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
secret for living a long healthy and
happy life Dr Peter attia's new book
lays out a how-to guide for longevity
focusing on preventative approaches
rather than treatment and he is joining
Hari sreenivasan to discuss the best
habits for a healthier life
Diana thanks Dr Peter attia thanks so
much for joining us now in your new book
outlive the science and art of longevity
you're not just trying to help us live
longer but you're trying to get us to be
healthy as well I mean you you have you
kind of make a distinction between
lifespan and health span spell that out
yeah lifespan is probably the easier of
those two things to explain which is uh
you know obviously how long you live and
that in that sense is is kind of binary
it's all or none you're alive or you're
not alive
um and unfortunately I think our medical
system uh mostly fixates on that metric
and obviously what gets measured gets
managed as the old saying goes what I
think we're not paying nearly enough
attention to is the quality of life and
uh that's what's captured in health span
right so there's a there's a cognitive
component to that there's obviously a
very physical component to that and
there's an emotional component to that
and if you don't really Define metrics
around those things it's probably not
surprising that we're not managing those
things and therefore most of the
resources and attention go to Simply
prolonging life even at the expense of
quality so when a patient approaches you
in your practice I mean kind of what are
the questions that you're asking them so
that you're kind of on the same path
together
well obviously we want to talk about all
of the medical things and all of the
things that deal with prolonging life as
well so we certainly want to understand
all the risks coming in with respect to
you know what we talk about as the Four
Horsemen of death you know
cardiovascular disease neurodegenerative
disease cancer Etc
but on the health span side we spend
just as much time and energy thinking
about for example what do you want to be
able to do in the last decade of your
life this becomes a very important
framing question and the more detail
that a person can provide sometimes with
our prodding as to what they actually
want to be able to do right do you want
to be able to pick up a grandchild do
you want to be able to travel these
things require very deliberate planning
and most people can't do these things in
the last decade of their life unless
they train for it so you know you took a
look and studied
people who are 100 years old and
was there something
that they had in common that we can
apply in our lives so the one thing that
is common to all centenarians is that
from the standpoint of chronic disease
there are about 20 to 25 years younger
than their birth certificate age says
wow in other words their first brush
with cancer their first brush with heart
disease their first brush with any sort
of chronic ailment is about 20 to 30
years after you would expect based on
their you know birth certificate age so
they have a superpower and the
superpower is they delay the onset of
chronic disease now the question of
course the million dollar question is
are they doing something in in order to
get that superpower right is it is it
you know
is there some magic diet or something
like that yeah and unfortunately I say
unfortunately for the rest of us who
don't have those genes the answer is no
um and and it's actually more likely
your observation which is on average
believe it or not centenarians are more
likely to smoke more likely to drink
less likely to exercise and less likely
to eat well and yet despite those things
they have this Supernatural lifespan
but that doesn't mean we can't learn
from them what we learn is we have to
apply to ourselves other tools to get
their benefits in other words we have to
use nutrition exercise sleep stress all
those other things as tools to get what
they get for free genetically we have to
create a phase shift of time in the
onset of chronic disease let's first
talk about
um just exercise I mean you write a
tremendous amount that that is one of
the most beneficial things that we could
be doing earlier in our lives to prevent
a lot of ailments
yep exercise is hands down the most
potent tool slash intervention that we
have to affect both of the metrics we
care about lifespan and health span so
on the lifespan side of the equation
having a very high degree of
cardiorespiratory Fitness having high
muscle mass and high strength relative
to your sex and age
is a better predictor
of longer life meaning a greater
reduction of all cause mortality death
for many causes than anything else we
have positive or negative the benefit
bestowed on an individual from being
very high in those categories is greater
than the harm that comes from smoking
having high blood pressure having type 2
diabetes even having kidney disease
which would be the step right before
needing a transplant so as much as we
understand how harmful those things are
it's even more beneficial to be
incredibly fit and incredibly strong so
if you're just thinking about how do I
live longer that's the ticket
on the other side of the Ledger when we
think about the quality of life there
simply is no greater tool to Foster
neurodegenerate neuro neuro protection
and ward off neurodegeneration than
exercise and of course exercise is the
most important piece in maintaining your
physical body as you age so you can do
all those things you would want to do in
that last decade of your life is there
a combination of things that will help
your body prepare for aging better than
anything else
you know if there's one drawback to
exercise it's that it takes more time
than all of the other things that we
might think of as being beneficial few
things take as much time to reap the
full benefit uh from as exercise you
need to be doing strength training you
need to be doing cardio respiratory
training and that cardio training needs
to be at different levels of intensity
about 80 percent of it needs to be at
relatively low intensity the level of
intensity at which you could still carry
out a conversation albeit a strained one
and about 20 of it needs to be at a
higher level of intensity where you
couldn't carry out a conversation and I
think for the individual who says look
Peter I am not willing to spend more
than 90 minutes a week exercising yes I
would rather have them you know focus on
what's not necessarily what I think the
best approach to exercise is but doing
whatever they can to get some benefits
but the way I ask my patients is very
different I start in Reverse I say
tell me how many hours a week you're
willing to put into this and I've
already explained to them and shown them
all the data that explain why this is
going to have a greater impact on the
length and quality of their life than
anything they will ever do
let's talk a little bit about nutrition
you for a time being were a big fan of
Keto diets and and in the book you kind
of walk through why and how you changed
your mind about that
um explain to our audience
um how should we be thinking about
nutrition
in the context of Aging I go to Great
Lengths in the book to detach from diets
and really just talk about nutrition as
a biochemistry phenomenon let's just
talk about it through the lens of
biochemistry and molecules
the most important component of your
nutrition is basically the energy
balance it creates in your body in other
words is a person overnourished or
undernourished now for most of our
existence we have been undernourished
right for if you think about a thousand
years ago 500 years ago 200 years ago
most of us were barely getting enough
energy right and and our bodies of
course evolved remarkable ways to store
and hold on to energy this is what
basically allowed us to LeapFrog ahead
of all other species in terms of our
remarkable brains because our brains are
so energy hungry well that worked really
well until our you know modern
environment which basically created such
an abundance of food that now most of us
are on the other side of that we are
overnourished strategy number one is you
have to reduce energy intake
and there are basically three approaches
to that Each of which can work Each of
which has advantages and Each of which
has disadvantages so broadly speaking
they are direct caloric restriction
dietary restriction and time restriction
to say a bit more about them direct
caloric restriction as the name suggests
means
you just deliberately go about eating
less while paying attention to how much
you are eating not necessarily paying
attention to when you're eating or what
you're eating but just reducing the
total caloric burden
dietary restriction of which you
mentioned an example a ketogenic diet is
a form of dietary restriction but so are
most quote unquote diets this is when
you just restrict certain elements
within the diet and what that results in
is less overall consumption so it's an
indirect way to go about calorie
restriction
finally time restriction is also an
indirect way to go about calorie
restricting by creating a narrower and
narrower window in which you eat and if
you create a narrow enough window you
will end up reducing intake now
you know we don't have to go into the
details of how each of these has a
benefit and each of these has a risk but
none of these are you know things that
you should do mindlessly each of these
are things you have to be mindful of the
blind spots and pitfalls and work around
them
you spent a fair amount of time talking
about sleep why is it
as important I mean I'm somebody who
doesn't get enough sleep and I feel like
it's underrated but you know younger
points in my life I didn't really think
about how much I was getting maybe
because I was obviously younger and I
was fitter and I was able to rebound
faster but now if I don't get a good
night's rest it's really difficult to
perform at the same level every day in
the book I talk about a thought
experiment which is effectively like you
know Evolution didn't muck around right
Evolution
everything about evolution is is really
laser focused and if you think about it
no one disputes that we are optimized to
forage for food to reproduce to fend for
ourselves I mean these are the
characteristics that Evolution owned why
would Evolution have kept around this
behavior that rendered us unconscious
for eight hours a day it just doesn't
make any sense and the only way you
could really justify this is if that
eight hours I.E one third of our life
that is spent in unconsciousness must be
doing something so important we have
never figured out a way to out evolve it
we've never even figured out a way to
reduce it by half like it's basically
just stuck there at about seven to eight
hours
and
that's kind of what I think I talk a
little bit about in the book right is
like what are those features of sleep
why is that important to brain health
why is that important to memory
consolidation why does that play an ins
in a profound role in metabolism right
so many of the problems that I think we
have with obesity metabolic Health
insulin resistance type 2 diabetes can
actually be attributed to poor sleep
just as much as they can be attributed
to poor diet
you know a lot of the book also it takes
a critical look at our existing Health
Care System you write that both health
insurance companies won't pay a doctor
very much to tell a patient to change
the way he eats or to monitor his blood
glucose levels in order to help prevent
him from developing type 2 diabetes yet
insurance will pay for this same
patients very expensive insulin after
he's been diagnosed so is there a way to
turn what seems like the largest
industry in the country around to think
kind of proactively instead of
reactively
I mean there clearly is from a
conceptual standpoint from a structural
standpoint I don't want to be naive and
and suggest that it's going to be easy
but uh that example that you you read
the quote from I think illustrates kind
of the point right which is
everything follows the dollar and I
don't say that as a skeptical guy like
dollars are important I'm a capitalist
it's all about you know you have to set
the right economic incentives but right
now the economic incentives in medicine
are around diagnosis and pharmacologic
treatment and I'm not here to say
pharmacologic treatments don't matter
they're very important and we do rely on
them but the point here is we were
really only educated along one parameter
of Intervention which is procedural and
pharmacologic and if the entire system
of reimbursement is based on creating a
diagnosis and developing a treatment
plan along those metrics and by the way
go back to what I said at the outset and
the only metric of interest is length of
life
you you will create the machine we have
called medicine 2.0 and by the way
medicine 2.0 was very successful at
treating some things namely infectious
diseases and acute problems such as
trauma this is what has effectively
doubled the lifespan of humans in the
last 150 years it's the success of that
model medicine 2.0 applied in that way
which is wait till the problem happens
treat it with pharmacologic intervention
or procedural intervention
yeah what we're seeing is that Playbook
is not working with chronic diseases not
even close and the only way you're going
to treat chronic diseases is moving on
to an approach where you treat you where
you really enact prevention
and if you want to incentivize
Physicians to do that they have to be
educated in this way and you have to be
able to reimburse for these tools you
have to be able to reimburse Physicians
uh and you have to be able to
incentivize patients to take care of
themselves 30 years before they have
that heart attack if you were to advise
a patient that's heading to their doctor
what are the kinds of things that you
would tell them to kind of perk their
ears up on or listen close to this
number that are good guides for
healthfulness
I want patients to understand there are
some things that labs are really good at
there are a lot of things they're not
good at everybody should know their APO
B APO B is a number that measures the
total concentration of the cholesterol
carrying particles in the blood that
drive atherosclerosis which is the
dominant Force driving heart disease
again
can't say it enough right heart disease
is the leading killer globally about 19
million people per year die of
atherosclerotic cardiovascular disease
which dwarfs the number two Killer By
the way which is cancer at about 12 to
13 million so you've got to know this
APO B concentration everybody at least
once in their life needs to have their
LP little a measured that's it that's
genetically determined so once you've
measured it once you don't really need
to recheck it
um and we think everybody needs to know
their APO e genotype this is a gene that
plays an important role in Alzheimer's
disease and also in cardiovascular
disease and knowing that can help you
understand how aggressive you might need
to be in prevention so those are a
handful of the the things that you know
we just think are very important for
everybody to know you write in the book
about emotional health and why it's so
important and you you know there's a
line from your therapist I want to say
that kind of sums up the whole book I
mean why do you you want to live longer
if you're so unhappy it's just a pretty
simple question but pretty profound
yeah this is another one of those things
that doesn't show up anywhere in the
standard diagnostic list of criteria and
it's one of those things that probably
matters more than anything else because
if you don't have it nothing else
matters right so if if your life sucks
living longer is actually a curse not a
blessing regardless of the state of your
physical health so I do think that even
though it's probably not something as a
PR as a as a profession we spend enough
time talking about we do really want to
understand what a person's sense of
purpose is how strong their
relationships are I do think that
generally people understand that there's
a there's a reasonable correlation
between the the strength of your
relationships and your happiness yeah
and there's a reasonable correlation
between happiness and length of life and
I and I think that there's some
causality there too and I think the real
question becomes what can you do about
it right at the individual level if
you're you're sitting where I was
sitting six years ago which was to say
you know physically healthy but not
emotionally healthy can can you bend the
Arc of that curve in the same way that
you can bend the Arc of the curve of
your Fitness your muscle mass your
strength your lipid numbers your insulin
resistance numbers and the answer
unequivocally is yes
Dr Peter attia author of outlive the
science and art of longevity thanks so
much for joining us yeah thank you so
much for having me
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