Dr. Attia graduated from the Stanford University School of Medicine in 2001, and until 2006 he was a surgical resident at Johns Hopkins Hospital. During this time he was a surgical oncology fellow at the National Institutes of Health's National Cancer Institute. In 2012, Dr Attia co-founded the Nutrition Science Initiative, and 2 years later, in 2014 he opened his medical practice, Attia Medical, PC. This institute focuses on the applied science of longevity and optimal performance to minimise the risk of chronic diseases and improving lifespan. He serves on the editorial board for the journal ’Aging’, and is the host of ’The Drive’ podcast.



In this conversation Dr Attia and Steven discuss topics, such as:


 The next evolution of medicine
 How healthcare is failing people
 The main way to prevent a heart attack
 Why you should be thinking about old age and disease right now
 How to improve your quality of life as you age
 Why emotional health is as important as physical health
  How to live well until you are 100
  The easy hack to losing weight
  The importance of lifting weights and building muscle
  How to slow down all diseases



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Going from 0 activity to just 90 minutes a week is about a 15% reduction in all-cause mortality.

For anything performance or longevity related.

He has the secret for living a long, healthy and happy life.

Most people listening to us are going to die from cardiovascular disease, cancer, diabetes.

If we want to really figure out a way to live longer, we need a totally different playbook.

How early do some of these diseases begin?

But we only really think about the risk over a 10-year time horizon.

As a 30-year-old, you don't get excited about exercise and your sleep, but there's a 400% higher risk of dying in the coming year when you compare the fittest 2.5% to someone at the bottom 25%.

And then once you hit the age of 65, if you fall and you break your hip, there's a 15 to 30% chance you will be dead within the next 12 months.

You have to realize you're taking this for granted.

When you talk about the deterioration of health you have these 3 categories emotional health deterioration Why have you included that

because despite being very physically healthy?

I was not living a good life I was in such an awful cycle of anger workaholism that I don't think my marriage would have survived.

I realized I don't want to be this person and lose my kids.

And I'm sure many people listening to us can relate.

Were you able to discover the root cause of that?

More than that, I was able to get rid of it.

What are the biggest misconceptions in your mind about weight loss?

Peter Atiyah He is the man that wrote the book on how to live a long, happy and healthy life.

And he argues that everything we know about health and what that actually means, health of the mind, the body and the emotions, is wrong and outdated.

He says that there's disease growing in you and me right now.

But the problem is because we can't see it, We're doing nothing about it.

It allows you to see that in many cases, inaction now will increase your chance of disease and a much shorter life by

and in some cases, if we don't take action now, by

I've had lots of conversations on this podcast about health, about diet, about all of these things.

But for many of you, this 1 will be the 1 that changes your life.

This will be the 1 that makes you ask some difficult but important questions about your health and what health means for you.

I walked away from this conversation realizing that if I don't take action now, I'm going to be forced to take action then and I can unequivocally say that this conversation has changed my life.

I have a suspicion it's going to change yours.

I've been through every interview you've done, your book, other conversations you've had.

You talk about a lot, so many things that I'm absolutely fascinated by.

My first question for you is, what is your mission and why are you doing this?

You know, I think that there is no greater desire for people than to be healthy.

Especially when you consider how we can define health more broadly than just physical health.

Once you can include kind of emotional health, it's kind of the great equalizer And nothing else really matters if you don't have it.

So it doesn't really matter if you're famous or not famous.

It doesn't matter if you're rich or poor.

If your health is compromised, and anybody who's been through an illness where their health has been compromised, I think will realize in a moment what they've taken for granted.

And I've just become personally endlessly fascinated by this topic.

And in my own quest to understand this better and better, the next natural step was to begin to do it as a doctor, right?

To begin to kind of help patients with this.

And at some point, you can only treat so many people.

And so podcasting and ultimately writing a book just became a way to put as much of that information as possible out there for more and more people to access.

Do you know why you of all people became fascinated by this?

I mean, I think, You know, I had always been interested in performance, because I'd always, you know, at least as, as far back as, you know, being 12 or 13 years old, you know, I'd always been obsessed with 1 form or another of, of some sort of physical, obsession, whether it be, you know, boxing when I was really young or marathon swimming later in life.

But when my daughter was born, when I was 35, that was the first time that everything kind of pivoted.

And I had a little bit of a glimpse into the future, I would say.

And I just sort of realized, oh, you know, the, the joy I'm experiencing in this moment is so surprising to me, so unanticipated.

And I really want to be able to experience this again, which means not just with other children of mine, but potentially with grandchildren.

And on top of that, I had a bit of a wake up call, which was, I realized that all the men in my family died prematurely of heart disease.

Obviously, I knew that fact before this time, but I think it was the confluence of those 2 things.

It was the realization that, yeah, if you don't figure something out and do something about this, you're probably going to die of heart disease in your 60s, which is not that far from now, 25, 30 years from now.

And you now really have a motivation to live longer and to live better longer.

And so that in many ways kind of began the change in my direction, my focus to being 1 that was not purely just focused on performance anymore, but sort of focused on understanding health in a different way.

This concept of medicine 3.0 is a concept which I only discovered in your work, I've never heard the term used before.

What is Medicine 3.0 and how did you get to the point when you realized that there needed to be an iteration on the current system of medicine?

Yeah, the reason I think you hadn't heard of it before is I don't think it's been described before, so you can't be faulted for that.

But as I began writing the book and thinking about how I was practicing and how people like me practice, I realized that it is a very distinct change from the current form of medicine.

And in a way to not be just critical of the current form of medicine, I had to put it in the context of what existed even before that.

And that's how I sort of realized, well, we're in this version of medicine called medicine 2.0, but it's following something called medicine 1.0, and it's an enormous improvement above that.

So maybe I can spend a moment just kind of explaining what those 3 are, and I think that's probably the easiest way to explain the current form.

So medicine 1.0 is everything that existed before we really understood the science of medicine.

So for most of human history, we had no idea why people got sick or why people died or what an infection meant.

We sort of thought that these were plagues from the gods or things of that nature.

But a couple of things happened in the past few hundred years.

The first was the idea of a scientific method, something that we take for granted today where you can make an observation about something in the world, formulate a guess called a hypothesis about why it's happening, and then design an experiment to test it.

Also things like a light microscope, which up until 140 years ago or so didn't exist, allowed scientists and doctors to be able to actually see these microscopic things called bacteria.

And then ultimately the development of things like antibiotics and eventually vaccines.

All of these things made an enormous difference in reducing the suffering and death due to what I call in the book fast death.

So fast death is pretty much how we used to all die.

Fast death would be trauma and infection.

And up until about 150 years ago, life expectancy would have been high 30s, low 40s, and most of us succumbed to fast death.

But with the advent of medicine 2.0, through all those transitions I just described, in the span of a few generations, we've doubled life expectancy.

So now life expectancy is roughly twice what I just said a minute ago.

And most people do not die from fast death, but it's been supplanted by slow death.

Today most people listening to us are going to die from cardiovascular disease, from cancer, dementia, or other neurodegenerative diseases, complications of diabetes.

And on the 1 hand, that's a sign of progress.

It means like, hey, we're living long enough to die from those things, but we've made scant progress against those things.

In fact, if you go back and strip out the top 8 causes of infectious death or communicable death, death from communicable diseases or infectious diseases, today, if you strip them out, our life expectancy is not much better than it was in the 1800s.

In other words, that doubling of life expectancy that we've experienced comes almost exclusively to the reduction of those fast deaths and has little to do with any success we've had against slow death.

If we want to really figure out a way to live longer, and I would argue more importantly, live better, meaning when we're in the last decades of our life, not be in a state of total decline, we need a totally different playbook.

And that playbook is Medicine 3.0 and it involves real prevention.

So that means taking true steps at prevention very early in life.

It also involves being very personalized in how you do things.

So it means you can't just do paint by numbers.

You can't just sort of say the same thing to everybody.

Clearly there are certain things that make absolute sense across the board, such as sleep and exercise, you know, but the way you might use medications is going to have to be much more tailored to an individual.

You say that there are 4 points to medicine 3.0, which is the prevention, being unique in your treatment to each individual, an honest assessment and acceptance of risk?

1 of the things that I don't think we think enough about as doctors sometimes is risk, right?

Now, I think doctors are very good at thinking about the risk of doing something.

I think usually a doctor is pretty good at understanding, if you have this surgical procedure, there's a risk of an infection, there's a risk of bleeding, there's a risk of all of these things.

If you take this medicine, there's a risk of this side effect or that side effect.

But I don't think we spend enough time thinking about the risk of not acting or the risk of not acting when we do.

So this is where I think it gets a bit more nuanced.

Prevention doesn't come without risk, right?

I mean, you're still going to have to do something in the state of prevention.

So the question is understanding the time horizon upon which you're considering risk.

So I'll give you 1 very specific example.

At least in the US, and it might be the same in the UK, we only really think about the risk of heart disease over a 10-year time horizon.

So look at someone like you, you're 30 years old, right?

So what is your 10-year risk of having a heart attack?

I can tell you without knowing anything about you, it's really low.

It's as close to 0 as we could have in medicine.

But what if I did a blood test on you and I found biomarkers in there that were predictive of very high risk later in life?

Now that would be actually quite possible.

There's about a 1 in 10 chance you might have a biomarker called LP little a, for example, which is just a certain lipid in your body.

About a 1 in 10 chance you have that dramatically increases your risk of cardiovascular disease.

I believe in his 50s of a cardiovascular disease.

So knowing that, by the way, could be helpful, because that would prompt me to ask you more questions and want to know more about all the people in your family.

And by the way, we wouldn't leave it to chance.

And let's say we checked your level and you had that lipoprotein, or you had an elevated level of another lipoprotein, APO lipoprotein little b.

And again, these are kind of technical terms, but they're very common things and they're easy to measure.

The medicine 2.0 view here would be, well, there's nothing wrong with you now and there's not going to be anything wrong with you for the next 10 years.

Conversely, if I take a lifetime view of risk, I would say, yeah, but the risk to something happening in the next 40 years is actually quite significant.

So my risk of doing nothing is probably much higher than my risk of doing something today.

So my risk of doing something today would be non-zero but small, but my risk of doing nothing if I take the appropriate time horizon is much bigger.

This is 1 of the things in your book that really, really got me thinking was, I have to say, and I believe a lot of people probably feel the same way I've gone through my life thinking to some degree.

I'll worry about Avoiding these diseases later.

Oh When I get to 45, then I'll start taking this thing seriously.

Because then I'm getting into that territory where most people I know that get cancer or Alzheimer's or all of these cardiovascular things, that's when it tends to happen.

And I'll frame this in the context of a question I get asked all the time, which is, Hey Peter, when is the best time to start thinking about this stuff?

And I say, look, I can't answer that because there are 2 competing issues that are crossing.

When I meet somebody who's in the last decade of their life, do you know how much they are thinking about this?

Every minute of every day is a confrontation with their own mortality.

The problem is they don't have much time to change the direction of the ship.

You may recall in the book, I write the sort of, I use the metaphor of the Titanic, right?

It's not that the Titanic didn't see the iceberg, it's that it didn't see the iceberg in time.

It didn't have enough runway to really move out of the way, and that's why the Titanic gashed the side of the boat.

Now, at the other end of the spectrum, a 30-year-old like you has unbelievable potential to change the arc of your life.

You have so much runway to, through manipulating nutrition and exercise and sleep and stress and all of these things to completely alter the disease trajectory of your life.

The problem is, and I'm not just speaking to you personally, but more broadly to someone who's as young as you, it's harder to find the motivation because there are no reminders of your own mortality.

The worst thing that happens to you is a hangover.

I always get asked, like, when is the right time to start worrying about this?

And the short answer is like, as soon as possible.

But then there's a reality that says for most people, it's not until they're in their forties.

Maybe once they have kids that they start to appreciate their own mortality and that that provides some of the motivation to say, you know, maybe I'll be a little less focused on optimizing everything for today and I'll start thinking a little bit about tomorrow.

So again, another way to think about this is saving for retirement.

A lot of people in their 20s and 30s who are making good money aren't necessarily taking the most prudent financial steps to ensure financial freedom when they're in their 70s.

Because let's be honest, It's more enjoyable to spend money today than to set some of it aside.

But there are a lot of people later in life who think, I wish I was a little bit more responsible earlier on.

How early do some of these disease, if you looked at my sort of metabolic health or if you were able to look inside my body, which I'm sure you're able to do, how early do some of these diseases begin in my life?

At what age do you see some of these things coming?

Yeah, it's super interesting because there are some elements of you as a person that are going downhill the minute you're born, and there are others that are not.

Let's start with something where your body is getting better and better, and you're probably only peaking now, but you haven't really started to age.

So when you were 5 years old, Your muscle quality was nothing like it is today.

But as you enter your twenties, the quality of those muscle fibers, these type 2, these type 1 and type 2 muscle fibers, so these are kind of slow to fatigue, but high endurance fibers are the type 1 fibers, the type 2 fibers are very, very powerful, but they're kind of quick to fatigue.

The quality of both of those fibers is very high.

And the more you train them, the higher quality they will be.

But as you enter your thirties, you will now start to experience a shrinkage of those type 2 muscle fibers.

You will be less powerful in your 30s, in your late 30s especially, than you were in your mid to late 20s.

It's not an accident that the most powerful athletes in the world are at their peak in their late 20s and early 30s.

So sprinters, for example, that's a prime example of a pure, pure power sport.

We look at other things like more of your muscular endurance that will peak even a little bit later.

You can keep that going a little bit later.

So if we look at something called fluid intelligence, right?

Meaning, you're gonna have faster processing speed, better memory, all of these things are gonna be better when you're 30 than at my age, I'm 50.

Because that's already started to decline in me.

There are some things, however, that began aging in you the minute you were born.

And 1 of them is actually going back to this idea of atherosclerosis or cardiovascular disease.

Well, That's an example of a disease process that begins right away at birth.

And even though it almost never rears its head as far as death before you're 50, make no mistake about it, it's starting on day 1.

And we know this, by the way, because when we look at studies of people who die for completely unrelated reasons, so somebody who, you know, dies in a car accident or soldiers dying in war, and we look at their, the arteries of their heart, we already see quite advanced disease.

So the truth of it is, you already have pretty significant disease in your coronary arteries.

It hasn't risen to the level of ever causing a heart attack and it's unlikely to do so for another 20 years, maybe even another 30 years.

And if you want to live to be 90, free of cardiovascular disease, it makes a big difference if you can slow it down when you're in your 20s and 30s.

That's really what I'm trying to change in myself is I'm trying to find the motivation.

Like you said, when we're not confronted with our mortality, it's interesting because my life changed because of the pandemic in part, because I got to see the relationship between things like obesity, poor metabolic health and mortality for the first time.

And that's really when I started working out pretty much every day now.

And it was that confrontation of like, oh my God, the reason why I'm having a better outcome with this disease is because I'm in better metabolic health, metabolic shape.

And it's funny that It has to take those things in our lives for us to make the changes.

Quick 1 before we get back to this episode, just give me

The first thing is a huge thank you for listening and tuning into the show week after week.

It means the world to all of us and this really is a dream that we absolutely never had and couldn't have imagined getting to this place.

But secondly, it's a dream where we feel like we're only just getting started.

And if you enjoy what we do here, please join the 24% of people that listen to this podcast regularly and follow us on this app.

I'm gonna do everything in my power to make this show as good as I can, now and into the future.

We're gonna deliver the guests that you want me to speak to, and we're gonna continue to keep doing all of the things you love about this show.

When you talk about the deterioration of health, you have these 3 categories, cognitive decline, decline in loss and function of our physical body, and then emotional health deterioration.

Well, I mean, maybe I'll just take a step back and say where I kind of put these all in perspective.

So, you know, the title of the book, right, is Outlive the Science and Art of Longevity.

Well, longevity is really about 2 things.

It's about the length of life, and the word for that is lifespan, but it's about the quality of life, and the word for that is healthspan.

And it's healthspan that has those 3 components you just described.

Healthspan, meaning quality of life, is determined by your cognitive function.

What capacity do you have to do whatever you want to do physically?

Are you limited in any way by pain, strength, movement, balance, et cetera?

And then the final piece is emotional health.

But do you have the capacity to regulate your emotions?

And so now to answer your question, why would that be included?

Well, the truth of the matter is it wasn't something I always included, right?

It wasn't something I necessarily thought much about until it was, I think, very starkly pointed out to me by a very astute therapist who, in observing my own struggles in life, said something to the effect of, isn't it really ironic that you are putting so much energy into helping people live longer, and yet you are paying no attention to your own misery.

And I think that was, and that was about 6 years ago, and that was kind of when I realized I needed to rethink my approach to this problem.

And as I write about in the book, I think I would make the case today that if your emotional health is suffering, none of the others really matter that much.

So what you really need to do is think about a way to have all of these things in order.

I think at that point in my life, I mean, there's no 2 ways about it.

I mean, I was just incredibly miserable, incredibly angry, despite being very physically healthy, right?

Despite doing all of the important things to be physically healthy, right?

Exercising, you know, in all the right ways, eating well, sleeping well, optimizing every aspect of my health, but living a bad life.

What were the kind of, for you to start to spot that?

Because sometimes we don't know in our own behavior and sometimes it's reflected back on from other people.

See all The Diary Of A CEO with Steven Bartlett transcripts on Applepodcasts

The LIFE-EXTENSION Doctor: "The ONE thing that's increasing your chance of early-death by 170.8%!" Peter Attia (E267)