The Peter Attia Drive - 92 - AMA #12: Strategies for longevity (which don't require a doctor)

Episode Date: February 10, 2020

In this “Ask Me Anything” (AMA) episode, Peter explains the various levers one can pull to affect longevity with a specific focus on the strategies and tactics one can implement that do not require the help of a physician. Once again, Bob Kaplan, Peter's head of research, will be asking the questions. If you’re not a subscriber and 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 on our website at the AMA #12 show notes page. We discuss: The five levers you can pull to affect longevity [1:15]; Nutritional biochemistry: Framework, 3 nutritional interventions, and how to approach your goals, and what you should be tracking [4:30]; Exercise for brain health, and the 4 components of exercise [20:45]; Exercise component—Stability [24:30]; Exercise component—Strength [29:00]; What is Peter optimizing for with his exercise? [30:30]; Exercise components—Zone 2 and zone 5 training [33:15]; More about DNS, and why we need to be careful with rushing kids through neuromuscular development stages [45:00]; Sleep: How to improve quantity and quality [48:15]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode:  https://peterattiamd.com/AMA12 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

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 AMA episode number 12. In this episode, we discuss all things related to longevity that you don't need a doctor for. This actually came out of a discussion I was having

with Bob and Nick about how much of the stuff that I do with patients, I think people could do on their own if they had sort of the right guidance. So we focus by looking at nutrition, exercise, physiology, and sleep physiology for the most part. If you enjoyed this conversation, we're happy to have a follow-up AMA based on any more questions that come out of it. And of course, if the reception to this is positive, we can certainly go into other things that we didn't have time for in this episode, which would include, for example, things around supplements, techniques around distressed tolerance,

things like that. And once again, joined and hosted by my head of research, Bob Kaplan. So without further delay, here is today's AMA episode. So welcome to another AMA episode. I'm Bob Kaplan and with me is full-time shepherd and part-time race car driver. Peter Athea, Peter, how are you doing? I'm good. I was thinking today, I've never done anything as bad as I do driving. It is actually the worst thing I do. I'm a much better everything than I am driver. That's why you're a full-time shepherd and a part-time risk hard driver. We wouldn't want to switch those. Yeah, and today I just was really frustrated in the simulator at how bad I was. It is definitely the hardest activity I've ever tried.

It's inferior. So in another life, you know, a thing or two, are about longevity and lifespan and health span. So we might get to a few questions on those and not just shepherd-related longevity and lifespan and health span. So we might get to a few questions on those and not just shepherd-related topics today. So despite all the questions we do get around shepherds and racecar driving, which we actually do of the latter, we thought a great theme for today's AMA is all things related to longevity that you don't need a doctor for with a focus on the five tactics of longevity, which this covers a huge range of questions that come from the listeners. And to remind the listeners what those five levers are, or five tactics, are nutritional biochemistry, exercise physiology, sleep physiology, distress tolerance, and telomeres.

distressed tolerance and telomeres. Wait, sorry, exogenous molecules, which includes drugs, hormones, and supplements, and maybe telomeres. So I thought we would just go down the list and start with nutritional biochemistry. We get a lot of questions around these. And if we just start with nutrition, I would say that people are asking a lot of different questions. Should I eat this?. I would say that people are asking a lot of different questions. Should I eat this? Should I not eat that?

But I think in some ways they're asking the same thing, which is, what or how should I be eating or not eating in order to live better now and or in the long run. So Peter, how do you approach this question maybe, how about personally, and what do you think is the answer to that question, or how do you even approach that question? Well, before even getting into that, I would say that this is a great place to start for the theme as you've laid it out, which is we're really gonna focus today on things

that one can do that specifically does not require the help of a physician. Because I know that it's just difficult for people depending on where they are geographically or otherwise to find physicians who are thinking about the problem this way. So I think there are lots of physicians who do think about the problems this way, meaning they think long and hard about the long tail of longevity and what the long arc of prevention needs to look like. But I also realize that a lot of people don't happen

to be in an area where they're gonna be able to find a doctor that can help them with that. And so what I've been thinking about and what I think we'll talk about today is, okay, imagine for a moment you absolutely have no access to medical care, you have no access to a physician who can help navigate you through this, what could you do on your own?

And I think the good news is you can do more on your own than you require the help of a physician for. So to your question, I think of all of these tactical domains, I think in some ways nutrition is the most complicated and I think it might be the most complicated because I think it has the most variable response for a given individual to a given stimulus. So if the things that you put in your mouth to eat, the molecules you put in your mouth to eat are the inputs or the stimuli, the responses can be totally variable.

So you and I, Bob, could eat the same thing at the same time under the otherwise same conditions and it produces a Very different output one of us might have a favorable response to that the other one might have a lukewarm or even an unfavorable response to that And I think that's where a lot of frustration comes from I can sense that frustration in people's questions at times I feel it in myself. I feel it in my patients. It can be infuriating when you are doing everything, quote unquote, right, because you're listening to someone who sounds like they know what they're talking about. You're reading something that seems reasonable. You try to adhere to that prescription, that dietary prescription, and you don't get a result, or you don't get the result that you were promised or you think you should get. So I think the overarching principle of nutritional biochemistry is you have to be malleable, you have to be empirical, and you have to assume that if it doesn't work and you've tried it

correctly, that that's okay and that there's another approach. So I don't want to harp on the framework because I think we've talked about it quite a few times, but the framework that I find helpful is to be thinking about the three things that you can restrict within nutrition. You can do what's called dietary restriction, which is restricting some type of macromolecule. So examples of dietary restriction would be something, quote unquote, as simple as restricting sugar, restricting carbohydrates, restricting animal protein, animal product in general, fats, one type of fat like polyunsaturated fat. It's basically any time you're saying I'm not going to eat from certain food groups or certain macros or certain subsets of food. The second type of restriction is time restriction. This says, I'm going to limit

the window during which I eat. Again, you and I have talked about this a lot written about it recently. This gets lumped into the broader terminology of intermittent fasting. I've never liked that term. And so I try to steer people away from the term intermittent fasting towards time-restricted feeding or time-restricted eating. But I think this is an idea that a lot of people are familiar with. So 16.8 as an example means a 16-hour window when you are not eating anything or being exposed to nutrients other than water or tea, and then an 8-hour window in which you are consuming food. And that number tends to shrink as you become more extreme. So 16, 8 is less extreme than 18, 6, which is less extreme than 21, 3, as you

open the non-feeding window and close the feeding window. The third and final lever that I think of in nutrition is caloric restriction. This is when you actually reduce the input. Obviously, these three can be combined, but they don't have to be. So, as an example, since my last fast, now ended about two weeks ago, I have been only utilizing one of these levers. I have been exclusively going down the rabbit hole of dietary restriction, with absolutely no cholera restriction and absolutely no time restriction. So what that translates to is I'm pretty much eating whenever the hell I want. In fact, I seem to be eating constantly. The first thing that goes into my mouth is five in the morning and the last thing that goes into my

mouth is like seven at night. It's like a 14 hour window in which I'm feeding. I'm also making no effort whatsoever to restrict how much I'm eating, but where I'm really strict. In fact, at this point, maniacally strict is what I'm eating. I hate using the word clean, but people would understand what that means. I'm basically completely restricting carbohydrates

outside of vegetables. I think I had three berries the other day, but I'm pretty much having no fruit. I'm having no starch whatsoever. I'm eating not a single crumb off my kid's plates, which is kind of my New Year's resolution. I'm eating vegetables like my life depends on it, meat, eggs, things like that, avocado, nuts, but otherwise quite restricted when it comes to most carbohydrates. So another point I want to make here is I've learned over many years that that approach works very well for me when I want to lose a few pounds.

And I wrote about this earlier in the year. One of my goals this year is to lose about seven pounds, which is sort of an arbitrary number, but there's actually a reason behind that. And I just know that dietary restriction is the lever for me that tends to result in weight loss provided it's this form of dietary restriction. I'm positive that I could prescribe the same dietary intervention to another person person and it would not produce the effect. In fact, I have many patients for whom they say, the only thing that really results in weight loss for them is time restriction.

It's making that feeding window narrower and narrower and narrower. And so it's neither good nor bad. One isn't right, one isn't wrong. The idea is approaching this problem through the lens of being malleable enough to A, know what it is you're trying to address, B, figuring out how to measure that when possible. In the case of something as trivial as weight, it's very easy to measure, but for other things it's potentially impossible to measure, sticking with a plan long enough to assess it and being ready to abandon it if it doesn't seem to work. So I don't think I fully answered your question because I think there's a lot there, but I'll

pause for a moment and let you digest and ask more if you feel like I could shed more light on that. Yeah, I think one of the things that you brought up is essentially a goal or some type of marker to look at in terms of whether your diet is successful or not. Where you say I want to lose seven pounds, and I think that's an important question to ask when the original question is, what should I be eating or how should I be eating in order to live better?

And that may mean a number of different things for somebody, and I was thinking in that context, what are some of the tools that people can use to help guide them in answering this question for themselves? I mean, I often think of like a continuous glucose monitor, but that might be where you're crossing that line between whether you need a doctor or not, or on the flip side, sometimes I think in medicine we look at randomized controlled trials and wonder whether something was

efficacious or not, but when you think about it in the clinic, I think an important question to ask the patient or ask another doctor about the patient is, well, how does the patient feel? So, I think in terms of a diet, maybe somebody just wants to feel better, feel like they have more energy, feel less lethargic, or it is losing weight, or lowering their glucose, or something like that. So, how can people keep track of that? 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.

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