The longevity treatment no one’s talking about: Peter Attia, M.D. | mbg Podcast

Dr. Peter Attia discusses the importance of exercise, lifestyle modifications, and personalized management of lipid-related concerns in eradicating chronic diseases like cardiovascular disease and atherosclerosis

Questions to inspire discussion 

• What is the number one killer globally?

  —Cardiovascular disease is the number one killer globally, surpassing cancer, and is often overlooked as a leading cause of death for both men and women.

• What are the risk factors for atherosclerosis?

  —Atherosclerosis is driven by smoking, high blood pressure, insulin resistance, hyperinsulinemia, and elevated levels of glucose.

• How can APO B levels be lowered?

  —There is no clear answer on how to lower APO B other than possibly reducing saturated fat or using lipid-lowering therapy, which has been effective but controversial.

• What are the benefits of exercise?

  —Exercise is the ultimate elixir for longevity, with high cardiorespiratory fitness, muscle mass, and strength being the most important metrics, and even 30 minutes of exercise, split between cardio and strength training, three times a week can significantly reduce the risk of all-cause mortality.

• How can blood pressure be managed?

  —Lifestyle modifications such as exercise, weight loss, sleep, and stress reduction have a significant impact on blood pressure, with cardio training being more effective than strength training.

Key Insights 

Exercise and Muscle Mass for Longevity

• 💪 Exercise is a factually proven elixir for longevity, with no other metric coming close to its benefits.
• 💪 Exercise, weight loss, sleep, and stress reduction are the big lifestyle modifications that have a significant impact on blood pressure.
• 💪 The amount of muscle mass you have is a key factor in longevity and health, with those at or above the 75th percentile being considered adequately muscled.
• 💪 Protein is the most important macronutrient for building lean muscle mass, and the recommended dietary allowance (RDA) of 0.8 grams per kilogram of body weight is misleading and incorrect.
• 💪 Exercise is the ultimate elixir for longevity, with high cardiorespiratory fitness, muscle mass, and strength being the most important metrics to achieve.
• 💪 Going from zero exercise to three hours a week can reduce your risk of all cause mortality by 50, making even a small amount of exercise incredibly beneficial for overall health.

Cardiovascular Disease and Risk Factors

• 💔 Cardiovascular disease is the number one killer in the US and globally, with a larger gap between it and cancer as the number two killer than most people realize.
• 🕰️ Doubling life expectancy has led to new challenges: "We're simply living long enough to be entrenched in the disease processes that lead to slow death."
• 💉 Measuring APO B levels is a better predictor of cardiovascular risk than just measuring LDL cholesterol levels.
• 🚺 Women typically see a significant bump in their APO B levels as they transition through menopause, which explains why they eventually catch up in terms of heart disease once they lose the protection of estrogen.
• 🚬 Waiting until someone has a heart attack to start treating their risk factors is not as effective as preventing the risk factors in the first place, similar to how stopping smoking before lung cancer is more effective than after. 

#Health #Wellness #Longevity 

Clips 

• 00:00 💪 Exercise can eliminate cardiovascular disease as a risk factor for mortality and lifestyle modifications and pharmaceuticals can eradicate chronic diseases like CBD, according to Dr. Peter Attia.
  • Exercise is a factually proven ultimate elixir that can eliminate cardiovascular disease as a risk factor for mortality.
  • Dr. Peter Attia discusses how lifestyle modifications and pharmaceuticals can eradicate chronic diseases like CBD.
  • The speaker's passion for longevity and health span stems from a family history of premature deaths and a personal shift in thinking after the birth of their child.
  • Cardiovascular disease is the number one killer globally, surpassing cancer, and is often overlooked as a leading cause of death for both men and women.
  • Neurodegenerative diseases, including Alzheimer's, Parkinson's, Lewy Body dementia, and others, along with metabolic diseases, such as hyperinsulinemia, insulin resistance, fatty liver disease, and type 2 diabetes, amplify the risk of other diseases and may be the single greatest killer.
  • There are multiple theories on the causes of mental health issues, including environmental factors and lack of sleep.
• 09:14 💊 Medicine 2.0 has improved fast death caused by trauma and infections, but slow deaths from disease processes are still a challenge; modern lifestyle negatively impacts health, but focusing on nourishment, exercise, and preventing cardiovascular disease can help. 💉 Knowing your APO B levels is important for achieving healthy goals as it measures the concentration of atherogenic particles, which is a better predictor of cardiovascular risk than just measuring LDL cholesterol. 🩺 Atherosclerosis is driven by various factors, with APO B being a necessary but not sufficient criteria for atherosclerosis, meaning eradicating APO B could potentially eradicate atherosclerosis.
  • Medicine 2.0, the era we live in, has been remarkable at dealing with fast death caused by trauma and infections through the introduction of the scientific method, the invention of the light microscope, and the development of antimicrobial agents.
  • Life expectancy has doubled in the past century, but slow deaths caused by disease processes have not been successfully addressed.
  • Modernity accelerates fast death and negatively impacts our health through over-nourishment, under-muscling, under-sleeping, and over-stressing, but we can avoid its pitfalls by focusing on nourishment, exercise, and preventing cardiovascular disease.
  • APO B is a powerful marker in the CBD conversation and it's important to know your APO B levels for achieving healthy goals.
  • APO B is a protein that measures the concentration of atherogenic particles, which is a better predictor of cardiovascular risk than just measuring LDL cholesterol.
  • Atherosclerosis is driven by smoking, high blood pressure, insulin resistance, hyperinsulinemia, and elevated levels of glucose, with APO B being a necessary but not sufficient criteria for atherosclerosis, meaning eradicating APO B could potentially eradicate atherosclerosis.
• 16:36 💊 New drugs like PCSK9 inhibitors, acetamide, and benpinoic acid can effectively lower APO B levels and prevent heart disease in high-risk individuals.
  • APO B levels in children are very low, but by adulthood, it becomes difficult to maintain levels below 80 milligrams per deciliter, and even more so for women after menopause, requiring pharmacotherapy to achieve physiologic levels.
  • Exercise can have a beneficial effect on lipoproteins, but there is no clear answer on how to lower APO B other than possibly reducing saturated fat or using lipid-lowering therapy, which has been effective but controversial.
  • New classes of drugs, including PCSK9 inhibitors, acetamide, and benpinoic acid, have no side effects and can effectively lower APO B levels, making it feasible to prevent heart disease in high-risk individuals.
  • APO B is the number one killer and can be obliterated with CBD, but most physicians are not aware of it.
  • The current standard of care for lipid management is to only treat preventatively based on a five to ten year risk time horizon, but the speaker disagrees and believes that lifetime risk should be considered.
  • Causality is everything in science and smoking is causally related to lung cancer, so it is illogical to not tell people to stop smoking immediately to reduce their risk of cardiovascular disease.
• 30:17 💊 Consult a lipidologist for personalized management of lipid-related concerns and consider lifestyle modifications for better blood pressure control.
  • The speaker takes a mild Statin and a pcsk9 inhibitor called repatha, and the dosage and type of drug taken depends on individual factors such as cholesterol production and sensitivity.
  • Consult a lipidologist through the National Lipid Association to manage lipid-related concerns, including LP little a testing, which cannot be changed pharmacologically, and consider biomarkers such as genetics and blood pressure for overall cardiovascular and neurodegenerative disease prevention.
  • High blood pressure and type 2 diabetes can cause significant damage to the kidneys, which are a vital organ responsible for filtering blood and managing electrolytes and glucose.
  • Keeping blood pressure at or below 120 over 80 has significant advantages, but implementation and awareness are lacking among the population.
  • To accurately assess blood pressure, patients should monitor it at home twice a day and lifestyle changes can have a greater impact on blood pressure than medication.
  • Lifestyle modifications such as exercise, weight loss, sleep, and stress reduction have a significant impact on blood pressure, with cardio training being more effective than strength training.
• 38:49 💤 Take the stop bang test to determine your risk for sleep apnea, regardless of weight or health, and seek a proper sleep evaluation if necessary.
  • Take the stop bang test online to determine your risk for sleep apnea, as it can affect anyone regardless of weight or health, and seek a proper sleep evaluation if necessary.
  • Body weight and stress have a significant impact on blood pressure, and it is important to demand testing for LPA from doctors.
  • Knowing your apoe genotype can provide valuable information about the risk of cardiovascular and Alzheimer's disease, allowing for preventative measures to be taken, but it is important to note that having the high-risk isoform does not guarantee the development of Alzheimer's disease.
  • Lab test reference ranges are based on the fifth to 95th percentile of the population being tested, but since a large portion of the population is unhealthy, more stringent ranges are used in medicine.
  • Food is essential for energy and structure, but our genetic adaptations to prioritize storage and avoid starvation in a scarcity environment are not serving us well in a world where most people are overexposed to nutrition.
• 44:19 🍎 Determine if you're over or undernourished, adequately muscled or under muscled, and metabolically healthy or not to develop a personal philosophy on eating, aim for 1.5 to 2 grams of protein per pound of body weight, and exercise regularly for longevity.
  • We face new nutritional problems that require counter-intuitive solutions due to lack of evolutionary preparation, and determining whether a person is undernourished or overnourished is crucial in developing a personal philosophy on eating.
  • The three important questions to determine nutrition plan are: whether a person is over or undernourished, adequately muscled or under muscled, and metabolically healthy or not.
  • Protein is the most important macronutrient for gaining lean muscle mass, and the recommended dietary allowance is misleading and incorrect.
  • To be at your best self, aim for 1.5 to 2 grams of protein per pound of body weight, spread out over three to four servings per day, and include eggs, protein shakes, and meat or fish at dinner.
  • The speaker's favorite snacks include egg whites and yolks, venison sticks, protein shakes, and Greek yogurt with granola, and he prefers two percent Greek yogurt and sardines are a good go-to for those who can tolerate them.
  • Exercise is the ultimate elixir for longevity, with high cardiorespiratory fitness, muscle mass, and strength being the most important metrics, and the only way to achieve them is through training.
• 56:08 💪 Regular exercise, including cardio and strength training, can significantly reduce the risk of all-cause mortality, but it's important to prioritize rest and focus on the basics of health and wellness.
  • Even 30 minutes of exercise, split between cardio and strength training, three times a week can significantly reduce the risk of all-cause mortality.
  • For cardio training, aim for 80% of the time in zone two and 20% closer to your red line, with a mix of steady state and interval training.
  • Increasing intensity or frequency and duration are necessary to continue making gains in a training program, and there is no upper limit to the benefits of exercise, but trade-offs must be made when sacrificing rest for cardio during weight training.
  • We lack effective biomarkers to measure the efficacy of interventions such as exercise and nutrition, and we don't know what to look for in terms of gene transcription and epigenetic changes, making it difficult to develop drugs or supplements that mimic the benefits of these interventions.
  • Grip strength is a proxy for physical robustness and can be improved by carrying heavy things, which is beneficial for our connection to the outside world.
  • Focus on the basics of health and wellness instead of getting lost in minor details and science fiction approaches to longevity.
• 01:07:49 📚 Peter recommends reading Jason's book Outlive and acknowledges his contributions, while also mentioning his desire for Senna to join Formula One.
  • Peter would write "Senna you have to go to Formula One" or "John Coctos tosin" on his giant billboard, and he appreciates Jason's contributions and encourages everyone to read his book Outlive.

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