Peter Attia on Lifespan and Healthspan

Dr. Peter Attia is someone I’ve followed ever since I started blogging.  He was an early champion of the ketogenic diet and wrote a 10 part series on cholesterol that served as the foundation of much of my cholesterol knowledge.

He’s eloquent and intelligent and thoughtful and whenever he surfaces on a podcast (it’s too bad he doesn’t have one of his own), I make the time to listen to what he has to say.

So when he popped up in an investing podcast that I’d never heard of before, The Investors Field Guide, I downloaded it and got to taking notes.

This comes at a great time since Peter Attia recently launched his new website, PeterAttiaMD.com, which is filled with new content while also hosting all of his old content.  Combing through his new posts has now made it’s way to the top of my to do list.

Here are the notes I took:

The Investors Field Guide: How to Live a Longer, Higher Quality Life, with Peter Attia, M.D. [Invest Like the Best, EP.27]

Peter Attia redefines wealth in terms of relationships, ie aside from immediate family, how many people would he give a kidney to?

Peter’s goal with both his clients and himself is to increase both lifespan AND health span (you can find a picture of his lifespan vs healthspan graph here):

Lifespan – How long you live.

Healthspan – Quality of your life.

Beginning at age 40, you start to lose 1% of muscle mass per year, and decreased muscle mass is associated with a decreased health span.

By the age of 70, your body is now at about 1/2 of your maximum health span.

Compounding

They discuss the importance of compounding both in terms of investments/finances as well as in health.  Peter asserts that:

Health is the most biologically manifestation of compounding. We tend to think that a lot of things that go wrong appear suddenly, unfortunately none these things happen in a moment. These things are occurring for generations before.

Cancer spends more than 80% of its life undetectable.

Heart disease begins at birth.

Healthspan

Mind – Cognition, which is measureable with three things: executive function, processing speed, and short term method.

Body – Maintenance of muscle mass. Ability to carry out functional movement. Freedom of pain.

Spirit – Sense of purpose and social support.

Maximizing Healthspan AND Lifespan

There are various inputs we can control to nudge things in our favor like

  • How you eat, when you eat, what you eat
  • How you sleep, how you exercise, how you manage external stress
  • What drugs you take, what hormones you take, what supplements etc.
  • Avoid harmful behaviors.

80% of people if you make to age 40 and are not smokers or suicidal will die of cardiovascular/cerebrovascular disease, cancer, and neurodegenerative disease.

Genetics

Centenarians are people who live to 100 or longer.

The first thing we’ve learned from studying them is that they don’t do anything better or worse than anyone else. They’re just as likely to smoke or not smoke, exercise or not exercise as rest of us.

But what they DO have are genetic advantages.

They have hypoactive genes that result in less ApoC3, less growth hormone receptor, less IGF, and are more likely to have genes that code for ApoE2 vs ApoE4.

  • Deficiency in ApoC3 protects against heart disease.
  • ApoE2 protects against Alzheimers
  • Lower GHR and IGF protects against cancer.

Centenarians have genes that will protect them from the top 3 killers!

Animal Studies

Three things that are universal across all species, yeast, flies, worms, and mammals.

  1. Caloric and/or dietary restriction – Some combination of caloric restriction and dietary restriction offers benefit. Peter is convinced that the answer is NOT caloric restriction but that cyclic fasting might work.
    1. Caloric restricting mimicking diet.
      i. Daily intermittent fasting – Don’t eat 16/8 and 18/6 are two popular formats
      ii. Valter Longo (an expert Dr. Rhonda Patrick frequently references) – Advocates a 5/25  system where for 5 days consume 750 calories, then 500, 500, 500, 500, then 25 days eat whatever you want.
      iii. In a monkey diet, caloric restriction was beneficial in monkeys that initially ate a crappy high carb diet. However it did not show a benefit in monkeys that were eating a normal monkey diet.
    2. Dietary restriction – Don’t have to restrict numbers calories, but restrict subset of calories.
  2. Rapamycin – Only drug that has worked on all species to extend life.
    1. Peter Attia thinks it’s one of the single most important drugs of all time, especially in our understanding of longevity and nutrient sensing.
    2. Mechanistic Target of Rapamycin (mTOR) – this sits at the heart of how our body decides when to grow vs repair.
  3. Genes that are manipulated across above species that result in a favorable longevity phenotype
    1. C. elegans worm – lives for 7 days. First 4 days it’s a rock star and last 3 days it shrivels up and dies. If they knocked out Daf2 gene completely, the worm does not survive, however if they made it less effective, the worm lived for 2 weeks! And it looked amazing for 13.5 of those 14 days. This was both an increase of healthspan AND lifespan.
      1. DAF2 gene is analogous in humans to IGF.
    2. All of the genes that seem to offer longevity in humans through the centenarian studies have analogs in animals that do the same thing.

Autophagy

From an evolutionary perspective, nothing about our world today mimics from a nutrient standpoint what it would have been like millions of years ago.

Today we can very easily never be hungry, which is a relatively recent phenomenon.

In previous lives we would have been alternating between feast and famine.

Feast is cellular building.

Famine – Body has to be more efficient. There are all these cells here, but they’re not that great, so why waste energy on them, why not just eat them and recycle their constituent elements.

Then when feast comes and body is re-fed it can selectively replenish the good cells.

This system is effectively what we’re all trying to hack into.

We don’t know what the best fasting system is right now because we don’t have a tool to measure autophagy.

We can measure autophagy in animals by sacrificing them and measuring proteins, but we don’t’ have a metabolic signature for autophagy.

Wouldn’t it be great to draw blood and measure the proteins and changes in small molecules that tell us when we’re in and out of that autophagy maximally?

Benefits of Exercise

Hopefully in 60 years we’ll view it as absurd that all calories are created equal and everyone understands importance of maintaining muscle mass and importance of lifting weights.

Peter breaks down his thinking of exercise into two main categories:

1. Metabolic Benefit

  • Glucose disposal – One of the tenets of living as long as possible is maintaining the lowest average glucose with a minimal standard deviation.
    • These glucose measurements serve as a proxy to something that cannot possibly measured which is the area under the curve of insulin in 24 hrs.
    • Glucose homeostasis is one of those miracles of life and depends on two things:
      • 1. How much can your liver buffer glucose into and out of circulation
      • 2. When enormous amounts of glucose enter your system (which is when you eat), how quickly can you get it out of your system. It can only go two places
        • Liver – Relatively small capacity for storage
        • Muscle – Relatively larger capacity and it’s probably the greatest difference across people. It’s certainly the greatest difference between fit and unfit people.
    • Oral glucose tolerance test – Test where he measures their glucose and insulin levels, then has them consume a large amount of sugar, and then serially measures their blood glucose and insulin levels.
      • One of 5 most important tests any human should have done because he learns everything about a person’s ability to dispose of glucose efficiently.
        • If you can dispose of glucose but need a high amount of insulin, this is the canary in the coal mine.
        • Optimal is of there is no bump in glucose and your body requires little insulin to do this.
    • Muscle is all about glucose disposal. You control the input which is what you eat and you control the output which is how much of a reservoir you have in your muscles to dispose of blood glucose.

2. Structural Benefit

  • Maintenance of muscle mass
  • Ability to move
  • Ability to move without pain
  • Preserve bone density

All of these contribute to healthspan.

You can die if you break your hip typically because it results in a complete loss of mobility and a relatively precipitous decline.

If you want to avoid this you need a strong chassis.

Bones need to have as much density as possible. Muscles need to be long and strong and act on the levers they’re meant to.

10% OFF with code: bjjcaveman

I hope you learned as much from this as I did.  He’s mentioned in a few places that he’s in the process of writing a book with an estimated publication date in 2019.  I plan on pre-ordering that sucker the moment it’s available!

In the mean time, if you want to read more from Peter Attia there’s plenty more at www.PeterAttiaMD.com

*Image found here.

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