Dr. Peter Attia: This Is What You Need to Do to Live Longer | Amanpour and Company

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well our next guest says that he has the

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secret for living a long healthy and

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happy life Dr Peter attia's new book

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lays out a how-to guide for longevity

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focusing on preventative approaches

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rather than treatment and he is joining

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Hari sreenivasan to discuss the best

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habits for a healthier life

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Diana thanks Dr Peter attia thanks so

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much for joining us now in your new book

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outlive the science and art of longevity

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you're not just trying to help us live

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longer but you're trying to get us to be

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healthy as well I mean you you have you

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kind of make a distinction between

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lifespan and health span spell that out

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yeah lifespan is probably the easier of

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those two things to explain which is uh

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you know obviously how long you live and

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that in that sense is is kind of binary

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it's all or none you're alive or you're

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not alive

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um and unfortunately I think our medical

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system uh mostly fixates on that metric

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and obviously what gets measured gets

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managed as the old saying goes what I

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think we're not paying nearly enough

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attention to is the quality of life and

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uh that's what's captured in health span

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right so there's a there's a cognitive

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component to that there's obviously a

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very physical component to that and

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there's an emotional component to that

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and if you don't really Define metrics

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around those things it's probably not

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surprising that we're not managing those

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things and therefore most of the

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resources and attention go to Simply

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prolonging life even at the expense of

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quality so when a patient approaches you

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in your practice I mean kind of what are

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the questions that you're asking them so

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that you're kind of on the same path

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together

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well obviously we want to talk about all

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of the medical things and all of the

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things that deal with prolonging life as

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well so we certainly want to understand

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all the risks coming in with respect to

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you know what we talk about as the Four

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Horsemen of death you know

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cardiovascular disease neurodegenerative

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disease cancer Etc

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but on the health span side we spend

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just as much time and energy thinking

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about for example what do you want to be

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able to do in the last decade of your

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life this becomes a very important

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framing question and the more detail

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that a person can provide sometimes with

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our prodding as to what they actually

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want to be able to do right do you want

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to be able to pick up a grandchild do

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you want to be able to travel these

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things require very deliberate planning

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and most people can't do these things in

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the last decade of their life unless

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they train for it so you know you took a

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look and studied

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people who are 100 years old and

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was there something

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that they had in common that we can

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apply in our lives so the one thing that

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is common to all centenarians is that

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from the standpoint of chronic disease

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there are about 20 to 25 years younger

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than their birth certificate age says

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wow in other words their first brush

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with cancer their first brush with heart

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disease their first brush with any sort

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of chronic ailment is about 20 to 30

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years after you would expect based on

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their you know birth certificate age so

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they have a superpower and the

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superpower is they delay the onset of

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chronic disease now the question of

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course the million dollar question is

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are they doing something in in order to

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get that superpower right is it is it

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you know

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is there some magic diet or something

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like that yeah and unfortunately I say

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unfortunately for the rest of us who

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don't have those genes the answer is no

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um and and it's actually more likely

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your observation which is on average

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believe it or not centenarians are more

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likely to smoke more likely to drink

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less likely to exercise and less likely

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to eat well and yet despite those things

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they have this Supernatural lifespan

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but that doesn't mean we can't learn

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from them what we learn is we have to

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apply to ourselves other tools to get

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their benefits in other words we have to

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use nutrition exercise sleep stress all

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those other things as tools to get what

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they get for free genetically we have to

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create a phase shift of time in the

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onset of chronic disease let's first

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talk about

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um just exercise I mean you write a

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tremendous amount that that is one of

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the most beneficial things that we could

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be doing earlier in our lives to prevent

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a lot of ailments

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yep exercise is hands down the most

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potent tool slash intervention that we

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have to affect both of the metrics we

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care about lifespan and health span so

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on the lifespan side of the equation

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having a very high degree of

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cardiorespiratory Fitness having high

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muscle mass and high strength relative

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to your sex and age

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is a better predictor

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of longer life meaning a greater

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reduction of all cause mortality death

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for many causes than anything else we

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have positive or negative the benefit

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bestowed on an individual from being

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very high in those categories is greater

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than the harm that comes from smoking

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having high blood pressure having type 2

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diabetes even having kidney disease

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which would be the step right before

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needing a transplant so as much as we

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understand how harmful those things are

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it's even more beneficial to be

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incredibly fit and incredibly strong so

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if you're just thinking about how do I

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live longer that's the ticket

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on the other side of the Ledger when we

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think about the quality of life there

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simply is no greater tool to Foster

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neurodegenerate neuro neuro protection

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and ward off neurodegeneration than

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exercise and of course exercise is the

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most important piece in maintaining your

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physical body as you age so you can do

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all those things you would want to do in

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that last decade of your life is there

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a combination of things that will help

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your body prepare for aging better than

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anything else

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you know if there's one drawback to

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exercise it's that it takes more time

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than all of the other things that we

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might think of as being beneficial few

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things take as much time to reap the

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full benefit uh from as exercise you

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need to be doing strength training you

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need to be doing cardio respiratory

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training and that cardio training needs

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to be at different levels of intensity

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about 80 percent of it needs to be at

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relatively low intensity the level of

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intensity at which you could still carry

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out a conversation albeit a strained one

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and about 20 of it needs to be at a

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higher level of intensity where you

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couldn't carry out a conversation and I

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think for the individual who says look

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Peter I am not willing to spend more

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than 90 minutes a week exercising yes I

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would rather have them you know focus on

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what's not necessarily what I think the

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best approach to exercise is but doing

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whatever they can to get some benefits

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but the way I ask my patients is very

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different I start in Reverse I say

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tell me how many hours a week you're

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willing to put into this and I've

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already explained to them and shown them

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all the data that explain why this is

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going to have a greater impact on the

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length and quality of their life than

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anything they will ever do

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let's talk a little bit about nutrition

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you for a time being were a big fan of

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Keto diets and and in the book you kind

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of walk through why and how you changed

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your mind about that

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um explain to our audience

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um how should we be thinking about

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nutrition

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in the context of Aging I go to Great

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Lengths in the book to detach from diets

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and really just talk about nutrition as

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a biochemistry phenomenon let's just

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talk about it through the lens of

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biochemistry and molecules

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the most important component of your

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nutrition is basically the energy

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balance it creates in your body in other

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words is a person overnourished or

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undernourished now for most of our

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existence we have been undernourished

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right for if you think about a thousand

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years ago 500 years ago 200 years ago

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most of us were barely getting enough

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energy right and and our bodies of

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course evolved remarkable ways to store

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and hold on to energy this is what

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basically allowed us to LeapFrog ahead

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of all other species in terms of our

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remarkable brains because our brains are

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so energy hungry well that worked really

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well until our you know modern

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environment which basically created such

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an abundance of food that now most of us

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are on the other side of that we are

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overnourished strategy number one is you

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have to reduce energy intake

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and there are basically three approaches

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to that Each of which can work Each of

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which has advantages and Each of which

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has disadvantages so broadly speaking

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they are direct caloric restriction

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dietary restriction and time restriction

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to say a bit more about them direct

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caloric restriction as the name suggests

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means

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you just deliberately go about eating

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less while paying attention to how much

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you are eating not necessarily paying

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attention to when you're eating or what

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you're eating but just reducing the

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total caloric burden

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dietary restriction of which you

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mentioned an example a ketogenic diet is

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a form of dietary restriction but so are

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most quote unquote diets this is when

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you just restrict certain elements

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within the diet and what that results in

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is less overall consumption so it's an

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indirect way to go about calorie

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restriction

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finally time restriction is also an

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indirect way to go about calorie

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restricting by creating a narrower and

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narrower window in which you eat and if

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you create a narrow enough window you

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will end up reducing intake now

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you know we don't have to go into the

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details of how each of these has a

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benefit and each of these has a risk but

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none of these are you know things that

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you should do mindlessly each of these

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are things you have to be mindful of the

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blind spots and pitfalls and work around

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them

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you spent a fair amount of time talking

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about sleep why is it

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as important I mean I'm somebody who

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doesn't get enough sleep and I feel like

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it's underrated but you know younger

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points in my life I didn't really think

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about how much I was getting maybe

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because I was obviously younger and I

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was fitter and I was able to rebound

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faster but now if I don't get a good

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night's rest it's really difficult to

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perform at the same level every day in

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the book I talk about a thought

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experiment which is effectively like you

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know Evolution didn't muck around right

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Evolution

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everything about evolution is is really

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laser focused and if you think about it

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no one disputes that we are optimized to

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forage for food to reproduce to fend for

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ourselves I mean these are the

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characteristics that Evolution owned why

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would Evolution have kept around this

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behavior that rendered us unconscious

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for eight hours a day it just doesn't

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make any sense and the only way you

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could really justify this is if that

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eight hours I.E one third of our life

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that is spent in unconsciousness must be

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doing something so important we have

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never figured out a way to out evolve it

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we've never even figured out a way to

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reduce it by half like it's basically

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just stuck there at about seven to eight

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hours

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and

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that's kind of what I think I talk a

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little bit about in the book right is

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like what are those features of sleep

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why is that important to brain health

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why is that important to memory

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consolidation why does that play an ins

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in a profound role in metabolism right

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so many of the problems that I think we

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have with obesity metabolic Health

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insulin resistance type 2 diabetes can

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actually be attributed to poor sleep

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just as much as they can be attributed

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to poor diet

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you know a lot of the book also it takes

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a critical look at our existing Health

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Care System you write that both health

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insurance companies won't pay a doctor

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very much to tell a patient to change

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the way he eats or to monitor his blood

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glucose levels in order to help prevent

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him from developing type 2 diabetes yet

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insurance will pay for this same

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patients very expensive insulin after

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he's been diagnosed so is there a way to

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turn what seems like the largest

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industry in the country around to think

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kind of proactively instead of

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reactively

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I mean there clearly is from a

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conceptual standpoint from a structural

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standpoint I don't want to be naive and

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and suggest that it's going to be easy

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but uh that example that you you read

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the quote from I think illustrates kind

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of the point right which is

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everything follows the dollar and I

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don't say that as a skeptical guy like

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dollars are important I'm a capitalist

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it's all about you know you have to set

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the right economic incentives but right

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now the economic incentives in medicine

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are around diagnosis and pharmacologic

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treatment and I'm not here to say

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pharmacologic treatments don't matter

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they're very important and we do rely on

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them but the point here is we were

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really only educated along one parameter

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of Intervention which is procedural and

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pharmacologic and if the entire system

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of reimbursement is based on creating a

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diagnosis and developing a treatment

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plan along those metrics and by the way

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go back to what I said at the outset and

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the only metric of interest is length of

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life

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you you will create the machine we have

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called medicine 2.0 and by the way

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medicine 2.0 was very successful at

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treating some things namely infectious

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diseases and acute problems such as

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trauma this is what has effectively

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doubled the lifespan of humans in the

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last 150 years it's the success of that

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model medicine 2.0 applied in that way

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which is wait till the problem happens

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treat it with pharmacologic intervention

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or procedural intervention

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yeah what we're seeing is that Playbook

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is not working with chronic diseases not

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even close and the only way you're going

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to treat chronic diseases is moving on

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to an approach where you treat you where

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you really enact prevention

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and if you want to incentivize

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Physicians to do that they have to be

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educated in this way and you have to be

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able to reimburse for these tools you

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have to be able to reimburse Physicians

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uh and you have to be able to

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incentivize patients to take care of

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themselves 30 years before they have

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that heart attack if you were to advise

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a patient that's heading to their doctor

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what are the kinds of things that you

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would tell them to kind of perk their

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ears up on or listen close to this

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number that are good guides for

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healthfulness

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I want patients to understand there are

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some things that labs are really good at

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there are a lot of things they're not

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good at everybody should know their APO

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B APO B is a number that measures the

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total concentration of the cholesterol

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carrying particles in the blood that

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drive atherosclerosis which is the

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dominant Force driving heart disease

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again

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can't say it enough right heart disease

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is the leading killer globally about 19

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million people per year die of

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atherosclerotic cardiovascular disease

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which dwarfs the number two Killer By

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the way which is cancer at about 12 to

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13 million so you've got to know this

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APO B concentration everybody at least

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once in their life needs to have their

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LP little a measured that's it that's

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genetically determined so once you've

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measured it once you don't really need

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to recheck it

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um and we think everybody needs to know

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their APO e genotype this is a gene that

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plays an important role in Alzheimer's

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disease and also in cardiovascular

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disease and knowing that can help you

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understand how aggressive you might need

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to be in prevention so those are a

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handful of the the things that you know

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we just think are very important for

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everybody to know you write in the book

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about emotional health and why it's so

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important and you you know there's a

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line from your therapist I want to say

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that kind of sums up the whole book I

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mean why do you you want to live longer

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if you're so unhappy it's just a pretty

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simple question but pretty profound

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yeah this is another one of those things

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that doesn't show up anywhere in the

16:34

standard diagnostic list of criteria and

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it's one of those things that probably

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matters more than anything else because

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if you don't have it nothing else

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matters right so if if your life sucks

16:48

living longer is actually a curse not a

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blessing regardless of the state of your

16:53

physical health so I do think that even

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though it's probably not something as a

16:58

PR as a as a profession we spend enough

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time talking about we do really want to

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understand what a person's sense of

17:07

purpose is how strong their

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relationships are I do think that

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generally people understand that there's

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a there's a reasonable correlation

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between the the strength of your

17:17

relationships and your happiness yeah

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and there's a reasonable correlation

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between happiness and length of life and

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I and I think that there's some

17:22

causality there too and I think the real

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question becomes what can you do about

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it right at the individual level if

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you're you're sitting where I was

17:31

sitting six years ago which was to say

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you know physically healthy but not

17:36

emotionally healthy can can you bend the

17:39

Arc of that curve in the same way that

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you can bend the Arc of the curve of

17:44

your Fitness your muscle mass your

17:45

strength your lipid numbers your insulin

17:48

resistance numbers and the answer

17:49

unequivocally is yes

17:52

Dr Peter attia author of outlive the

17:55

science and art of longevity thanks so

17:57

much for joining us yeah thank you so

17:58

much for having me

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