272: Perfectionism, Self-Discovery, and Emotional Wellbeing

This week’s conversation is with Dr. Peter Attia, a physician focusing on the applied science of longevity.

Peter earned his M.D. from Stanford University and holds a B.Sc. in mechanical engineering and applied mathematics.

He trained for five years at the Johns Hopkins Hospital in general surgery, where he was the recipient of several prestigious awards, including resident of the year, and the author of a comprehensive review of general surgery.

Peter has since been mentored by some of the most experienced and innovative lipidologists, endocrinologists, gynecologists, sleep physiologists, and longevity scientists in the United States and Canada.

His practice deals extensively with nutritional interventions, exercise physiology, sleep physiology, emotional and mental health, and pharmacology to increase lifespan (delay the onset of chronic disease), while simultaneously improving healthspan (quality of life).

In this conversation, we discuss Peter’s journey – his battle with perfectionism, his quest to reinvent himself, and why emotional wellbeing is the thing that interests him the most right now.

Peter is downright one of the best at what he does so I think you’ll be fascinated to hear how his mind works.

“Much of the drive and the perfectionism that I’ve had most of my life actually came from a set of beliefs that are sad and are beliefs that I don’t want my children to have, which is, “That I’m not enough, and that I need to do these things to be valued either by others or by society or by myself.”

In This Episode:

What was childhood like?

My interests at the time, were not academic, they were based on physical things. And so that was probably the little bit of tension as I entered my teenage years and got further along and then was more and more of my attention was going into training. And then all of a sudden, a gap is starting to open up between what I’m doing and what my parents expectation was, which is that I should be focusing more and more on school and work.

What did he learn from sport?

Boxing is a sport that very few people can do just naturally, it doesn’t matter how tough somebody is, to get in a ring and go even three rounds, you have to be in ridiculous shape. And that’s very different from someone who just naturally can pick up a basketball and be some significantly better than the next guy, which is not to diminish the amount of work that has to go into that. So then I realized, “Well, God, if you really want to be good at boxing, why don’t you just be in better shape than the other guy?” And since at the amateur level, you only have to do this for three rounds, I was like, “What if you trained as though it was six rounds or eight rounds, and pushed your fitness to that level? And then when you showed up to actually fight, and you only had to do three rounds, you could do it at a pace that nobody else could do.” And then I just took that further and further and further and I said, “Well, why don’t you just pretend it’s 12 rounds and cram 12 rounds into three rounds and see how that goes for the other guy?”

What motivates him?

I think that much of the drive and the perfectionism that I’ve had most of my life actually came from a set of beliefs that are sad, right? And are beliefs that I don’t want my children to have, which is, “That I’m not enough, and that I need to do these things to be valued either by others or by society or by myself.” I know that we live in a society that just loves to worship this dogged determination to do these things, and I’m no stranger to them

What inspired him to swim the Catalina channel?

I can’t tell you that I was really scratching an itch, because at the time, I don’t think I knew that this was just another manifestation of needing to graduate first in the class, needing to be good at this, needing to be good at that, which is all basically an inferiority complex. I think on the surface, what it was doing was demonstrating an obsession with trying to master something new, another skill. It’s the same reason I chose surgery. Surgery was the most technical field of medicine, and it’s the same reason I was not just attracted to surgery, but attracted to the most technical parts of surgery. Which is, I think, they’re serving two masters, which is the master of low self worth and then the master who truly gets pleasure out of learning something.

What levers can you pull on to impact your lifespan?

Nutritional biochemistry, exercise, physiology, sleep physiology, distress tolerance, and frankly all the tools of emotional health. And then all the exogenous molecules you can put in your body.

Which lever is he most interested in?

I’m quite interested in this idea of emotional health truthfully, because I think it’s the one that gets the least attention in this field. My field, unfortunately, is littered with the fecal excrement of bio-hackers and idiots. So everything is about what’s the minimum effective dose to do this and boost your brain this and do this and do all this kind of nonsense. And then if you leave the excrement filled layer of that world and move into the truly scientific world, where actual scientists talk about longevity in a very rigorous way, I think the one piece that is missing is how does all of this matter if the state of your relationships suck? If the state of your own mental and emotional health is suboptimal? In other words, if you’re suffering does any of this matter? If there’s a way to live an extra 20 years, and not just live longer, but live longer with a sound body and sound mind, but you are suffering emotionally, you’re unhappy, you’re unfulfilled, you’re constantly wanting. I’m just not sure that’s a life worth living. So understanding and examining that, to me is actually very interesting, as as unscientific as that is.

What drives him crazy about nutrition

I simply can’t stand this subject matter because it’s so charged. And it’s like talking about religion, or politics or guns. And I’ve never seen people, I’ve never… I shouldn’t say never, you rarely see people having smart conversations about them when they come in with strong priors, right? When people show up with very strong priors on those subject matters, it’s usually nonsense in terms of a discussion. So my interest in nutrition is purely from a biochemical lens, which is I don’t want to talk about diets, and not that you’ve asked about these things, but I don’t want to talk about any of those other things. Let’s just talk about what does the body do with glucose? What does the body do with amino acids? What does the body do with fatty acids? How do these things move around? Where are people going to differ? How is exercise going to impact the way these things work? And hopefully, by being able to talk about those things in that way, it becomes a little less wed to a lot of the nonsense that I just find so unpalatable, but I almost rue the day, I somehow became associated with nutrition.

What’s his relationship with suffering?

I don’t feel like I suffer nearly as much today as I used to, truthfully. I think I’ve been on a pretty difficult journey for the past three and a half years that has included, I hope as much suffering as I need to go through, in a sort of self inflicted way. I don’t doubt for a moment that there’s going to be lots of suffering that’s going to come in the next 50 years of my life that I won’t have any control over. That’s just what life is. But when you really think about self inflicted suffering, I want to believe I’ve crested that hill, and that I’ve experienced the greatest some of that in the last few years. And there were a couple of nodes where I had to make a decision about whether I was going to accept responsibility for things I’d done and make a change, or commit to a lie, which is those things can’t be changed. That’s just who you are, you are broken. Everybody else is going to have to learn to accept it, or that’s just the way it is, and you’re going to live a lonely miserable life, but so be it.

What is he most proud of?

I actually think that when I lay on my deathbed, which I hope is 50 years from now, but maybe it’s a year from now, we don’t know how these things turn out. But I actually think that when I look back from my deathbed, the thing I will be most proud of hands down, won’t be any swim, won’t be any body of literature, won’t be anything I’ve done as a doctor, it will be the decision to basically challenge every existing belief that got me to a certain point in life. And say, “You’re going to go back and revisit all of that and potentially completely change who you think you are so that you don’t have to be a slave to that mentality.” And there are times I wish I did it a lot sooner. But, I don’t dwell too much on that. I also think I probably wasn’t ready to do it sooner. So it really makes no sense to think of it that way. And it’s just I’m really grateful that I got to do it when I got to do it. And I hadn’t wasted too much time, because it would be sad to me if I’d gone my whole life and not done this and figured it out in old age, when I’d lost everything that mattered.

What does he understand most?

I have a very good understanding of why nutrition science is flawed. I could teach a PhD course in why nutrition science is unreliable. And here is every pitfall and blind spot that exists… And not every bit, but certainly the majority of them. So I probably have an outsized knowledge of a topic like that.

The importance of frameworks

Everything I do is based on a framework. And I want people to understand the framework. And let’s take the framework and apply the best knowledge to it today, but more importantly, make sure that in five years, when new knowledge is available, you can still apply it to a framework.

If he could sit with a master who would it be and what would he ask?

Ayrton Senna. I’d want him to settle once and for all. Well, I’d asked him why he raced that day. Why on May 1st, 1994, did he choose to race when every… I have to believe that every bone in his body knew it was wrong. He was in a horrible state of mind. Rubens Barrichello’s crash Friday, Roland Ratzenberger died on Saturday. He was very unhappy with the car and he went out and he pushed it way too hard and, I think that that’s what ultimately cost him his life. I’m not saying that, I would ask him why he didn’t retire, but he wouldn’t have been faulted for sitting out that race. I would want an honest answer as to did he raced that day for him, or did he race that day for the nation of Brazil?

What is he trying to sort out?

I think the only thing that keeps me up at night is just wondering if I’m doing the right thing by my kids, which is a hard one, because, at least I disproportionately spend time on things that are not about my kids, my work and things like that. But I think that’s the only thing that I have real concern about is, what am I doing to allow them to be the best versions of them even though I don’t know what that means? In other words, I don’t know how much adversity is optimal. I don’t know how much suffering is optimal. I know it’s not either extreme, I know that they can’t be marshmallows, right. And I know that they can’t be tortured, so, without knowing what environment is right to produce the best version of them and knowing that it’s not going to be the same for my three kids, I do lose a lot of sleep trying to understand how to be a great dad and how to have a great eulogy. Because, I don’t know if you’re familiar with David Brooks’ book, The Road To Character, but it’s definitely one of the most important books I’ve ever read. I think about it every day, right. Which is, what are my eulogy virtues versus my resume virtues? And we spend most of our time on our resume virtues, but the only thing that matters is the eulogy virtues. So I’m just trying to be better at those and care less about the resume ones.

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