's causing the
the
break how much of this is sedentary and
just not getting after it killing things
and dragging it
back probably quite a bit of it although
I think there's probably a lot of things
going on so the the modern world today
like if you if you could imagine going
back in time 10,000 years and bringing
one of our ancestors forward here today
ask yourself the question what would
they
recognize like let's go through things
so they were sitting in this room with
us so it's you me and one of our
ancestors sitting there so he would he
wouldn't know what these things are that
we're wearing like clothing like what
are these things on your face that have
glass on them like what is glass uh what
are these lights like everything in this
room would be everything in this world
would be so foreign can you imagine what
they would think when they looked out at
Los
Angeles um how long would that person
survive I I just I don't I don't I don't
I just don't think they could survive
very long at all despite the fact that
they would have everything given to them
they wouldn't be able to eat the food it
would probably I mean it would taste
really palatable but like it would be
very foreign to them like all these
things be foreign and yet from an
evolutionary perspective there's not
much of a leap between us so um when
when we sit here and and think about uh
everything you said which I which I
agree with by the way which is like this
idea that we and I put myself in this
category at the top of the list like
it's so easy to get worked up about
things that don't matter and if you
frame them through the lens of
survival you you you would take a step
back and laugh but it's also the
privilege we have to worry about stuff
that isn't life and death because of the
incredible Society we live in like
that's kind of the
the like if you're on the Titanic before
it hits the iceberg you can be worrying
about whether they're they're serving
Lobster or steak like that's that's
that's a reasonable thing to worry about
once you've hit the iceberg like there's
only literally one thing you're thinking
about am I going to get into a Lifeboat
and live or am I going to get in the
ocean and die and so I don't think we
should be too critical of the fact that
we are where we are I think what we need
to do is help realign like how do we
extract all the value from the modern
world because I don't think you want to
go back in time 5,000 years even if I
told you you could I just don't think
you'd want to I don't think anybody
would really want to if they understood
what it was like and how brutal the
world was I wouldn't want to go back in
time a hundred years years think about
100 years ago Tom what was going
on let's see we were five years it was a
roaring 20s so the world was looking
pretty good you're five years away from
the depression which was gonna you're
also only a decade out well depending on
how deep into the 20s from World War one
which was God awful right so yeah you
probably lost yeah right you had you had
this influenza pandemic that kills you
know whatever 10% of the population um
you've got you know World War II you're
you're five years away from falling off
a cliff for the next 10 to 12 years of
the world's worst depression that was
less than 100 years ago I mean would any
of us actually want to go back to that
no so I don't I don't have personally a
lot of nostalgia for that I I tend to
take the view of like yes there's a ton
of stuff about the world today that I
don't like but I'm
still I just can't believe how lucky I
am you know people sometimes have a hard
time realizing how lucky we are in this
sense so there were about 8 billion
people on Earth today do you know how
many people came before us so what's the
total number of humans born in the last
250,000 years that's about when our
species showed up it's something roughly
equivalent to how many people live right
now at this very moment right no it's
actually much more and it's very
counterintuitive it's about a hundred
billion people yes okay that's 10x what
I thought yeah exactly yeah me too I I I
couldn't believe this when I first
learned this a few years ago there have
already been a hundred billion people on
this planet who have lived and died
before us and so to think you're sitting
here I'm sitting here we are one of the
very very lucky eight billion people to
have been born everybody who's listening
to us right now like right out of the
bait like right out of the gate that's a
lottery ticket now factor in how many of
us are born in the United States Canada
Australia Western Europe like born into
a country where you're not under you
know some horrible regime that's like
completely taken away your rights so so
go through that math in how many
countries would you like to be born into
today you've now reduce that number even
more so we we really have hit the
lottery to be here where we are right
now and instead I like to think about
okay how can I modify my current world
to not be as you know not have as many
of the unintended consequences of
modernity um as as are obviously going
to take place if I'm
not deliberate about it yeah what really
blows my mind so I'm totally with you
and as a student of History uh I don't
think there's any way that you could
ever want to go back when you realize
people were just slaughtered put on
Pikes in front of the you know the road
leading up to your town and was just
crazy genas Khan killed 10% of the
world's population just killed them in
the most brutal fashion that you can
imagine it's just absolute Insanity uh
and that's history but even go one step
further Tom let's say I said you can go
back 500 years ago and be the king of
England M okay so now you're the most
powerful person in the world 500 years
ago how's that working out for you in
your dark dingy castle with like nappy
ass food and disease and like War like
none of it's good none of it's good like
we're so much better off no doubt and
yet deaths of Despair and so what I find
so interesting is looking at all of the
improvements that we've made elongating
life obviously we' have not Fallen back
to where the average ages 40 but there
is something really emotionally
distressing about seeing that line begin
to bend down yes and so I start asking
myself okay what are the things that I
need to do to make sure that I am not
falling prey to the things that that
cause issue so um I'm going to lay out
the things that I think are most
problematic let me know what you think
about this list so um I would have in
fact if I'm honest in my soul I still
think uh that diet is problem number one
one so you've got you said very
eloquently that diet has um it it is
huge downside if you get it wrong but
limited upside if you get it right so I
think that we're getting that wrong so I
think that's the first problem uh number
two exercise you have to manufacture it
and so now people just aren't doing it
uh meaning and purpose obviously you
already talked about that I think that
one is huge but somewhat ironic given
that people are going to spend a lot of
their time working uh to get money to
theoretically live in this modern world
but somehow they're not attaching
they're not taking the conscious action
of attaching that to I do this for this
reason and I think that that probably
has a large part to do with the
dissolution of the family unit so few
people are having kids now comparatively
um so that becomes a big problem uh but
then you also have things like uh
industrialized farming uh highly
processed Foods things where it becomes
almost impossible to get around things
that are creating a problem for you and
so now you have to be there's no default
setting that just works out from a
health perspective whereas before the
default answer was uh you wanted to have
sex so you were going to end up having
kids uh you were part of a social fabric
that made huge demands on you in terms
of taking care of the group taking care
of your kids uh so you were just sort of
forced into a role that would be wildly
emotionally advantageous for the average
person of course some people are going
to hate it uh but for the average let's
not forget that those of us that those
of our ancestors who couldn't bend to
those Norms were killed that's or
isolated and killed isolated and died
from a social pressure a social
perspective
right life moves fast you're rushing
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or racing to meet project deadlines
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Theory so I I was actually talking to
somebody a while ago and they asked me
why are we as humans
so like the question came up in the
context of why is it if I look at my
YouTube comments and there are 2,000
good ones and one negative one it's the
only one I think of I'm sure you can
relate to this I can relate comments for
that reason but yes but totally
understood and I said it's it's called
negativity bias and we're hardwired to
it it's evolutionarily very adaptive
because in that setting that you
describe in our tribe you had to be way
more attuned to when you were upsetting
people than when you were pleasing
people because if you are upsetting
people and you get cast out you don't
have too many days of life left you're
not going to survive on your own like
that's that's sort of the the human gift
is our ability to work together so we're
hardwired to accept that and so my only
point there is like a lot of weeding out
took place during this process to get us
to where we are for good and bad yeah no
doubt because natural selection and
evolution were optimizing for um our
genetic lineage not our happiness it's
very important to understand this
difference natural selection does not
care if you're
happy doesn't care at all it cares how
fit your genes are that's
it unless you're so unhappy that you
will kill yourself before you can pass
on your genes that you would have a
negative pressure to get that Gene out
but but if if the answer is like you're
not happy you're not satisfied you're
not who cares can you procreate and pass
on your genes that's the only pressure
that is maniacally driving Evolution
forward yeah and once People wrap their
heads around that it becomes a lot
easier to structure their life in a way
that's actually going to make sense uh
so given that given that Clarity what
should somebody do that is facing that
basket of goods that we just went at
least through a partial piece of that um
how should a guy who SE the numbers of
deaths of despair of skyrocketing how do
they begin to structure their life such
that they deal with the biological
realities and the
psychological so one quick anecdote
before we do that and obviously we could
talk about this for so long because I
think that's the essence of of
everything um several years ago I
interviewed an amazing doctor on my
podcast his name is Tom Katen so he's a
he's a US physician who uh became a
missionary so he's now um a physician in
Sudan in the nuba mountains of Sudan
where the government is you know killing
its own people so there's an area in the
mountains where there's a million people
who don't have any medical care and he
provides all the medical care to these
million people by himself he now has a
little bit more help he has some nurses
uh and stuff and and and so uh a group
of us support his work there and he's
doing incredible work I mean he's truly
one of the most amazing human beings
I've ever met right very rarely I meet
somebody and think like I'm not sure I
deserve to be in this guy's presence
like there's such a gap between us as
human beings and one of the things I
remember Tom when I was asking um this
this question um I said to him because
he's going through just what the hellish
life is like I mean to be clear bombs
are being dropped on these people
routinely so half the stuff he's doing
is taking care of kids who' have had
their legs ripped off from shrap null um
like it's just you know they have they
have holes they have to be able to jump
into when the government is like you
know dropping these bombs on them and
stuff like that and I said Tom it sounds
horrible I mean like what is the suicide
rate there and he's like oh in the
entire time I've been here there's only
been one suicide and it was someone that
we later found out had a really bad
brain tumor and we actually just wonder
if it was the brain tumor that had kind
of altered his behavior and I was like
and these aren't people that are all
dying in their 30s I mean yes some of
them do but also many people survive
into their 70s and 80s so it's not just
that you can say well you know we don't
have deaths of Despair because we're all
dying from trauma no there's something
else going on and I think about that all
the time because here you have people
living
today who are living in a situation that
is abject misery and yet somehow it
doesn't cross their minds to end their
lives the way it would cross our minds
I'm sure like if I said to you Tom I'm
gonna I'm going to ship you over to
Sudan for the next 10 years
like or if you sent the same thing to me
I'm like I don't know that I can do this
right um so what is that like to me
that's super interesting and I think a
lot of the things you talked about are
covered right so even though they're
eating not that much they don't have
great food you know it's a very bland
diet that is you know lots of rice and
beans and you know they're eating meat
that's not particularly wonderful and
flavorful and they're probably eating
the same food every single day when it's
available
um you know they they have the internet
but it's obviously not a huge part of
their lives um they're they family is
very important right so lots of kids uh
family is very important to produce the
food and build the shelter and all of
the stuff that they that they survive in
there um so clearly that gives them a
purpose even though in the eyes of the
world they're not building businesses
they're not building companies they're
not quote unquote changing the world so
purpose doesn't really have to be
necessarily on a world
scale um so I say that only as an as a
foray into the question of well what
what what should we do with the
privilege we have now which is amazing
uh to to mitigate some of the downsides
of it and I honestly I don't think it's
like that much of a mystery right I
think um the nutrition sleep exercise
piece is so obvious that I just I think
to ignore it is problematic um but I
also don't know if we really need to
talk about it because is there anybody
who would honestly be listening to us at
this point who wouldn't agree with the
notion that if if if you're thinking
about eight hours of sleep versus six
hours of sleep which one's going to
produce better mental and emotional
health if you're thinking about being
sedentary versus not being sedentary if
you're thinking about eating well versus
not eating well these things are really
clear now part of the question becomes
how do you motivate yourself to do those
things if you're starting in the low
spot where it's like I don't want to do
these things like I'm isolating myself
I'm
or I'm working too hard and I can't make
the time to do these things how do I
prioritize them I think that's a
discussion worth having um I think in
terms of sense of purpose maybe that's
one of the most difficult ones to
manufacture um and honestly I just don't
know
that like I don't know that I'm enough
of an expert in that area I I feel
fortunate that that's not something I've
ever struggled with I've always kind of
felt like I know what I'm supposed to be
doing um whether you have people that
come into your practice that lack
motivation they've got the money yeah I
think I think look there are people who
come into my practice who certainly
struggle with the motivation for
how they can look after themselves right
so there there's definitely um I think
it's independent of of Education
independent of wealth status anything
like that that sort of intrinsic drive
for self-care um with respect to the the
sort of variables that we talked about
and and I and again I think that that's
where you you kind of have to start with
something that's a win you got to give
people a win I think and um I tend to
always gravitate towards exercise
because I think that gives most people
maybe not everybody but I do think that
most people when they get into a routine
of exercise really start to experience
physical benefits and psychological
benefits and the physical benefits are
are evident right so when people look
better when they feel better physically
that's reinforcing but the actual active
exercise is typically followed by a
period of of not necessarily Euphoria
although in some people it can be but
just a you know there's an increase in
dopamine so you're going to actually
feel better transiently and that becomes
rewarding and and self-reinforcing so I
always think that exercise is a great
place to start building habits for
people um and I also think that you know
if you take a person who says well I'm
not really to take that step yet I don't
really want to exercise Peter what can I
I do then I think being outdoors is very
important um one of the things that is
pretty jarring about this world is
the um the overabundance of symmetry and
right angles and things like that again
going back to the example of the guy who
shows up in our who's sitting over here
from 10,000 years ago that's something
that's going to be very jarring he's not
used to having seen straight lines and
right angles and perfectly symmetric
things right he's
seen sort of fractal geometry everywhere
um so there's some literature on this
it's not the most robust literature
because it's very difficult to study but
there are some literature that suggest
that people who spend a period of time
Outdoors every day in nature um actually
experience benefits in terms of brain
chemistry so it's it's again it's it's
it's challenging to test because it's
challenging to measure but it's actually
quite plausible and it makes a lot of
sense again going back to the fact that
our brains are still kind of 10,000 year
old brains an obvious example of this is
our response to fear a lot of times we
still you and I both I'm sure all day
long experience the the the mid-brain
fear right like the amygdala based
response the lyic system response as
opposed to the cortical response to
things and that's clearly a vestage of
our Evolution like we we needed to be
able to have a fear response quickly
before thinking um most of the time
today we don't need that but certainly
we needed that you know 10,000 years ago
and so a lot of times we still have to
think about how can I nurture and feed
that brain that part of my brain that is
still there what are the um Health
consequences of
laziness well there's obviously the
physical consequence of it right so um
the body
does need to have a hormetic stress and
and that's true in virtually everything
we do I mean most of the times
stressor that's temporary produces a
more robust uh organism following the
stressor so in that sense exercise is
just one of the most remarkable examples
we have of stressing the system if you
think about it in the acute state of
exercise everything that's happening is
actually taking the body out of
equilibrium so heart rate goes up blood
pressure goes up body temperature goes
up all of those variables are actually
going out of the area that produce that
that the body wants to be in normally so
the body has to kind of counteract those
things and the counteracting of those
things produces a response that makes
the body stronger so if a person is
sedentary and again it's obviously easy
to be sedentary in the world today that
wasn't an option for our ancestors who
by the way were quite sedentary when not
working right so it's not like we
exercised um we were we were conserving
energy as much as we could but you know
we were still probably walking a lot and
doing a lot of physical activity even
when we sat by the way like think about
it so you and me are sitting how like
are we actively sitting or passively
sitting I feel pretty passive super
passive right but how did our ancestors
obviously would sit but they would sit
in a low
squat so if you've ever sat in a low
squat on the floor it's you know it's
still sitting but it's very active so
you're saying people weren't sitting on
their ass they were actually they would
sit on their ass which is still way more
active than sitting in this chair say
more more uncomfortable super
uncomfortable right but why is it
uncomfortable you have to still stay
somewhat active to support your body you
have to keep your back forward right you
have to keep your hips in a certain
position sitting on a log sitting in
just a very low squat as you're sitting
over the fire as you're cooking as
you're preparing something everything
that they did just a low level of
activity was significantly more than
what we're doing right this is you know
this chair is designed to make us as
relaxed as possible as comfortable as
possible um and again you know some
people will take that to the level and
say look don't sit on chairs like this
don't sit on a chair that has a back
just sit on a chair that only has uh a
platform so that you are forced to
engage your core to sit up that's that's
great but you get the sense that you
could go through life quickly realizing
Little Things things that you can do to
work around that I sit on a chair with
the back but you know I also make sure
I'm going to exercise you know every
single day so that I can sort of offset
the damage that comes from you know
turning into a piece of wagu
beef very fair uh do you worry at all
about the way that people manipulate
their dopamine loops with things like
pornography Netflix video
games yeah and again not an area of my
expertise so I I come at this through
the lens of a consumer of information
I've obviously talked about this on
podcasts and interviewed people who are
the experts on this um so I don't know
if youve have you interviewed Anna lmka
from Stanford I have yeah a while ago
but yes yeah so look I think it is
problematic um I I think when you I
think dopamine responses to things that
are unnatural tend to produce too much
of a counter effect where the
deprivation of dopamine following the
stimulus creates more discomfort than
the comfort you gained through the
stimulus so explain that again English
yeah so um well let's start with the
right way to get to manipulate dopamine
the right way to manipulate dopamine
again let's go back to that idea that
about like you have this idea of um
homeostasis is this very important part
of the human body so the you know a lot
of this stuff I'm sure you know but
maybe just to make sure listeners
understand like how tightly the body
regulates um every process so
temperature so if if we assuming you're
not sick right now I'm not sick right
now we put a thermometer in our ear or
on our mouth you know you and I are
going to be within one degree of each
other and we're going to be within one
degree we're going to be between 98 and
99 degrees Fahrenheit that's going to be
our body temperature right now and
that's going to be the case almost under
any circumstance until what happens
right if we're sick we are going to push
the envelope of that and get higher and
higher 102 103 104 anything beyond that
and we're in trouble right you go much
beyond that you're going to die um if
you're outside in the cold freezing if
you're in water and you're freezing and
your temperature drops much below about
92 you're pretty much going to die so
high regulation of body temperature is
an amazing power of the body similarly
how much we can regulate acid base
balance in the body is even more
impressive than temperature truthfully
um how you can regul glucose levels the
difference between a person who's about
to die of hypoglycemia and a person with
type 2 diabetes is still actually a tiny
amount of glucose in the grand scheme of
things it's literally teaspoons of
glucose spread across the whole body in
the plasma level so our ability to
regulate every single thing is
remarkable so now if you look at the
brain dopamine is actually something
that needs to be kind of regulated and
so a lot of times painful stimulants uh
things like exercise cold water uh
therapy they create enough discomfort
that the body actually increases
dopamine production as a way to offset
that discomfort right you having you
have to give you a little bit of
pleasure for that pain and so when you
remove that stimulus you still get a
little bit of the lingering dopamine but
it's not a super high Spike that is
unnatural and so over time that doesn't
become problematic now a lot of the
things that you mentioned are kind of
hijacking the system and again it sort
of comes back to Evolution like
we didn't you know have slot machines
and video games and porn and um you know
pick your favorite drug that really
hijacks the system like cocaine or
something like that um and so what these
things do is they're creating such a
surge of dopamine along with other
hormones as well it's a bit overs
simplistic to just say dopamine but you
know norepinephrine epine and all these
other things that when this when the
stimulus is removed the drop in that
dopamine is so high because as You'
experienced that huge spike your body is
pulling its dopamine down right again
it's homeostasis we have this huge Spike
of dopamine well our body is saying
that's too much we're going to make less
so less endogenous production of
dopamine then that stimulation is gone
and you're in a dopamine deficit so um
one of the things that actually Anna
talks about is is is when when she
encounters somebody who's who's dealing
with this is they do I think she calls
it a dopamine fast right so if a person
says like I can't stop playing video
games she's like okay we're going to do
30 days of no video games and this
person will go through withdrawal they
will literally go through a painful
withdrawal that is no different than the
withdrawal that you know if you remember
train spotting when you watch like you
know when those guys are trying to get
off heroin like how painful that was she
saying there's a literal physical
withdrawal period from dopamine Loops
whether James porn whatever whatever y
and again you have to differentiate
between there are certain dop there are
certain times when these these
withdrawal symptoms are so difficult
that they actually even require other
medication that's usually not the case
with something like video games gambling
and porn but we know for example it
could be the case with alcohol so if you
took a person who's drinking an enormous
sum of alcohol and they want to quit
cold turkey they actually have to do
that stuff under medical supervision is
that dopamine though I was assuming that
something else in well I mean dopamine
is part of it but but they actually it's
actually probably more Gaba related so
those people actually end end up needing
to be on sort of bzo diazines to help
cope with that um Jesus yeah otherwise
it can actually actually be fatal they
can de they can develop fatal arhythmia
um if they are if they withdraw off
alcohol too much to be clear that is not
the case for most people so if you're if
someone's watching us and they're you
know they're in a habit of drinking two
to three drinks a night you can stop
that cold turkey but I'm talking about
people who are drinking like you know a
40 of Jack every single day day for
breakfast yeah th those people need to
be under medical supervision as they as
they what is the benzo doing does it
slow their heart rate like I don't
understand yeah so it's probably
balancing out the Gaba agonism that that
ethanol was doing for them because Gaba
is a ethanol is a huge Gaba Agonist as
well so basically the body is trying to
compensate for the um the suppressive
nature of the alcohol so you technically
have this like over
abundance of go go go from what blood
pressure heart rate catacol amines yeah
the whole thing interesting so the body
is relentlessly trying to balance the
scale so it's just jumping on go go go
and as soon as you stop the depressant
now it's gonna throw you so hard yeah
that is fascinating I never stopped to
run the math on that okay that's very
interesting so uh all right putting this
all back in context we're living in this
modern world it is a world of joy and
abundance and I have a fascinating
relationship with this because as I've
moved over into developing video games
people will come and be like yo bro I
thought you were about mindset like what
are you doing you're giving people a
drug and I'm like what uh my thing is
the modern world is so full of these
amazing things to like you said go back
in time I don't want to do that that's
not interesting uh so I want to have a
relationship with these things but I
want a good relationship now for better
or worse uh I did not have discipline as
a young person I'm talking into my mid
20s so as somebody who developed
discipline learned how rules can be
super beneficial I've developed a
relationship with what I'll call
gamification it's the thing that makes
games fun but I apply it not only to
games but to other areas of my life and
so I'm like I want to see people have a
good relationship with this now as a
father have you thought about like do
you just try to deny your kids access to
this stuff or do you have a method by
which they can do all the fun things at
the modern world world has to offer but
do them
well yeah I think being a parent today
is
um probably a bit more challenging than
being a parent 40 years ago um which is
to say it might even be more challenging
in 40 years although I'm sure everybody
thinks that their that their time is the
most difficult time so um and this is
the situ this is what I think about more
than anything so to me this is this is
the jugular question right is what what
do I do to give my kids the best chance
of being well adjusted adults like
that's the thing that actually matters
right I'm not asking the question what
do I do to give my kids the greatest
chance to be successful because I you
know how do you define success like do I
give a [ __ ] if my kids you know go to
the best university or get the best
degrees or get the best jobs or make the
most money I don't care about any of
that stuff like all that stuff is
garbage if they are unhappy and if
they're not well-adjusted human beings
so I don't actually want them to make
the mistakes I made where you don't
think about that and all you think about
is the pursuit of success and success
and success I don't so I want to make
sure that they don't repeat my errors
and and and and sort of so so what can I
do as a parent to set them up for that
because at the end of the day they're
going to make their own choices so you
know one I don't think that complete
abstinence is the right strategy because
you know as my really good friend Rick
Elias said to me on a
podcast five or six years ago parenting
is like playing a game of tug-of war
that you have to lose after 18 years
that's a great analogy yeah now how do
you lose it you can't let go of the Rope
all at once you can't hold on to the
Rope for dear life and when they're 18
just let go because what's going to
happen they're going to go
flying so you have to slowly slowly
slowly slowly lose such that by the time
they head off to college or leave the
house whenever that is they won the game
but they won it slow and so I mean I
think about this so much with my
daughter who is
16 and obviously we have a very
different set of rules for her than my
10-year-old and my
seven-year-old and you know so for
example it has to do with letting her
make choices that I think are wrong but
you know in three years she's not going
to live with us anymore she's going to
be able to make all the choices she
wants so it's probably better under my
roof that she figures out some of these
mistakes so let's use alcohol as an
example I didn't drink in high school
because I was a health nut right so it's
like it just none of like nothing about
like the normal things of high school
like I didn't go to parties if I did I
didn't I rarely went I didn't drink like
all I did was train train train train
train it was the only thing I did so in
a way I can't really relate to my
daughter wanting to go to parties cuz I
was like you know my head I'm thinking
why would you want to go to a party you
could just study and train um but that's
also that's pretty dumb so I also
realize it's pretty naive of me to say
like go to this party but don't have a
sip of alcohol even if everybody else is
drinking it's probably much better for
me to
say what do you think about drinking
like what you know what are your
thoughts on it what are you curious I
mean you clearly watch Mom and Dad have
a glass of wine a couple times a week
you know we have tons of alcohol in our
house it's not like you don't know what
this stuff is but have you seen other
kids drink do you want to try it
anything you want to try with us right
here this is a really good glass of wine
I promise you they won't have this at
the party right um and and then talk
about well what could happen to you if
you drink too much um what happens when
kids drink and get in cars like so
instead we just sort of talk about all
of these things because what we really
want to do is get to the point where
she's going to basically be able to go
and make her own decision and if her own
decision is like I'm going to have some
nasty drink I want to make sure she
holds on to the drink she never drinks
anything that someone gives her you kind
of go through all the rules that you
would go through for a young girl who's
drinking to make sure that something
catastrophic doesn't happen to her and
she also gets to know that at any time
of day or night if you need a ride you
can call us and there'll be no questions
or judgment so I mean that's just one
example but like I'm kind of giving you
a how would I do that now would I have
that type of thinking with my kid with
my boys who are younger not a chance in
hell we're way more restrictive with
what those guys do because we're still
holding on to the Rope because if we
didn't they could kill themselves at any
given day by accident just because their
brains are not developed and they'll do
stupid [ __ ] exactly like they're still
at the point where if we're walking them
to school and they're fighting they can
easily fall out onto the road and get
hit by a car so they're just like
they're they're still in the stage of
like they could kill themselves any
given day like and you know you just
have to decide like okay well if they
really want to climb that tree where
that branch is going to break and I've
warned them six times that branch is
going to break but they don't want to
listen it's only a three-foot
fall okay that's a lesson they might
have to learn it's interesting so I
don't know if you know Brett Weinstein
but he has a fascinating rule for his
kids I hope I get this right this is
directionally correct if it's not
literally correct um you can do anything
that doesn't cause like uh cervical
damage or brain trauma like it was like
these really specific things if you
you're putting yourself at risk of
breaking a finger or an arm or a leg
cool but if it could damage your neck
your back or your head absolutely out of
the question and I was like that
actually makes a lot of sense now scares
the life I just I just don't know how
you I
mean it's it's it's it's in theory a
nice rule but I don't know how you would
adjudicate that in the real world like
you know is falling off a three-foot
branch likely to damage your c-spine or
your skull no but look theoretically
it's possible Right like riding a bike
and a scooter really really fast even
with a helmet you can still really cause
some damage um
so it's it's probably a nice heris I'm
not sure how I would how I would put it
into practice Yeah it's tough because
ultimately you are you're certainly
running that calculus with your boys now
about what branch you've tried to tell
them and they're going to just keep
pushing it's interesting that is one of
the many reasons that I did not have
kids like that that is terrifying I
don't know how I survive child just to
be completely honest and I was tame in
the extreme like you I did not drink I
didn't do drugs I was quite literally
terrified of all that stuff um and yet
still when I look back I'm like bro
there was one time my friend just like
we had these bean bags and when my
parents were gone of course we would run
down the hall jump off the chair the arm
of the chair and then like do a flip or
whatever onto the bean bags and there
was one time he landed like face first
and the this probably isn't literally
true but this is what it seemed like at
the time his heels hit the back of his
head just to give you an idea of how far
he bent and I was like he's paralyzed or
dead and then he you know gets up and
he's fine but you have this moment where
you're like my life just changed in this
instant because of a dumb thing that
we're doing uh almost ran over a girl
that I really liked long story but like
obviously on accident showing off just
crazy crazy crazy it is all I feel I
feel the same way I I feel
um I feel an immense sense of gratitude
for how much of a role luck has played
in my life how many stupid stupid things
I did as a young uh boy you know as a
teenager especially was probably Peak
stupidity um and like how many car
accidents I almost got in because I was
doing something totally stupid and and
and by the way it's not just that I
could have died it's how is my life
different if I had killed somebody in a
car and um so I I yeah I I just th that
that's you're right that's the hardest
part about being a parent is you just
you you want to protect them so much but
at the same time you know that you have
to let them make some mistakes or else
they will never learn speaking of
potential mistakes how do you think the
mass adoption I don't know the right
word of weed is going to play out over
time and do you like when you think
about your daughter is it different
between alcohol and weed or How's that
gonna play out yeah so I I I I kind of
don't have the I probably don't have the
popular point of view on this so I I
think we need to be pretty concerned
with the ubiquitous adoption of
THC
um I I think there are a couple of
things going on that are not properly
being distinguished right so do I think
that if you told me that you smoked a
joint every night before you went to bed
or you know whatever in the evening or
whatever like that's to me is a very
different situation than um than than
maybe what we talk about so so you know
with someone who's you know a fraction
of your age right so I think we have to
sort of think about this through the
lens of a developing brain versus a
developed brain I think we also have to
think about the mode of delivery so
what's you know smoking a joint versus
you know a much more potent concentrated
thing that you're vaping um I think you
know we have to think about quality
control which is like the difference
between Edibles in which you have no
idea what you're getting sometimes where
it's like you know batch to batch
variability can be quite High um you
know things that are being uh basically
bred to be more and more potent so you
know we when we look at a lot of the
epidemiologic data it's based on what
THC what marijuana looked like 20 years
ago but that that's not necessarily what
it looks like today
um and again it also just begs the
question like what are we numbing right
so what what do we want people to be
numbing with this experience so um I
also think that there is I I think the
evidence is not completely solidified
yet that I put it this way let me
restate that I don't think it's I don't
think it's entirely clear that we can
say that marijuana provides no gateway
to other drugs right so if if you if you
take people on either extreme of this
debate and I don't consider myself on
either side I'm kind of more in the
undecided but I would really like more
data you have people on one side that
say marijuana is a gateway drug and kids
that smoke marijuana are much more
likely to go on to do other hard drugs
well that's undeniably true but the
question is is the marijuana causally
related to that that's what's not clear
right and then people at the other end
of the spectrum say no that's just
categorically not true and they're
basically saying the causality is
categorically not true but again we
don't know this for certain
so that's the question that I would
really want to understand is it's not
that kids who smoke marijuana are more
likely to do harder drugs later that are
problematic it's did they do that
because of the marijuana or did they do
the marijuana because they were more
predisposed to do that other drug later
on very important question um I yeah
I've talked to my daughter about this a
lot and I've said honestly like alcohol
is an absolute toxin um but you know I
think marijuana is a slipperier slope
and you know I've given her all the
reasons why I think it's just not worth
doing until you're older tell me about
those reasons because that was going to
be my next question is there a mechanism
of action that you're worried about with
THC is it ingesting A flammable material
into your lungs like what's the concern
prob no I'm assum I'm even taking all of
that off the table because I think all
of those are fair points right which is
you know toxicity and all sort of I'm
thinking more through the lens of
anxiety right and um and I'm thinking
that as you know like I mean we've all
smoked pot at some point it's I mean it
can be a drug that produces obviously a
Euphoria and a great feeling it can also
produce a lot of paranoia as well and um
if you look at the literature on kids
that smoke a lot of pot you're seeing a
much higher prevalence of anxiety now of
course the question is causality we
don't know the answer are the kids who
smoke pot more anxious because that's
the reason they're smoking pot they're
smoking pot to manage their anxiety or
is chronic use of pot associating
causally with more anxiety uh actually
this is you know going back to Anna lmka
um she wrote she wrote an interesting
case study about this in her book about
a girl who was you know using ever ever
more increasing amounts of pot and her
anxiety was getting worse and worse and
worse and basically you know when Anna
got her to stop smoking pot the anxiety
went away now that was a difficult detox
but it became clear that that it was the
other way around that the pot was
actually making her more anxious so you
know again I I think you have to take a
nuanced approach to these things which I
know people don't want to hear but it's
it's I would just be very cautious using
that in kind of a developing brain U
both boys and girls and and that window
of development is a bit longer in boys
um and I would always just come back to
the question of why like what's the itch
we're scratching here right like I know
for example when I drink alcohol which I
drink um the primary itch I'm scratching
is the ritual and the taste like I
actually don't care for any form of
inebriation W um but I really love the
taste of certain types of alcohol now
that said non-alcoholic beer has become
a great thing for me now because it
still gives me something special to do
because all day I'm sitting there
drinking soda water right like I'm
drinking topa Chico all day because topa
Chico is dope I me that stuff is amazing
I wish it was here so so when night time
comes if it's like 6 o' I need something
different I just don't want to drink
another Topo Chico so sometimes I'll
drink a Cho where I'll put like this Gia
in it which is like this thing I really
like that is like a it's kind of like
the skin of grapes so it's a it's a
pretty potent little um
aaria GH a I have no affiliation with
them but I love it so I'll pour that
like I'll pour you know whatever two
ounces of that into a glass throw a topa
has sugar nope it has no calories just
it's a very bitter thing yeah you're
drinking so little of it that it has no
calories right um or like have a
non-alcoholic beer or have a glass of
wine or something like that right but so
for me there's part of it is the ritual
like I like ritual I like taste so I
always just ask people like okay well if
you're smoking what are you smoking for
oh I need to relax okay why do you need
to relax like that's the question I want
to understand okay is there something
else you could do to relax and of course
people love to point out that alcohol is
more toxic than pot and it probably is
on a peruse basis at a high enough dose
of alcohol uh meaning like you
know 60 gram of ethanol which is what
you'd have in a bottle of wine is
undoubtedly more toxic than smoking a
joint um but again you have to drink
that much like you know you I mean you
just kind of get into the dose you get
into the the dose effect it's
interesting so my wife introduced me to
marijuana I had never tried that was
like on my list of Reefer Madness and
even though I'm too young for that uh
I'm old enough that I suppose I still
had a sense of like that is a hard drug
and my wife really liked it likes she
loves it and I was just I don't know she
got me to try it anyway long story short
I was like oh this is interesting so
sometimes it will break bad and it will
give almost a panic attack and what's
fascinating is the amount of control
that I can exert over that that I I can
feel it coming and I'm like hold on that
won't be fun and I'm just absolutely not
going to tolerate that and you can
normalize it but you can still feel it
there like trying to mess with you very
very interesting but by way of like if
my wife is like I this is going to be me
representing her in a way that she would
not represent herself but my wife I
think thoroughly enjoys the manipulation
of her brain chemistry so when she's got
a day off or whatever she's going to
want to play with her brain chemistry in
some way so if I said hey let's have a
few drinks she'd be like cool uh if I
said let's smoke some weat she' be like
yeah cool but she's going to want to do
something on special occasions and I've
just found that the day after I feel way
better if we've smoked weed versus Al
and now aded I don't drink just to like
enjoy the taste that's why I was like
you like it for the taste I hate
everything about the way alcohol taste
but I absolutely love the way it makes
me feel it makes me feel like I'm
suppressing the urge to dance on a table
it is one of the most fun feelings ever
and if it didn't have a knock on effect
the next day I would probably drink
weekly but it does and so I have it a
few times a year and that's that but um
with weed I'm like I don't feel bad the
next day at all now I don't smoke a lot
I'm a cheap date in that sense um but I
the way that it has been embraced by
culture worries me now maybe I'm being
overly paranoid but H it just seems
impossible when you hear like how much
people smoke some people but the people
that are very popular uh I'm just
thinking of people that talk about it in
typically songs right that it's just
like morning noon and night I'm high all
the time and I'm like I am paranoid I'm
the guy that won't I try not to take
anything daily I only drink things we've
been drinking for thousands of years um
I just have a paranoia about ingesting
ingesting exogenous substances
regularly yeah I mean
I I'm not sure that that's my concern I
I think that it's
more um you hit on something a moment
ago that I think not enough people
probably understand which is the lack of
reproducibility of their response
is also a little bit alarming what do
you mean um you don't it's really nice
when
you ingest a molecule and it always
produces the same respon when the
response is is predictable that's that's
desirable what's not desirable is I do
the same input five times and I get
three different responses that's not
necessarily desirable especially if any
of those responses are unfavorable and
you're saying weed has that variability
yeah I mean just think about like you
described it like you sometimes can take
it and you end up kind of going down
that more paranoid path now the fact
that you can kind of rescue it is great
not everybody can um I think the same is
true with psychedelics and I'm not here
to say psychedelics are good or bad I I
I think they're very interesting tools
but they're it's like it's like riding a
lion I mean it's not it's it's you know
so so the real the difference between
taking sort of you know regular standard
pharmacology and taking psychedelics is
pretty significant in dose respon
and lack of
predictability um and and just you know
sort of the way in which they work right
they're a much bigger punch so you you
you have to sort of be ready to kind of
roll with those
punches yeah and except the fact that
sometimes more more harm is done than
good yeah that is
uh that is a very interesting question
the developing brain versus developed
that is fascinating um given the like if
you have a of psychosis in your family
don't do weed that always scared me in
terms of what the actual effect that
it's having on the brain is and I would
I would extend that to not just I
wouldn't do weed I wouldn't do
psychedelics if that's the situation
certainly not at a young age that tells
me that there's something fragile about
the psyche which I will Define as stable
sense of
self yeah I don't know what a great
definition is for psyche it's again
that's one of those things where it's
like when it's rattled you know what it
is but it's hard to exactly Define yeah
uh I'm going to try because this feels
interesting as a thread
so uh to your point about variability of
response to something um feels a lot in
the way of interpretation so I was
actually listening to an episode that
you did with Lane Norton he was talking
about anxiety something unfortunately I
know up close and personal and he was
saying uh it was a big breakthrough for
him to recontextualize to the nothing
about the um physiological stimulus
needed to change for him to change his
relationship with it he just had to tell
himself oh this means that I'm focused
and I'm ready and this is a good thing
uh and this is engaging my brain and
making sure I take this seriously and
and I'm going to move forward and he
said that that just completely changed
his sense of what anxiety was um so that
is and it's it's very similar to what I
do when either I feel anxiety coming on
or uh like when I've smoked and it I can
feel it that the panic attack trying to
become the the thing that's hijacking my
brain so the way that I think of these
things is this is a means of processing
data it's an interpretation of a
stimulus and the way that I will often
change my psychological interpretation
of the stimulus and this is what I'm
trying to get to psyche that to me is
psyche it is my sense of um what I call
the OverWatch mechanism or my sense of
self that there feels like I know this
isn't true but it feels like there is a
part of my being that exists above uh
whatever physiological state I'm in so
there is a watcher that sees me being
drunk there is a watcher that sees me
being high again I know that's not
accurate but that's how it feels now
that Watcher can send a signal and the
signal I almost always send is don't be
a [ __ ] and so I'll just tell myself ah
like knock it off you don't you're not
going to let yourself be paranoid uh
stop that I once had a vagal response to
getting a bunch of injections in my
wrist and I didn't know it was a vagal
response the first time it happened so
the second time it happened and the guy
was like basically you're just being
weak I was like hold on and because I
now had a new context for the same thing
I just told myself absolutely not like
you don't get because it felt like I was
about to black out I was like 100% not
like this is not a physiological thing
this a psychological
thing that to me that OverWatch
mechanism however badly I just explained
it is psyche it is the ability to uh
inter
what is happening to you rather than be
swept up by it and so if you are Swept
Away by oh I just smoked weed and I'm
feeling paranoid and now I'm having a
full-blown panic attack and I cannot get
above it uh that's a problem now the one
I have struggled with is by the way I I
I think that's actually a really
interesting idea Tom I I I think that's
pretty cool I'd like to I'm going to
continue to think about that through the
lens of how I imagine the the
relationship we have to mind altering
substances
um you know for me just like I never
drink to the point of even remotely
getting like I mean I've had too many if
I even start to notice it now I also
have a very high tolerance to alcohol so
if I have two glasses of wine like I
feel literally nothing nothing nothing
there is not even a semblance of a buzz
that I would feel wow but that's an
interesting point right is when you get
to the point where
that that third eye of yours is not able
to see what's going on yeah I would
argue that that's not a place you ever
want to be agreed regardless of
substance agreed the only time that I
cannot extract myself from it is if my
anxiety runs wild now there is one thing
that I have managed to Peg that I'm like
this causes anxiety and this makes me so
sad because I love these so much but uh
diet
monster now I ran this experiment so for
a long and monster is torine caffeine
what's the substance y i those are the
two that I could tell you offhand what
all the other one I mean it's just long
long but is that different like I don't
drink energy drinks particularly but is
that different than Red Bull is that
different than all the other monster is
the only one that I enjoy enough that
I've drank so many of them that it taste
of it is good enough that you can drink
the can and therefore hit that critical
dose of whatever is in it yes and I
don't feel it on the day I feel it the
next day so it's just really it took me
a long time to realize what it was but I
went through a period where admittedly
was under so much stress that I actually
thought this is just I actually have a
reason to be anxious uh and then I was
like but there was one time I turned
left instead of right and I had this
massive Spike of anxiety and it was
literally just to exit a parking garage
and so I was like uh like there that's
when I realized oh this is generalized
anxiety because there's no reason I
should be anxious yeah um and so that
put me on the path to okay there's
something I'm I've either allowed my
anxiety to hardwire itself so deeply in
my brain that now I'm interpreting
stimuli in a way that just doesn't make
any sense uh or I because I always ask
myself what advice would you give if
somebody came to you with this and I was
just like I would tell somebody this is
your diet just because I you you are
helping slowly maybe break me of this
but I just come from a place of anything
bad in your life you're your cat just
died it's your diet like I just I have
such a kneejerk reaction especially
given my family history um and so I was
like what are you consuming a lot of
stop consuming it and see what happens
and I was like well I drink a hell of a
lot of monsters
and I was a day the big ones the big
ones and they were amazing I love them
so much uh but I just cut them out and
it went away and I was like Wow and then
I literally recently what's interesting
to me Tom in that story is not that you
had that response it's that you didn't
have that response on the day of and it
was the day after that that's actually
kind of interesting interesting and it
makes it really hard to steer by
especially because I have a shockingly
poor ability to recognize pattern
so uh that that was hard that took me a
while and it was really just whittling
things down of of like I know what I'm
consuming a lot of uh and yeah finally
cutting that one out because again I
would cut it out but nothing would
change on the day so I thought okay well
it wasn't that uh and then once I was
like leave it out for three weeks and
see what happens and then that was when
I was like whoa I really think this is
and then I would I tried reintroducing
it and it came back so I was like wow
there's just no way around that because
uh I love them so I would keep them if I
could but alas can you imagine if we had
our little cave friend here and we gave
him some monsters Jesus man so you're
just you got to play this game sometimes
I love playing this game you you go back
in time little time machine 10,000 years
ago you bring one of our ancestors
forward assume he can speak our language
we'll give him
that that like just imagine you give him
in how much does he stroke out over the
things that he sees yeah like think
about him like the next time you're
sitting in traffic annoyed just imagine
he's sitting in the passenger seat like
how are you explaining this thing to him
that he is sitting in that's crazy it's
crazy and that's what makes me want to
save the modern world I I am absolutely
here for it I'm here for flying cars I'm
here for going to Mars I am certainly
here for Virtual Worlds that you can
explore that have more depth than the
real world um but I also want to
recognize that there's a biological
reality to be faced about what we do
speaking of that what do you think is a
thing that we think of as wisdom right
now for health longevity that we're
going to cringe at in 5 to 10 years you
know we're in the process of doing this
but it's interesting I was just talking
with your wife before we started today
and we were talking a little bit about
menopausal care so I I think we're this
we're in the process of making this
transition but if you asked me this
question five years ago I would have
said 100% the denial of HT for women
right so this this idea that women
should suffer their way through
menopause and they should never be given
hormones like there's still a lot of
doctors who believe that and I hope that
in 5 years we look back at that as just
about the way we would now look back at
how they did surgery in the 1880s
without anesthetic whoa like Tom how do
you feel about having an amputation
where I'm just going to give you a piece
of leather to bite on Jesus sign me up
right pretty Savage and that's I I hope
that in five years we're we we have that
view of if you have a woman who wants
HRT and you deny it to her that's in my
mind that's that's that level of Savage
and the reason right now that they
denied is they worry it increases cancer
risk yeah there's we still have this
kind of um uh kind of demonization of
estrogen and this belief that that um
that HRT causes breast cancer which
again the data are really clear on this
that that HRT does not cause breast
cancer um and even if there's a tiny
tiny subset of of women who are going to
a slight increase in the risk of getting
breast cancer it's there's no increase
in the risk of mortality from breast
cancer and even that risk of the
increase of breast cancer is almost
assuredly due to a formulation of
synthetic progestins that were used
years ago that aren't used today so when
it's in its current form um you know
it's just there's there's just no no
evidence that this is that this is
happening in fact the evidence is
probably a little bit the opposite so um
that that would be something change you
know as far as like on the more Fringe
side I don't know if in five years I
this is one of those things you can't
prove a negative but I'm pretty
skeptical of the mass use of stem cells
so I think that I think there's probably
some utility to stem cells in certain
situations um but you know when you look
at the ubiquity of which stem cells are
proposed as the solution for everything
um you know intravenous stem cells
exosomes all of these things like I like
the total lack of data
supporting any of this stuff um and I
just have a hard time believing it so so
there's there's clearly indications
where I think stem cells could be
beneficial my hope is that it gets
studied so that we could understand how
to standardize stem cells and how to you
know use them correctly like make a drug
out of it right so you have to like if
you're if you want to get a drug
approved by the FDA you have to be able
to demonstrate that you can produce the
drug the same every time under GMP
conditions if you can't do that can't
have a drug
like what we we're in the wild west here
so like we have to be able to do the
same thing with stem cells so my belief
is if we did that with stem cells we
would probably find a handful of things
for which it works and it would be a
pretty narrow indication and a whole
bunch of things for which it's total
Malarkey and we should just stop
stealing people's
money well that makes me sad Peter I
would really like to think that there is
a magic Cur all um speaking of magic
curs for aging so the last time that you
and I met you said you were on the cusp
of thinking maybe testosterone
replacement therapy might be a thing you
want to do uh have you done it yeah um
so last so over the winter I just
continued to watch my testosterone
levels go down and down and down and so
uh yeah about six months ago I started
HCG so so HCG is um it's a hormone that
mimics lutenizing hormone so our
pituitary gland makes two hormones
luteinizing hormone and follicle
stimulating hormone they tell the testes
to make testosterone so the first
question I had which is again this is a
question we would ask with our patients
right if you have really low
testosterone is it primary or is it
secondary is it low because the testes
can't make anymore or is it low because
the pituitary gland is not making the
signal to to do that so one way to test
that is to actually take HCG and if you
take HCG and your testosterone goes up
then you know that the problem wasn't
that you couldn't make it um the problem
is that you're getting not getting the
right signal for whatever reason so in
my case it turned out that it worked so
when I took HCG which is you know a
small peptide that you take um so you do
an you know subq injection a couple
times a week uh my testosterone got to
normal and that obviously tells me that
the reason I've had a couple of years of
super low testosterone is something in
my pituitary and given that virtually
everything I
think um I'm managing well the one thing
that I would point to is probably stress
I would say probably you know stress is
the one thing because you know my sleep
is actually pretty good I I I don't tend
to struggle with sleep I you know by by
all the means that I track it it's it's
really something that I I I've I've
optimized not perfect every night of
course but on balance it's it's not a
chronic issue whereas for many people
you know poor sleep is the cause of
central hypop hypogonadism which is the
technical term for that um so yeah I'm
just
I'm walking around with normal
testosterone now now is that where you
would start any guy that has low
testosterone is that the first thing you
test or um it's not necessarily every
case is a little bit different but but
that would be a discussion which is you
know where you know for me again it
doesn't really matter I could take
testosterone as well because I'm not
planning to have kids and all the things
that would come my way if I sto making
my own testosterone which is what would
happen if you took exogenous
testosterone for a few years you would
you would stop making your own
testosterone um that's not actually a
concern for someone my age but I don't
know for whatever reason just
psychologically it was a little bit of
an easier pill to swallow to start with
this kind of indirect way now would HCG
pop you for doping yep okay yeah it's it
would still be a water band drug got it
okay very interesting um what do you
consider normal for testosterone for
guys well it's a bit complicated because
I mean I can give you obviously the
percentiles right so for you know a guy
my age and by the way I don't even think
normal is what we want to Aspire to I
think we'd want to Aspire to be top
cortile right if you're going to bother
treating somebody you should at least
take them to the I think the the you
know sort of top core tile so you know I
just wanted to see my total T above 800
and my free tea you know kind of above
16 wow you got your total te over 800
with uh HCG yeah starting with a t of
300 wow yeah or maybe 275 I mean pretty
low to T maybe 275 with a free te of
about
five um and then went to a total te of
about 800 and a free tea of you know
actually the first time I took it I
overcooked it a little bit I was more
sensitive to the HCG I ended up going to
like 1,200 total tea with a free tea of
22 so I backed it down and now I think I
walk around at probably about 800 with a
free te of 15ish does it feel different
it does I definitely feel better um I
would say the two areas where I've
noticed the biggest difference is I I
genuinely just feel better like from a
mood perspective um and secondly I'm I'm
I'm definitely stronger in the gym what
about sex drive was never an issue
before so that wasn't like despite my
low tea I didn't I didn't really
struggle for libido it's interesting so
when I was in my call it early to mid
20s uh my poor wife the friction Burns
by but as I've gotten older uh I've hit
a more reasonable Pace but I've always
wondered if I started doing some sort of
um testosterone replacement therapy
would I go back to my poor wife
suffering or does this stay somewhat
balanced like how does that probably
depends on how how how high your levels
go how high the testosterone levels
depends how it would depend a little bit
on how high you are now and and here's
the part about this that's a little bit
complicated what we can't measure is the
thing that matters most so your
testosterone and your free testosterone
are just proxies for what we most care
about what we most care about is how
many molecules of testosterone are
binding to your Androgen receptors so
it's Androgen receptor saturation that
is the variable of interest so if a guy
has symptoms and his Androgen receptors
are not saturated that's the guy you
want to be replacing h
conversely if a guy has no symptoms or
if a guy has symptoms but his Androgen
receptors are fully saturated you need
to look for something else and we don't
have a test that measures that so the
way testosterone works of course is
testosterone comes into the cell binds
to the Androgen receptor and then that
testosterone Androgen receptor complex
is what goes into the nucleus and it
binds as a transcription factor that
increases uh Gene transcription so all
of those things are happening happen in
a favorable way if you have a sufficient
amount of that but if you don't that's
where you're deficient so when people
have really low tea we just kind of make
the assumption that hey they probably
have not saturated their Androgen
receptors where it gets a bit
complicated is when guys have like a te
of 700 a free tea of 10 and they have
symptoms and at the end of the day I
just think sometimes you just try it
empirically you you just say well if we
boost you such that you're free goes
from 10 to 20 and you don't feel a
difference this is not a t problem you
shouldn't be on T now testosterone from
what I've read is dropping like crazy
men are at across averages all-time lows
uh what's happening should they be on
HCG I'm guessing the answer is no that
there are plenty of things they can do
before they get there well the most
common we think that the most common
reason for that Trend um and it is a
pretty significant Trend so for context
I think the
average 30y old today has about the same
level of testosterone as the average 50
year old 30 years ago oh God yeah so
that's that's pretty clear we actually
look those data up and
um the best explanation for it honestly
is increasing body fat it's just that
men are having men have more body fat
today than they did 30 or 40 years ago
and so body fat um is doing two things
to lower testosterone the first first is
it's increasing um the aromatization of
testosterone so you're making more
estrogen from your testosterone estrogen
is very important you want to actually
make estrogen but it needs to be in the
balance right so if you're making more
estrogen than you should you're
depriving yourself of the substrate uh
testosterone that you want and then the
second thing is more body fat is going
to be accompanied by other metabolic
changes that are going to lead to more
um uh like more sexor binding globulin
kind of like less available testosterone
so you're going to make less
testosterone you're going to utilize
less testosterone because of more being
aromatized and so that's probably the
single biggest driver of what is
obviously happening which is a trend
towards lower and lower testosterone in
men's in men today for a given age so
the the fat itself is sending out a
signal that's causing the body to react
differently to testosterone well so so
so fat isn't fat fat is inflammatory
right so the more inflammation you have
the more metabolic disease you have the
more that process of making testosterone
is going to get interrupted um so
something in that hypo hypothalamic
pituitary uh gatal access is being
disrupted that's producing less
testosterone so you're going to make
less testosterone the testosterone you
make you're going to spend you're going
to put more of it into estradiol so it's
kind of like a double whammy all right
at what number do you want to see um men
looking at their testosterone like what
what number is too low and is that
entirely tied to age well it's highly
correlated with age um so we you know
and I I think we've and I'm I know we've
written about this where we've got like
we kind of go through the taable so by
decade what are the percentiles so you
can you know somewhere on our site lives
this table where you can see by decade
of life this would be bottom 25% second
quartile third quartile top quartile um
so very predictable age response again I
I think that it would always be
desirable to be in the top cortile for
your for your age bracket which by
definition means three quarters of men
are below that now why not push a
60-year-old into a 25-year-old top
cortile well there there are side
effects of testosterone so you have to
be kind of mindful of those side effects
right so one of the side effects of
testosterone is um you're going to make
more DHT so
dihydrotestosterone is a hormone that is
more potent than testosterone so it's
it's an even more potent binder of the
Androgen receptor um and it does some
really good things but it also does some
undesirable things so one of the things
it does it's going to accelerate hair
loss so if a guy is particularly
concerned with androgenic hair loss
that's going to increase it also
increases the size of the prostate gland
and so when a guy is 60 his prostate
gland is already kind of getting big
enough on its own so we don't really
need to put too much more fuel on that
fire um now of course there are ways
around that because you can take a drug
that blocks the conversion of
testosterone to DHT and of course many
men do this so drugs like finasteride
and dutasteride which are commonly used
either for hair loss or gonna say yeah
so propia uh would be the the the hair
loss version of finasteride doesn't
finasteride though have like potentially
huge sexual consequences yes so some men
have really nasty um side effects to
finasteride um where they have a total
loss of libido and it kills their mood
and stuff like that back right well
fortunately for most men if they stop
the drug the symptom goes away but there
is a small subset of men who appear to
maybe be irreversibly damaged by that
fortunately that number seems to be very
small it's called post finasteride
syndrome uh PFS and it it definitely is
you know it's a controversial Topic in
the Urology literature um but it's it's
it's another reason why I don't just
recommend those drugs willy-nilly I
think I I would want to make sure that
if a guy's taking one of those drugs he
really kind of understands the potential
risks of it um but there are other
drawbacks to taking those drugs right so
you can take that drug let's say you're
in the majority of the cases of folks
who they don't have that side effect
right they don't have a post finasteride
syndrome or a finasteride syndrome but
now something else happens which is
you've arly artificially suppressed your
PSA so now one of the things we want to
be you know making sure of in an older
man or basically any man above 50
basically is what's happening with
respect to your risk for prostate cancer
well now I just took away one of my best
screening tools now it's not the end of
the world if the doctor understands that
but most doctors don't know that when
you put a man on um finasteride or
dutasteride you have to be much more
diligent about how you screen for
prostate cancer and you're looking for
much smaller changes in PSA to cause
alarm very very interesting um going
back to something that potentially is
cringeworthy down the road or uh maybe
is amazing do you know Brian Johnson and
his don't die movement uh I know I I
don't know him but I've heard of it what
do you think about that I don't have any
thoughts on it so it's tied to AI
basically so he's saying uh Hey Now is
like the period you don't want to die
because if AI comes in and does what
it's going to do then we really might be
able to find patterns in biology that
right now are just completely invisible
to us that will allow us to radically
extend and human life um so the question
then really becomes about AI do you see
anything in AI that you think is
promising that could have a uh
substantive impact on the way that we do
Health now even if it's not to radically
extend LIF span but maybe radically
extend health span or help us overcome
diseases like cancer or whatever I mean
I I would put myself in the camp of
being very excited about AI um which is
not a hard Camp to be in today I think
most people are I also think we're in an
AI bubble so this I think where we are
for AI right now is where the internet
was in the late '90s do you mean that as
an investor though or as in the ultimate
promise both both so absolutely as an
investor I think it's a totally
overpriced bubble that's going to crash
um but also in terms of expectation and
timeline of expectation right so if you
think back and you know you're old
enough as well to remember in the mid
90s as we were heading into the the the
new uh millennium I mean people just
thought the internet was going to change
the world in ways that it hasn't quite
and yet there are ways in which it has
changed the world that nobody could have
predicted at the time let's take two
obvious examples Uber and Airbnb like
nobody thought about that at the time
right um people thought about Commerce
um and that was a big deal U but it even
took longer there for it to really
become the profitable you know
disruptive technology that was so so
look I just think there's a parallel
between how we about Ai and how we
thought about the internet um I think AI
will be more important than the internet
so I think when we're looking back in
you know 50 years I do believe and I I
don't think I'm alone in believing this
I think AI will be an even bigger
disruption um hopefully in a positive
way than than the internet was um but I
think there are certain things that will
take longer than we expect so to your
question where do I think it's going to
help I think I think there's some really
unsexy things it could do to help that
you know this would be a good time for
people to go and get a snack or go take
a leak but like if you think about
health care for example like um
adjudication and Reconciliation of
Healthcare billing is arguably the
stupidest most innan like part of this
country right like the amount of dollars
that are wasted the amount of brain
damage that is inflicted on our species
trying to reconcile medical payments and
stuff like that is it's impossible by
the way nobody knows how to do it like
if I gave you an EOB an explanation of
benefits and like walked you through
what was in there you you'd be like dude
why don't you just talk to me in
Japanese like I literally have no idea
what you're talking about just tell me
how much to pay and oh by the way you're
getting ripped off so AI should solve
that problem like we need to train AI to
basically solve the entire system of how
medication is adjudicated I would love
for AI to absolutely eviscerate PBS
Pharmacy benefit Benefit Management uh
entities so these are the companies that
live between the payers and the
employers that are responsible for
totally ripping off everybody in America
these this these are the biggest cancer
in the Health Care system today so if we
could just eradicate that and actually
have a pricing optimization run by an AI
that is not skimming off literally tens
of billions of dollars to itself that
would be incredible wow um but none of
those things are really going to help
you live longer so to the question of
how are we going to live longer um
probably the most exciting thing that AI
has done at the moment um again not that
sexy if you don't understand the biology
but um do you know how a protein works
like the idea of what a protein is in
the body yes but good Lord as a a person
at a 880,000 foot view not in any way
mechanistic all right so you eat a steak
right now right so you're eating and a
steak is great because it has all the
amino acids in all the essential amino
acids so you just ingested a whole bunch
of protein that gets broken down into
these building blocks called amino acids
there are 20 of them um when your body
wants to make something a lot of the
things your body makes are proteins they
can be structural proteins uh like
collagen hair muscle they can be
functional proteins like
enzymes your
DNA gets transcribed into RNA that RNA
gets turned into a signal to make a
protein and it brings together the amino
acids Now by itself that's not the
protein it has to undergo structural
change and what's called post post-
transational modification so sometimes
it gets turned into a helix sometimes it
gets turned into something that folds
and that's called the secondary
structure of the protein and ultimately
it gets folded over onto itself into the
most complicated three-dimensional
structure you can ever imagine with
thousands of amino acids okay
until AI came
along we had absolutely no clue what the
relationship was like between the string
of amino acids and the final shape of
the protein and that is a big part of
what made biotech really really hard so
we could look at a receptor and
say man I'd really love to have a drug
that fits into that receptor and turns
it on I know the shape of the
receptor and I therefore know the shape
of the thing that needs to fit in it in
other words I have the
keyhole I can impute what the key is but
the key is a complicated
structure and I have to from the key
impute what the 4,000 amino acids were
that went into it that had to be done by
trial and error
woof today that is done with AI That's
actively happening right now yeah
is this Alpha fold or okay how's that
being used right now other than now we
know but how do we get that into we just
completely so it's basically changing
Pharma it's basically changing drug
discover speak yeah now I want to be
clear everybody said oh my God Alpha
fold is g to make drug Discovery take
one year instead of 10 not really
because what they're forgetting is the
long piece of this can't be done yet by
AI which is the clinical trials yeah so
it's totally shaving off all this time
at the beginning and saving a ton of
money but the long pole in the tent of
Pharma is not the drug Discovery it's
the clinical trials you're still going
to have to test this in humans in a very
careful way that is you know incremental
like first let's make sure it's safe
okay let's do a dose escalation okay now
let's make sure it kind of works okay
and it kind of works and it's kind of
safe now let's do a bigger trial over a
long enough period of time with enough
people in it that if it really works and
it's really safe we're comfortable
approving it so all of that still has to
happen I'm sure AI will come up with
ways to help make that better but again
as nerdy as that example is I mean the
the folding pattern is it's that's
pretty freaking cool yeah that that
stuff is unbelievably cool and this is
one of those things at the risk of me um
dragging people into my madness this is
why I'm so obsessed with game
development when you start doing game
development you realize that all all all
of life is simply based on a set of
rules and once you know those rules you
can actually begin to predict what will
happen but the joy of being a human is
you can't predict all of the things that
are going to happen and so now as you
create a virtual world you can set up
these rules that are so complex and
interact in these really fascinating
ways that you effectively and I don't
think people are going to like this
sentence but you effectively get to um
play God so as a developer you get to
play God because you're creating this
set of rules but as somebody exploring
those worlds imagine creating a world
that is based on a set of rules and it
it will spawn literally an infinite
number of Worlds and you can have a
world that is is an entire universe unto
itself that you will get to explore
uniquely nobody else will ever encounter
that world unless you want them to uh
and once you understand that the
sophistication with which you can create
these Virtual Worlds is tied to what the
AI can predict in our world so now you
could now in the future you'll be able
to apply AI like Alpha fold to a virtual
world where it's building up from amino
acid building blocks but creating
creatures in your world that are like
built literally down at that level yeah
and so it becomes fascinating I mean
obviously this
is this is you know an incredible topic
to explore it's one for which
so let's take a step back so people can
kind of understand the complexity of the
problem I know you understand this but I
think it's important for the listeners
to understand
um we're about 25 years out from the the
sequencing of the human genome right yep
so Human Genome Project was completed I
think about the year
2000 and that was heralded as the single
most important breakthrough in all of
human health but it hasn't really panned
out in other words that didn't Come
Close didn't come close to being as
helpful to human health as the discovery
of insulin penicillin sterile technique
sanitation like you know the the the the
elucidation of the human Human Genome
has saved fewer lives in the last 25
years than 10 minutes of what sanitation
antibiotics and Insulin have saved in
since we've been talking okay so why is
that well it's because of something you
sort of alluded to but I'm going to
twist it and make it my
words the rule book doesn't
transmit so what we coded was the human
genotype there are three billion base
pairs that Define you and Define me by
the way the only difference between you
and me is a couple percent so it's we're
virtually identical genetically um but
obviously if you look at us we look
nothing alike I mean we both have two
eyes you know we stand on our feet like
you can recognize that we're of the same
species we otherwise look quite
different so what we have no clue of for
the most part is the relationship
between the genotype and the
phenotype it's why we can't go and make
something genetically so as an
example let's assume that I had all the
control to manipulate the genome that I
wanted which I don't by the way but
let's assume crisper was so so perfect
that I could and it is by the way
crisper is probably at this point good
enough that we can change any Gene what
we can't do is insert it so we're good
at developing payloads we have we still
have horrible Delivery Systems but let's
assume all that's done let's assume I
can make any Gene of any size edit any
Gene of any size and deliver it to your
entire genome if I want to that's a big
if not clear that's ever going to happen
let's grant that it's going to happen if
you said Peter I want to be
smarter can you genetically manipulate
me to be smarter we would say we don't
have the foggiest clue what genes are
responsible for being
smart okay can you make me taller never
mind me my growth plates are fused can
you make my kid taller no we have no
clue what genes reg we can't even we
wouldn't even know what genes to adjust
the eye color of your Offspring think of
how trivial these things things are and
we don't we do not understand the
relationship between genotype and
phenotype and so it just speaks to how
complex this problem is now is AI going
to help us on that front I sure as hell
hope so but if we don't have
that we don't even have a prayer of
basically doing AI clinical trials but
here's the other thing genotype is only
part of the equation it's also at
adaptation so it's the whole nurture
nature problem so why is it that you
could take three gen genetically
identical embryos and put them in three
totally different environments and
they're going to end up producing three
pretty different people that by the way
might respond different to three
different
drugs and why is that well it's diff
differential gene expression this is now
getting into What's called the
epigenome and you could say well Peter
can't we figure out that okay maybe but
like it's getting awfully comp
so
look the the beauty of futurism is it
makes us all look stupid because all
this all the stuff we sit here and think
is going to happen we can't imagine the
things that are going to happen um but
my my intuition is that there are lots
of really incredible ways that AI is
going to make what I do so much better
but but they're they're not as like wham
bam super sexy as maybe people would
like to believe at least not in the
foreseeable future do you use AI right
now yes um use it quite a bit um you
know definitely
still kind of struggling with some of it
like I think honestly it's
just you know I would I would describe
AI right now as a really unhelpful
analyst like it's an analyst it
functions as an analyst but it's
like the fastest working fastest reading
least intelligent analyst I
have like there's some value to that
right amazing at spitting out a first
draft of thought but like you know we
have five research analysts on our team
like they're all here GPT 4 is like way
down here right yeah I uh for the type
of work we do obviously gp4 is way above
all of us in certain areas the type of
work we do
it's borderline a [ __ ] I will be very
surprised if in call it three years that
for an analyst position that it's not
able
to match or surpass the brightest that
you have that's Pur it's going to come
down to the training set so so this is
so for certain things it already does
like you know you I I could argue maybe
for coding and things like that where
the training set is so high it has the
real challenge of the work we do it's
very difficult to train an AI on why
because how do you it just hasn't been
done like we could do it but like you'd
have to we'd have to quit our jobs and
just work on training the AI so nobody's
out there to my knowledge who's trying
to train an AI to do what we do which is
how do you critically read papers and
you know how do you read 10 papers on a
subject matter go and read all the
references be critical of which studies
suck which ones are good what the
limitations and strengths are of each
paper and all of that stuff I mean what
AI could do if AI could do that it could
clearly write better than us it could
clearly write faster than us it just
it's it's going to take a while for us
to train it how to think and it's not
been from a lack of trying on our end
like I've I've I really push gp4 to um
to to to try to get smarter on stuff
that I wanted to do I I Jam a lot of
papers into it and it's great at
summarizing it's just not a synthesizer
it's just not smart in that regard yeah
I'll be very interested to see if um uh
as the cost of compute goes down which
that's a huge question mark whether
we're going to run out of compute or not
but let's say that the cost of compute
goes down you get more people training
models if you're able to reduce the
amount of data that the models need to
be trained which it seems like they will
be able to now all of a sudden put it in
the hands of a team like yours and
thousands maybe tens of thousands of
other teams out there I I think it'll be
really interesting even if it only
uh gets more efficient at the level of
model training we could see some pretty
big breakthroughs because now you have a
lot of people training these and
depending on whether they get made
proprietary or open source there's just
so much benefit to humankind obviously
if we can begin to
um recognize patterns I mean that
anything where it really seems obvious
that this is a pattern recognition game
to me it it is only a matter of time
before AI will be able to do it that
aren't pure pattern recognition Okay and
maybe some of what you're doing isn't
just pattern recognition and so there
becomes a a judgment thing I don't know
I don't know the level of data that
would be required for the genome type I
forget how you said that uh to the
phenotype that translation like is like
if we were to get everybody billions of
people um would that be enough for AI
yeah that would be awesome so if you had
the genome if you had the three billion
base pairs of every one of the eight
billion of us on this planet and you
could code the phenotype that's what you
have to be able to do right so what how
are you going to how are you going to
quantify and code phenotypes so let's
what would we do for you height weight
skin tone eye color IQ like what are the
parameters we're going to put in there I
don't know like we'd want to be able to
put hundreds of thousands parameters in
there we don't know Quant like how can
what can we measure and quantify to put
in there vertical jump well I don't know
how do I know your vertical jump is what
it is because you hurt your knee 10
years ago versus what your genetic
capability was right so this is the
problem yeah look H and that for sure is
going to be a limiting factor but when I
one is I think about this on longer
timelines a lot of this goes away but
when I also think about if you could do
this prospectively right so if if if
starting today every kid that was born
you took their gen
and you could map some quantity of their
phenotype we came up with like the 50 to
100 metrics we wanted and we just
tracked everybody serially over time I
mean sure you could produce something
really remarkable no doubt and then um
also I think we're kicking off so much
data now if we were aggregating all of
that data to your point you're not going
to have everything that we will ever
care about um but you certainly would be
able to get things like
um sleep data uh so this person
how do they respond to sleep how do they
respond to stress heart rate variability
there there are so many things that we
kick off now it's not going to you know
I mean it's going to be less than
probably a percent of the things we will
ultimately care about but you can really
begin to zoom in on things especially
again over time so it's like all right
if you're tracking what a kid's doing
from whatever age 13 Even if you start
clocking them at 18 and you collect data
on them for 20 years including things
like that you would get in a census so
how much money do they end up making now
all of a sudden and I'm not even saying
this doesn't lead to something dystopian
but you'll be able to to figure out a
lot of these things in their genotype
are coded to these outcomes or we see
patterns in these out but then it begs
the question to what
end yeah uh I will answer that question
and this comes down to I think Society
ends up bifurcating this is again where
we get into my personal hobby horses
here uh but I think Society bifurcates
there going to be people that don't want
anything to do with this and then
there're going to be people that break
uh on the technological side and now all
of a sudden you are quite literally
crafting superhuman people and how do we
bifurcate this Society is it a
geographic bifurcation o uh so yes I
think this is where I break company with
bology who I think you know oh you don't
know bology shason oh my god do two
people who I think would find each other
fascinating um so bology has a whole
thesis that we're going to break into
what he calls Network states where you
won't be geographically bound you're
going to be bound by effectively
ideology um and that you'll see a
weakening of governments as money um
decentralizes anyway I don't think
humans are wired like that I think
ultimately we respond most strongly to
the people that were around and I think
we
respond very negatively to over
isolation and uh it does not yet seem
that the connections that you get online
can replicate the things you need in
your real life so uh I have a feeling
that unless we overcome that you're just
you're not going to see that play out
what you will see is a further
segregating by geography now how big
that geography will have to be is it
City versus rural probably that seems
like the sort of play throughout human
history uh is that you see people
aggregating in cities and they think
about the world very differently than
people that aggregate out in rural areas
uh so my gut instinct will be that
you'll get something like the Amish and
uh in my mind I was clocked them as
Puritans people who literally use the
word I am a Puritan I my body is pure I
do not put technology in my body I do
not interface with AI and so they'll
break somewhere along the 90s
effectively is how I think about it
they'll want technology they're not
going to want to go too far backwards
but they will go to the 90s and say okay
this is a state of technology that is
useful meaning they'll go back from here
they will go back from here reg from
where correct just like we're going to
stop I think stop letting kids have um
social media before they're 16 that'll
probably end up being a little bit later
again these are factions this won't be
Universal but I think parents are waking
up to the fact that that it is Parental
malpractice to let your kid um suffer
the psychological consequences of having
social media too early uh more and more
studies will come out it'll just be
impossible to ignore it'll start getting
mandated you'll start seeing people
really Embrace that uh
as literally Elon Musk continues to do
uh brain computer interfaces it won't be
long 15 years before you've got people
that legitimately are getting upgrades
there's nothing wrong with them they
just want a brain implant because it
allows them to see an infrared or
whatever and so you're going to start
seeing people do that and you will get
people that respond violently to that
this is not what God intended it will
break in very similar ways to religion
you're already seeing a geographic segre
ation based on right and left uh which I
I worry about that when you start like
in the next three years probably not in
the next 30 Years yes like this stuff is
going to get exacerbated so I think we
have enough things with modern
technology that is both outlandishly
amazing and so it will attract people
like me and really detrimental and
people are going to respond and they're
going to go down that path so anyway I
think anything extreme like this is
going to push people farther and farther
into those two camps uh so yeah I think
the ultimate segregation will be
Geographic but this comes down to uh
ideology how far people Embrace AI being
the most important yeah interesting
thesis it is going to get fascinating
that is for sure all right as you um
look at some of the things that are
right now today uh in terms of positive
negative
so modern ills overfeeding being I think
maybe the most profound but I have OIC
why can I drug my way out of this can I
pour more modernity on modernity and
solve the problems it looks like you can
I mean it really looks like the and and
remember OIC is just sort of the the
first effective group of those drugs so
the gp1s have been around for a decade
uh and they've been largely in a
effective um for weight management in
fact they were never brought on as
weight management drugs they're brought
on as drugs for improving insulin
sensitivity but something about
semaglutide as OIC um was the first time
when it was like oh my God like all
these people with diabetes their
diabetes is getting better but they're
losing an unbelievable amount of weight
and so that realization happened four
years ago and now we've got a second
drug that's even better than OIC um
called
tepati um or wo
pardon me or um manaro and it's even
more effective right fewer side effects
even more effective and then we've got
another one that's not approved yet but
it's in phase three called ratr tide
that is even more potent than both of
these um with no more side effects so if
and if you actually go down the list of
all of these drugs out there there's you
know there's 30 more of them in the
pipeline so we have no shortage of drugs
coming at us that are going to help
people eat less um and now a number of
these drugs are also being targeted at
reversing sarcopenia so it's not just
how do I eat less it's how do I preserve
more muscle now the the challenge is we
still don't know if these drugs preserve
strength and right now the early
versions of these drugs appear to
increase muscle mass but not strength so
it doesn't appear to be a functional
gain they actively increase muscle mass
yeah so there's one drug called Bea that
actually increases muscle mass even in
the setting of using
um semaglutide which decreases muscle
mass all things equal because you're
losing muscle mass and fat Mass um
you're getting leaner by the way so it's
it's decreasing fat mass at three times
the rate it's decreasing muscle mass so
you're you're still you know you're
still you're getting your body
composition is improving um
so you know that begs the question that
you might not have a complete
pharmacologic ill to training like you
you still have to train it seems that at
least based on what we know today the
only way to actually get stronger is to
put the muscle under stress like you
it's not enough to just take a drug that
increases the size of the muscle or
prevents the muscle from shrinking that
shouldn't be that surprising right like
it's hard to imagine that there was
going to be a hack around getting
stronger um but um it it really seems
that these drugs have done something
that no other class of drugs have ever
done before which is to be
simultaneously reasonably safe I say
reasonably
because I I don't think we know enough
yet to know that they are completely
safe and I don't really know what
completely safe means I don't think
there's a single drug that is completely
safe like Tylenol Advil and aspirin are
not completely safe so you know with a
with with any drug there's going to be a
side effect um but when I say reasonably
safe I mean it is not it does not appear
to be the case that these drugs are
causing cancer or pulmonary hypertension
or you know some sort of irreversible
damage in the brain or something like
that where we certainly had concerns
with previous drugs that had really good
efficacy for weight loss like fenfen but
they were you know killing people
eventually so you have this drug that's
safe and effective and that's a first we
just haven't had that in the weight
space um there are a lot of things that
are being touted about um gp1 agonists
as like panaceas for all sorts of
conditions but we did a pretty thorough
review on this and most of the evidence
that these things have benefit for you
know heart disease kidney disease
dementia seem more related to the fact
that you're losing weight and you're
getting more metabolically healthy
because these drugs are not just weight
loss drugs what they're also doing to
people is really increasing their
insulin sensitivity so with those two
things
happening it doesn't surprise me that
people are having less sleep apnea fewer
heart attacks less kidney disease less
hypertension you know less cancer I
think we'll see all of those things
happen but it begs the question question
would you get those same benefits if you
used sleep nutrition and exercise to
achieve the same spot and the answer is
probably but how many people can do that
without the assistance of of these drugs
that says nothing of the cost of these
drugs we can get into a much lengthier
discussion about you know if we truly
wanted to put every person who's
overweight on this country on one of
those drugs um well the Healthcare
System can't support that um and what's
the trade-off of the cost of doing that
versus the cost of letting those chronic
diseases come to roost 20 years down the
line so there's there there's a whole
bunch of really complicated economic and
and sort of social questions around this
but I think the more important question
really comes down to what's the safety
profile what's the efficacy
profile wow I did not realized that
there were that many more coming out I
had a very negative view of OIC I would
have told people hey stay away from it
there are going to be consequences that
we can't anticipate uh listening to that
description maybe I heard what I wanted
to hear but it sounds like uh I've got
something that's like a steroid that
I'll have to lift because if I want to
get strong and I do I still have to put
in the energy but if I've got something
that's helping me get leaner while
adding muscle mass which is the Holy
Grail as long as I take care of making
sure the muscle mass can actually
contract hard and lift heavy things and
lower heavy things uh I'm pretty excited
about that yeah although I don't see how
you're going to need to take one of
these drugs I mean you're already pretty
lean I think yeah I'm probably 12% body
fat let's say why would you want to be
leaner is that a joke no have you seen
Fight
Club Peter like I could look better I'll
tell you that I look good I don't look
bad I get comments from my wife I'll be
the first to admit but I've been leaner
and it when you're really lean it looks
good yeah I I mean you know there's Pro
I honestly think this sweet spot is
probably 10 to 14 % for a male um so if
you're you your mouth Peter well again
we're not optimizing for how we look we
should be optimizing for how we perform
and how our body functions yes yeah
again if you're if we're talking about
Peak Physical performance if you're
trying to win the Tour to France by all
means you're going to need to be leaner
if you're trying to you know win a
bodybuilding competition of course
you're going to need to be leaner but um
there are probably consequences of
walking around at 6% body fat for
prolonged periods of time yeah more
tension from the opposite sex feeling
better naked yes terrible terrible
consequences Peter no I'm sure you're
right un I'm just a fat guy
rationalizing his it is that's I was
thinking that your your obesity is
making me very uncomfortable Peter right
now uh Dude tell me about
David so super exciting um basically for
folks not knowing what we're talking
about we're talking about David the
protein bar that uh I'm involved with um
yeah I've just no offense I've never
really liked protein bars shame on you I
know as the founder of quest I know I'm
sorry I've never really been able to
find a protein bar that I could eat
consistently so most of my um
supplementary protein has had to come in
two forms shakes and jerky and the good
news is both of those things are so much
better today than they were 10 years ago
I mean you and I are ogs like we were
the guys drinking protein shakes 40
years ago when they were
hideous um but in the past five five or
six years I think the the ability to
just get incredibly good tasting highly
dissolvable way isolate is like we're
done like that problem's been solved
it's now a commodity product um
similarly on the salty solid side of
things you know to be able to like eat
my Maui Nei venison jerky uh carnivore
crisp those things like that like just
incredible um but this there's been this
void of how do I have something that is
sweet solid high in protein low in
calories and so and this bar which um
was primarily developed by a guy named
Peter rall who's the um founder of a
company called RX bar that you're
probably familiar with they made a kind
of a Paleo Bar um he went off sold that
bar um a few years ago to Kelloggs I
believe and um and then I think after he
read outlive kind of came to this idea
that if we can maximize protein and
minimize calories that's kind of an
ideal spot for snacks kind of realized
that there was a big impediment doing
that protein bars I mean you know this
very well you know this better than I do
protein bars are hard to make yes they
protein is an awful nutrient to
manipulate um carbohydrates and fat are
pretty easy to manipulate protein is
awful it tastes horrible um it's very
chalky it's difficult to bind to there's
nothing about protein that is meant to
exist in the state that we do it this
way right like protein really should
just be consumed and it's natural state
you should eat eggs you should eat fish
you should eat meat you know you should
consume Dairy like those are the best
sources of protein and so how do you get
a PDC of one meaning a perfect uh
protein digestibility and absorption
score in something that's manufactured
using things like whey um you need a
really good binding system and you need
a really good fat system and so that's
kind of the technology that went into
making David to sort of we wanted to
have this bar that was basically going
to be able to get 75% of its calories
coming from from
protein um which to put that on
perspective with other foods like that's
what you would get in a cooked chicken
breast right you're getting 75% of the
calories from
protein it's an incredible not as good
as Cod I will admit Cod is closer to 86%
so but for something it tastes like
cookie dough yeah it's a a big leap over
Cod uh well as the Elder Statesman in
the room when it comes to protein bars I
will say move fast and build that moat
man because whatever problem you have
solved people will come for you bet uh
but it is very exciting I love you guys
picking up the torch and running with it
and creating something new uh I mean
you're you're you're one of the few
people who probably has a better
understanding of this I mean there the
list of people who know this industry as
well as you do is is probably a one-hand
industry so yeah yeah no doubt it's
exciting man where can people follow
along with you well probably on uh
Instagram and YouTube which are all it's
all Peter AA MD and on our site where
they can sign up for an awesome
newsletter nice I will say subscribe to
everything that you do uh in terms of
the the the q&as and stuff that you do
the video content is amazing every time
uh you sit across from me I make sure
that I spend hours and hours and hours
uh with your content it is extraordinary
and I am not incentivized in any way
shape or form to tell people that it's
just because I really believe that's
true uh so I hope people will do that
appreciate that very much speaking of
things that I hope people do if you
haven't already be sure to subscribe and
until next time my friends be legendary
take care peace if you like this
conversation check out this episode to
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