Feel Better, Live More with Dr Rangan Chatterjee - BITESIZE | The Most Critical Factor for Overall Health and Longevity | Dr Peter Attia  #423

Starting point is 00:00:00 Today's Bite Size episode is brought to you by AG1, a science-driven daily health drink with over 70 essential nutrients to support your overall health. It includes vitamin C and zinc, which helps support a healthy immune system, something that is really important at this time of year. It also contains prebiotics and digestive enzymes that help support your gut health. It's really tasty and has been in my own life for over five years. Until the end of January, AG1 are giving a limited time offer. Usually they offer my listeners a one-year supply of vitamin D and K2 and five free travel packs with their first order. But until the end of January, they are doubling the five free travel packs to

Starting point is 00:00:51 10. And these packs are perfect for keeping in your backpack, office, or car. If you want to take advantage of this limited time offer, all you have to do is go to drinkag1.com forward slash live more. Welcome to Feel Better Live More Bite Size, your weekly dose of positivity and optimism to get you ready for the weekend. Today's clip is from episode 356 of the podcast with medical doctor and longevity expert, Dr. Peter Atiyah. In this clip, Peter shares why he believes that exercise is the area we need to focus on the most when it comes to our health and longevity. In the book, you make the case that exercise may well be the most potent longevity intervention that exists. Do you still stand by that? And if so, why do you put that right at the

Starting point is 00:01:57 top? The answer to the first question is very simple. Yes, I certainly do. And the answer to the second question is also quite simple, which is it really is not a matter of opinion. It is simply a matter of the data. The data make it abundantly clear. Maybe for the sake of the audience, we can explain what a hazard ratio is, right? So a hazard ratio is a number that communicates the relative risk of one condition relative to another. So for example, the hazard ratio associated with all-cause mortality for a smoker versus a non-smoker is about 1.4. And so statistically, what that means is a smoker is about 40% more likely to die in any given year than a non-smoker, all other things being equal. That's what the 1.4 means. And if we were to look at something, some intervention, I'm making this up, but drinking a certain type of tea, if that had a hazard ratio of 0.91, we would say that

Starting point is 00:03:03 that intervention is associated with a 9% relative reduction in risk. If the hazard ratio is one, it means there's no difference. Okay. So that's the math on hazard ratios. So when you look at the hazard ratios associated with all-cause mortality, and of course, all-cause mortality is the gold standard of thinking about lifespan. Let's consider the known things that rob people of lifespan. Type 2 diabetes, high blood pressure, coronary artery disease, smoking, end-stage renal disease. Those would be the big ones. What are the hazard ratios associated with each of those conditions? Well, at one end of the spectrum, you'd see hypertension has a hazard ratio of about 1.2. It's about a 20% increase in all-cause

Starting point is 00:03:48 mortality, meaning you're 20% more likely in any year to die than someone who's otherwise equal without hypertension. Smoking, as I said, is about 1.4, 1.41. Coronary artery disease, about 1.3. Type 2 diabetes, about the same. End-stage renal disease, about 2.75, somewhere between 1.75 and 2.75. So anywhere from a 75 to 175% increase. But now when you do the same analysis based on different metrics of cardiorespiratory fitness, strength, and muscle mass, the numbers are simply bigger and they're bigger by a lot. So for example, when you look at comparing the VO2 max of somebody in the bottom 25% of the population for their age and sex, so meaning someone in the bottom quarter of their age and sex in terms of maximal oxygen uptake, which is a test that we can readily do on people,

Starting point is 00:04:43 it's a measure of peak aerobic capacity, and you compare that to someone in the top 2% of the same age and sex, the hazard ratio is 5, slightly over 5, meaning it's a 400% difference in all-cause mortality. In fact, if you just go from being in the bottom 25th percentile to being slightly above average from the 50th to 75th percentile, the hazard ratio difference is 2.75, meaning it's even more significant than having end-stage renal disease. I could go through this analysis all day long and I could do the same thing for muscle mass and I could do the same thing for strength. But across the board, the difference in all-cause mortality is significantly wider when it comes to measures of strength and fitness than it is for any disease condition we know. And so the corollary

Starting point is 00:05:39 of all of this is, by definition, whatever it is you have to do to have that higher vo2 max greater muscle mass and greater strength must be hands down the most potent thing we have at our disposal to live longer and of course the only way one can have those things is through the right type of exercise yeah i really appreciate how you broke that down peter. Very, very clear. I think it would be useful to talk about your four horsemen, because I think it's such a beautiful concept for people to get their heads around the kind of core philosophy behind your approach. So when you want to think about lifespan, it seems only logical that one must have a great understanding of what the impediments are to lifespan. In other words, what takes our life away?

Starting point is 00:06:32 And for a non-smoker, this can be pretty easily distilled into the big four. And the big four are the diseases of atherosclerosis, so cardiovascular and cerebrovascular disease, far and away number one, followed by cancer. Number three is neurodegenerative disease and related dementias. And then the fourth horseman is not so much on the list because of the number of lives that it directly takes, but because of the number of lives that it indirectly takes. And that's less a disease and more of a spectrum, the spectrum ranging from insulin resistance and NAFLD or non-alcoholic fatty liver disease, all the way to type two diabetes. It's basically what we think of as the metabolic diseases,

Starting point is 00:07:26 type 2 diabetes. It's basically what we think of as the metabolic diseases, which again, in terms of how often those diseases show up on the death certificate as the proximate cause of death is not that large, but it's how those things amplify the risk of the other three horsemen by typically about twofold. So what we really want to be careful of is understanding that when you have type two diabetes, non-alcoholic fatty liver disease, insulin resistance, your risk of cancer, neurodegenerative disease, and heart disease goes up significantly. And so by understanding everything we can about the four horsemen, we have a chance to delay their onset. And that's really the objective here. I don't think we are in a situation, barring science fiction, to completely eliminate the horseman. Certainly, some of these diseases seem somewhat inevitable to our species. Cancer, for example, at the end of the day,

Starting point is 00:08:20 is ultimately a tug of war between acquired genetic mutations that alter cellular properties and the ability of our immune system to detect them and evade them. But we can certainly delay these, and we have great proof already that that happens. And the proof exists in the long-lived people, the so-called centenarians, people who live already to the age of 100 or more. And we know from studying these people that their superpower is not living longer with the four horsemen. It's living longer without the four horsemen. Once they come down with the same diseases as the rest of us, the time it takes for them to die is about the same. It's that they get the diseases about two decades later than everybody else.

Starting point is 00:09:10 And that's what we have to figure out. Right now, are there any generic health recommendations you can make to people without knowing their personal history? Yeah. I mean, I think the most obvious ones would certainly be around exercise, adequate sleep, and adequate protein consumption. I mean, I think those are three almost across the board recommendations that can be made. Now, what adequate means will differ for different people. So for me, the amount of exercise that I now need, given my training history, right, I've been exercising, you know, my entire life. So for me to receive what we would call the training effect requires me to do quite

Starting point is 00:10:00 a bit. Whereas a person who doesn't exercise only requires about three hours a week to get an even greater benefit than I'm probably getting incrementally going from say nine hours a week to 12 hours a week if I were to make a change of that magnitude. So the details still matter, but exercise really has shown no upper bound in terms of benefit, at least through the lens of strength, muscle mass, and most importantly, cardiorespiratory fitness. There does not appear to be an upper bound of benefit, but that doesn't mean there isn't an upper bound to what you do in the pursuit of those things in terms of time and opportunity cost and also using injury as a risk. those things in terms of time and opportunity cost and also using injury as a risk. I mean, I do have a patient who was just hell bent on getting 20,000 steps a day. This became like this person's mission in life. Well, until they developed an injury in their foot from walking so much, because it turns out their mechanics and their shoes weren't really optimally suited for

Starting point is 00:11:01 what they were doing. So in pursuit of something that was clearly beneficial, it actually created a little bit of a problem. For people who go, okay, I get it. I get your philosophy. It's about getting stuck in earlier and not waiting till it's too late or very late before I start addressing things around my health and my longevity. I always like to finish the podcast with some sort of actionable take-homes for my audience. So for that person who does feel inspired and goes, okay, right, you've convinced me. I'm going to get on top of this now. I'm 40 years old. It's not going to happen to me what happened to my father or my brother or my granddad or whatever. I want to take control of my life and my health. What would you say to them?

Starting point is 00:11:51 What you want to do is take advantage of the fact that you're 40, right? And take advantage of the fact that you have hopefully four or five decades ahead of you on which to compound benefit. This is a much different proposition than if you're in the last few years of your life, what I call the marginal decade, and you realize, oh, I want to do something about it. There's still value in making change at any point, but you're going to be able to move the needle less. So if you're talking about this through the lens of somebody who's in midlife or even younger, what you want to do is say, what changes can I make consistently? I often say, I'd much rather someone do seven out of 10 work every single day than do 10 out of 10 work some days

Starting point is 00:12:33 and zero out of 10 work other days. The ping-ponging back and forth tends to produce inferior results. As far as what to do, if your VO2 max is at the 25th percentile, that's an enormous opportunity. You have to be doing the type of training that's going to increase VO2 max, both increasing your aerobic efficiency, your base of aerobic fitness, and your peak. If by extension, your VO2 max is already at the 80th percentile, but your muscle mass and strength are at the 20th percentile, then that's where you just need to disproportionately train while you do things to maybe maintain your aerobic fitness. Again, the list goes on and on. If your sleep is really the thing that's suffering,

Starting point is 00:13:17 then that's where you need to focus. If you're overnourished and under muscle, then you're going to be focusing on strength training, protein, and calorie reduction. And that's probably going to be your biggest focus to get back onto a level playing field of health. Hope you enjoyed that bite-sized clip. I hope you have a wonderful weekend. And I'll be back next week with my long-form conversational Wednesday and the latest episode of Bite Science next Friday.

Feel Better, Live More with Dr Rangan Chatterjee - BITESIZE | The Most Critical Factor for Overall Health and Longevity | Dr Peter Attia #423

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Feel Better, Live More with Dr Rangan Chatterjee - BITESIZE | The Most Critical Factor for Overall Health and Longevity | Dr Peter Attia  #423