#329 ‒ Special AMA： Peter on exercise, important labs, building good habits, promising longevity research, and more
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Summary
In today's bonus AMA, Dr. Nick Stenson joins me to answer a variety of commonly asked questions from the past year across a wide range of topics and frameworks. We cover topics such as: - Why I don t believe exercise is an ideal strategy for weight loss - The importance of strength training while traveling, and why I don't believe exercise should be your primary focus when traveling. - What's your favorite exercise to do when traveling? - What are your favorite foods to eat on the road? - How do you stay awake when driving? - Are you a night driver? - Do you ever fall asleep in your car while driving? - What do you do to stay awake while driving to and from appointments?
Transcript
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Hey everyone, welcome to a sneak peek, ask me anything or AMA episode of the drive podcast.
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I'm your host, Peter Atiyah. At the end of this short episode, I'll explain how you can access
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the AMA episodes in full, along with a ton of other membership benefits we've created,
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or you can learn more now by going to peteratiyahmd.com forward slash subscribe.
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So without further delay, here's today's sneak peek of the ask me anything episode.
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Welcome to a special rapid fire, ask me anything episode. I'm once again joined by my cohost,
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Nick Stenson. In today's AMA episode, we thought it would be fun to do an end of year bonus AMA
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in a more rapid style manner to answer many questions that are commonly asked that have
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come through over the past year across a wide range of topics and frameworks. We discuss questions on
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exercise such as grip strength, exercise while traveling, the importance of strength training,
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and why I don't believe exercise is an ideal strategy for weight loss. We talk about labs,
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including the quote, top five most important biomarkers, unquote, that everyone should know
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for themselves. Spoiler alert, I hate that question. We talk about new research on longevity,
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that has come out and that has been particularly exciting. And I answer the question, if I have
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changed my mind on anything recently, as it relates to longevity, we speak about some of the frameworks
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that I use and the importance of using the objective strategy tactics model as an approach
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versus a one size fits all approach. We close the conversation by talking about building good habits
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and my recent reading list. If you're a subscriber and want to watch the full video of this podcast,
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you can find it on the show notes page. If you're not a subscriber,
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you can watch the sneak peek of the video on our YouTube page. So without further delay,
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Peter, welcome to a special bonus AMA. How are you doing?
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I say that with not knowing anything, but just anything that jumps out to you.
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No, but I did wake up to an awesome text message today. I've got this car that I'm trying to do
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something to the stereo system. And the guy who really, really knows what he's doing has been
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working on it for six weeks. He cannot figure out what's wrong with this thing. And it's super
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complicated. And he sent me this video this morning and it was like a video of him moving
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through the car. And he says, I figured it out. And he hits the stereo. And all you hear is the
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beginning of ACDCs back in black, like full beans. And I was like, that is an awesome video to wake up
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too. That's amazing. Back in the day, the younger days, did you ever put like one of those big
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subwoofers in your car ever? No, I did not. You know, believe it or not, I didn't actually own my
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first car until I was in med school. I kind of rode my bike and took the bus everywhere.
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Well, that's fair. Maybe we'll get to it. You told the story, I think in the book too,
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and I think it's come up on another podcast, but whenever I think of you med school and driving,
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I think of you falling asleep in the park in Baltimore.
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Residency. Yeah, yeah, yeah. Med school is not that exhausting.
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I love it. So for today's AMA, it's going to be kind of a little different style,
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just more conversational, a little bit covering questions that come through that we haven't
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covered before. Some of it will be conversations that we've had internally that we were like,
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ah, it'd be great to record this and kind of put it out there. So it's going to be a mix
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of specific questions, more framework, organizing principle questions. We'll cover
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things like labs, prioritization as it relates to actions, what you're excited about in the
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field of longevity, books you've maybe read recently, and a bunch of other random stuff.
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So with all that said, we'll get going. First topic, your favorite exercise. And within it,
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we're going to cover grip strength. So it's something you've talked about before, the importance
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of, but I don't think we've ever really covered a little bit in depth on like how you train for
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and how you think about it in the weight room. So before we get to that, do you just kind of want
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to remind people why you think grip strength is important? Yeah. So grip strength is important
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probably for a little bit of the reasons that we understand the drunk under the streetlight
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problem, which means the old adage of the drunk guy standing under the streetlight and someone
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asks him what he's doing. And he says, he's looking for his keys. And they ask him if this is
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where he dropped him. And he says, no, but this is where the light is. Right. So sometimes where it's
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brightest is where you end up looking. So I don't want to, of course, minimize grip strength,
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but I also want to just point out that in the literature, when you are interested in studying
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the relationship between strength and outcomes, everything from onset of dementia, all cause
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mortality, cardiovascular disease, all of these things, which has been studied, you need objective
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measurements of strength to test. If your hypothesis is strength is positively associated
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with correlates with, or even causal towards these things, you have to be able to test it.
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And so the question then becomes, well, how do you test strength? Should we have people deadlift
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things? And I think if you go through that exercise, you pretty quickly realize that's probably not a good
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idea because most people don't deadlift and technique is pretty important in deadlifting and it's pretty
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easy for somebody to hurt themselves. So what scientists have done instead over the years is they've
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tended to study things that anybody can do, even if they don't do the particular exercise that's
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being tested. You shouldn't be testing squat strength or deadlift strength if a person doesn't
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deadlift or squat. So the things that have typically emerged as strength tests are grip strength,
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wall sits. So that's a test of, you know, at least isometric quad strength, bench press. If you don't
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bench press, that's a bit of a stretch. Leg extension. Those tend to be the big ones. Sometimes leg press
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as well. So I just want to caveat it by saying, I don't think there's something super, super magical
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about grip strength. We just have such an abundance of data on it because it's such an easy thing to
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test. So the next question then would be, is there something magical about having a strong grip? And
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here, I think the answer is partly yes. A strong grip in isolation doesn't really exist. So there's
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really no example I can think of where a person has a very strong grip in their hand, but their
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forearm, deltoids, scapula, triceps, all of these other things are weak. So a strong grip is sort of
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a way to test very strong, very stable control through the upper extremity all the way down to
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the outside world. And again, it's a very practical thing. Just talk to any person who's reached an age
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where they can't open a new jar of pickles, or they struggle to unlock a door, or they struggle
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to carry a heavy plate. So when your grip strength goes, your quality of life absolutely goes. But
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again, I think it's just a proxy for people who are strong. And that kind of leads into your question,
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which is, how should you train it? So what's undeniable is the strength of the association. So
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I'm not even going to go into that because the data are overwhelming. The strength of the association
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between grip strength and any and everything positive warrants no further discussion. The more
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important question is, is it causal? If grip strength is just a proxy for health, and increasing
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grip strength does nothing to increase health, then we really shouldn't be talking about this.
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I don't believe that that's the case. I make an argument for that in Outlive, which is going
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through sort of the Bradford Hill criteria and explaining why I think there is causality in the
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association. In other words, why is it that increasing metrics of strength and endurance
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also improves lifespan and healthspan, not that they are just markers of healthy people
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who go on to have a better lifespan and healthspan. So how would you train it? Well, I can't tell you
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the number of times I give a talk, or I just run into somebody in the airport, and they tell me that
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they went out and bought a little grip squeezer on Amazon. And they said, Peter, you've got me
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convinced I got to strengthen my grip. So now I sit around and I squeeze these little things all day.
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And I said, well, that's great. I don't think there's anything wrong with that. But I don't
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think that's the optimal way to train grip strength. I think what you really want to do is do all of the
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other things that rely on strong grip. And the most obvious example of these things are exercises
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that involve carrying and pulling and hanging. That's really where we put our grip to the test.
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So I'm giving you a very long-winded answer, Nick, but the point is you want to train your
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grip strength by doing the things that rely on grip. So when you pick things up, when you carry
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things, when you pull things, if you're doing a seated cable pull, if you're doing a pull down,
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if you're doing a pull up, if you're doing a farmer's carry, if you're doing a deadlift,
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those are the way we train grip. So I don't do very many things that are quote unquote deliberate grip
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strength exercises. I suppose that when I do farmer's carries, I'm almost exclusively doing
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that to push the limits of my grip. And maybe let's isolate two of the things you mentioned
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that I think are easiest for people to potentially test on themselves at a gym, you know, with the
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least amount of equipment. Like you said, if you haven't deadlifted before, you probably shouldn't
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just start deadlifting without understanding the form. So I think looking at farmer's carry
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and dead hang, let's say farmer's carry. What do you think is like the ideal goal for someone to be
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able to do a farmer's carry with in terms of time and weight? Well, lots of people have weighed in on
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this question. And I think the question just becomes like, how extreme do you want to go?
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There's a standard out there that basically says the definition of exceptional strength is being able to
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walk with twice your body weight for 30 seconds. So if you weigh 175 pounds, you should be able to do
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a trap bar deadlift with 350 pounds and then carry it, walk with it for 30 seconds. And obviously that's
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a very high standard, but I would say a more reasonable standard for maybe sub elite athletes.
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I think for a male in his forties to be able to carry his body weight for one minute is good.
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And for two minutes is very good, just your body weight. So again, if you weighed 175 pounds,
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you'd put 175 pounds on a trap bar, you'd pick it up and march with that for one to two minutes.
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And I think for a woman, I would probably consider 75% of her body weight to be also an excellent
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achievement. Of course, you might discount that by 10% per decade. I don't think a person should be
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discouraged if the first time they try to do that, they can't do it. In fact, if you haven't been doing
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that sort of thing, and if you're not used to deadlifting and doing a lot of pull-ups and hangs,
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I would not expect anybody to be able to do that. And so you do want to work up to that. And I really
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believe in the principle of working up to that without going to maximal effort. I know that there's
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a lot to be said from doing maximal efforts, but I think this is an area where I prefer to see people
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build resilience slowly. For example, if an individual tried that test, so let's just say you take 175
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pound person, they put 175 pounds on a hex bar. They say, look, I want to carry this for at least a minute.
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And 30 seconds in, they drop it. I'd say, great. Okay. What I want you to do is drop the weight on
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that bar to call it 150 pounds. So 25 pounds below that, that 175. And I'd like you to do 30
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second sets. I'd like you to do 10 sets at 30 seconds. And then I want you to advance weight
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and or time accordingly. But I want you to be able to get through those 10 sets such that at the end of
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the 10, you're really completely gassed. That's the way I kind of like to see people build strength
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there. Another test that we've talked about is the dead hang. So as its name suggests,
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you just sort of put your hands up on the bar. You can do it over any configuration of bars,
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but I kind of like to just do it over a straight bar and you hang. Now, again, there's two big things
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to be thinking about here. Do you do it with the scapula engaged or not engaged? And I like to do it
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with the scapula engaged. So the scapula are down. And so the lats are under a lot of stress,
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but they're not being as stretched. If the scapula go up, if the scapula go up, you're going
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to put a little bit more stress on the elbows. That doesn't necessarily cause problems. By the
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way, I can dead hang both. And my dead hang record was actually an attempt where my scapula were up.
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So sometimes I will go back and forth between the two techniques. And I didn't suffer any permanent
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injury from doing that or anything like that. So again, I think here, a standard would be a very
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strong 40 year old male should be able to dead hang for at least two minutes. And a very strong
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40 year old female should be able to dead hang for at least 90 seconds. And again, you would discount
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that as time goes by decade and probably subtract about 10 seconds per decade. And again, a lot of
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people don't succeed in that at their first time. That's fine. But again, you can do that either by
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adding bands. So you use a band, a resistance band that you are sinking into, right? You put your feet
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into it. So it's removing some of the weight. Alternatively, I just like to have people go
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for much shorter periods of time, maybe do 30 second hangs and repeat those.
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And do you have a preference on like hands the same way, hands that are switched? Do you even
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Sure. You can mix and match, but I think for this, I like to be palms out. So I'm palms out,
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Four minutes, 35 seconds. And that was with full scapula up, not engaged scaps.
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And my wife's record is three minutes and 10 seconds, which I think is actually more impressive.
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And she probably trains it a little less than you were training for your record.
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It was literally the second time she ever did a dead hang. And she literally just did it to,
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she was like, why do you keep doing this? Let me try.
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Yeah. Just to show you, it's not that hard. You're spending too much time on it.
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You mentioned wall sits. So I got to ask, what's ideal for wall sits? Again, it's another one
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anyone can kind of do and test a little bit. Do you think about like, what is an ideal time
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Yeah, there are standards and I apologize. They're not tip of tongue for me. I want to say
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two minutes is considered a pretty good wall sit for anybody. I don't tend to do wall sits like that.
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There's another exercise I prefer to do, which is I'll do an air bike. I'll ride on the
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air bike for a minute hard and then I'll hold a kettlebell and wall sit for 30 seconds to a minute.
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So it's a shorter sit, but I come in pre-fatigued. Plus I'm adding some stress to it by holding a
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weight. But if you just do a straight up wall sit, I apologize. We'll put it in the show notes for what
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a good standard is. I want to say it's two minutes, but it might be five minutes. I honestly don't
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remember. Anything else on grip strength before we move on? No, I think that's good. Perfect.
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Another question that comes through a lot is on exercises, people who are traveling. So whether
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it's for work, whether it's family, you're not at your traditional location, gym, whatever it may be.
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So if you're traveling, any advice you would give patients on easy exercises they can do,
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ways they can continue to stay active, even when they're not in an ideal setting.
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Yeah, I do get asked this question a lot. And honestly, like my answer is you have to be
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deliberate. And that sounds like maybe not what people want to hear. I think people are looking
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for a quick fix, but when I travel, you can ask my assistant, what's the first thing I'm asking?
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What's question number one? It's show me the gym. I want to know exactly what the gym looks like.
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And if the website doesn't have good pictures, please have somebody who works at the front desk,
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go down with their phone, film the gym, send us the video so we can evaluate. Yeah, I know.
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It sounds ridiculous. I get it. But unless you're going to the middle of nowhere where you have no
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choice in hotel, you have a choice in where you stay. Now you'll have to make a concession. Maybe
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you have to be a little bit further from the place you want to be at. Maybe you're going to add
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10 minutes or 15 minutes of driving time. Maybe the hotel is going to be a little bit more
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expensive. Like there will be a trade-off and everyone has to make that trade-off. But I start with
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that question, which is how can I make sure that whatever hotel I'm at has a good enough gym?
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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
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at home, but that's okay. Basically, I've never been to a hotel where I can't do something.
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Even if they just have a bench and dumbbells, then I can do presses and I can do rows and I could do
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push-ups and hopefully the bench incline. So maybe I can do an incline bench as well as a flat bench.
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I could do rear foot elevated split squats, regular split squats. Like there's a lot you can do
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with a modest amount of dumbbells and a bench. And then of course, most gyms have much more than
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that. That to me is sort of step one. Step two is when traveling, you have to sort of be mindful of
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what jet lag is going to do to you. So because I'm in central time zone and when I travel west,
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it's really easy for me to work out early in the morning. A 5 a.m. workout is easy when I go to
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California for three days. So I can start my meetings actually quite early on those days
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because I know I'm going to get the workout done early. Conversely, if I go to New York,
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I have to keep in mind, like I'm going to be a little bit tired. I am not going to want to work
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out at six because six feels like five and I don't like working. I mean, even though I'm comfortable
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getting up at five, I don't want to work out first thing at five o'clock. So then I have to adjust
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the timing of the meetings. So I think those are basically the two big things is make sure that your
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schedule has the time for you to do the workout and budget according to what jet lag is going to
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do to you and pick a place to go so that you can get the workout in the hotel. That's always going
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to be easier than if you have to leave the hotel to go to the gym. You can do that. And of course,
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there's been many times in my life when my training was so elaborate that I had to go into a commercial
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gym, but it was the same playbook. I would just book a hotel near the commercial gym.
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Yeah. And it sounds like the key is something's better than nothing when you're traveling.
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A hundred percent. The goal of exercising when you're traveling is not to maybe make the most
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incredible gains. It's just to prevent the losses.
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Another question that comes through often is sex specific. So if you have female patients who
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prefer cardio compared to weightlifting, why do you think women should pay special attention to
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Yeah, there are two big reasons for this. The first is that women naturally have less muscle mass
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and are not as strong as men. And yet they still live in the same environment as men do,
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which is to say they're going to be subject to all the same forces. And this is one of the reasons why
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we see women fall more than men. It's not just that women are more injured by falls, which they are,
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and we'll discuss that in a moment. It's that women actually fall more than men. And one of the
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reasons for that is a disparate exchange in strength. So that's reason number one. Reason number two
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is, of course, strength training is one of the most important exercises that we have, one of the most
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important behaviors that we have to stabilize bone density. And because women tend to have a lower
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genetic ceiling, and more importantly, because women lose estrogen during the middle of their lives,
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they begin to experience a disproportionate drop in bone density as they age. And so the gap between men
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and women that's always there really begins to widen in the fifth or sixth decade of a woman's
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life. And that's all the more reason why she needs to be strength training, because there really is no
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substitute for the type of strain that is placed on bones during strength training. It can't be
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replicated by running, certainly can't be replicated by cycling or swimming or other endurance sports,
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yoga, all of those things are simply not going to do it. And therefore, they've got to be able to put
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this kind of external load on. Last exercise question is kind of a conversation that you had
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internally with a few people that we thought was interesting on how you think about exercise
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as a strategy for weight loss. Do you kind of want to talk a little bit about that?
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Well, I overall don't think exercise is a phenomenal strategy for weight loss, which is not to say that it
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doesn't play a role in maintaining a healthy weight. I think it does. But I think if you look at the
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experimental evidence, exercise, i.e. calorie expenditure does not appear to be a very viable
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tool for weight loss. And by weight loss, we're obviously talking about fat loss. The majority of the
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work on that front really has to be done through caloric restriction. So if you just want to simplify and
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think of a machine with inputs and outputs, it's really reduction of the inputs that seems to play
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the greater role in weight loss. That said, we think that exercise is a very important part of health
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and that health is the single most important thing. It's more important than weight loss per se.
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Furthermore, exercise does indeed make a difference for body composition. And body composition should
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probably be thought of as more important than weight per se. So if an individual, like I don't
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think a BMI is an especially valuable tool at the individual level. I think it's a reasonable tool at
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the population level. But for any one individual, BMI is not really that helpful. I don't know my BMI,
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but I would bet that it's in the overweight. I know it's in the overweight category. My BMI is probably
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27 or 28, which again, overweight is once you're above 25, but below 30. 30 is obese. I'm not quite there.
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So if my BMI is overweight, is that a bad thing? Well, not necessarily. It depends on my body
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composition. And so here's an area where exercise makes a huge difference. I think indirectly there
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are other areas where exercise is very important for weight maintenance. And I think, for example,
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exercise maintains insulin sensitivity and the more insulin sensitive a person is, I think the easier
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it is for them to respond to appetite signals. And so while just doing the accounting of
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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
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