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

Summary

Dr. Peter Attia, author of 'Outlive: The Science and Art of Longevity,' discusses the distinction between lifespan and health span, emphasizing the importance of quality of life. He highlights the role of exercise, nutrition, sleep, and emotional health in delaying chronic diseases and enhancing both lifespan and health span. Attia critiques the current healthcare system for its focus on treatment rather than prevention and suggests a shift towards incentivizing preventive measures and patient self-care.

Takeaways

• 📚 Dr. Peter Attia's book 'Outlive' focuses on a preventative approach to health and longevity, emphasizing the distinction between lifespan and health span.
• 🌟 Health span is more than just living longer; it includes cognitive, physical, and emotional well-being, which are often overlooked in favor of prolonging life at all costs.
• 🏋️‍♂️ Exercise is the most potent tool for improving both lifespan and health span, providing significant benefits in reducing all-cause mortality and protecting against neurodegeneration.
• 🏃‍♀️ A balanced exercise routine includes both strength training and cardiorespiratory training, with 80% at low intensity and 20% at higher intensity.
• 🍽️ Nutrition should be viewed through the lens of biochemistry, focusing on energy balance and avoiding overnourishment, which can be addressed through caloric restriction, dietary restriction, or time restriction.
• 🥗 The ketogenic diet is mentioned as a form of dietary restriction, but Dr. Attia has revised his views on it, advocating for a more nuanced understanding of nutrition and its impact on aging.
• 💤 Sleep is crucial for overall health, playing a profound role in brain health, memory consolidation, and metabolism, with poor sleep linked to obesity and metabolic issues.
• 🏥 The current healthcare system is criticized for its focus on reactive rather than proactive measures, with economic incentives aligned with diagnosis and pharmacologic treatment rather than prevention.
• 🧠 Patients should be aware of certain health markers like APO B and APO E genotype, which are crucial for understanding cardiovascular and Alzheimer's disease risks.
• 💡 Emotional health is essential for a meaningful longer life, with happiness and strong relationships positively correlating with both emotional well-being and longevity.

Q & A

What is the main focus of Dr. Peter Attia's book, 'Outlive'?

The main focus of Dr. Peter Attia's book 'Outlive' is to provide a guide for longevity that emphasizes preventative approaches over treatment, aiming to improve not just lifespan but also health span.

What is the difference between lifespan and health span?

Lifespan refers to the length of time an individual lives, which is binary (either alive or not). Health span, on the other hand, captures the quality of life, including cognitive, physical, and emotional components.

How does Dr. Attia approach a patient's health span?

Dr. Attia approaches health span by considering what the patient wants to be able to do in the last decade of their life, emphasizing deliberate planning and training to achieve those goals.

What commonality did Dr. Attia find among centenarians?

Dr. Attia found that centenarians are, on average, about 20 to 25 years younger in terms of chronic disease onset than their actual age suggests, indicating they have a delayed onset of chronic diseases.

What role does exercise play in longevity and health span?

Exercise is the most potent tool for affecting both lifespan and health span. It significantly reduces all-cause mortality and provides neuroprotection, aiding in maintaining physical capabilities as one ages.

What are the three approaches to reducing energy intake for better nutrition?

The three approaches are direct caloric restriction, dietary restriction (such as ketogenic diets), and time restriction, which involves narrowing the window of time in which one eats.

Why does Dr. Attia believe sleep is important for health?

Dr. Attia believes sleep is important because it is a behavior that evolution has not optimized out, suggesting it plays a crucial role in health, including brain function, memory consolidation, and metabolism.

What is the issue with the current healthcare system's approach to chronic diseases?

The current healthcare system focuses on diagnosis and pharmacologic treatment, which is not effective for chronic diseases. A more proactive approach focusing on prevention is needed to address these conditions effectively.

What advice does Dr. Attia have for patients visiting their doctor?

Dr. Attia advises patients to understand the limitations of lab tests, to know their APO B levels, and to be aware of their APO E genotype, as these factors can provide insights into their risk for heart disease and other health conditions.

How does emotional health factor into overall health and longevity?

Emotional health is crucial because if one's life lacks happiness and purpose, living longer can feel more like a curse than a blessing. Strong relationships and happiness are correlated with longer lifespans.

What does Dr. Attia suggest about the possibility of improving emotional health?

Dr. Attia suggests that just as one can improve physical fitness and health markers, it is possible to positively influence emotional health and well-being through proactive measures.

Outlines

00:00

📚 The Art of Longevity: Dr. Peter Attia's Insights

Dr. Peter Attia, author of 'Outlive: The Science and Art of Longevity,' discusses the distinction between lifespan and health span, emphasizing the importance of quality of life over mere longevity. He highlights the need for a preventative approach to health, focusing on habits that promote both a longer and healthier life. Attia shares insights from studying centenarians, noting their delayed onset of chronic diseases and the importance of defining metrics for health span. He also addresses the common misconceptions around diet and exercise, advocating for a more deliberate approach to maintaining health and fitness.

05:01

💪 The Power of Exercise in Aging Gracefully

This paragraph delves into the profound impact of exercise on both lifespan and health span. Dr. Attia asserts that high cardiorespiratory fitness, muscle mass, and strength are the most potent predictors of a longer life, outweighing the risks associated with smoking, high blood pressure, and other health issues. He discusses the role of exercise in neuroprotection and maintaining physical capabilities in old age. Attia also addresses the time commitment required for exercise, advocating for a balanced approach that includes both low and high-intensity training.

10:03

🍽️ Nutritional Strategies for Healthy Aging

Dr. Attia shifts the focus from diets to nutrition as a biochemistry phenomenon, emphasizing the importance of energy balance. He outlines three strategies for reducing energy intake: direct caloric restriction, dietary restriction, and time restriction. Attia explains the advantages and disadvantages of each approach, urging listeners to be mindful of potential pitfalls. He also critiques the modern healthcare system's focus on treatment rather than prevention, advocating for a shift towards proactive healthcare that incentivizes lifestyle changes.

15:05

💤 The Evolutionary Mystery of Sleep and Its Role in Health

In this section, Dr. Attia explores the significance of sleep, challenging the evolutionary rationale behind spending a third of our lives unconscious. He posits that sleep must serve a vital function, crucial for brain health, memory consolidation, and metabolism. Attia links poor sleep to obesity, metabolic health issues, and insulin resistance, advocating for a greater understanding and prioritization of sleep in healthcare. He also addresses the need for a systemic change in healthcare, moving from a reactive to a proactive model that focuses on prevention and early intervention.

🧠 Prioritizing Emotional Health for a Fulfilling Longevity

Dr. Attia concludes the discussion by highlighting the importance of emotional health in the pursuit of a long and happy life. He emphasizes that without happiness, longevity becomes a curse rather than a blessing. Attia suggests that understanding one's sense of purpose and the strength of personal relationships can be as important, if not more so, than physical health metrics. He encourages individuals to actively work on improving their emotional well-being, bending the arc of their emotional health curve just as they would with their physical fitness and other health indicators.

Mindmap

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Keywords

💡Longevity

Longevity refers to the quality of living a long, healthy, and happy life. In the context of the video, Dr. Peter Attia discusses strategies for achieving longevity through preventative approaches rather than focusing solely on treatment. It's about enhancing both lifespan and health span, which involves maintaining good health and cognitive function throughout one's life.

💡Health Span

Health span is the period of a person's life during which they are generally healthy and free from serious, chronic illnesses. Unlike lifespan, which is simply the length of time one lives, health span emphasizes the quality of life. Dr. Attia highlights the importance of focusing on health span to ensure that the additional years of life gained through longevity are also years of good health.

💡Preventative Approaches

Preventative approaches refer to strategies that aim to prevent diseases or health issues before they occur. In the video, Dr. Attia advocates for a shift from primarily reactive medical treatments to more proactive measures that focus on maintaining health and preventing chronic diseases, such as cardiovascular disease, neurodegenerative diseases, and cancer.

💡Cardiorespiratory Fitness

Cardiorespiratory fitness is the ability of the circulatory and respiratory systems to supply oxygen to the muscles during sustained physical activity. It is a key component of overall health and is crucial for longevity. High cardiorespiratory fitness can significantly reduce all-cause mortality and is a better predictor of longer life than many other factors, including smoking, high blood pressure, and diabetes.

💡Neuroprotection

Neuroprotection refers to the preservation and protection of neurons (nerve cells) in the brain, which is essential for maintaining cognitive function and preventing neurodegenerative diseases such as Alzheimer's. Exercise is highlighted in the video as a critical tool for fostering neuroprotection and warding off neurodegeneration as one ages.

💡Nutrition

Nutrition encompasses the intake and utilization of nutrients that are essential for growth, maintenance, and overall health. In the context of the video, Dr. Attia emphasizes the importance of understanding nutrition as a biochemistry phenomenon and focusing on the energy balance it creates in the body. He discusses the need to reduce energy intake through various approaches such as caloric restriction, dietary restriction, and time restriction.

💡Sleep

Sleep is a vital physiological process that is crucial for brain health, memory consolidation, and metabolism. The video discusses the importance of sleep and how poor sleep can contribute to various health issues, including obesity and metabolic health problems. It suggests that the evolutionary significance of spending one-third of our lives asleep indicates the critical role sleep plays in our well-being.

💡Health Care System

The health care system refers to the organization, management, and delivery of health care services, including preventive, curative, and palliative care. In the video, Dr. Attia critiques the current health care system for its focus on reactive rather than proactive care, highlighting the need for a shift towards incentivizing prevention and lifestyle changes.

💡APO B

APO B is a measure of the total concentration of cholesterol-carrying particles in the blood that contribute to atherosclerosis, the build-up of plaque in the arteries, which is the leading cause of heart disease. Knowing one's APO B level is crucial for assessing the risk of heart disease and can guide preventative measures.

💡APO E Genotype

APO E genotype refers to the specific set of genes an individual has that influence how their body processes cholesterol and fats. Different APO E gene variations can affect a person's risk for Alzheimer's disease and cardiovascular disease. Understanding one's APO E genotype can help inform prevention strategies and lifestyle adjustments.

💡Emotional Health

Emotional health pertains to a person's psychological well-being, including their emotional state, mental health, and overall happiness. The video stresses the importance of emotional health for a fulfilling life, suggesting that living longer is not beneficial if one's emotional health is poor.

Highlights

Dr. Peter Attia's new book focuses on a how-to guide for longevity, emphasizing preventative approaches over treatment.

Attia distinguishes between lifespan and health span, noting that the medical system often focuses on the former, neglecting quality of life.

Health span encompasses cognitive, physical, and emotional components, which are crucial for a good quality of life.

Attia asks patients about their desires for the last decade of their life to frame their health goals.

Centenarians are, on average, 20-25 years 'younger' in terms of chronic disease onset than their actual age.

Despite common habits like smoking and drinking, centenarians have a 'superpower' of delayed chronic disease onset.

Exercise is the most potent tool for affecting both lifespan and health span, providing significant benefits for neuroprotection and physical maintenance.

Attia advises on the importance of a balanced exercise routine, combining strength training and cardiorespiratory training.

Nutrition should be viewed as a biochemistry phenomenon, with a focus on energy balance and avoiding overnourishment.

Attia discusses three approaches to reducing energy intake: direct caloric restriction, dietary restriction, and time restriction.

Sleep is crucial for brain health, memory consolidation, and metabolism, with poor sleep linked to obesity and metabolic issues.

Attia critiques the healthcare system for incentivizing reactive rather than proactive healthcare, particularly regarding chronic diseases.

Patients should be aware of their APO B levels and APO E genotype for heart disease and Alzheimer's prevention.

Emotional health is vital for a meaningful extended life, with happiness linked to both relationship strength and life length.

Attia suggests that emotional health can be improved just like physical health, and it significantly impacts overall well-being.

The conversation emphasizes the importance of a holistic approach to health, combining medical, lifestyle, and emotional factors.

Transcripts

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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