The Tim Ferriss Show
#661: Dr. Peter Attia — The Science and Art of Longevity, Optimizing Protein, Alcohol Rules, Lessons from Glucose Monitoring with CGMs, Boosting Your VO2 Max, Preventing Alzheimer's Disease, Early Cancer Detection, How to Use DEXA Scans, Nature’s Longevity Drug, and More
Episode guests
Podcast summary created with Snipd AI
Quick takeaways
- Medicine 3.0 emphasizes early intervention and prevention, shifting from evidence-based medicine to evidence-informed medicine for better health outcomes.
- Becoming medically literate involves reading credible sources, understanding research concepts, and critically evaluating studies.
- Medical literacy empowers individuals to navigate the medical system, make informed decisions, and identify misinformation.
- The objective-strategy-tactics framework helps individuals define healthcare goals, develop effective strategies, and implement them through appropriate tactics.
- Exercise, particularly aerobic exercise and strength training, reduces the risk of neurodegenerative diseases by building movement and cognitive reserve, improving insulin sensitivity, and increasing BDNF levels.
Deep dives
The Importance of Medicine 3.0
Medicine 3.0 proposes a shift from the current medicine 2.0 approach to a more proactive and preventive system. Medicine 2.0 has been successful in treating acute diseases and infectious diseases, but it has largely failed to address chronic diseases and neurodegenerative conditions. The new approach emphasizes early intervention, starting prevention strategies before diseases progress. It also advocates for a transition from evidence-based medicine to evidence-informed medicine, where insights from randomized controlled trials are adapted and tailored to individual patients.
Developing Medical Literacy
Becoming medically literate requires effort and practice. One way to start is by reading credible sources such as scientific newsletters and blogs that provide case studies or discuss new research findings. Developing familiarity with basic research concepts, such as study design, biases, and statistical significance, is crucial. Resources like online courses or books on scientific literacy can also be helpful. Understanding the scientific method and being able to critically evaluate studies are essential skills in becoming medically literate.
Benefits of Medical Literacy
Being medically literate empowers individuals to make better decisions about their health. It helps navigate the complex medical system, understand research studies, and parse information from various sources. Medical literacy enables individuals to participate actively in their healthcare and have informed discussions with healthcare providers. It can also aid in identifying potential misinformation and making evidence-based choices for better health outcomes.
Applying Objective, Strategy, Tactics in Medicine
Using the framework of objective, strategy, and tactics can guide decision-making in medicine. Identifying clear objectives, such as living longer with a lower risk of chronic diseases, allows individuals to define their healthcare goals. Developing effective strategies, like early intervention and preventive measures, can lead to better health outcomes. Then, selecting appropriate tactics, such as nutrition and exercise, becomes crucial in implementing the chosen strategies. This framework helps individuals take a proactive role in their healthcare and make more informed choices.
Exercise and its role in preventing neurodegenerative diseases
Exercise, particularly aerobic exercise and strength training, has been found to be the most important modifiable behavior for reducing the risk of neurodegenerative diseases like Alzheimer's, Parkinson's, and Lewy body dementia. Exercise helps to build movement reserve, cognitive reserve, and provides hormonal, vascular, and metabolic benefits. It increases levels of brain-derived neurotrophic factor (BDNF), a growth factor for neurons, and improves insulin sensitivity and glucose disposal. Requesting a physician who understands the importance of exercise and prevention, and discussing specific goals and preferences with them, can be helpful in optimizing health.
The impact of exercise on VO2 max and the importance of base-building and peak-building
VO2 max, a measure of maximal oxygen consumption and cardiovascular fitness, can be significantly improved through exercise. To build a high VO2 max, it is important to have a strong aerobic base, which involves spending around 80% of aerobic training time in zone 2 (a comfortable but challenging intensity). This base-building should be complemented with interval training at higher intensities (zone 5) to build the peak. Interval durations of 3 to 8 minutes are effective, with one-to-one work to recovery ratios. Starting with a once-a-week high-intensity interval training session, along with several zone 2 sessions per week, can be a good starting point.
The benefits of rucking for overall strength and endurance
Rucking, which involves walking or hiking with a weighted backpack, has shown to have numerous benefits for overall strength, endurance, and cardiovascular health. It helps in building movement reserve and provides an excellent workout without the impact of running. It is recommended to start with a weight that is around a sixth to a quarter of the body weight and gradually increase the duration and intensity. Rucking on inclined terrain can further enhance the benefits.
Enhancing medical advocacy and discussions with healthcare providers
To improve the quality of discussions with healthcare providers and enhance medical advocacy, it is important to find doctors who embrace prevention strategies and have a philosophy that aligns with individual health goals. Asking doctors about their approach to ongoing learning outside of medical school, discussing specific objectives related to prevention and overall health, and being proactive in seeking information and understanding can help in empowering individuals to actively participate in their healthcare decisions.
Developing Medical Literacy
One key point discussed in the podcast is the importance of developing a working vocabulary and framework to assess medical literacy. This involves acquiring a certain level of medical knowledge and understanding in order to effectively evaluate medical information. By developing this foundational knowledge, individuals can better assess medical advice, research, and recommendations, ensuring they make informed decisions about their own health.
Broadening Health Care Perspectives
The podcast highlights the need to expand the concept of healthcare beyond just primary care physicians and disease treatment. The speaker suggests that a comprehensive approach to healthcare should include professionals such as exercise physiologists or trainers, as there is significant overlap and integration between various aspects of health. While concierge medicine may not be accessible to everyone, finding a good strength coach or endurance coach can provide significant health benefits. Therefore, it is essential to consider a diverse range of healthcare professionals to optimize overall well-being.
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Peter Attia, MD (@PeterAttiaMD), is the founder of Early Medical, a medical practice that applies the principles of Medicine 3.0 to patients with the goal of lengthening their lifespan and simultaneously improving their healthspan. He is the host of The Drive, one of the most popular podcasts covering the topics of health and medicine.
Dr. Attia received his medical degree from the Stanford University School of Medicine and trained for five years at the Johns Hopkins Hospital in general surgery, where he was the recipient of several prestigious awards, including Resident of the Year. He spent two years at the National Institutes of Health as a surgical oncology fellow at the National Cancer Institute, where his research focused on immune-based therapies for melanoma.
His new book is Outlive: The Science and Art of Longevity (3/28).
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[07:00] How and why Peter’s muscle mass has increased significantly.
[18:48] Why the long wait for Outlive: The Science and Art of Longevity?
[23:19] Objective, strategy, and tactics.
[28:50] From Medicine 1.0 to Medicine 3.0.
[39:04] Randomized control trial results: guidelines, not gospel.
[43:21] Revisiting why and how one should increase their medical literacy.
[52:44] Avoiding scientific method misconceptions.
[55:43] Austin Bradford Hill.
[56:22] Observational study versus randomized control trial.
[1:00:09] Are sleep trackers downgrading the quality of our sleep?
[1:02:53] Under what conditions does Peter feel alcohol might be worth its downsides?
[1:06:47] Continuous glucose monitors (CGMs).
[1:18:24] Underutilized metrics and tools for expanding health and lifespan.
[1:25:01] Strength.
[1:33:11] Rucking around and finding out about VO2 max.
[1:38:32] Finding the zone two sweet spot.
[1:41:10] How skinning and rucking have upped my endurance.
[1:42:24] Rucking vs. weighted vests.
[1:46:39] Are neurodegenerative diseases preventable?
[1:51:47] Helping your doctor understand and embrace Medicine 3.0.
[1:53:47] How much is an ounce of prevention worth to you?
[1:58:23] Early cancer screening.
[2:06:33] Outlive chapters.
[2:08:46] The chapter on emotional health that almost didn’t make the book.
[2:10:16] Peter’s 47 affirmations.
[2:14:18] Parting thoughts.
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