The Peter Attia Drive - Qualy #89 - Cortisol and healthy aging

Episode Date: January 7, 2020

Today's episode of The Qualys is from podcast #31 – Navdeep Chandel, Ph.D.: metabolism, mitochondria, and metformin in health and disease.   The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive. Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now. Learn more: https://peterattiamd.com/podcast/qualys/   Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/  Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

Welcome to a special bonus episode of the Peter Atia Qualies, a member exclusive podcast. The Qualies is just a shorthand slang for Qualification Round, which is something you do prior to the race, just much quicker. The Qualies highlight the best of the questions, topics and tactics that are discussed in previous episodes of the drive. So if you enjoy the quality you can access dozens more of them through our membership program. Without further delay, I hope you enjoy today's quality. Talk to me a little bit about cortisol and your views on it. How does cortisol interact with the mitochondria?

Yeah, well, I don't know. I see another one that I would love to work on. So it's just a weird observation. I don't know if you have this. I mean, I think maybe in our circles, we have a lot of kind of type A personalities who exercise vigorously, they wash their diet, they do all this sort of stuff.

I don't know anybody that does that. No, you don't know anybody. You just don't know anybody. No, nobody. But I always wonder if they're stressing themselves out by being so careful about everything. You know, and you know me, I am the opposite. I, you've seen me eat and drink. Yeah, but you're pretty fisted-y as with your exercise.

I am. You play soccer every day. No, I do. And I don't overeat and I do time-feedings, right? I still fast 12 to 15 hours. Most days closer to 15 hours. No, I do watch what I mean. But what I'm saying is I know people who get very, very regimented about these things,

things. And it's like the marathon runners who, you know, the old line that they die, don't run marathon. Well, I was, yeah, I was with, I was with the friend last night and he was joking about this exact concept. And he, he was joking about this exact concept. And he was talking about his, he's an orthopedic surgeon. He was talking about his partner or someone he knows and he was like, the guy is so into yoga, but it's become, he's like, the way he described it was really funny.

He's like, he stuck in traffic and he's like, I gotta get to my fucking yoga class. Yes, exactly. And it's like, yeah, and of course, there's the irony to that. Right. So, you know, your insulin levels might be fine and everything's fine, but, you know, what's your cortisol levels? So I'm fascinated by cortisol. In fact, I'm fascinated by, I would love for you

to basically develop a very simple test that you can sell at Walgreens, where you take a prick, a blood, and you can do it as often as you want, and you tell me my thyroid in hormones, you tell me my insulin, my glucagon, my estrogen, my testosterone, my dopamine serotonin and obviously cortisol, right? These five or six seven things that I just said because it's about a lot of biology or physiology you can explain. Yeah, we're not going to be able to get it that way because cortisol is mostly bound to

Albumin and cortisol binding protein. So it's the free cortisol that exerts its metabolic effects and it's physiologic effects. And most of it's not free. So you can only measure the free cortisol in saliva and urine. And then the other, you know, of this other one. But you know what I'm saying?

Like I would love to have those mota, those mota, those hormones I hormones, I'd my disposal, and is my testosterone too low, my ass rate too high, this too high insulin. You know what I mean? Just having that data points all the time, and then you could sort of modify your diet and your exercise. But I think the cortisol one is, I pay more attention today to stress than anything else. I'll be honest with you.

I mean, I still exercise and I watch what I eat. Those things seem intuitive because I've done it for so long. But I've been wondering if myself and many of my colleagues, especially because we fly, get talks, you have grand pressures, a teenager daughter. She's lovely. Lots of different pressures we all have, right? And if that somehow is being manifested

metabolically through cortisol, to the mitochondria, just like we think about insulin, right? So that's all. That's the only reason I want to talk about cortisol. No, I think I agree with that wholeheartedly. I think certainly in the last three years as I've dug my heels into it, I think hypercortisolemia is a problem.

And I think I wish people would think of these hormones through more broad endocrinologic terms. It's very easy for people to think of hypothyroidism. We accept those as states. You can be euthyroid or you can have too much or you can have too little. And yet people have such a hard time thinking of insulin in those terms.

You can have too much. You can have too little. There's, people have such a hard time thinking of insulin in those terms. You can have too much, you can have too little. There's a range in which this hormone makes sense. And cortisol is probably equally important, if not more important, in terms of the damage that can be done, especially from too much, with respect to everything, from blood pressure, which would then impact the endothelium, what it does in terms of inhibiting melatonin secretion in the brain, and melatonin obviously plays an immediate role in terms of sleep, but also plays an indirect role in terms of neuro-regeneration. And that says nothing about what we just talked about, which was the role that cortisol

may even play in the mitochondria, which I'm just learning about, literally in the past couple of months. So, I don't disagree. I think the challenge in many ways, for anyone listening to this, if we're going to be brutally honest, I think for many people it's easier to control what they eat, how they exercise, and exert discipline around taking medications, taking supplements. But in many ways, one of the hardest things to control is our response to stress. And I think that's an important distinction to make.

I don't think there's anything that's particularly troubling with being in stressful situations. I think the difference is less about the situation you're in and more about the response you have to it. And that's probably where the greatest difference is live between people. Is there some people who can be in relatively low stress situations and yet they're sort of,

they're not reacting well to it. They're not coping with it well, and there are others who can be... They have different set points where they begin from. Maybe. I mean, I guess I just don't understand enough of this stuff. I mean, I think... But it's, I don't, you know,

I don't hear too many people talk about it. I don't know. I think it's... You know, people talk about stress, but, but sort of. Like we talk about insulin all the time and glucose levels and for men testosterone, you mean, you mean sort of in longevity circles. Yeah. And longevity circles, like, you know, is that a variable we're missing? You know, I, I agree. You're, you're right. You know, what it is in cortisol. Well, part of it is we don't have a target for it. No one's thinking about pharmacologic ways to manipulate this, and we don't have great, obvious ways to curb our behaviors. Meditation probably is the single most valuable thing I've ever found to help regulate this,

but you also don't have the ability to measure cortisol levels that easily. Every time you want to do one of these tests, you're collecting urine over the course of a day and doing a bunch of other things. It's involved. You. You don't have the means. Yeah, it's really funny. I think there's a paper that came out probably about three months ago that looked at basically the punch line of the paper was, look at any loose alcohol is toxic. If you look at those events, it's like 950 954. The point of it is there's no dose of ethanol where the ethanol becomes valuable, but the toxicity takes a while to kick in. For some people, a glass a day seems perfectly reasonable.

There's no toxicity. But the flip side of it is, and this is where I kind of try to have this discussion with every patient, is, look, I'm not going to tell somebody not to drink. I'm not going to tell myself not to drink. I probably have four drinks a week, And, you know, I pick and choose my shots. You know, I have this rule called don't drink on airplanes because the alcohol on airplanes sucks. So I'm not drinking alcohol just for the sake of drinking alcohol. But if you're sitting there and the alcohol is really great and it's something you really,

the downside of the ethanol, the hepatic toxicity of the ethanol, can be offset by the emotional benefit that could come from the enjoyment of having that glass of wine with your body. and all the hepatic toxicity of the ethanol can be offset by the emotional benefit that could come from the enjoyment of having that glass of wine with your body. That brings me to another one of those things we should always measure. ALT, you know, the liver, yeah.

I agree. How will your liver be? How's your ALT this morning, by the way? It's pretty good. Yeah. I went check day. Yeah. Hope you enjoyed today's special bonus episode of the quality. New episodes of the qualities are released I'll uncheck that. md.com forward slash subscribe. This podcast is for general informational

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