Today, most people listening to us are going to die from cardiovascular disease, from cancer, dementia, or other neurodegenerative diseases, complications of diabetes. On the one 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 eight 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. 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. That playbook is Medicine 3.0, and it involves real prevention. That means taking true steps at prevention very early in life. It also involves being very personalized in how you do things. It means you can't just do paint by numbers. You can't just say the same thing to everybody. Clearly, there are certain things that make absolute sense across the board, such as sleep and exercise.

But the way you might use medications is going to have to be much more tailored to an individual.

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

Yeah. One of the things that I don't think we think enough about as doctors sometimes is risk. 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. This is where I think it gets a bit more nuanced. Prevention doesn't come without risk. I mean, you're still going to have to do something in the state of prevention. The question is understanding the time horizon upon which you're considering risk. I'll give you one 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. Look at someone like you. You're 30 years old, right? 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 zero 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(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.

My uncle died very early, I believe in his 50s of a cardiovascular disease.

Interesting. 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. Here we have a one in 10 chance, and by the way, we wouldn't leave it to chance, we would just check it. Let's say we checked your level and you had that or you had an elevated level of another lipoprotein, apoprotein little b. Again, these are 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. We don't need to do anything about it. 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. My risk of doing nothing is probably much higher than my risk of doing something today. 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 one of the things in your book that 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. 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. I'll think about it then.

Totally understandable. 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? I say, Look, I can't answer that because there are two 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? It's all they're thinking about. It's all they're thinking about. 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 use the metaphor of the Titanic. 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. You're Superman. The worst thing that happens to you is a hangover.

I.

Always get asked, When is the right time to start worrying about this? The short answer is, Look, as soon as possible. But then there's a reality that says for most people, it's not until they're in their 40s, maybe once they have kids, that they start to appreciate their own mortality. That that provides some of the motivation to say, Maybe I'll be a little less focused on optimizing everything for today, and I'll start thinking a little bit about tomorrow. 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 did some of these disease... If you looked at my metabolic health or if you were able to look inside my body, which I'm sure you're able to do, how early did 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. There are others that are not. Let's use two examples. Let's start with something where your body is getting better and better. You're probably only peaking now, but you haven't really started to age. Your muscle quality. When you were five years old, your muscle quality was nothing like it is today. But as you enter your 20s, the quality of those muscle fibers, these typethese type 1 and type 2 muscle fibers. These are slow to fatigue, but high endurance fibers are the type 1 fibers. The type 2 fibers are very, very powerful, but they're quick to fatigue. The quality of both of those fibers is very high. The more you train them, the higher quality they will be. But as you enter your 30s, 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. That's a form of aging. You are declining. 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 sprinter, 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. We look at certain forms of cognition. If we look at something called fluid intelligence, this is raw horsepower processing speed. You have more of it right now than I do, meaning you're going to have faster processing speed, better memory. All of these things are going to 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. One 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. 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 one. We know this, by the way, because when we look at studies of people who die for completely unrelated reasons, so somebody who dies in a car accident or soldiers dying in war, and we look at the arteries of their heart, we already see quite advanced disease.

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. But it's compounding. It is compounding, exactly. 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.

Medicine 3.0, as we talked about earlier, you talk about these five core things that help to increase our chances of longevity as it relates to our health span. What are those five things?

Exercise. Again, we can talk a lot about it if you want a little about it, but the point is, it is not remotely given anything beyond lip service by medicine 2.0. If you go to your doctor here at the NHS and say, Okay, tell me what my workouts should be. Good luck. How much time should I be spending in zone two versus zone five? What type of lifting should... I mean, there's no way they're going to give you that type of insight or specificity. The third one is nutrition. Again, sure, every doctor is going to tell you, eat less exercise more, but they're not really, for the most part, going to be able to help you manage nutrition. Certainly, I didn't learn anything about nutrition or exercise when I was going through my medical training, and most physicians don't. I'm not saying that there aren't doctors out there who don't understand these things. What I'm going to say is they had to learn that stuff on their own outside of their traditional training. That's crazy.

That's so crazy.

The fourth one is sleep, and that fits in the same category. Sleep is an essential pillar of health, but we learn nothing about it in our medical training. In fact, most of our medical training is paradoxically sleep-deprived.

Sleep is really important to you, isn't it? For sure. Super important to me as well. It's been a life-changing. This little whoop thing who are especially- Yeah, I see that there. -absolutely changed my life.

It's the first thing I've seen. You've probably noticed how your whoop score changes with and without alcohol in your system.

One glass and it's all flashing red. The first time that happened, I had one glass of wine and I woke up the next day and my vital signs, my heart rate variability was flashing red and it literally says, Did you have a drink last night? It changed my life.

It.

Changed my life forever. Honestly, I'm absolutely obsessed with sleep in a very healthy way. Some people think, Oh, you might be waking up and feeling bad. No, I look at it and if I've not slept well, I'll adjust my day accordingly. You share some stats around sleeping in the book. What is the stat or the two stats that changed your perspective on sleeping or that really you would tell someone if you're trying to convince them of the importance of sleep?

It's so interesting, I'll tell you, it's not even a stat. I think it's more of... It almost goes back to the type of discussion you'd have with somebody like a Daniel Lieberman, thinking about this through the lens of our ancestors. I was always someone who deprioritized sleep. I'm a very busy person, high energy, didn't really seem to need that much of it. Even in high school, I was always go, go, go. At one point, I was having a discussion with a colleague about sleep, and I was making the argument that I didn't really need any of it. I almost made a point like it's almost a shame we can't just work our way out of it. He posed to me in a very Socratic way, Well, given how evolutionarily unwise sleep would be, you are unconscious for a third of your life. We know that our ancestors slept on an average of about seven to eight hours every 24 hours. They didn't do it always straight away, but we know that they're sleeping basically a third of their life. That's a time when you can't forage for food, you can't defend yourself against predators, you are not mating.

There's nothing, from an evolutionary perspective, you're doing... Those are the three highest priorities of evolution, and you're not doing them. Why would evolution have kept this thing around? By the way, why has no species figured out a way out of it? I think through that lens, I was like, Huh, yeah, interesting. Maybe this thing does matter. In some ways, I think that's probably one of the most powerful things that you can hear. Sure, there are lots of statistics about how fragmented sleep, broken sleep or short sleep can increase your risk, in particular, of cardiovascular disease and dementia. I think there's a less clear relationship to cancer, but I think the relationship is quite clear to cardiovascular disease and dementia. In addition to insulin resistance and obviously, therefore, weight gain. For people, even if you're just coming at this through the lens of weight or excess body fat, I mean, that's probably motivation enough for many people. Then, of course, there's how you feel and how you perform.

Oh, my gosh. Your creativity and your ability to articulate yourself, which I notice in your mood, huge one for me, especially when you're running teams. My unsleep days and my worst days.

The fifth and final thing that you have as a tool in the longevity toolkit is all the molecules. Drugs, hormone, supplements. There that's the one thing you do learn in traditional medicine is you at least learn about the pharmacologic side of it. You don't really learn anything about supplements, so most doctors don't really understand much about supplements. Interestingly, most doctors don't really understand a lot about hormones as well. Medicine 2.0 is good at what it does, but it's very limited. It's like having a contractor that only has one tool instead of five tools. As we discussed earlier, I think they're applying those tools too late in the game.