The Peter Attia Drive - #262 - AMA #49: Heart rate recovery, strength training, rucking, kidney function, and brain health

Episode Date: July 17, 2023

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter In this "Ask Me Anything" (AMA) episode, Peter goes into depth on the topic of brain health, starting with how Alzheimer's disease is diagnosed, the significance of blood-based biomarkers in diagnosis, and what the various APOE gene variants mean in terms of a person's risk of developing Alzheimer's disease. Next, Peter discusses the various strategies for preventing Alzheimer's disease and neurodegeneration. He touches briefly on exercise as a potent tool, but focuses more on lesser-known factors that could impact brain health, such as nutrition supplementation, lipid management, brain games, sauna, oral health, hearing loss, and more. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #49 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Topics: exercise, kidneys, and brain health [1:30]; Rucking: advice for beginners, proper load, packs, and shoes [4:30]; Rucking for women, bone health, using a treadmill, zone 2, and more [11:45]; Building vs. maintaining: when and how to transition from the goal of building muscle and strength to focusing on maintenance [16:00]; Should you lift weights before or after a cardio session? [24:00]; Heart rate recovery: defining heart rate recovery and how it relates to cardiovascular fitness [28:45]; How to measure heart rate recovery, and what is considered a "good" heart rate recovery [33:15]; How kidney health and function typically measured [42:30]; Differentiating between creatine and creatinine [48:15]; The cystatin C blood test as a practical way to assess kidney health [52:45]; How kidney function impacts lifespan and the five stages of kidney disease [59:15]; Slowing the decline of kidney function [1:08:15]; The main drivers of kidney disease [1:11:15]; The importance of managing homocysteine levels for brain health [1:14:00]; The relationship between alcohol consumption and brain health [1:21:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

Hey everyone, welcome to a sneak peek, ask me anything, or AMA episode of the Drive Podcast. I'm your host, Peter Atia. At the end of this short episode, I'll explain how you can access the AMA episodes in full, along with a ton of other membership benefits we've created. Or you can learn more now by going to PeterittiaMD.com forward slash subscribe. So without further delay, here's today's sneak peek of the Ask Me Anything episode. Welcome to Ask Me Anything episode 49. I'm once again joined by Nick Stenson. In today's episode, we discuss a few different topics. We start by answering some follow-up questions we've raised around some exercise content,

including questions for people who are interested in starting to rock, questions around how one may think about building muscle versus maintaining it, should you lift before or after cardio, and finally, some questions around heart rate recovery. From there, we dive into all things related to the kidney. This is something I've spoken about before, and quite recently, and we've gathered a lot of questions around what blood tests are the best to measure kidney function and what levels you would want to be at. How does this decline with age and why is it so important for anyone who cares about lifespan to have the highest possible glimereolar filtration rate and make sure that the rate of decline as we age is kept to a minimum.

We end the conversation with some follow-up topics from our latest Brain AMA, including those specifically around Homoostine and alcohol. If you're a subscriber and want to watch the full video of this podcast, you can find it on the show notes page. If you are not a subscriber, you can watch the sneak peek of the video on our YouTube page. So without further delay, I hope you enjoy AMA number 49. All right Peter, welcome to another AMA. How you doing? Doing very well.

I think we're just going to get right into it because we got a lot of good stuff to talk about today and we don't really want to run out of time. So what we did for today's AMA is we're going to cover a few different topics, the first of which is exercise. Now anyone who's listened is not going to be surprised we're talking about exercise. It's a topic we've covered before. But what we did is we really pulled questions that were follow up from a lot of previous conversations that we haven't touched on before. So these will hopefully be new exercise topics and

also hopefully be really actionable for people as they think about how they should exercise what it looks like. And so that includes questions around a lot of people are interested in how to start rucking, you know, what weight to do, how to know when to ratchet it up, shoes to wear, kind of the more nitty gritty, and so we're going to get into that. We'll also talk about kind of when you think about building, talk about when you think about building versus maintenance in terms of strength training, how you know where to break down those two, as well as questions around, should you lift before or after cardio? What one is quote unquote better? And then we also have some questions on heart rate recovery, which is something we haven't necessarily dove too deep into. So I think it'll be good to talk about

that from there, we're going to get to questions around the kidney. And now, the kidney is something that we haven't talked about a ton on the podcast, but have a little more recently in the podcast with Ethan Weiss, talked about it in AMA48 on blood pressure. And so we pulled some questions from there, which hopefully will be really applicable to people in terms of what do you even know about kidneys in terms of what is a good and bad metric as it relates to a blood biomarker? Because there's typical biomarkers that people track, and I know there's ones that you

track with your patients and kind of looking at the difference in those and what people should be looking at to determine kidney function, as well as also talking about how kidney function declines as we age and what we know about that. So much like muscle, you always talk about because it declines, you wanna start as high as possible. So getting into what do we know about the kidney as it relates to that?

So even if you're 30, 40, 50 and your kidney metrics are quote unquote good, how does that look for your age with what we know about decline? And then we'll end with a few follow-up questions that kind of arose in topics from the brain. AMA that we're going to dive a little deeper on, provide a little more clarification on as it relates to alcohol, homocysting.

We got a lot to do, which is why we're kind of getting into it. So anything you want to touch on before we hit it No, that sounds like a great order of operations. Let's get to it So the first question is a set of questions which is around rucking. So again Everyone who's listened will know how much you enjoy rucking not only for the physical but also emotional benefits We've talked a lot about it in the past. A lot of people are interested. They kind of get their packs.

They are starting to do it and just have some more follow up questions on the details and the specifics to start safely, make sure they don't get hurt, and also how to know when to ratchet it up. So I think the first question that we get all the time is, what weight should people start at when they're going to rock? So if someone says to you, hey, never rock before. I'm really interested

in it. How do I think about what the weight should be on my pack? I don't think there's a correct answer of this question. It's completely dependent on the fitness and health of the person. So for some people, you know, like if my mom said, I want to start rucking, I would say a far lower weight than if you asked me that question. One end of the spectrum is little as just go out and walk. Let's just make sure you can walk easily, safely, comfortably with a backpack on your back that has nothing in it. And then for others, you might say, well, let's start with 10% of your body weight, et cetera. I think you don't really need to go beyond about a third of your body weight. So the answer is going to ultimately probably get you to there. But this is also highly dependent on the terrain, how flat it is, how uneven it is.

All of these things make it obviously more or less difficult. So I just think that the first few times you go out there, it's hard to overstate how foreign it can feel on your shoulders on your traps and so you don't want to overdo it for a couple reasons one. There's just a risk of getting injured but two You want to enjoy this, right? So I'm suggesting this to people I don't want them to go out there and get destroyed So when I have friends that come over to Ruck with me for the first time, I'm not trying to prove to them how tough I am and making them carry the same weight I've carried because

all it's going to do is leave them feeling like this sucks. That's not fun. I don't want to do that again. So when in doubt, start low and if you come back from a Ruck and you're like, that just felt like I went for a walk, there was no additional stress. Great. Had more weight the next time. No, I think that's a good point, which is right.

Like, don't have an ego in it when you're starting and just start slow. I also appreciate that you think I'm in better health than Mama Attia, who's probably a little older than me. So that's always appreciated. The next question is people looking at packs. And there's shoulder packs and there's shoulder packs with weight bands.

And you've talked about waistbands before, but I think it's just important to just double click on it for 30 seconds, which is, do you recommend everyone gets a waistband to go with a rug bag? You know, I certainly like it, but there are very different styles of rucking. I know people who really prefer to have all the weight in their shoulders and they don't want to have any of it on their waist. And there's really three things to consider. So there's the waist band that allows you to, if you cinch it down correctly, it allows you to keep more of that weight on your hips. There's also on the front of a backpack, there's

a little strap that keeps the straps of the pack more or less tight. And then obviously there's the shoulder pack, meaning there's like the straps that are pulling on your shoulders. Okay, so those are kind of like the three variables you can tweak. I say experiment with all of the above. I do think most people benefit from a hip belt because I think it is advantageous to put more of the weight on your hips than on your shoulders. Now for me personally, I go one step further and I don't even buckle the little strap that joins the shoulder straps. I like to have as little weight as possible on my shoulders and as much

weight as possible on my hips. So I'm cinching down like crazy on my hips and it's actually kind of loose on my shoulders. Again, no right way or wrong way to do this, but you wanna get a feel of what works for you. I use a go-ruck pack. I have three or four of them here, so I've got mine, my wife's got hers. We have like, you know, a couple bonus ones for when people come over to Ruck.

We put hit bands on all of them. And when folks come over to Ruck with us, we always recommend that they sing it down. You mentioned terrain, right? So oftentimes you can rock on different terrains. We've talked in the past podcast with Irene Davis, kind of on the minimal issue and kind of looking at shoes and how they work. What would you recommend for people who are going to rock maybe on a little more of a terrain?

Is that something that they can do with a minimal issue? Do you want to shoe with more support? What do we know about that? Yeah, my thinking has actually evolved here. I went from the point where I thought you should be doing everything in a minimalist shoe 24-7 to now thinking, no, when I'm asking a great deal of myself, the risk reward tradeoff isn't worth it. So I no longer use a minimalist shoe when I rock, although I did. And now I actually

like using the boot that's made by GoRuck. So the company GoRuck that makes all of these great things also happens to make a great boot by no means the only boot you have to go on. But what I like is it's got an 8 millimeter drop. So it's a little bit easier on your Achilles than a flat shoe, which is a minimalist shoe. And it provides a little bit of support. Again, I'm pretty proficient at walking on uneven terrain, but when I am walking down hills, especially if I'm doing so on kind of an uneven surface, any little bit of extra support I can get that saves me or reduces the risk of rolling an ankle is worth it. So in summary, I do wear a somewhat supported shoe, but if you saw it, you'd still think it's relatively mild. I'm not wearing like an enormous hiking boot, but let's take that one step further.

What do I hunt in? Well, hunting is sort of similar to rucking, except the terrain is typically even much worse, and you may be carrying far more weight. And yeah, in that situation, I'm wearing the most supportive boot I can wear, because again, I don't always get to see where my feet are going down if it's dark and all sorts of things. So again, playing the long game means run fast on the straightaway and slow it on the curves a little bit. And therefore, when I have much more control over what I'm doing, such as when I'm lifting weights

and walking around the house or walking around town, I can afford to be in a more minimalist shoe. And when the stakes are higher, I wanna provide some support. Have we ever told the story before on the podcast? The first time, I think it was the first time that you went hunting with Jake Meas and Hawaii and you wore your minimalist shoe?

No, that wasn't the first time. It was the first time I went to that part of Hawaii, which was normally I had hunted with Jake in other parts that were just a little more civilized, but this was a particular area very high in the mountains where there's just incredibly sharp lava rocks beneath knee-high grass. So you can never see what you're stepping on. And yeah, I just went in a very, very minimalist shoe

and I turned out to be a strategic error. I remember Jake telling the story about it after just being like, he saw you roll up in those shoes and he was just like, this guy's not gonna make it. This is gonna be a tough day. It's a very, very difficult four days. Yeah, I believe it. We also receive questions from women specifically,

which is, is there a benefit to women as well, rucking? And we know that there's bone mineral density is so important for women, especially as they age. Is that something that rucking can help with? And do you recommend that your female patients, just like your male patients, do possibly pick up rucking? Absolutely. Again, any load bearing activity is beneficial, the greater the load, the greater the benefit.

So walking is reasonable, better than swimming or cycling, but rucking is better because you're under more load. That said, I also wouldn't want someone to think that rocking is good enough. Right? So if we're really in the business of increasing bone mineral density, you really have to lift weights. There is no substitute, right? Nothing else matters. Because even if you're saying, well, God, I run like I'm, you know, I'm running. That's got to be an even greater impact than rockingucking, and it is, by the way, but you're only getting your lower body. We have to think about bone health across the entire body and simply put, when you're

picking up and carrying heavy things, when you're pressing, when you're pulling, when you're lifting, all of those things with weight are going to have the greatest impact on bone stress, and it's that stress on the bone that leads to the remodeling that strengthens it. So I think of rucking is an adjunct to that, but not the primary mover. And I just wouldn't want anybody rucking thinking, now I can check the box of bone health. I don't think it's sufficient. That makes sense. And I think we mentioned this on a podcast before, but you do think if you have a treadmill, so if

you live in the northern states and it's cold in the winter, if you live in a place like Minnesota, for example, where it's no, it's in April, yeah, yeah. Yeah, I've heard that that may happen in places like that. That is true. You know, with a treadmill, with like tweaking the weight on your back, how high the treadmill is, you could also do zone two, rocking as an activity. Oh, completely, totally. Again, it's hard. Once you get to a certain level of fitness,

the only way you're going to get into zone two, rocking is if you start to shuffle. So there's a kind of cool thing you can do when you're rocking that is not running, but it's moving quickly, and it's hard for me to describe, but it's kind of cool thing you can do when you're rucking that is not running, but it's moving quickly. And it's like hard for me to describe, but it's kind of like a shuffle run, but it's much easier on your knees because you're not picking your feet up very high like you would

in a running gate. So imagine just sort of keeping your knees bent and shuffling your feet forward as fast as you can go. You can certainly get to a point, and I like to do that on the track, by the way. So I'll kind of rock from here to the local school track, and that's a lot of up and down, up and down, up and down, and then the track I like to do, like, shuffle runs, like I'll do quarter mile shuffles.

Based on how fast I want to do that, I can go way past zone two, or I could park it in zone two. And of course, being on the treadmill, you can throw, I wouldn't recommend going very fast. So here I would say, you know, let gravity do the work. So you might want to set it to like two and a half to three miles an hour and then just slowly start to play with the incline. Are there other people rocking when you're shuffled

rocking on the track? Or are you by yourself? Are there other people out there? No, I am by myself, but there are kids playing sports on the field inside the track. And they're looking at me like I probably looked at old people when I was a young buck, thinking I was the cool kid. And I saw old people doing really weird things like walking or whatever. So yes, there's no question. I look like an absolute idiot doing this. It's it's it's undeniable.

Hey, we need to we need to get a video of this. You need to bring your wife or daughter with you on time and throw up an Instagram video. You just do on a quarter mile shuffle out there. I'll do it. I'll do that for sure. Just for pure comedic value. I mean, I mean, it would be beneficial so people can see what that shuffle looks like, but I would like to see the whole quarter mile. So not kind of a 10 second. I want to see the full awkward go around. Yeah, it's, it's, yep, very well. Moving on from rucking, the next question that we kind of see

come through is you talk about a lot centenary into Catholic and you say, you know, your goal isn't to deadlift as much weight as you once could or absolutely max out on reps in terms of weight and instead trying to also think about maintenance. And so a lot of people are wondering, at what point do you make the switch from building strength to maintaining it? You know, how could people think about that in terms of assuming you're doing that for trying to not injure and trying to not go too hard?

And so at what point do you start to think about the, okay, this is probably enough and now I'm going to maintain. Thank you for listening to today's sneak peak AMA episode of the Drive. If you're interested in hearing the complete version of this AMA, you'll want to become a member. We created a membership program to bring you more in-depth exclusive content without relying on paid ads. Membership benefits are many and beyond the complete episodes of the AMA each month, they include the following. Redeculously comprehensive podcast show notes that detail every topic, paper, person, and thing we discuss on each episode of the drive. Access to our private podcast feed, the qualities which were a super short podcast typically less than five minutes,

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