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Medicine 2.0 was successful in treating fast death caused by infections and trauma, but it has been less effective in treating slow death caused by chronic diseases like cardiovascular disease, cancer, and neurodegenerative diseases. Medicine 3.0 emphasizes a lifetime risk approach, focusing on preventative measures and addressing causal risk factors. It aims to shift the mindset from treating diseases after they occur to preventing them through lifestyle modifications, including exercise, nutrition, sleep, stress management, and emotional health.
Exercise has a significant impact on longevity, with studies showing that it has the highest association with reduced all-cause mortality compared to other factors like smoking, type 2 diabetes, and hypertension. High levels of cardiorespiratory fitness (measured by VO2 max) and strength are particularly important, with hazard ratios up to 400% higher in individuals with low fitness levels compared to those with high fitness levels. Exercise has both physical and mental health benefits, making it a crucial element in a person's portfolio of exercise for longevity.
The mindset shift towards exercise as a powerful tool for longevity can be influenced by both the healthcare system and individual action. It is not solely dependent on healthcare initiatives but can be driven by individuals taking charge of their own health and prioritizing exercise. While some individuals may not enjoy exercising initially, consistency and finding enjoyable activities or socializing while exercising can help develop a positive mindset towards exercise. Over time, exercise can become a source of joy and a vital part of daily life.
Dr. Peter Attia prioritizes exercise as a key component of his longevity strategy, using the centenarian decathlon model to guide his exercise choices. His exercise portfolio includes about four hours per week of steady-state cardio in zone two, 30 to 60 minutes per week of higher intensity cardio, six hours per week of strength training split equally between upper and lower body, and three to four hours per week of rucking (walking with a backpack) in nature. Dr. Attia emphasizes the importance of tailored exercise programs that address specific physical skills and integrate physical and emotional health.
The podcast highlights the importance of optimal sleep and nutrition and the potential negative consequences of being undernourished or overnourished. The speaker suggests that while it is crucial to correct extreme nutritional imbalances, once an individual is adequately nourished, the focus should shift towards metabolic health and maintaining lean mass rather than fixating on specific dietary nuances. The speaker also mentions the impact of soil health on food and acknowledges that while better nutrition is desirable, it should not overshadow the importance of regular exercise and achieving energy balance.
The podcast explores the concept of metabolic health and the absence of a definitive benchmark for measuring it. Although there is no single number to gauge metabolic health, the speaker suggests paying attention to indicators such as zone two capacity during exercise. Zone two refers to a level of exertion at which an individual can maintain a conversation while exercising. Higher wattage output in zone two is associated with better metabolic health. Other factors such as glucose disposal, triglyceride levels, and inflammatory markers are also considered. The speaker emphasizes the importance of maintaining metabolic health and highlights the need to prioritize a calm mind and nurturing relationships for a fulfilling and good life.
My guest this week is Dr. Peter Attia. I’ve had Peter on the show twice before but it’s been over 5 years since his last appearance. In that period, his work has exploded and today he’s one of the clear leaders on the topic and practice of longevity and health span. He has a new book out called Outlive, which I heartily recommend. You’ll hear us refer to the last chapter of his book early in our conversation but we chose not to reveal the whole story live so you can read and enjoy it. We highlight the big picture in our conversation, including the transition from Medicine 2.0 to Medicine 3.0. I always leave these conversations with Peter full of ideas, and in this case, highly motivated to go outside and move my body in nature. I can think of no better actionable advice. Please enjoy my conversation with Peter Attia.
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Invest Like the Best is a property of Colossus, LLC. For more episodes of Invest Like the Best, visit joincolossus.com/episodes.
Past guests include Tobi Lutke, Kevin Systrom, Mike Krieger, John Collison, Kat Cole, Marc Andreessen, Matthew Ball, Bill Gurley, Anu Hariharan, Ben Thompson, and many more.
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Show Notes
Peter on The Tim Ferriss Show Podcast
(00:04:15) - (First question) - How Patrick influenced Peter’s decision to launch his podcast
(00:05:45) - How Peter has changed in the process of writing this book
(00:08:11) - Process of writing the last chapter of this book
(00:11:12) - How he stopped dealing with imposter syndrome
(00:15:58) - Slow vs. fast death and medicine 2.0 vs. medicine 3.0
(00:22:55) - Doing more early detection screening to avoid slow death
(00:27:00) - Impacts of compounding risks
(00:31:24) - How do we shift thinking to better lifestyle changes vs. pill popping
(00:35:32) - The outsized impact of exercise on health
(00:46:18) - Peter’s exercise portfolio (The Comfort Crisis book)
(00:50:55) - Why habitual workouts create euphoria for exercise
(00:54:45) - How Peter’s views on nutrition have evolved
(00:59:30) - Measuring metabolic health
(01:01:55) - Where Peter hopes the future of healthcare is heading
(01:05:40) - Benefits of mindfulness to health
(01:12:55) - Defining your purpose in life
(01:16:46) - An index card summation of this book
(01:19:45) - Lessons learned being a better interviewer
(01:21:46) - Frontier of Peter’s curiosity
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