The Peter Attia Drive - #329 ‒ Special AMA： Peter on exercise, important labs, building good habits, promising longevity research, 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 a special rapid fire, ask me anything episode. I'm once again joined by my cohost,

00:00:45.080 Nick Stenson. In today's AMA episode, we thought it would be fun to do an end of year bonus AMA

00:00:49.620 in a more rapid style manner to answer many questions that are commonly asked that have

00:00:55.100 come through over the past year across a wide range of topics and frameworks. We discuss questions on

00:01:00.280 exercise such as grip strength, exercise while traveling, the importance of strength training,

00:01:04.220 and why I don't believe exercise is an ideal strategy for weight loss. We talk about labs,

00:01:09.860 including the quote, top five most important biomarkers, unquote, that everyone should know

00:01:14.700 for themselves. Spoiler alert, I hate that question. We talk about new research on longevity,

00:01:19.600 that has come out and that has been particularly exciting. And I answer the question, if I have

00:01:24.240 changed my mind on anything recently, as it relates to longevity, we speak about some of the frameworks

00:01:28.740 that I use and the importance of using the objective strategy tactics model as an approach

00:01:34.160 versus a one size fits all approach. We close the conversation by talking about building good habits

00:01:39.920 and my recent reading list. If you're a subscriber and want to watch the full video of this podcast,

00:01:45.840 you can find it on the show notes page. If you're not a subscriber,

00:01:48.620 you can watch the sneak peek of the video on our YouTube page. So without further delay,

00:01:53.540 I hope you enjoy this bonus AMA rapid fire.

00:02:01.640 Peter, welcome to a special bonus AMA. How are you doing?

00:02:06.000 I'm doing well. Thank you for having me back.

00:02:08.200 Anything new going on in your life?

00:02:10.500 Just a few things.

00:02:13.480 I say that with not knowing anything, but just anything that jumps out to you.

00:02:18.480 No, but I did wake up to an awesome text message today. I've got this car that I'm trying to do

00:02:25.500 something to the stereo system. And the guy who really, really knows what he's doing has been

00:02:29.860 working on it for six weeks. He cannot figure out what's wrong with this thing. And it's super

00:02:34.080 complicated. And he sent me this video this morning and it was like a video of him moving

00:02:40.480 through the car. And he says, I figured it out. And he hits the stereo. And all you hear is the

00:02:45.820 beginning of ACDCs back in black, like full beans. And I was like, that is an awesome video to wake up

00:02:54.240 too. That's amazing. Back in the day, the younger days, did you ever put like one of those big

00:03:00.200 subwoofers in your car ever? No, I did not. You know, believe it or not, I didn't actually own my

00:03:06.600 first car until I was in med school. I kind of rode my bike and took the bus everywhere.

00:03:10.940 Well, that's fair. Maybe we'll get to it. You told the story, I think in the book too,

00:03:14.680 and I think it's come up on another podcast, but whenever I think of you med school and driving,

00:03:19.260 I think of you falling asleep in the park in Baltimore.

00:03:22.800 That was residency.

00:03:24.280 Oh, residency.

00:03:25.180 Residency. Yeah, yeah, yeah. Med school is not that exhausting.

00:03:27.480 I love it. So for today's AMA, it's going to be kind of a little different style,

00:03:32.020 just more conversational, a little bit covering questions that come through that we haven't

00:03:37.360 covered before. Some of it will be conversations that we've had internally that we were like,

00:03:43.100 ah, it'd be great to record this and kind of put it out there. So it's going to be a mix

00:03:47.420 of specific questions, more framework, organizing principle questions. We'll cover

00:03:52.500 things like labs, prioritization as it relates to actions, what you're excited about in the

00:03:58.600 field of longevity, books you've maybe read recently, and a bunch of other random stuff.

00:04:03.760 So with all that said, we'll get going. First topic, your favorite exercise. And within it,

00:04:10.360 we're going to cover grip strength. So it's something you've talked about before, the importance

00:04:15.640 of, but I don't think we've ever really covered a little bit in depth on like how you train for

00:04:20.160 and how you think about it in the weight room. So before we get to that, do you just kind of want

00:04:24.400 to remind people why you think grip strength is important? Yeah. So grip strength is important

00:04:31.020 probably for a little bit of the reasons that we understand the drunk under the streetlight

00:04:36.840 problem, which means the old adage of the drunk guy standing under the streetlight and someone

00:04:42.060 asks him what he's doing. And he says, he's looking for his keys. And they ask him if this is

00:04:45.920 where he dropped him. And he says, no, but this is where the light is. Right. So sometimes where it's

00:04:49.640 brightest is where you end up looking. So I don't want to, of course, minimize grip strength,

00:04:53.500 but I also want to just point out that in the literature, when you are interested in studying

00:04:59.000 the relationship between strength and outcomes, everything from onset of dementia, all cause

00:05:04.720 mortality, cardiovascular disease, all of these things, which has been studied, you need objective

00:05:10.460 measurements of strength to test. If your hypothesis is strength is positively associated

00:05:16.640 with correlates with, or even causal towards these things, you have to be able to test it.

00:05:21.460 And so the question then becomes, well, how do you test strength? Should we have people deadlift

00:05:25.340 things? And I think if you go through that exercise, you pretty quickly realize that's probably not a good

00:05:29.940 idea because most people don't deadlift and technique is pretty important in deadlifting and it's pretty

00:05:37.100 easy for somebody to hurt themselves. So what scientists have done instead over the years is they've

00:05:41.180 tended to study things that anybody can do, even if they don't do the particular exercise that's

00:05:47.400 being tested. You shouldn't be testing squat strength or deadlift strength if a person doesn't

00:05:51.920 deadlift or squat. So the things that have typically emerged as strength tests are grip strength,

00:05:59.000 wall sits. So that's a test of, you know, at least isometric quad strength, bench press. If you don't

00:06:05.080 bench press, that's a bit of a stretch. Leg extension. Those tend to be the big ones. Sometimes leg press

00:06:10.780 as well. So I just want to caveat it by saying, I don't think there's something super, super magical

00:06:16.660 about grip strength. We just have such an abundance of data on it because it's such an easy thing to

00:06:23.120 test. So the next question then would be, is there something magical about having a strong grip? And

00:06:31.500 here, I think the answer is partly yes. A strong grip in isolation doesn't really exist. So there's

00:06:39.280 really no example I can think of where a person has a very strong grip in their hand, but their

00:06:46.260 forearm, deltoids, scapula, triceps, all of these other things are weak. So a strong grip is sort of

00:06:53.980 a way to test very strong, very stable control through the upper extremity all the way down to

00:07:01.640 the outside world. And again, it's a very practical thing. Just talk to any person who's reached an age

00:07:07.720 where they can't open a new jar of pickles, or they struggle to unlock a door, or they struggle

00:07:15.180 to carry a heavy plate. So when your grip strength goes, your quality of life absolutely goes. But

00:07:20.740 again, I think it's just a proxy for people who are strong. And that kind of leads into your question,

00:07:26.040 which is, how should you train it? So what's undeniable is the strength of the association. So

00:07:31.080 I'm not even going to go into that because the data are overwhelming. The strength of the association

00:07:35.300 between grip strength and any and everything positive warrants no further discussion. The more

00:07:41.300 important question is, is it causal? If grip strength is just a proxy for health, and increasing

00:07:47.500 grip strength does nothing to increase health, then we really shouldn't be talking about this.

00:07:51.300 I don't believe that that's the case. I make an argument for that in Outlive, which is going

00:07:56.360 through sort of the Bradford Hill criteria and explaining why I think there is causality in the

00:08:01.840 association. In other words, why is it that increasing metrics of strength and endurance

00:08:08.060 also improves lifespan and healthspan, not that they are just markers of healthy people

00:08:13.720 who go on to have a better lifespan and healthspan. So how would you train it? Well, I can't tell you

00:08:19.520 the number of times I give a talk, or I just run into somebody in the airport, and they tell me that

00:08:24.320 they went out and bought a little grip squeezer on Amazon. And they said, Peter, you've got me

00:08:28.540 convinced I got to strengthen my grip. So now I sit around and I squeeze these little things all day.

00:08:33.100 And I said, well, that's great. I don't think there's anything wrong with that. But I don't

00:08:37.220 think that's the optimal way to train grip strength. I think what you really want to do is do all of the

00:08:42.780 other things that rely on strong grip. And the most obvious example of these things are exercises

00:08:49.100 that involve carrying and pulling and hanging. That's really where we put our grip to the test.

00:08:54.900 So I'm giving you a very long-winded answer, Nick, but the point is you want to train your

00:08:59.740 grip strength by doing the things that rely on grip. So when you pick things up, when you carry

00:09:04.660 things, when you pull things, if you're doing a seated cable pull, if you're doing a pull down,

00:09:09.600 if you're doing a pull up, if you're doing a farmer's carry, if you're doing a deadlift,

00:09:14.560 those are the way we train grip. So I don't do very many things that are quote unquote deliberate grip

00:09:20.640 strength exercises. I suppose that when I do farmer's carries, I'm almost exclusively doing

00:09:25.780 that to push the limits of my grip. And maybe let's isolate two of the things you mentioned

00:09:30.240 that I think are easiest for people to potentially test on themselves at a gym, you know, with the

00:09:36.560 least amount of equipment. Like you said, if you haven't deadlifted before, you probably shouldn't

00:09:40.080 just start deadlifting without understanding the form. So I think looking at farmer's carry

00:09:44.660 and dead hang, let's say farmer's carry. What do you think is like the ideal goal for someone to be

00:09:51.960 able to do a farmer's carry with in terms of time and weight? Well, lots of people have weighed in on

00:09:59.800 this question. And I think the question just becomes like, how extreme do you want to go?

00:10:03.960 There's a standard out there that basically says the definition of exceptional strength is being able to

00:10:09.480 walk with twice your body weight for 30 seconds. So if you weigh 175 pounds, you should be able to do

00:10:16.840 a trap bar deadlift with 350 pounds and then carry it, walk with it for 30 seconds. And obviously that's

00:10:25.840 a very high standard, but I would say a more reasonable standard for maybe sub elite athletes.

00:10:32.320 I think for a male in his forties to be able to carry his body weight for one minute is good.

00:10:39.100 And for two minutes is very good, just your body weight. So again, if you weighed 175 pounds,

00:10:43.160 you'd put 175 pounds on a trap bar, you'd pick it up and march with that for one to two minutes.

00:10:48.660 And I think for a woman, I would probably consider 75% of her body weight to be also an excellent 1.00

00:10:55.240 achievement. Of course, you might discount that by 10% per decade. I don't think a person should be

00:11:00.340 discouraged if the first time they try to do that, they can't do it. In fact, if you haven't been doing

00:11:04.940 that sort of thing, and if you're not used to deadlifting and doing a lot of pull-ups and hangs,

00:11:09.880 I would not expect anybody to be able to do that. And so you do want to work up to that. And I really

00:11:13.820 believe in the principle of working up to that without going to maximal effort. I know that there's

00:11:18.280 a lot to be said from doing maximal efforts, but I think this is an area where I prefer to see people

00:11:22.920 build resilience slowly. For example, if an individual tried that test, so let's just say you take 175

00:11:28.780 pound person, they put 175 pounds on a hex bar. They say, look, I want to carry this for at least a minute.

00:11:33.820 And 30 seconds in, they drop it. I'd say, great. Okay. What I want you to do is drop the weight on

00:11:38.600 that bar to call it 150 pounds. So 25 pounds below that, that 175. And I'd like you to do 30

00:11:46.140 second sets. I'd like you to do 10 sets at 30 seconds. And then I want you to advance weight

00:11:51.160 and or time accordingly. But I want you to be able to get through those 10 sets such that at the end of

00:11:56.120 the 10, you're really completely gassed. That's the way I kind of like to see people build strength

00:12:00.160 there. Another test that we've talked about is the dead hang. So as its name suggests,

00:12:04.960 you just sort of put your hands up on the bar. You can do it over any configuration of bars,

00:12:08.800 but I kind of like to just do it over a straight bar and you hang. Now, again, there's two big things

00:12:14.660 to be thinking about here. Do you do it with the scapula engaged or not engaged? And I like to do it

00:12:20.680 with the scapula engaged. So the scapula are down. And so the lats are under a lot of stress,

00:12:26.440 but they're not being as stretched. If the scapula go up, if the scapula go up, you're going

00:12:30.820 to put a little bit more stress on the elbows. That doesn't necessarily cause problems. By the

00:12:36.020 way, I can dead hang both. And my dead hang record was actually an attempt where my scapula were up.

00:12:41.840 So sometimes I will go back and forth between the two techniques. And I didn't suffer any permanent

00:12:46.500 injury from doing that or anything like that. So again, I think here, a standard would be a very

00:12:51.260 strong 40 year old male should be able to dead hang for at least two minutes. And a very strong

00:12:57.000 40 year old female should be able to dead hang for at least 90 seconds. And again, you would discount 1.00

00:13:02.380 that as time goes by decade and probably subtract about 10 seconds per decade. And again, a lot of

00:13:08.940 people don't succeed in that at their first time. That's fine. But again, you can do that either by

00:13:13.700 adding bands. So you use a band, a resistance band that you are sinking into, right? You put your feet

00:13:18.600 into it. So it's removing some of the weight. Alternatively, I just like to have people go

00:13:22.040 for much shorter periods of time, maybe do 30 second hangs and repeat those.

00:13:27.420 And do you have a preference on like hands the same way, hands that are switched? Do you even

00:13:32.500 think about that? Or is it just a matter of...

00:13:34.540 Sure. You can mix and match, but I think for this, I like to be palms out. So I'm palms out,

00:13:39.880 both hands the same over.

00:13:42.120 And remind me, what was your record?

00:13:43.780 Four minutes, 35 seconds. And that was with full scapula up, not engaged scaps.

00:13:49.200 Wow.

00:13:49.400 And my wife's record is three minutes and 10 seconds, which I think is actually more impressive. 1.00

00:13:54.100 Yeah. She's a machine. 1.00

00:13:55.360 Yeah.

00:13:55.660 And she probably trains it a little less than you were training for your record.

00:13:59.340 It was literally the second time she ever did a dead hang. And she literally just did it to,

00:14:05.300 she was like, why do you keep doing this? Let me try.

00:14:08.240 Yeah. Just to show you, it's not that hard. You're spending too much time on it.

00:14:11.260 Yeah, exactly.

00:14:11.920 You mentioned wall sits. So I got to ask, what's ideal for wall sits? Again, it's another one

00:14:17.360 anyone can kind of do and test a little bit. Do you think about like, what is an ideal time

00:14:23.140 that you should be able to do that for?

00:14:25.440 Yeah, there are standards and I apologize. They're not tip of tongue for me. I want to say

00:14:29.660 two minutes is considered a pretty good wall sit for anybody. I don't tend to do wall sits like that.

00:14:35.460 There's another exercise I prefer to do, which is I'll do an air bike. I'll ride on the

00:14:41.760 air bike for a minute hard and then I'll hold a kettlebell and wall sit for 30 seconds to a minute.

00:14:49.600 So it's a shorter sit, but I come in pre-fatigued. Plus I'm adding some stress to it by holding a

00:14:55.040 weight. But if you just do a straight up wall sit, I apologize. We'll put it in the show notes for what

00:15:00.400 a good standard is. I want to say it's two minutes, but it might be five minutes. I honestly don't

00:15:04.140 remember. Anything else on grip strength before we move on? No, I think that's good. Perfect.

00:15:10.820 Another question that comes through a lot is on exercises, people who are traveling. So whether

00:15:15.700 it's for work, whether it's family, you're not at your traditional location, gym, whatever it may be.

00:15:22.580 So if you're traveling, any advice you would give patients on easy exercises they can do,

00:15:29.240 ways they can continue to stay active, even when they're not in an ideal setting.

00:15:35.300 Yeah, I do get asked this question a lot. And honestly, like my answer is you have to be

00:15:41.060 deliberate. And that sounds like maybe not what people want to hear. I think people are looking

00:15:45.680 for a quick fix, but when I travel, you can ask my assistant, what's the first thing I'm asking?

00:15:50.940 What's question number one? It's show me the gym. I want to know exactly what the gym looks like.

00:15:56.820 And if the website doesn't have good pictures, please have somebody who works at the front desk,

00:16:00.780 go down with their phone, film the gym, send us the video so we can evaluate. Yeah, I know.

00:16:06.040 It sounds ridiculous. I get it. But unless you're going to the middle of nowhere where you have no 0.81

00:16:10.400 choice in hotel, you have a choice in where you stay. Now you'll have to make a concession. Maybe

00:16:14.820 you have to be a little bit further from the place you want to be at. Maybe you're going to add

00:16:18.720 10 minutes or 15 minutes of driving time. Maybe the hotel is going to be a little bit more

00:16:22.220 expensive. Like there will be a trade-off and everyone has to make that trade-off. But I start with

00:16:26.620 that question, which is how can I make sure that whatever hotel I'm at has a good enough gym?

00:16:32.380 It's not going to be the gym I have at home. It's not going to allow me to do everything I would do

00:16:36.520 at home, but that's okay. Basically, I've never been to a hotel where I can't do something.

00:16:41.080 Even if they just have a bench and dumbbells, then I can do presses and I can do rows and I could do

00:16:47.060 push-ups and hopefully the bench incline. So maybe I can do an incline bench as well as a flat bench.

00:16:52.520 I could do rear foot elevated split squats, regular split squats. Like there's a lot you can do

00:16:56.520 with a modest amount of dumbbells and a bench. And then of course, most gyms have much more than

00:17:01.060 that. That to me is sort of step one. Step two is when traveling, you have to sort of be mindful of

00:17:07.260 what jet lag is going to do to you. So because I'm in central time zone and when I travel west,

00:17:12.100 it's really easy for me to work out early in the morning. A 5 a.m. workout is easy when I go to

00:17:17.900 California for three days. So I can start my meetings actually quite early on those days

00:17:22.880 because I know I'm going to get the workout done early. Conversely, if I go to New York,

00:17:27.440 I have to keep in mind, like I'm going to be a little bit tired. I am not going to want to work

00:17:31.040 out at six because six feels like five and I don't like working. I mean, even though I'm comfortable

00:17:35.660 getting up at five, I don't want to work out first thing at five o'clock. So then I have to adjust

00:17:40.380 the timing of the meetings. So I think those are basically the two big things is make sure that your

00:17:45.000 schedule has the time for you to do the workout and budget according to what jet lag is going to

00:17:49.960 do to you and pick a place to go so that you can get the workout in the hotel. That's always going

00:17:56.920 to be easier than if you have to leave the hotel to go to the gym. You can do that. And of course,

00:18:01.340 there's been many times in my life when my training was so elaborate that I had to go into a commercial

00:18:06.680 gym, but it was the same playbook. I would just book a hotel near the commercial gym.

00:18:10.720 Yeah. And it sounds like the key is something's better than nothing when you're traveling.

00:18:14.880 When it comes to exercise.

00:18:16.600 A hundred percent. The goal of exercising when you're traveling is not to maybe make the most

00:18:19.940 incredible gains. It's just to prevent the losses.

00:18:22.380 Another question that comes through often is sex specific. So if you have female patients who 0.91

00:18:29.000 prefer cardio compared to weightlifting, why do you think women should pay special attention to 1.00

00:18:36.860 strength training?

00:18:38.320 Yeah, there are two big reasons for this. The first is that women naturally have less muscle mass 1.00

00:18:42.860 and are not as strong as men. And yet they still live in the same environment as men do,

00:18:47.660 which is to say they're going to be subject to all the same forces. And this is one of the reasons why

00:18:52.640 we see women fall more than men. It's not just that women are more injured by falls, which they are,

00:18:57.780 and we'll discuss that in a moment. It's that women actually fall more than men. And one of the

00:19:02.480 reasons for that is a disparate exchange in strength. So that's reason number one. Reason number two

00:19:07.460 is, of course, strength training is one of the most important exercises that we have, one of the most

00:19:13.140 important behaviors that we have to stabilize bone density. And because women tend to have a lower 1.00

00:19:20.740 genetic ceiling, and more importantly, because women lose estrogen during the middle of their lives, 1.00

00:19:27.900 they begin to experience a disproportionate drop in bone density as they age. And so the gap between men

00:19:34.620 and women that's always there really begins to widen in the fifth or sixth decade of a woman's 1.00

00:19:40.100 life. And that's all the more reason why she needs to be strength training, because there really is no

00:19:45.700 substitute for the type of strain that is placed on bones during strength training. It can't be

00:19:54.080 replicated by running, certainly can't be replicated by cycling or swimming or other endurance sports,

00:19:58.760 yoga, all of those things are simply not going to do it. And therefore, they've got to be able to put

00:20:03.620 this kind of external load on. Last exercise question is kind of a conversation that you had

00:20:09.940 internally with a few people that we thought was interesting on how you think about exercise

00:20:15.860 as a strategy for weight loss. Do you kind of want to talk a little bit about that?

00:20:21.140 Well, I overall don't think exercise is a phenomenal strategy for weight loss, which is not to say that it

00:20:27.980 doesn't play a role in maintaining a healthy weight. I think it does. But I think if you look at the

00:20:34.240 experimental evidence, exercise, i.e. calorie expenditure does not appear to be a very viable

00:20:42.240 tool for weight loss. And by weight loss, we're obviously talking about fat loss. The majority of the

00:20:48.880 work on that front really has to be done through caloric restriction. So if you just want to simplify and

00:20:54.680 think of a machine with inputs and outputs, it's really reduction of the inputs that seems to play

00:20:59.820 the greater role in weight loss. That said, we think that exercise is a very important part of health

00:21:07.000 and that health is the single most important thing. It's more important than weight loss per se.

00:21:12.740 Furthermore, exercise does indeed make a difference for body composition. And body composition should

00:21:20.160 probably be thought of as more important than weight per se. So if an individual, like I don't

00:21:25.680 think a BMI is an especially valuable tool at the individual level. I think it's a reasonable tool at

00:21:31.820 the population level. But for any one individual, BMI is not really that helpful. I don't know my BMI,

00:21:37.440 but I would bet that it's in the overweight. I know it's in the overweight category. My BMI is probably

00:21:41.400 27 or 28, which again, overweight is once you're above 25, but below 30. 30 is obese. I'm not quite there.

00:21:47.720 So if my BMI is overweight, is that a bad thing? Well, not necessarily. It depends on my body

00:21:52.400 composition. And so here's an area where exercise makes a huge difference. I think indirectly there

00:21:58.940 are other areas where exercise is very important for weight maintenance. And I think, for example,

00:22:05.500 exercise maintains insulin sensitivity and the more insulin sensitive a person is, I think the easier

00:22:10.480 it is for them to respond to appetite signals. And so while just doing the accounting of

00:22:17.580 calories burned versus calories in, exercise generally falls short there. In other words,

00:22:22.760 whatever calories you expend doing the workout, you're generally going to pay them back. The goal,

00:22:27.260 I think, is to be sensitive to the appropriate appetite signals so that one doesn't overeat in

00:22:33.060 that state. Awesome. Any other things on exercise at top of mind that you want to share with the people

00:22:40.680 before we move on? I like exercise. I tried to say that in a Steve Carell voice. Like I like lamp.

00:22:48.240 I love lamp. You could have saved a lot of time and a lot of words by just having that

00:22:53.200 have been outlive. It probably would have come out a lot earlier if it was just one page,

00:22:58.860 one sentence. Okay. Moving on to labs. So this question I know is a tough one for you to answer.

00:23:07.420 The reason I know that is it's been on other AMAs and it always gets scrapped because you're like,

00:23:12.960 I can't answer this. It's too simple, too hard to do it, but we keep sneaking it on. And now you

00:23:18.880 kind of have to answer it, which is if you had to pick gun to your head, the quote unquote top five

00:23:27.320 most important biomarkers that everyone should know for themselves. And, or if you were going to meet

00:23:33.100 with a new patient and you could kind of only see five biomarkers to figure out their risks,

00:23:38.760 to figure out where they're at, what would those be? Thank you for listening to today's sneak peek

00:23:44.320 AMA episode of The Drive. If you're interested in hearing the complete version of this AMA,

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The Peter Attia Drive - December 16, 2024

#329 ‒ Special AMA： Peter on exercise, important labs, building good habits, promising longevity research, and more

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