The Peter Attia Drive - #329 ‒ Special AMA: Peter on exercise, important labs, building good habits, promising longevity research, and more

Episode Date: December 16, 2024

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 special episode of The Drive, Peter tackles a wide range of listener questions submitted over the past year. The discussion spans essential topics such as exercise—covering grip strength, traveling workouts, and why Peter doesn’t consider exercise an ideal weight-loss strategy—and the top biomarkers everyone should track. He also explores promising new longevity research, his evolving views on longevity, and frameworks like “objective, strategy, tactics” for personalized decision-making. The episode wraps up with insights on building good habits and a glimpse into Peter’s recent reading list. 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 Special AMA show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Overview of episode topics (and Peter’s car stereo saga) [1:45]; The importance of grip strength and the best methods for training it effectively [3:45]; Exercise while traveling: strategies for staying active and maintaining an exercise routine [14:45]; Why women should prioritize strength training [18:00]; The limited role of exercise in weight loss and its greater importance in improving health, body composition, and insulin sensitivity [19:45]; The “top five most important biomarkers” for assessing health [22:45]; Promising developments in longevity research [28:15]; The development of Klotho as a neuroprotective drug: challenges, timelines of trials, and more [34:00]; Peter’s updated view on the potential of epigenome manipulation to restore aged cells to their youthful state [39:45]; How reversing age-related epigenetic changes in immune cells could revolutionize our approach to aging and disease [43:30]; The “objective, strategy, tactics” framework, and the importance prioritizing impactful lifestyle habits over less significant health trends [49:30]; Strategies for building and maintaining good habits [56:45]; How to think about drugs and supplements as part of a longevity toolkit [1:02:00]; Peter’s recent reading list [1:05:15]; 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 Atiya. 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 peteratiamd.com forward slash subscribe. So without further delay, here's today's sneak peek of the Ask Me Anything episode. Welcome to a special rapid fire Ask Me Anything episode. I'm once again joined by my cohost, Nick Stenson. In today's AMA episode, we thought it would be fun to do an end of year bonus AMA in a more rapid

style manner to answer many questions that are commonly asked that have come through over the past year across a wide range of topics and frameworks. We discuss questions on exercise, such as grip strength, exercise while traveling, the importance of strength training, and why I don't believe exercise is an ideal strategy for weight loss. We talk about labs, including the quote, top five most important biomarkers unquote, that everyone should know for themselves. Spoiler alert, I hate that question. We talk about new research on longevity that has come out and that has been particularly exciting. And I answer the question if I have changed my mind on anything recently as it relates to longevity, we speak about some of the frameworks that I use and the importance of using the objective strategy tactics model as an approach

versus a one size fits all approach. We close the conversation by talking about building good habits and my recent reading list. 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're a subscriber and wanna watch the full video of this podcast, you can find it on the show notes page. If you're not a subscriber, you can watch the sneak peek of the video on our YouTube page. So without further delay, I hope you enjoy this bonus AMA rapid fire.

Hey! Hey! Hey! Hey! Hey! Peter, welcome to a special bonus AMA. How are you doing? I'm doing well. Thank you for having me back.

Anything new going on in your life? Just a few things. I say that with not knowing anything, but just anything that jumps out to you. No, but I did wake up to an awesome text message today. I've got this car that I'm trying to do something to the stereo system. And the guy who really, really knows what he's doing has been working on it for six weeks. He cannot figure out what's wrong with this thing and it's super complicated. And he sent me this video this morning and it was like a video of him moving through

the car and he says, I figured it out. And he hits the stereo and all you hear is the beginning of ACDCs back in black. Like full beans. And I was like, that is an awesome video to wake up to. That's amazing. Back in the day, the younger days, did you ever put like one of those big subwoofers in your car ever? No, I did not.

You know, believe it or not, I didn't actually own my first car until I was in med school. I kind of rode my bike and took the bus everywhere. Well, that's fair. Maybe we'll get to it. You told the story, I think, in the book too, and I think it's come up on other podcasts,

but whenever I think of you med school and driving, I think of you falling asleep in the park in Baltimore. That was residency. Oh, residency. Residency, yeah, yeah, yeah. Med school's not that Baltimore. That was residency. Oh, residency. Residency, yeah, yeah, yeah. Med school's not that exhausting. I love it. So for today's AMA, it's gonna be kind of a

little different style, just more conversational, a little bit covering questions that come through that we haven't covered before. Some of it will be conversations that we've had internally that we were like, ah, it'd be great to record this and kind of put it out there. So it's gonna be a mix of specific questions, more framework, organizing principle questions.

We'll cover things like labs, prioritization as it relates to actions, what you're excited about in the field of longevity, books you've maybe read recently, and a bunch of other random stuff. So with all that said, we'll get going. First topic, your favorite exercise. And within it, we're going to cover grip strength. So it's something you've talked about before the importance of, but I don't think we've ever really covered a little bit in depth on like how you train for

it and how you think about it in the weight room. So before we get to that, do you just kind of want to remind people why you think grip strength is important? Yeah, so grip strength is important probably for a little bit of the reasons that we understand the drunk under the streetlight problem, which means the old adage of the drunk guy standing under the streetlight and someone asks him what he's doing and he says he's looking for his keys

and they ask him if this is where he dropped him and he says, no, but this is where the light is. So, sometimes where it's brightest is where you end up looking. So, I don't want to, of course, minimize grip strength, but I also want to just point out that in the literature, when you are interested in studying the relationship between strength and outcomes, everything from onset of dementia, all-cause mortality, cardiovascular disease, all of these things, which has been studied. You need objective measurements of strength to test. If your hypothesis is strength is positively associated with, correlates with, or even causal towards these things, you have to be able to test it.

And so the question then becomes, well, how do you test strength? Should we have people deadlift things? And I think if you go through that exercise, you pretty quickly realize that's probably not a good idea because most people don't deadlift and technique is pretty important in deadlifting and it's pretty easy for somebody to hurt themselves. So what scientists have done instead over the years is they've tended to study things that anybody can do, even if they don't do the particular exercise that's being tested.

You shouldn't be testing squat strength or deadlift strength if a person doesn't deadlift or squat. So the things that have typically emerged as strength tests are grip strength, wall sits, so that's a test of at least isometric quad strength, bench press. If you don't bench press, that's a bit of at least isometric quad strength. Bench press, if you don't bench press, that's a bit of a stretch. Leg extension, those tend to be the big ones. Sometimes leg press as well.

So I just wanna caveat it by saying, I don't think there's something super, super magical about grip strength. We just have such an abundance of data on it because it's such an easy thing to test. So the next question then would be, is there something magical about having a strong grip? And here I think the answer is partly yes.

A strong grip in isolation doesn't really exist. So there's really no example I can think of where a person has a very strong grip in their hand, but their forearm, deltoids, scapula, triceps, all of these other things are weak. So a strong grip is sort of a way to test very strong, very stable control through the upper extremity, all the way down to the outside world. And again, it's a very practical thing. Just talk to any person who's reached an age where they can't open a new jar of pickles or they struggle to unlock a door or they struggle to carry a heavy plate.

So when your grip strength goes, your quality of life absolutely goes. But again, I think it's just a proxy for people who are strong. And that kind of leads into your question, which is, how should you train it? What's undeniable is the strength of the association. I'm not even going to go into that because the data are overwhelming. The strength of the association between grip strength and any and everything positive warrants no further discussion. The more important question is, is it causal?

If grip strength is just a proxy for health and increasing grip strength does nothing to increase health, then we really shouldn't be talking about this. I don't believe that that's the case. I make an argument for that in Outlive, which is going through sort of the Bradford Hill criteria and explaining why I think there is causality in the association. In other words, why is it that increasing metrics of strength and endurance also improves lifespan and health span, not that they are just markers of healthy people who go on to have a better lifespan and health span? So how would you train

it? Well, I can't tell you the number of times I give a talk or I just run into somebody in the airport and they tell me that they went out and bought a little grip squeezer on Amazon. And they said, Peter, you've got me convinced. I got to strengthen my grip. So now I sit around and I squeeze these little things all day. And I said, well, that's great. I don't think there's anything wrong with that, but I don't think that's the optimal way to train grip strength.

I think what you really want to do is do all of the other things that rely on strong grip. The most obvious example of these things are exercises that involve carrying and pulling and hanging. That's really where we put our grip to the test. I'm giving you a very long-winded answer, Nick, but the point is you want to train your grip strength by doing the things that rely on grip. When you pick things up, when you carry things, when you pull things, if you're doing a seated cable pull, if you're doing a pull down, if you're doing a pull up, if you're doing a farmer's carry,

if you're doing a deadlift, those are the way we train grip. So I don't do very many things that are quote unquote deliberate grip strength exercises. I suppose that when I do farmer's carries, I'm almost exclusively doing that to push the limits of my grip. And maybe let's isolate two of the things you mentioned

that I think are easiest for people to potentially test on themselves at a gym. You know what, the least amount of equipment, like you said, if you haven't deadlifted before, you probably shouldn't just start deadlifting without understanding the form. So I think looking at farmer's carry and dead hang, let's say farmer's carry.

What do you think is like the ideal goal for someone to be able to do a farmer's carry with in terms of time and weight? Well, lots of people have weighed in on this question and I think the question just becomes like, how extreme do you wanna go? There's a standard out there that basically says the definition of exceptional strength is being able to walk with twice your body weight for 30 seconds.

So if you weigh 175 pounds, you should be able to do a trap bar deadlift with 350 pounds and then carry it, walk with it for 30 seconds. Obviously that's a very high standard, but I would say a more reasonable standard for maybe sub-elite athletes. I think for a male in his 40s to be able to carry his body weight for one minute is good and for two minutes is very good, just your body weight. Again, if you weighed 175 pounds, you'd put 175 pounds on a trap bar, you'd pick it up and march with that for one to two minutes. I think for a woman, I would probably consider 75% of her body weight to be also an excellent achievement.

Of course, you might discount that by 10% per decade. I don't think a person should be discouraged if the first time they try to do that, they can't do it. In fact, if you haven't been doing that sort of thing and if you're not used to deadlifting and doing a lot of pull-ups and hangs, I would not expect anybody to be able to do that. So you do want to work up to that. I really believe in the principle of working up to that without going to maximal effort. I know that there's a lot to be said from doing maximal efforts, but I think this is an area where I prefer to see people build resilience slowly.

For example, if an individual tried that test, so let's just say you take 175 pound person, they put 175 pounds on a hex bar, they say, look, I want to carry this for at least a minute and 30 seconds and they drop it. I'd say, great. Okay. What I want you to do is drop the weight on that bar to call it 150 pounds, so 25 pounds below that 175. And I'd like you to do 30 second sets.

I'd like you to do 10 sets at 30 seconds. And then I want you to advance weight and or time accordingly, but I want you to be able to get through those 10 sets such that at the end of the 10, you're really completely gassed. That's the way I kind of like to see people build strength there.

Another test that we've talked about is the dead hang. So as its name suggests, you just sort of put your hands up on the bar. You can do it over any configuration of bars, but I kind of like to just do it over a straight bar and you hang. Now, again, there's two big things to be thinking about here. Do you do it with the scapula engaged or not engaged? And I like to do it with the scapula engaged. So the scapula are down and so the lats are under a lot of stress, but they're not being stretched. with the scapula engaged. The scapula are down and so the lats are under a lot of stress, but they're not being as stretched if the scapula go up.

If the scapula go up, you're going to put a little bit more stress on the elbows. That doesn't necessarily cause problems by the way. I can dead hang both and my dead hang record was actually an attempt where my scapula were up. Sometimes I will go back and forth between the two techniques and I didn't suffer any permanent injury from doing that or anything like that. So again, I think here a standard would be a very strong 40 year old male should be able to dead hang for at least two minutes and a very strong 40 year old female should be

able to dead hang for at least 90 seconds. And again, you would discount that as time goes by decade and probably subtract about 10 seconds per decade. And again, a lot of people don't succeed in that at their first time. That's fine. But again, you can do that either by adding bands. So you use a resistance band that you are sinking into, right? You put your feet into it so it's removing some of the weight. Alternatively, I just like to have people go for much shorter periods of time. Maybe do 30 second hangs and repeat those. And do you have a preference on like hands the same way, hands that are switched?

Do you even think about that or is it just a matter of? Sure. You can mix and match, but I think for this, I like to be palms out. So I'm palms out, both hands the same, over. And remind me, what was your record? Four minutes, 35 seconds. And that was with full scapula up, not engaged scaps. Wow.

And my wife's record is three minutes and 10 seconds, which I think is actually more impressive. Yeah, she's a machine. Yeah. And she probably trains it a little less than you were training for your record. It was literally the second time she ever did a dead hang. And she literally just did it to, she was like,

why do you keep doing this? Let me try. Yeah, just to show you it's not that hard, you're spending too much time on it. Yeah, exactly. You mentioned wall sits, so I gotta ask, what's ideal for wall sits? Again, it's another one anyone can kinda do

and test a little bit. Do you think about like, what is an ideal time that you should be able to do that for? Yeah, there are standards and I apologize. They're not tip of tongue for me. I wanna say two minutes is considered a pretty good wall sit for anybody. I don't tend to do wall sits like that.

There's another exercise I prefer to do, which is I'll do an air bike. I'll ride on the air bike for a minute hard, and then I'll hold a kettlebell and wall sit for 30 seconds to a minute. So it's a shorter sit, but I come in pre-fatigued. Plus I'm adding some stress to it by holding a weight. But if you just do a straight up wall sit, I apologize. We'll put it in the show notes for what a good standard is.

I want to say it's two minutes, but it might be five minutes. I honestly don't remember anything else on grip strength before we move on. I want to say it's two minutes, but it might be five minutes. I honestly don't remember. Anything else on grip strength before we move on? No, I think that's good. Perfect. Another question that comes through a lot on exercise is people who are traveling. So whether it's for work, whether it's family, you're not at your traditional location, gym, whatever it may be. So if you're traveling, any advice you would give patients on, easy exercises they can do, ways they can continue to stay active even when they're not in an ideal setting?

Yeah, I do get asked this question a lot. And honestly, like my answer is, you have to be deliberate. And that sounds like maybe not what people want to hear. I think people are looking for a quick fix, but when I travel, you can ask my assistant, what's the first thing I'm asking? What's question number one? It's show me the gym. I want to know exactly what the gym looks like.

And if the website doesn't have good pictures, please have somebody who works at the front desk, go down with their phone, film the gym, send us the video so we can evaluate. Yeah, I know, it sounds ridiculous, I get it. But unless you're going to the middle of nowhere where you have no choice in hotel, you have a choice in where you stay.

Now you'll have to make a concession. Maybe you have to be a little bit further from the place you wanna be at. Maybe you're gonna add 10 minutes or 15 minutes of driving time. Maybe the hotel's gonna be a little bit more expensive. Like there will be a trade-off and everyone has to make that trade off.

But I start with that question, which is how can I make sure that whatever hotel I'm at has a good enough gym? It's not going to be the gym I have at home. It's not going to allow me to do everything I would do at home, but that's okay. Basically I've never been to a hotel where I can't do something. Even if they just have a bench and dumbbells, then I can do presses and I can do rows and I could do push-ups and hopefully the bench incline. So maybe I can do an incline bench as well as a flat bench. I could do rear foot elevated split squats, regular split squats. There's a lot

you can do with a modest amount of dumbbells and a bench. And then of course, most gyms have much more than that. That to me is sort of step one. Step two is when traveling, you have to sort of be mindful of what jet lag is going to do to you. So because I'm in central time zone and when I travel west, it's really easy for me to work out early in the morning. A 5 a.m workout is easy when I go to California for three days. So I can start my meetings actually quite early on those days because I know I'm going to get the workout done early.

Conversely, if I go to New York, I have to keep in mind, like I'm going to be a little bit tired. I am not going to want to work out at six because six feels like five and I don't like working. I mean, even though I'm comfortable getting up at five, I don't want to work out first thing at five o'clock. So then I have to adjust the timing of the meetings. So I think those are basically the two big things is make sure that your schedule has

the time for you to do the workout and budget according to what jet lag is going to do to you and pick a place to go so that you can get the workout in the hotel. That's always going to be easier than if you have to leave the hotel to go to the gym. You can do that. And of course, there's been many times in my life when my training was so elaborate that I had to go into a commercial gym, but it was the same playbook. I would just book a hotel near the commercial gym. Yeah. And it sounds like the key is something's better than nothing when you're traveling

and it comes to exercise. A hundred percent. The goal of exercising when you're traveling is not to maybe make the most incredible gains. It's just to prevent the losses. Another question that comes through often is sex specific. So if you have female patients who prefer cardio compared to weightlifting, why do you think women should pay special attention to strength training? Yeah, there are two big reasons for this.

The first is that women naturally have less muscle mass and are not as strong as men, and yet they still live in the same environment as men do, which is to say they're going to be subject to all the same forces. This is one of the reasons why we see women fall more than men. It's not just that women are more injured by falls, which they are, and we'll discuss that in a moment. It's that women actually fall more than men. One of the reasons for that is a disparate exchange in strength. So that's reason number one.

Reason number two is of course, strength training is one of the most important exercises that we have, one of the most important behaviors that we have to stabilize bone density. And because women tend to have a lower genetic ceiling and more importantly, because women lose estrogen during the middle of their lives, they begin to experience a disproportionate drop in bone density as they age. And so the gap between men and women that's always there really begins to widen

in the fifth or sixth decade of a woman's life. And that's all the more reason why she needs to be strength training because there really is no substitute for the type of strain that is placed on bones during strength training. It can't be replicated by running, certainly can't be replicated by cycling or swimming or other endurance sports, yoga. All of those things are simply not going to do it and therefore they've got to be able to put this kind of external load on. Last exercise question is kind of a conversation that you had internally with a few people

that we thought was interesting on how you think about exercise as a strategy for weight loss. Do you kind of want to talk a little bit about that? Well, I overall don't think exercise is a phenomenal strategy for weight loss, which is not to say that it doesn't play a role in maintaining a healthy weight. I think it does, but I think if you look at the experimental evidence, exercise, i.e. calorie expenditure, does not appear to be a very viable tool for weight loss. By weight loss, we're obviously talking about fat loss.

The majority of the work on that front really has to be done through caloric restriction. If you just want to simplify and think of a machine with inputs and outputs, it's really reduction of the inputs that seems to play the greater role in weight loss. That said, we think that exercise is a very important part of health and that health is the single most important thing. It's more important than weight loss per se. Furthermore, exercise does indeed make a difference for body composition and body composition should probably be thought of as more important than weight per se.

So if an individual, like, I don't think a BMI is an especially valuable tool at the individual level. I think it's a reasonable tool at the population level, but for any one individual, BMI is not really that helpful. I don't know my BMI, but I would bet that it's in the overweight. I know it's in the overweight category. My BMI is probably 27 or 28, which again, overweight is once you're above 25, but below 30. 30 is obese. I'm not quite there. So if my BMI is overweight, is that a bad thing?

Well, not necessarily. It depends on my body composition. And so here's an area where exercise makes a huge difference. I think indirectly, there are other areas where exercise is very important for weight maintenance. And I think, for example, exercise maintains insulin sensitivity and the more insulin sensitive a person is, I think the easier it is for them to respond to appetite signals. And so while just doing the accounting

of calories burned versus calories in, exercise generally falls short there. In other words, whatever calories you expend doing the workout, you're generally going to pay them back. The goal I think is to be sensitive to the appropriate appetite signals so that one doesn't overeat in that state. Awesome.

Any other things on exercise at top of mind that you want to share with the people before we move on? I like exercise. I tried to say that in a Steve Carell voice, like, I like LAMP. I love LAMP. You could have saved a lot of time and a lot of words by just having that have been outlive. It probably would have come out a lot earlier if it was just one page, one sentence. Okay, moving on to labs.

So this question I know is a tough one for you to answer. The reason I know that is it's been on other AMAs and it always gets scrapped because you're like, I can't answer this. It's too simple, too hard to do it. But we keep sneaking it on and now you kind of have to answer it, which is if you had to pick gun to your head the quote-unquote Top five most important biomarkers that everyone should know for themselves And or if you were gonna meet with a new patient and you could kind of only see five biomarkers

To figure out their risk to figure out where they're at. What would those be? Thank you for listening to today's sneak peek AMA episode of The Drive. If you're interested in hearing the complete version of this AMA, you'll want to become a premium member. It's extremely important to me to provide all of this content without relying on paid ads. To do this, our work is made entirely possible by our members, and in return, we offer exclusive member-only content and benefits above and beyond what is available for free. So if you want to take your knowledge of this space to the next level, it's our goal to

ensure members get back much more than the price of the subscription. Premium membership includes several benefits. First, comprehensive podcast show notes that detail every topic, paper, person, and thing that we discuss in each episode. And the word on the street is, nobody's show notes rival ours. Second, monthly Ask Me Anything or AMA episodes. These episodes are comprised of detailed responses to subscriber questions, typically focused on a single topic, and are designed to offer a great deal of clarity and detail on topics of special interest to our members. You'll also get access to the show notes for these episodes, of course.

Third, delivery of our premium newsletter, which is put together by our dedicated team of research analysts. This newsletter covers a wide range of topics related to longevity and provides much more detail than our free weekly newsletter. Fourth, access to our private podcast feed that provides you with access to every episode including AMAs, Sans the Spiel you're listening to now, and in your regular podcast feed. Fifth, The Qualies, an additional member-only podcast we put together that serves as a highlight reel featuring the best excerpts from previous episodes of The Drive. This is a great way to catch up on previous episodes

without having to go back and listen to each one of them. And finally, other benefits that are added along the way. If you wanna learn more and access these member-only benefits, you can head over to peteratiamd.com forward slash subscribe. You can also find me on YouTube, Instagram, and Twitter, all with the handle peterateaMD. You can also leave us a review on Apple Podcasts or whatever podcast player you use. This podcast is for general informational purposes only and does not constitute the

practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. No doctor-patient relationship is formed. The use of this information and the materials linked to this podcast is at the user's own risk. The content on this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice from any medical condition they have, and they should seek the assistance of their healthcare professionals for any such conditions. Finally, I take all conflicts of interest very seriously. For all of my disclosures and the companies I invest in

or advise, please visit peteratiamd.com forward slash about where I keep an up-to-date and active list of all disclosures. you