The Peter Attia Drive - #306 - AMA #60： preventing cognitive decline, nutrition myths, lowering blood glucose, apoB, and blood pressure, and more

00:00:00.000 Hey everyone, welcome to a sneak peek, ask me anything or AMA episode of the drive podcast.

00:00:15.820 I'm your host, Peter Atiyah. At the end of this short episode, I'll explain how you can access

00:00:20.280 the AMA episodes in full, along with a ton of other membership benefits we've created,

00:00:24.900 or you can learn more now by going to peteratiyahmd.com forward slash subscribe.

00:00:30.600 So without further delay, here's today's sneak peek of the ask me anything episode.

00:00:38.980 Welcome to ask me anything episode number 60. I'm once again joined by my co-host Nick Stenson.

00:00:46.460 In today's AMA, we're going to do something a little different. While often our AMAs dive deep

00:00:51.740 into one or two subjects, today will be more of a rapid style question where we cover many topics

00:00:58.260 and many questions. We've done this in the past, and it's been quite popular, so we'll do it again

00:01:02.680 here. In today's AMA, we cover topics ranging from the prevention of cognitive decline and the

00:01:08.780 relationship between cardiovascular disease and Alzheimer's disease, how you can lower your blood

00:01:14.020 glucose, insulin, and ApoB, three biomarkers we talk an awful lot about, a variety of questions around

00:01:20.220 nutrition, including its relationship to weight loss and longevity, and how a person can identify

00:01:25.780 the best diet for themselves, along with tackling a number of what we think are the most common myths

00:01:32.000 around nutrition. We talk about blood pressure, step requirements per day, standing versus sitting

00:01:37.980 desks, and more. If you're a subscriber and you want to watch the full video of this podcast,

00:01:43.620 you can find it on the show notes page. And if you're not a subscriber, you can watch the sneak peek

00:01:48.380 of the video on our YouTube page. So without further delay, I hope you enjoy AMA number 60.

00:02:00.400 Peter, welcome to an AMA. How are you doing?

00:02:02.780 Good. Thanks for having me.

00:02:04.080 Are you feeling old today?

00:02:06.000 I feel my usual old age. Yes. No. Should I feel a little older?

00:02:10.200 Do you want to let people know what we were just talking about on terms of how

00:02:13.140 your age is starting to catch up to you?

00:02:15.140 Oh, no, no. That's been going on for a while. Yes. My vision is painful. And yes, before we

00:02:21.540 were live here, I was lamenting the increase in font size I need to be able to read my notes

00:02:27.600 if I'm not willing to put on readers, which I guess glare off lights.

00:02:33.060 Love it. Love it. Well, for today's AMA, we're going to do something a little different. So

00:02:37.480 traditionally, our AMAs can be kind of deep dives into one or two subjects, and we kind of go into them

00:02:44.260 in detail. But for this AMA, we're going to do a little more of a rapid fire Q&A style. We've done

00:02:50.480 this a few times in the past, and the reception has always been really good. And so through this,

00:02:55.260 we're able to cover a variety of topics, variety of questions, and the answers will kind of be a

00:03:00.720 little more how you would speak to a patient about it, as opposed to let's dive into 10 studies and

00:03:06.480 kind of go about it that way. And so through this, we'll talk about things like preventing cognitive

00:03:12.080 decline, a bunch of nutrition questions, relationship between cardiovascular disease

00:03:16.640 and Alzheimer's disease. We have questions on weight loss and longevity, fasting, blood pressure,

00:03:23.080 step requirements, a really big, wide range of content that I think anyone will find value and

00:03:29.400 hopefully enjoy it. So with all that said, before we get into it, anything you want to add outside of

00:03:35.040 how excited you are to talk about nutrition again?

00:03:37.280 You know what this feels like is since the book came out a year ago, I've been doing more public

00:03:44.520 speaking. And by public, it's really private speaking, meaning someone or company might say,

00:03:48.840 hey, can you come and speak to our team or whatever? And because I just actually don't like standing up

00:03:54.460 and giving lectures, some people do a great job of it. I think I do a fine job at it, but I don't

00:03:59.600 enjoy it as much. I enjoy discussions more. The way we've structured those talks has been a Q&A.

00:04:05.940 I just got back from one that I did yesterday. To me, a well-moderated Q&A is generally more

00:04:12.700 interesting for the audience. I actually think that's exactly what we're going to do here. This

00:04:17.140 is exactly the type of stuff I have been doing more and probably will continue to do more of

00:04:22.480 in lieu of my more traditional thing that I used to do, which was kind of stand up and just give a

00:04:28.340 lecture for an hour and then take a few questions after. I think these Q&As followed by audience Q&As

00:04:34.380 are more my jam. So this is starting to feel more and more familiar and enjoyable.

00:04:38.860 If you had to give a lecture right now on a topic not related to longevity, what would that be?

00:04:47.320 If it was just based on my interest, I would love to talk about the evolution of Formula One. I think

00:04:52.240 that would be a really fun talk to talk about the evolution of that sport mechanically and in terms of

00:04:58.180 the drivers, the history of the sport. Who are the greatest drivers of all time and what were their

00:05:03.900 strengths and how do they stack up? And I think that would be a super fun thing to talk about.

00:05:09.080 All right. Maybe we'll do a random one-off episode then on F1 and dive into that, but not today.

00:05:16.660 First question today, something we see a lot come through. And if you look at how you talk about

00:05:21.760 longevity, lifespan, healthspan, on the healthspan side, you have physical, cognitive, and emotional.

00:05:29.100 And we do a lot on physical health. There's a lot of exercise podcasts, bone health, everything on

00:05:35.340 that. We've done a lot on emotional health too, but cognitive decline is something that has come up in

00:05:41.540 various podcasts, but not as much as others. And so one question we're often getting is people who

00:05:46.520 are worried about as they age, or maybe they see their parents aging and they see that cognitive

00:05:52.160 decline start to happen. So if someone came to you and said, you know, what's the best thing I can do?

00:05:57.600 How can I prevent cognitive decline in my life? What would you say to them?

00:06:02.820 So this is a question we do get asked all the time amongst our patients. And it is something that

00:06:08.500 we in the practice work very hard on. What differentiates this form of decline from physical

00:06:18.040 decline, emotional decline, there are a couple of things. One of them is kind of a gift, which is that

00:06:25.580 all of the things that an individual puts into the effort around reducing the risk of neurodegenerative

00:06:35.220 disease, dementing neurodegenerative diseases and non-dementing neurodegenerative diseases. So

00:06:39.500 let's just think of dementia as the overall bucket. We have a playbook for what do you need to do to

00:06:45.960 reduce your risk in terms of modifiable behavior. So we of course acknowledge that, look, there are

00:06:51.540 certain people out there that have an APOE4 gene or two APOE4 genes or a family history that probably

00:06:57.500 with it comes with some genes that maybe we don't even know about yet. Or there are other genes that

00:07:01.540 we've talked about on the podcast that have even a higher or lower signal of risk than APOE4. Okay.

00:07:07.480 Outside of that, what can you do with respect to your behavior to reduce the risk? Well, you take that

00:07:12.200 entire suite of tools and guess what? Applying those things full force is also going to prevent

00:07:20.580 cognitive decline. So the overlap between reducing the risk of a disease known as dementia

00:07:28.500 is virtually identical to the steps you take to reduce the risk of cognitive decline. Are there

00:07:35.080 differences? Sure there are. If you're talking about patients in whom we're trying to reduce the

00:07:39.500 risk of dementia and for example, we see serum markers of low amounts of amyloid accumulation,

00:07:45.620 we may actually turn to pharmaceutical agents that reduce the amount of amyloid there. So that's

00:07:50.640 something that wouldn't be in the playbook. Okay. So let's not talk about cognitive decline in the

00:07:55.580 non-pathologic sense, which is really what we're talking about here. So you can't overstate the big

00:08:01.980 ones. The evidence is very clear here that the most powerful in terms of magnitude effect size,

00:08:09.200 the preservation of cognitive function is exercise. And again, both forms of exercise,

00:08:13.980 whether you want to talk about strength or cardio, both matter. And the answer shouldn't be which one,

00:08:18.500 it should be both. It's not an or, it's an and. I'm not going to go into great detail here because

00:08:22.920 we've already done that, right? I mean, we've got so many podcasts where we go through, you know,

00:08:26.760 we have an entire podcast dedicated to brain health, but I just want to highlight the points

00:08:30.580 here. The second one is metabolic health. So if you think about it this way, which is think of the

00:08:35.800 fact that the brain, this tiny organ, people have heard me say this before, roughly 2% of your body

00:08:40.560 weight and yet approximately 20% of your metabolic demand. So if you think about that enormous

00:08:47.360 asymmetry, it tells you that anything that plays a role in fuel partitioning and energetics is going

00:08:54.220 to have an outsized impact on your brain. And all of that points towards having remarkable fuel

00:09:00.940 partitioning, being very insulin sensitive and being very metabolically flexible. Luckily, those things

00:09:07.580 all go hand in hand. If you dispose of glucose very efficiently, you are by definition, very

00:09:13.280 metabolically flexible, which means you are able to access as substrate, both fatty acid and glucose

00:09:19.260 for ATP production. Again, the most obvious example of this is if you look at people at the far end of

00:09:25.440 the spectrum in terms of metabolic inflexibility, we see that in the disease state of type two diabetes.

00:09:30.920 And in people with type two diabetes, the increase in the risk for Alzheimer's disease, depending on

00:09:35.820 where you look, could be anywhere from 40 to even a hundred percent. So once you get to the point

00:09:41.040 where you're metabolically inflexible, with that comes a lot of other risk factors. So again, if we

00:09:46.340 want to be exercising a lot, we also want to be very metabolically flexible. And the good news is

00:09:49.620 those go hand in hand. Exercise is one of the most important tools to increase metabolic flexibility.

00:09:54.760 A third thing that we can't ignore here is sleep. The epidemiology here is very clear, right? The

00:10:00.240 epidemiology would suggest that if an individual is not sleeping in appropriate length or stages,

00:10:05.160 their increase in Alzheimer's disease specifically, but probably in other forms of dementia,

00:10:10.280 also goes up. This is one that I think, fortunately, we don't need to spend that much time on today

00:10:14.700 because I think the world has really, over the past decade, I think the work of Arianna Huffington

00:10:19.820 more recently and more robustly, maybe Matt Walker have shed a lot of light on the importance of sleep

00:10:26.920 with respect to health, right? Sleep is not a passive thing. It's actually an active thing. It's an active

00:10:31.700 form of recovery for the brain, even though we're obviously looking pretty passive when we're doing it.

00:10:35.420 Right. So after those three things, what would we talk about? Well, I would say that the next most

00:10:41.360 important thing is what you actually do with your brain and body. You know, we talked a little bit

00:10:47.500 about this in a previous podcast, but people often ask like, hey, how important is it if I'm doing

00:10:53.260 crossword puzzles or playing games like that? And I think those things are probably less important than

00:10:59.460 more complicated things that combine brain and body. So it seems that the brain body exercises are

00:11:07.460 more important. So dancing, I use as an example, because you are having to coordinate your movement,

00:11:15.020 you're having to coordinate it with another person. You don't necessarily know exactly what they're going

00:11:19.760 to do, especially if you're learning. I mean, the whole goal here is to be learning something.

00:11:24.280 Learning a language is another thing that's a little bit more cognitively challenging than,

00:11:28.760 say, doing a crossword puzzle. My hope on a personal level is that driving is one of those

00:11:34.120 things. It involves so many senses. So your eyes, your ears, and your proprioceptive vestibular system

00:11:42.400 and your, I call my butt dyno, right? So the ability of your butt to sense changes in movement and 0.91

00:11:47.880 gravitation, to sense yaw in the car, all of those things have to be working on a hyper overdrive.

00:11:53.120 My hope is that that's the kind of thing that keeps your brain sharp as you age.

00:11:58.760 When people ask me, what do you think about retiring at such and such an age? We should

00:12:03.860 think about retiring as a time when we don't work for money anymore. But I really think it's

00:12:09.100 probably important that people are working throughout their entire lives, meaning they're

00:12:13.720 working on something that is keeping their brain challenged. As of this recording, my dad

00:12:19.500 is almost 87 years old, and he still works every day at a quarry. Now, I have no idea why.

00:12:26.060 He doesn't need to be doing that, and it poses such an enormous risk to him. He's not stable

00:12:32.640 when he walks around. He's walking on these rocks. I'm worried every single day he's going

00:12:36.780 to fall and smash his head open. But I've stopped telling him to stay home because I realize that

00:12:43.860 he has to be doing that. And doing deals, selling stone is so important to him. Fortunately, for

00:12:51.960 all of my father's health problems, his brain is by far the best part of his body. So I think

00:12:58.220 there is something to that. That, I think, is the playbook. Now, you'll notice, Nick, there

00:13:02.020 was something I didn't talk about, which is I didn't rattle off a list of 57 supplements.

00:13:07.200 Is that because there are no supplements that could possibly improve cognitive performance? No. It's

00:13:13.920 because none of them will move the needle nearly as much as what I just said. So everything

00:13:19.960 else is a rounding error of basis points compared to the enormous percentage swings that you're going

00:13:26.960 to see from all of the above. Yeah. I do respect how you don't drive because you love it. You just

00:13:34.060 drive because of the brain health component. You're just trying to stay healthy cognitively.

00:13:39.600 I have no enjoyment when I drive. In fact, it's a chore. I don't enjoy it at all.

00:13:43.520 It's taxing, but you do it for the health of your brain, which is important to do.

00:13:47.820 So that's what I tell my wife who fortunately doesn't listen to this podcast. She will never

00:13:51.760 know the sarcasm in your voice, Nick. So the next question that we get a lot kind

00:13:57.800 of fits into that because you mentioned metabolic health being important. One question we get a lot

00:14:02.140 is how do you lower your blood glucose or insulin? And I think this comes up a lot because every

00:14:09.180 annual physical, those are getting measured. So I think every time someone gets blood work done and

00:14:15.180 they get biomarkers back, those are usually always included. And those are what people look at almost

00:14:20.540 as a baseline for their metabolic health. And I know we've talked a lot in depth about other ways

00:14:25.500 to measure metabolic health in more detail and how you can really see that. But given that it's a

00:14:30.560 metric that so many people see, it's a question that we get asked a lot. So you're talking with a

00:14:35.780 patient, they see their blood results and they're like, you know, Peter, I'm worried about my

00:14:39.440 glucose insulin. You say it's a little high. What should I be doing? Thank you for listening

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00:17:51.160 Thank you.

00:17:53.180 Yeah.

00:17:53.240 Thank you.

00:17:54.240 Thank you.

00:18:14.320 Thank you.

The Peter Attia Drive - June 17, 2024

#306 - AMA #60： preventing cognitive decline, nutrition myths, lowering blood glucose, apoB, and blood pressure, and more

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