Pietro Attia had a problem. It was 2006. He had just graduated from Stanford medical school and was completing a prestigious surgical residency at Johns Hopkins, but instead of celebrating his success, he was wracked with frustrations.
The medical establishment, it seemed to him, was stubbornly resistant to change and innovation; doctors could easily diagnose the diseases that kill most of us heart disease, cancer, Alzheimer’s and type 2 diabetes, but they struggled to help their patients avoid those diagnoses in the first place. Peter believed there must be another approach. He was convinced that it was possible to practice a cutting-edge form of medicine that didn’t just manage diseases but tried to prevent them. So he embarked on a journey to figure out how to do it.
Now, nearly twenty years later, he has compiled everything he learned on that trip into a book, No New York Times best seller To survive. It’s a complete guide to exercise, nutrition, sleep and mental health that will help you live better for longer. Attia joinsThe next big idea podcast for such a big discussion, we made two installments of it.
Sign up for The Next Big Idea newsletter here.
Do you want to be able to lift a suitcase when you’re 100? You’d better start exercising now.
Rufus Griscom: You have this really counterintuitive shot about thinking about our health working backwards, asking the question: In the last decade of your life, what would you like to be able to do? You call it the centennial decathlon.
Dr. Pietro Attia: I think a lot through this lens of what’s called the marginal decadeso one of the first questions I will ask a new patient is: What are your goals for the last decade of your life and what are your goals for the next 12 months? Almost without exception, nobody’s goals align. Most people have too lofty a set of goals in their fringe decade for what they’re doing today.
We actually have a list of 50 things and we tell our patients: pick the 10 that are most important to you. These are activities of daily living. Many people who ski want to be able to ski when they’re in the last decade of their lives and I wasn’t here to tell them that’s an unreasonable goal. We are simply here to tell them what the physiological requirement is to be able to do so. So we know how much strength decreases per decade. We know how much energy decreases from decade to decade. We know how much VO2 max decreases per decade. So let’s say, well, these are the physiological requirements for where you want to be at 90 based on how they’re declining. This is where you need to be today. Where are you? Oh, you are here. So you’re taller than where you need to be at 90, but you’re not tall enough.
Because exercise is the most important factor in improving your health.
Rufus: If you had to force diet, sleep, and exercise, which do you think are most effective at improving the health span of most listeners? How would you rank those three?
Peter: There is no doubt that exercise is number one. There should be no discussions. As a general rule, I would exercise, eat, sleep, but the gap between exercise and the other two is a chasm.
So the easiest way to imagine this is to ask the question: What are the gradations of improvement or damage that come in the extreme states of each? Let’s start with nutrition. What does nutrition consist of? Nutrition is about metabolic health. So what is the most extreme state of poor nutrition? It’s type 2 diabetes and obesity. How much risk does it pose for an individual? If you look at Cox proportional hazards, which are the statistical tools we use to generate so-called risk ratios, it is clear that the risk of type 2 diabetes is significant. If you’re talking about all-cause mortality, it’s about 30 to 50 percent more, and if you’re talking about disease-specific mortality, it can be 50 to 100 percent more.
As a general rule, I would exercise, eat, sleep, but the gap between exercise and the other two is a chasm.
When you look at sleep deprivation or disrupted sleep, it has lower risk ratios than that. Short sleep will come with a 20-30% increase in all-cause mortality.
But now let’s look at the exercise. In exercise, we have three really good metrics that supplement the work done, and those are VO2 max, muscle mass, and strength. If you have a very high VO2 max versus a very low VO2 max Let’s just say if you compare people in the bottom 25 percent of age and gender with the top 2.5 percent, the difference is 5 times, which is a 400 percent difference in all-cause mortality.
Rufus: Amazing.
Peter: The same goes for muscle mass. So what would I take away from it? If your VO2 max, muscle mass, and strength are in the top 10 percent for your age and gender, you’re bulletproof. Your nutrition doesn’t really matter. Now, again, there’s a caveat here, because you wouldn’t be able to get into that shape without reasonable nutrition and the sleep to support it. There is absolute cross-pollination of these things. But exercise is the most important tool we have.
How Much Exercise Should You Get?
Rufus: What must we do to obtain these extraordinary benefits? What amount of exercise do you recommend for your typical individual in any given week?
Peter: I usually start with the question: how much time are you willing to devote to this process? Take whatever that number is and divide it in half. Half will be strength and stability; half will be cardio. Strength and stability should be divided such that approximately 80 percent is strength and 20 percent is stability. The cardio should be broken down so that about 80 percent is Zone 2 (that is, exercise performed at 70 to 80 percent of your maximum heart rate) and 20 percent is VO2 max-specific training. This, in a nutshell, is the simplest formula for how to divide your time into exercise.
The best dietary advice is the simplest.
Rufus: You say, Peter, that you hate being asked about your diet at dinner parties. Why?
Peter: I just hate the subject. I hate everything about it. People come up to me and ask me things at parties, and there’s just genuine confusion, and I can understand that, but what I think I rail against is the religious zeal with which people try to tell you their diet is the only real diet. . The evidence is simply overwhelming that this is not the case. Nutrition is important in terms of energy balance, nutrition is important in regards to micronutrients, nutrition is important in regards to anabolic building blocks (i.e., nutrition is important in terms of preventing disease-causing agents).
Rufus: So the basic principles of nutrition that aren’t controversial are to avoid drinking sugar water, processed foods are generally a bad idea. Do you agree with this?
We can’t paint by numbers when it comes to nutrition.
Peter: I don’t want to be too picky, but even the term processed food is a bit complicated, because processing food is what allows us to live the way we do. It would be very difficult for us to live if we could only survive on completely unprocessed food. It’s true that if you’re eating something processed, the probability it’s bad is probably higher than the probability it’s good, but there are some processed things I eat that I think are really healthy, so you have to look at everything somehow. case by case.
If we’re looking for broad outlines, it’s all common sense. It’s shopping outside the grocery store, not inside. She always does the granny test: Did my grandmother eat it? If not, I probably shouldn’t eat it. But again, this isn’t a universal truth, right? Your grandma couldn’t have gotten a whey protein shake, but there’s really high-quality whey protein out there that’s a great way to get extra protein if you can’t get it through. through all of your meals. So that’s a long-winded way of saying we can’t paint by numbers when it comes to nutrition.
How to take a nuanced approach to drinking.
Rufus: We had a guy named Edward Slingerland on the show who wrote a wonderful book called Drunk on the coevolution of man and alcohol. And he cited a number of studies that conclusively show something most people wouldn’t be surprised by. Take a random sample of people. Some think they are drinking alcohol, but they are not. Some think they don’t drink alcohol, but they are. Those who have consumed alcohol, whether they realize it or not, will make more intense eye contact, laugh more, have more confidence. So I think it’s effective in helping humans connect, and we know it’s good for health. What do you think?
Peter: It would be hard for me to disagree with everything you said. Back to this discussion of nuances. At least in the case of red wine, there are probably some phytochemical benefits as well, and there are probably some antioxidant properties of red wine that are nutritionally beneficial. And everything that you said on the pro-social side, for a lot of people, that’s true, but obviously for some people, it’s not true. Let’s not forget that there are many people for whom alcohol is a bad thing. I don’t want to lose sight of it.
What is unequivocal is that ethanol is a toxin, a carcinogen and a harmful molecule. I want to make sure everyone understands this. There is nothing in ethanol that is, at any dose, beneficial.
That said, you can be careful how you use this thing to your advantage and protect yourself from some of its harm. If I have two glasses of wine at 6pm and go to bed at 10pm, I sleep pretty well. If I drink two glasses of wine at 9pm and go to bed at 11pm, I sleep really badly. So for me, this is what I would call the nuanced approach.
Rufus: This is a party of middle-aged experts. Start early.
Steps to take for a good night’s sleep.
Rufus: The dividends of a good night’s sleep run deep. It affects mood, cognitive function, glucose removal, memory formation, libido
Peter: It’s really wonderful. But you have to get to this point where you’re saying, “This is so important that I’m willing to do this, which means I’m willing to devote eight hours of my day to this thing.” This is what it takes to get seven and a half hours of sleep. You have to tell yourself: I will be consistent about when I go to bed and when I wake up, including weekends. The room will be dark. It’ll be cold. And I won’t have electronics in the room. You have to take the phone out of the bedroom. And you have to set the mood for sleep by not doing stimulating things beforehand and the most notable of these, for virtually every human being, is email and social media.
Edited and condensed for clarity.
You may also like:
To enjoy ad-free episodes of Next big idea podcasts, download the Next Big Idea app now:
#optimize #diet #sleep #fitness #longevity #expert
Image Source : nextbigideaclub.com