Episode 1: Peter Attia on how to live longer and better

Dr. Peter Attia, the guest for this episode of STEM-Talk, is a modern-day “Renaissance man,” says IHMC CEO Ken Ford. That term gets tossed around a lot, but in Attia’s case, it’s true. He is a top-notch physician, a former McKinsey consultant, and an ultra endurance athlete—who once swam twenty-something miles to Catalina Island, off the coast of California.

During the podcast show, Attia talks about his academic journey, from studying math and engineering, to then pursuing clinical medicine and developing research interests in longevity. The birth of Attia’s daughter marked his interest in quantity of life—as well as quality of life.

Attia discusses his eight “drivers of longevity,” all of which depart from the concept of preventing the onset of chronic disease. These include optimal nutrition, exercise, sleep habits, hormone optimization, stress management, sense of purpose/social connections, medications, and avoidance of harmful behaviors.

Check out Peter Attia’s blog “The Eating Academy,” at http://eatingacademy.com. You can also check out his TED talk “Is the obesity crisis hiding a bigger problem? https://www.ted.com/talks/peter_attia_what_if_we_re_wrong_about_diabetes?language=en

STEM-Talk’s host Dawn Kernagis and Ken Ford chats with Peter Attia.

3:25: In college, Attia volunteered at a children’s hospital, which inspired his interest in medicine.

4:08: Ford notes that math and engineering provide a useful background for medicine. Attia later notes that his early academic background in both these subjects “still colors how I look at the world.”

4:32: Attia’s advice to college students who are aspiring physicians: “I think you should study anything that you are not going to learn in medical school.”

5:25: Two things drive significant change in a person’s life: “abject misery and profound inspiration.” The former drove Attia out of clinical medicine.

6:27: The birth of Attia’s daughter spurred his interest in longevity.

7:05: Commercial break:

8:32: Centenarians get diseases 20-30 years later than most people.

9:20: Longevity is first and foremost about delaying the onset of chronic disease.

10:13: Animal literature shows that caloric restriction increases longevity; so do drugs that prevent mTOR (mammalian target of rapamycin).

11:52: Eight things improve longevity and quality of life: food, exercise, sleep patterns, management of chronic stress, hormone optimization, medications, sense of purpose/social support network, avoidance of harmful behaviors.

12:28: Accidental death is the fourth or fifth leading cause of death in the U.S.; 80 percent of these are auto accidents, accidental poisoning and falls.

13:09:  Ford and Attia agree that trade-offs sometimes exist between interventions likely to increase lifespan and those aimed at aimed at increasing healthspan.

15:50: People who consume fewer calories are likely to have a lower risk of diabetes, heart disease and cancer; they may also have more deficient immune systems and greater susceptibility to catastrophes like falls.

16:10: Caloric restriction creates an environment of cell signaling, cell growth, and nutrient sensing that slows down aging.

16:36: One of the greatest challenges in studying longevity is the inability to accurately measure biologic signals such as mTOR activity.

17:08: Attia characterizes protein optimization: “We want to see IGF-1 levels lower; AMP kinase more active; Ras less active.”

18:36: “Three things I walk through life wanting to keep at a minimum,” Attia says: How to minimize mean level glucose, variability of glucose, and insulin AUC (area under the curve).

19:24: Attia eats 125-150 grams of specific carbs per day, at times when he can maximally dispose of it. He also wears a continue glucose monitor that measures glucose every five minutes.

20:47:  Ford and Attia discuss the benefits of a ketogenic diets and the implications for IGF-1, mTOR, insulin, and amino acids.

22:18: The ideal diet minimizes glucose and has moderate but sufficient protein; the majority of the diet becomes fat.

23:30:  Ketogenic diets do not work for everyone.  The efficacy of the ketogenic diets mqy have a genetic basis and it does not seem appropriate for everyone.

24:27: We should talk about molecules and physiology instead of diets.

25:19:  Ford and Attia discuss the trade-offs associated with leucine supplementation which increases mTOR1 … which in turn stimulates protein synthesis necessary for maintaining and increasing muscle mass and staving off sarcopenia.  On the other hand, chronic elevation of mTOR is not desirable in terms of lifespan.  Attia and Ford discuss how they use amino acids around exercise.

28:00: Attia discusses his blog “The Eating Academy,” which he initially called “The War on Insulin.”

30:30: In the blog, Attia discusses how the ketogenic diet and intermittent fasting increase longevity.

30:57: A recent, retrospective paper on exceptionally long-lived humans finds they have low levels of IGF-1.

32:34: Low IGF from neck down is beneficial in preventing cancer/cardiovascular disease; high IGF above the neck helps prevent Alzheimer’s Disease.

33:54: Attia and Ford discuss IGF-1 and sacrocpenia in the context of healthspan.  Low IGF-1 may be correlated with increased longevity, but IGF-1 (and mTOR) is an important driver of muscle protein synthesis and, all things being equal, the more muscle mass you have, the better. We should all be striving to have as much of it as we can, Attia says.

34:45:  Ford notes, that although the causes for sarcopenia are multifactorial, it does seem that one of the drivers of sarcopenia is a general anabolic hormone resistance, very much like insulin resistance that we discussed earlier.

35:07: There’s a difference between training with massive specificity to optimally perform a specific task like pro athletes; and training to stay healthy and not get hurt. As we age, we need to focus on the latter and train to be the “athlete of your life.”

39:14: Nothing trumps resistance training.

40:18: More muscle allows you to tolerate greater glucose input.

41:10: The loss of muscle mass accelerates as we age.

43:12: We’re evolved to deal with acute stress; chronic stress is a newer, more difficult phenomenon.

44:12: Attia calls literature on meditation “messy.” His advice? Pick one and run with it. His choice is transcendental meditation.

45:20: “Phosphatidylserine” is a wonderful sleep agent that suppresses the adrenal glands in the evening.

46:06: “There’s no doubt that keeping cortisol levels in check requires the most work.”

49:19: Our ancestors spent one third of their lives sleeping. The benefit must have eclipsed the survival risk because we’ve held onto this habit.

50:00: Clinical trials on sleep show that between seven and a half and eight and a half hours of sleep is optimal.

54:04: Sleep agents like Ambien provide very little good quality sleep (stage three and four).

55:14: Sleep expert Kirk Parsley will be an upcoming guest on STEM-Talk.

55:39: Hormone replenishment takes place during sleep.

56:58: As we age, we get slower, fatter, colder, less energetic. Hormones drive those tendencies.

57:12: In men, the androgen system undergoes a slow and predictable decline; in women, it is more precipitous at menopause.

57:42: Attia discusses the flaws of the Women’s Health Initiative, which unnecessarily stigmatized hormone replacement therapy.

58:07: A woman without estrogen, progesterone, and testosterone in her body is neither healthy nor feeling good.

59:20: Testosterone is the dominant hormone in a woman’s body.

1:01: Attia discusses relative risk versus absolute risk.

1:03:18: There are no absolute black and whites in pharmacology, Attia says. Drugs such as statins and metformin are context-specific.

1:05:38: Heart disease is still the number one killer in both men and women.

1:05:40:  Attia discusses elevated uric acid levels.

1:06:08: Attia keeps a tool kit of 20-25 drugs. “It’s like building a custom home for somebody,” he says, based on their phenotype, risks, etc.

1:07:20:  Attia discusses Berberine and Metformin.

1:07:52: Ford mentions a newly approved study which will examine Metformin as a longevity drug.

1:09:19: People who work longer versus retire sooner have better cognitive outcomes. The more active the brain is, the better the brain is.

1:12:20: Attia says genetic testing is “a little over-hyped” and not a panacea. It is insightful for pediatric metabolic diseases and cancer germ-line mutations, but much of what genes are doing is still unknown.

1:17:54: Attia’s last (but not least) driver of longevity is to not do “stupid things.” Half of auto deaths occur on the freeway; of the half, most occur at intersections from the left-hand side. So at an intersection, first look left.