#342 ‒ Aging well： Peter shares strategies for improving longevity with residents at a senior living center
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Summary
In this episode of The Drive, my daughter, Olivia Atiyah, takes the lead as the interviewer as we visit a senior living center to discuss all things longevity as it relates to an aging population. We talk about the 4 horsemen of chronic disease, why it s never too late to start making changes for better health, and why relationships matter as much as physical health.
Transcript
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Hey, everyone. Welcome to the Drive podcast. I'm your host, Peter Atiyah. This podcast,
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my website, and my weekly newsletter all focus on the goal of translating the science of longevity
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into something accessible for everyone. Our goal is to provide the best content in health and
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wellness, and we've established a great team of analysts to make this happen. It is extremely
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important to me to provide all of this content without relying on paid ads. To do this, our work
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is made entirely possible by our members, and in return, we offer exclusive member-only content
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and benefits above and beyond what is available for free. If you want to take your knowledge of
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this space to the next level, it's our goal to ensure members get back much more than the price
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of the subscription. If you want to learn more about the benefits of our premium membership,
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head over to peteratiyahmd.com forward slash subscribe. Welcome to a special episode of
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The Drive. This conversation is a bit different from our usual format, as my daughter, Olivia,
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trades places with me to take this seat as the interviewer as we visit a senior living center
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to discuss all things longevity as it relates to an aging population. A bit of background,
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Olivia spent part of her summer last year volunteering at this center, where she connected
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with a number of the residents who had an interest in curiosity about healthspan, lifespan, and
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strategies for living well as they age. And through that experience, they invited me to speak with their
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audience, and we decided to record it and release it to you as well. In this conversation, we speak
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about all of these topics, but with a particular focus around an aging population. So we talk about
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what longevity really means, not just adding years to life, but life to years. We talk about
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the four horsemen of chronic disease, talk about why it's never too late to start making changes for
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better health, talk about the critical role of exercise, especially strength training in maintaining
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mobility, preventing falls, and preserving independence, and how to approach exercise
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later in life. Talk about the importance of protein intake and nutrition principles for aging. Talk about
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sleep optimization. And we talk about emotional health and social connection purpose and why
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relationships matter as much as physical health. So without further delay, please enjoy this special
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episode of The Drive. Welcome, everyone. My name is Olivia Atiyah, and I'm here with my dad,
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Peter Atiyah. We are here to talk to you today about longevity. So over the summer, I volunteered
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at a senior living center called Querencia, which is where I met Sally, who unfortunately couldn't be
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with us today because she's sick. But we got to talking, and I discovered that she's very interested
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in my dad's work, as I'm sure all of you are. So we decided that we'll be here today, and we'll be
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doing 45 minutes of conversing between us two to keep it interesting, and then a little bit of time at the
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end for you guys to ask him things that you're interested about. So with all that being said,
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are you ready? As I'll ever be. Okay. I think it'll be helpful to start talking about the actual
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word longevity, because it can mean different things to different people. When you talk about
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longevity, are you talking about living forever, or how are you defining it? Definitely not living
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forever, although understandably, that's probably what some people think of when they think of longevity.
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I'm talking about it in terms of two things. One of them is called lifespan, and the other is called
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healthspan. And lifespan is the part that I think most people think of. It's the how long you live
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part. But then there's healthspan, which is the how well you live part. And both of these things are
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important. I would argue that they're of equal importance, and an extreme of one without the other
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is not ideal. In other words, I don't think there's anybody sitting here who says, I'd love to live
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to 100, but I want to spend the last 20 of those years unable to move. I mean, that wouldn't be
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ideal. And similarly, I think the idea of living an amazing, healthy life, but that life being cut
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short prematurely at 50, nobody would think that that's ideal. So when I think of longevity, what I'm
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really thinking about is maximizing both the length of life and the quality of life. And again, quality
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could be further broken down into sort of a physical piece. So am I free of pain most of the time?
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Am I able to physically do the things I enjoy doing? And that could range from just the activities of
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daily living and self-care to recreational activities. If you like to garden, how long do you want to be
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able to do that? If you play golf, if you like to go for walks and hikes or swim. And then there's a
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cognitive piece. So I don't think anybody would fully expect, even at my age, that my brain is kind of
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as sharp as hers is. But I still want to believe that my mind is pretty sharp. And I think we all sort of
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want that for as long as possible. And then the final piece is an emotional piece that deals with
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happiness, sense of purpose, connection to others. And again, you can imagine a scenario where somebody
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has perfect physical health span, meaning they can do anything they want to do physically.
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Their brain is sharp, but they have no friends and no relationships. And I think we would all agree
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that that's not really an ideal life. And I don't think anybody would aspire to that.
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So that's a lot there. But when you put all those things together, to me, that's what longevity is.
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If some people here are wondering, is it too late to start caring about longevity and living longer,
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I would say that that's not the case. I would say that on the one hand, sure,
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the earlier a person begins to take steps to increase their longevity, the more opportunity
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they have. It's sort of like investing. When is the best time to start saving for retirement?
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Probably the minute you start earning your first paycheck in your teens or 20s. But does that mean
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you shouldn't save money when you're older? No, it doesn't. There's also a lot of data that we have
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from clinical trials that are done with seniors that demonstrate that, for example, people who have
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never lifted weights in their life before, who start lifting weights for the first time when they're in
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their 60s and 70s, have a remarkable benefit. This is not just true of weight training. It's true of
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any sort of exercise. So the short answer, I guess, is that no, it's never too late to really start
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thinking about this. But obviously, the best time to plant the tree is yesterday, if not today.
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Why do they have a benefit if they haven't done it before?
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Well, there's an effect of training. So specifically thinking of exercise, the body is really a use it or
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lose it organ or collection of organs. And the muscles are a great example of that. So it's actually
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true of young people and old people. The greatest effect of exercise is generally seen in the person
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who goes from being completely sedentary to even a mild amount of training. So if you look at somebody
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like me who exercises all the time or someone like you who exercises all the time, if we added three
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hours a week to your training or to my training, it actually wouldn't have an enormous impact. If you took
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an individual who did zero exercise and you took them to three hours a week, which let's be honest,
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guys, 30 minutes a day, six days a week is not a huge ask. The impact is enormous.
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That's strange. That's not what you'd think. Can you talk about the importance of adding life to
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years rather than just years to life and what that means to you?
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Yeah, it means a lot to me. I think it will mean a lot to people here because the metric that most
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people think of is life expectancy. How many times have you heard it? Life expectancy is increasing.
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Life expectancy is decreasing. And I think the reason for that is, frankly, it's just the easiest
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thing to measure because it's objective, it's quantitative, and it's a single number. It's a
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number that shows up and it can be measured from a death certificate. We know exactly how many years
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to the day that a person lived. And if we keep track of that, we certainly know something about
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them. But my argument would be that it is not the most important thing. And I would challenge us to
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find an individual who would, if given the choice, and I don't think one ever has to make this choice,
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but for the purpose of the thought experiment, if you said, look, you could live to 80 in remarkable
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and perfect health. And then when your life is over, it ends very quickly and suddenly versus you could
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live to a hundred, but you spend that last 20 years in a painful state of decline. I think very
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few people would choose the latter, even though they're living longer. And I think what most people
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want is quality of life over quantity outside of these extreme examples, which are common and tragic
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where people die and they're young. But I think when you really start to think about pushing those
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things, most people in my experience are more interested in quality of life.
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When it comes to someone's risk of dying, you characterize the biggest risks as the four
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Yeah. You can't have a discussion on this topic without talking about the four horsemen, which
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might seem a bit grim, but there's no reason to avoid talking about the inevitable, which is
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every one of us in this room is not going to be alive at some point. And I think to confront the how
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is important. So statistically speaking, all of us in this room are going to succumb to one of four
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processes or disease processes. So in rank order, the first of those would be cardiovascular and
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cerebrovascular disease. That's the leading cause of death in the United States. That's the leading
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cause of death globally. It's the leading cause of death for men and it's the leading cause of death
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for women, full stop. So that's a heart attack, a stroke. The number two, and it's not that far
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behind in the United States, is cancer. And of course, cancer isn't just one disease. We lump it
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all together. But of course, prostate cancer and breast cancer are frankly as different as a pickup
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truck and a Corolla. They both have four wheels, but that's about where the similarity ends.
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Number three would be the diseases of dementia and the neurodegenerative diseases. And there's a lot of
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things in here. So you have Alzheimer's disease, which is the most common form of dementia, but you
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also have lots of other types of dementia that are not neurodegenerative, such as vascular dementia.
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And then the fourth horseman is kind of a spectrum of diseases that we call metabolic diseases.
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The most extreme version of this would be type 2 diabetes. But of course, all along the way,
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you have conditions like fatty liver disease and insulin resistance. And all of these conditions
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form a continuum. And the most important thing to know about them is while not that many people
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will die directly from those diseases, if you have anything along that continuum, it's increasing your
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risk by about 50% of the other three horsemen. So we really want to think about a strategy at
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mitigating all four of these conditions and delaying them as long as possible.
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What would you say to someone that may already be navigating these chronic diseases that come
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with aging? And what advice would you give them on how to manage a high quality of life and keep
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You know, it would matter very specifically on which one we're talking about. I certainly won't ask for a
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show of hands, but just based on the age of everyone in this room, it's impossible for me to imagine
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that nobody in this room hasn't already faced some of these diseases. So if you're sitting in this room
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and you already had a stent placed in your coronary arteries, that says, look, you've already had a
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brush with coronary artery disease. Maybe someone in this audience has already had a heart attack and
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you're fortunate enough to have survived it. Well, the short answer is, look, the fact that you've
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survived it is great. And that means you get a second chance. Many people don't. So many people's
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first brush with heart disease is death. In fact, on average, about 50% of people, one in two people
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that have a heart attack, it's immediately fatal. So if you're in that group where you've had that
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heart attack or you know somebody who has, and they've lived to tell about it, they're in the
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lucky camp. And what they should be doing is everything in their power to not only prevent it
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from happening again, but to strengthen their body. And so the first thing I do is I ask myself,
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what were the conditions that I had that led to this heart attack in the first place?
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Now, some of these conditions, you don't have a lot of control over. Genetics play a strong role
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here. But there are many things that can be controlled, such as cholesterol levels,
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blood pressure, smoking. Those would be the big three. And we have ways to manage all of those
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things. Also, we know that exercise plays a very important role, as does metabolic health.
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So I've met many people who have had that near brush with death from that point of a first heart
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attack. They survive it. And what do they do? They turn it around and they say, look, I'm going to lose
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30 pounds. I'm going to stop smoking, or I'm going to manage my blood pressure, cholesterol better.
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I'm going to take up exercise. And I know people that have gone on to live 30 years after that
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event that might've happened when they were 60 and they live until they're in their 90s.
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So I guess I would always frame it through the lens of, hey, am I fortunate enough to have
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survived this thing? And if so, what am I going to do going forward?
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So someone here asked, what happens to our balance as we age? Falls seem to be so prevalent here in
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our senior community. Can we help these problems from increasing as we age?
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Yes. If there's a fifth horseman out there, it's accidental death. Now, what constitutes accidental
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death varies a lot by age. So when we're talking about people that are Olivia's age, the most common
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cause of accidental death is going to be car accidents and overdoses, drug overdose. When you
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talk about people my age, the most common cause of accidental death is overdose by far. When you talk
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about people your age, it's a total flip and the prevalence of accidental death goes up by five or
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six fold and it is virtually all related to falling. So I guess there's two questions. Why are falls so
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lethal? And maybe more importantly, why do people above the age of 65 fall so much more? And by the
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way, why do women fall disproportionately more than men? And why are women more injured by falls than
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men? These are the questions that I think we should spend a moment on. So let's start with the why do
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falls happen? You touched on it a moment ago. As we age, we don't just lose our balance, but we're losing
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something else that people my age and certainly her age take for granted, which is called reactivity.
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So the other day I was in the woods because one of my kids accidentally kicked the soccer ball down
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into the woods. So I had to go and get it. And as you can imagine, the ground is very uneven and
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it's covered in leaves and twigs and branches. So you can't even see what you're stepping on. I'm sure
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you can all picture exactly what this is like. Every step is a sprained ankle waiting to happen.
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And sure enough, at one point I step into something that wasn't as it appeared and I got jolted and I
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had to react very quickly with my leg to put it in the right place so I wouldn't fall. And I did.
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And I'm here sitting here talking about it and I don't even remember which leg it was. That's how
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insignificant this was. But the type of muscle fiber that was necessary to do that, which if we want to
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get technical, is called a 2A muscle fiber, is the type of muscle fiber that is responsible for
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explosive movement. It's the type of muscle fiber that is the most powerful muscle fiber. Well, those
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muscle fibers start getting weaker and weaker and shrinking at about the age of 25. So I'm long past
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my peak in my early 50s, but I still have enough to hold me on. But at some point they really,
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really start to diminish. And by the time someone's your age, you got threads of those things left. So
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you're losing those things. Now, the good news is you can train these muscle fibers, but the only way
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to train them is to move very heavy weights. It sounds crazy, counterintuitive, but that's what we have
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to do. We have to move really heavy weights and we have to train in movement patterns like that,
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which means, for example, bouncing, moving side to side, jumping rope. Things like that are necessary
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for our feet to have the reactivity that you had when you were young. A second obvious issue as we age
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is a reduction in bone density and a reduction in muscle mass. And this is the reason why women are more
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susceptible than men to these injuries because for obvious reasons, women have less muscle mass on
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average and have lower bone density on average, in part due to the fact that many women didn't receive
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hormones after menopause. And as their estrogen levels went down after menopause, their bones got
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disproportionately weaker relative to men because estrogen turns out to be the most important hormone
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in preserving bone density. And so all of these things taken together are what mean that falling
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is something we have to be very mindful of at any age, but boy, does it play a bigger role above the
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age of 65. And again, I won't ask for a show of hands, but I would be shocked if no one in this
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audience knew somebody, if not personally, who hadn't experienced a significant fall that resulted in a
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broken hip or a broken femur. And the tragedy of that type of accident is that in many cases,
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it's not fully recoverable. So you have the proportion of people that will die as a result of
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that. But even the people who live, often about 50% of them never regain the same level of mobility
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they had before. So all of this to me points back to the idea that we want to be exercising as much
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as possible. I'm going to sound like a broken record saying this, but you're going to want to
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have your body as prepared as possible because that physical piece is so important in preventing
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these types of injuries. Is there anything that people of this age can do now to preserve that
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muscle or strengthen it? Or did it have to be done while it was still like in their 20s?
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Obviously, if you could go back in time and I put you all in a time machine to when you're 20,
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knowing what you know today, maybe you would exercise more. But that's sort of an irrelevant point.
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I would say the point is what we do today is what matters. There's a woman named Belinda Beck that I
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interviewed on my podcast a few months ago. She's a researcher in Australia. And she did a study there
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that I really was fond of called the Liftmore Study. So this is a study that was done with a group of
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women, all of whom were over 65 years old, and all of whom had a disease condition of very,
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very low bone density. So there's a group of 65 and plus year old women who had very brittle bones,
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who didn't exercise beyond yoga and walking. So it's not like they were inactive, but they'd never
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lifted weights. And these women were randomized into two groups, one that continued with that type
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of exercise, and then one that engaged in really, really heavy strength training. And I love that
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there's a video of this on YouTube that is easily one of my 10 favorite videos of all time,
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because these women who look so frail by the end of the study are able to, in some cases,
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pick up their own body weight off the ground, do a deadlift with their own body weight.
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And they are coached on how to do this safely, and they gain strength. And they really do hardcore
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powerlifting exercises. Like they're not holding the little two pound dumbbells doing curls.
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They're doing squats, they're doing deadlifts, getting to pull-ups, bench press, all sorts of
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things. By the end of this study, they defied something that we thought was possible, which is
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we never thought it was possible to increase bone density. We thought the best you could do was
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maintain bone density or maybe slightly prevent the rate of decline. But amazingly, in these women,
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based on the CT scans of their bones, they actually increased bone density. I find this to be one of
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the most uplifting and important findings with respect to aging. And I think it speaks to how
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the idea that lifting weights is a young person's thing, or a male thing, I think both of those are
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just incorrect. Lifting weights is something every person on this planet should be doing.
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Moving from risks into action, do you want to quickly walk through the tactics in your longevity
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toolkit? And then from there, we can go into detail on each of them.
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Broadly speaking, there are five buckets of things that we have control over to impact all of these
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things we're talking about. So one we just talked about, exercise. And you can probably tell my bias
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is that that's the single most important one for the most part. So the second in no particular order
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would be nutrition. So what you eat matters. We'll talk about that, I'm sure, in more detail.
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The third one would be sleep. So the difference between sleeping well and not sleeping well has
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an enormous impact on your brain, but also on your metabolic health, which then indirectly plays a
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great role in other diseases. The fourth would be all of the medications and supplements, drugs,
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anything that your doctor prescribes or that you can buy over the counter. And these are of varying
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degrees of efficacy. Some of them are incredibly dubious. Some of them can be life-saving. But
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again, all of those things we'd want to think about. And then the final bucket would be kind of all the
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tools that we would have at our disposal to improve our emotional health and well-being.
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So we've already touched a little bit about why exercise is important, but for people in this
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audience, how can they start to safely exercise while also managing physical limitations?
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It's hard to provide a blanket statement on that because everybody's going to be different. But I
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think it's safe to say that people are less fragile than they believe. And I meet many people,
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for example, who have back injuries and say, look, I have a back injury. I can't really do anything.
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And the reality of it is when you sort of probe a little bit further, what you realize is nothing
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tends to make their back hurt more than inactivity. I don't remember who made the statement. I loved it
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and I paraphrased it or plagiarized it many times. Sitting is to lower back pain what bourbon is to
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alcoholism. Any of you whose back has hurt will probably think about that and go, you know,
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he's kind of right. When my back hurts, sitting is the one thing I don't like to do. Or after a long
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drive, it hurts worse. And for most people, actually being active makes them feel better. Now, let's be
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clear. There are certain activities, like if you have no cartilage left in your knee, more walking won't
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make you feel better. You're going to have to see an orthopedic surgeon. They might need to do a knee
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replacement. But boy, I will tell you in this day and age, in 2025, what can be done with a knee
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replacement, a hip replacement, even a shoulder replacement? I mean, these operations have come
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along so far and they have restored so much quality of life to individuals. So every one of these cases
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has to be managed individually. But if you have a really good PT or rehab professional who knows
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what's fixable with more training or more conditioning versus, hey, this actually does need some medical
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attention, I think the aspiration should be, what can I do to get as active as possible?
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Moving from exercise into nutrition, we saw questions come through that different diets are being talked
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about and they aren't sure which one they should follow. So is there a diet that you think is best or does
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I don't think there's a diet that is best. I think there are principles that matter and everyone should
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find the diet that best allows them to adhere to the principles. So what are the principles? The
00:24:25.420
principles are not to eat too much and not to eat too little. That sounds dumb, but it's just the
00:24:31.780
reality of it. And I think everyone struggles with a different end of that spectrum. There are some
00:24:38.000
people who just don't like to eat that much. They're like little birds. And as they get older, that becomes
00:24:43.660
a huge problem. They are too frail. At the other end of the spectrum, you have people like me who like
00:24:49.100
to eat too much and we will spend most of our life fighting against the urge to eat too much. And that
00:24:56.040
also becomes a problem as you get older because the heavier you are, the more weight you're putting on
00:25:01.160
each and every one of those joints. And again, we're thinking about all these things that are working
00:25:05.400
against us as we age, not to mention other complications that come from eating too much.
00:25:11.260
But I would say that in an aging population, the most important thing I want to emphasize is
00:25:17.340
getting enough protein. First of all, I just think for many people, it's kind of hard to get enough
00:25:23.780
protein in. Even I have to pay attention to it and I don't have a problem eating, but I need to be
00:25:30.280
mindful of, hey, did I get enough protein? It's really easy for me to get all the carbs in the world.
00:25:34.340
I don't have to go out of my way to eat more fat, but I do have to be cognizant of getting enough
00:25:38.960
protein. And enough protein is a pretty big number. It's about one gram per pound of body weight.
00:25:46.860
So I would challenge each of you to pay attention to, hey, if you weigh 150 pounds, are you getting
00:25:55.060
150 grams of protein a day? And I would bet that especially for the women here, that's even harder.
00:26:01.940
Now, if you fall a little bit short of that, it's okay. But if you're at half of that,
00:26:06.880
you're really not getting the optimal amount of protein. And as we age, we develop something
00:26:13.480
called anabolic resistance, which means that it is harder and harder for our muscles to synthesize
00:26:20.340
and grow new muscle cells with the given amount of amino acids, which are the building blocks in
00:26:27.060
protein that we get by eating protein. And therefore we actually need more and more protein to overcome
00:26:32.480
that. So we talk a lot about obesity. We talk a lot about osteoporosis and osteopenia, but there's
00:26:39.700
another condition of aging called sarcopenia, which is the condition of muscle loss. And that's a huge
00:26:47.480
problem. And there's really two ways in concert, two ways to address that. One is consuming enough
00:26:54.220
protein and the other is doing enough resistance training. So again, it doesn't matter if you're
00:26:59.200
a vegetarian, doesn't matter if you like a Mediterranean diet, doesn't matter if you like
00:27:02.840
steak and potatoes. If you can adhere to those principles, that's going to make your life easier.
00:27:08.000
Is it harder to adhere to those principles if you're a vegan? Yeah, it's a lot harder, but it's
00:27:12.120
not impossible. I know lots of people who have done it, but looking at a food tracking app in your phone
00:27:18.200
is a great way to spend a week evaluating how many grams of protein you're getting. And I think you'll
00:27:24.760
be surprised that for many of us, we're probably underdoing it. Now moving on to sleep. Sleep is
00:27:31.720
something that you've written a lot about and you said that you didn't use to take it very seriously,
00:27:35.840
but now you do take it very seriously. And that's true. He goes to bed at like eight every night.
00:27:40.600
Why do you think it's so important? I think I'm up till nine these days. Sleep is important and
00:27:45.640
you're right. I used to, probably until 12 years ago, I think my mantra was I'll sleep when I'm dead
00:27:52.420
and I just would try to sleep as little as possible. But the evidence are pretty overwhelming,
00:27:58.480
especially for both near-term and long-term function of the brain, that sleep is very important.
00:28:04.980
Now, I think at your age, a couple of unique challenges emerge. Again, I think most people,
00:28:11.360
once they're over 65 or 70, they're not fighting the will to sleep because they want to be out
00:28:17.520
partying all night. It's more that other things are getting in the way. So we know that as a person
00:28:23.700
ages, they tend to sleep a little bit lighter and their sleep architecture tends to change a little
00:28:29.140
bit. We also know that other things get in the way, especially for men, which is it gets harder
00:28:33.140
and harder to make it through a night without having to get up to pee. I'm already at that stage
00:28:37.520
where at least two out of the seven nights a week, if I am not mindful about when I had my last
00:28:42.280
glass of water, I'm going to be up at two or three in the morning to pee. And sometimes that's harder
00:28:47.120
to go back to bed after. So what are the things that we have under our control? Well, one of them is
00:28:52.540
absolutely timing of water. Now, again, water is super important. The older a person gets, the more
00:28:58.340
susceptible they are to dehydration. The older a person gets, the less reliable thirst is as an indicator
00:29:05.780
for fluid status. So at Olivia's age, you don't really, believe it or not, need to pay attention to how
00:29:11.460
much you're drinking. Thirst will be the guide. But that becomes less and less true as you age. So you're
00:29:18.580
juggling a narrow problem, which is on the one hand, you have to be mindful about drinking enough. But on the
00:29:24.420
other hand, you can't drink too much too close to bed, and that's going to keep you awake. Another thing that
00:29:30.520
makes a huge difference in sleep quality is timing of food. So the longer you can have between when
00:29:36.600
you have dinner and when you go to bed, the better. So we eat dinner really early because we have young
00:29:41.320
kids in our house. That's why I can get away with going to bed at nine because it's still been
00:29:45.220
three and a half hours or three hours since I ate. Another thing is alcohol. So some of you probably
00:29:50.560
drink alcohol. The less alcohol you have in your system when you sleep, the better you're going to
00:29:56.340
sleep. Having a super dark room, having a super cold room is going to make a big difference. And
00:30:04.020
perhaps the biggest thing to make a point about here is consistency of timing, especially on the
00:30:11.160
wake-up. So if you could tether yourself to one time, it's what time do I wake up? And if you force
00:30:19.300
yourself to wake up at the same time every day and don't allow yourself to take a nap during the day,
00:30:24.400
and this is a big ask because I know naps can be tempting, it's going to regulate when you end up
00:30:30.300
going to bed by building up enough sleep pressure. So if a person tells me I'm struggling to sleep at
00:30:37.440
night and I find out they're napping during the day, the first thing I want to do is get rid of
00:30:42.580
the nap. I'm going to fix the wake-up time, eliminate the nap, and then actually let them get
00:30:48.280
into a better sleep cycle that way. Are there any good sleep supplements that you recommend taking
00:30:53.900
and that are like not damaging to you? Yeah, there are. I mean, and I think one has to be very careful
00:30:59.880
with this stuff. There's certainly evidence to suggest that as we age, melatonin levels go down
00:31:04.980
and therefore melatonin can aid, at least with sleep initiation. But it's important to know that
00:31:10.840
melatonin really is only the signal to initiate sleep. It's not going to necessarily keep you
00:31:16.700
asleep all night. So if you're not doing all of the other things correctly, melatonin is going to be
00:31:22.680
limited in its efficacy. So before I go down the route of supplements, I want to get everything
00:31:28.040
we just talked about vis-a-vis the hygiene completely dialed in. And then yeah, if there's
00:31:33.320
still an issue falling asleep, I think melatonin can be a viable tool. Although I really want to
00:31:38.680
make sure it's the lowest dose you can buy. They tend to sell this stuff in high enough doses to kill
00:31:43.700
horses. It's not necessary. The lowest dose, which is maybe 300 micrograms, is probably all you need
00:31:49.700
at most twice that dose, but you don't need anything north of a milligram. I think one has
00:31:54.820
to experiment a little bit with other things. I find ashwagandha a little bit helpful. For others,
00:31:59.760
maybe not so much. Okay. And then we'll quickly touch on the last one, which is emotional health.
00:32:04.880
A lot of people think that this is not really something that matters in longevity, but you
00:32:09.520
talked about this in the last chapter of Outlive and how it's really important to you and that you've
00:32:13.520
recently discovered it. So do you want to talk a little bit about that and how it's important as
00:32:17.380
people are aging? I think it's actually important at any age. And I think that what I imagine is so
00:32:24.400
appealing about living at a place like this is you have a built-in system of friendship. I would
00:32:29.980
imagine that that's probably a great source of well-being that many of your peers would be missing
00:32:37.220
out on if they were living alone. I think about how little I see my parents, because we live in a
00:32:42.960
different country. So I can imagine that things that we take for granted when we're young, like
00:32:47.980
being close to our children or our grandchildren, aren't guaranteed when we grow older. Now, of course,
00:32:54.520
she's signed a contract that says she can't leave Austin. So this won't be a problem for me. I think
00:33:00.240
a social support network and some sense of purpose might be the single most important part of the
00:33:06.700
emotional health toolkit as it pertains to living longer. Every one of us knows the story of the
00:33:13.460
couple that have been married for 70 years. One of them passes away and then the other one dies within
00:33:19.740
a year. I don't think these are just anecdotal. I really think there's an understanding of why that
00:33:24.360
happens. So you can do everything right. You can eat the right diet. You can sleep right. You can exercise.
00:33:30.040
But if your emotional health is lacking, then it's like you won't live as long.
00:33:35.080
It's possible. I would say even more than that, regardless of how long you live, if it's unhappy,
00:33:39.320
why bother? Let's say you do live a long time, but you're alone or you're miserable. In some ways,
00:33:44.560
that would be the ultimate purgatory. Is there anything else you want to add before we hop into
00:33:48.380
the Q&A? No, let's turn it over to you guys. Okay. Yes. So why did you decide to start focusing in
00:33:55.140
longevity? I guess there's sort of two things. The first was when Olivia was born. She's my oldest.
00:34:02.720
I bet all of you can appreciate this. Those of you that have kids, which I'm guessing is most of you,
00:34:07.720
something about your mortality kicks in. There are many stages to mortality, but I think having a kid
00:34:13.500
is one. I think losing a parent is one. As we gain and lose things throughout life, we become aware of
00:34:19.280
its finitude. Her birth was a moment where I was like, huh, this is amazing. I'm not going to be
00:34:26.660
around forever to be a part of her life. That kind of got me thinking about it. That coincided
00:34:31.700
with me also coming to the realization that there are lots of things in my family history that might
00:34:37.840
otherwise suggest a short life for me. I wanted to get very serious about it. My own journey into
00:34:44.660
this space was actually very selfish and was strictly geared towards me figuring out things
00:34:50.140
for myself. Yes. Awesome. Okay. I'm going to repeat that question. So there were two questions
00:34:55.400
there. The first was an update on clotho, and I'll explain what that is for everybody else. And then
00:35:00.800
the second was on the gram of protein per pound of body weight. Is it ideal body weight if a person is
00:35:07.640
overweight? I'll start with the second question. The short answer is it depends on how overweight. So if a
00:35:13.780
person came to me and said, look, I weigh 260 pounds, I probably should weigh 200 pounds, I would
00:35:21.020
tell them if I agreed with that assessment, I'd say being closer to the 200 is probably fine. You
00:35:26.080
don't need to be at the 260. Okay. This gentleman was asking about a podcast I did. So I don't know how
00:35:32.260
many months ago it was, six, nine months ago. I had an amazing scientist on my podcast. Her name was
00:35:36.840
Dina Dubal. She's a neurologist at University of California, San Francisco, and she studies a protein
00:35:44.340
called clotho. This is a protein that is made by the body. It is made in response to exercise, but it
00:35:52.000
also is just made endogenously and declines with age for reasons we don't understand. So children make
00:35:59.240
six times more of this than adults. But of course, any one of us can transiently increase it by
00:36:04.740
exercising. What's special about this protein is it seems to be one of the most important proteins
00:36:11.100
that protects the brain. And so in both mice and monkeys, when you inject this protein, if these are
00:36:19.740
animals that have signs of dementia or cognitive decline, it reverses. If these are normal animals,
00:36:26.640
they seem to get superpowers like super cognitive powers. So that protein is going to be tested over the
00:36:33.440
next three years in humans. And if the results of that look promising, then a larger clinical trial
00:36:39.000
will take place. So I would say the best case scenario here would be that in seven to 10 years,
00:36:45.000
this could be an actual drug that humans take either to prevent cognitive decline or to treat it.
00:36:52.380
So what is the best type of protein supplement you recommend to get to your grams?
00:36:56.460
So I always ask people, if possible, and it's not always possible, whatever you can get from food
00:37:02.060
is great. But I understand that for many people, and again, especially for women, it's really hard
00:37:08.480
to just mash through that much protein. So we turn to supplements. Now, when it comes to foods,
00:37:14.220
the three that stand out the most are dairy products, beef, and eggs. Because there's a quantitative
00:37:20.960
way that you measure both the type of amino acid and the what's called bioavailability of the amino
00:37:27.800
acid. So how complete are the sources of amino acids and how readily can the body access them?
00:37:32.560
So again, if you're thinking about eating, beef, eggs, and dairy are the big ones. You can get lots
00:37:39.260
of amino acids and lots of other proteins. I'm not saying don't eat chicken or fish or vegetable
00:37:43.100
proteins, but those are big ones. Therefore, when you're supplementing, whey protein, which comes from
00:37:49.020
dairy, tends to be the winner. Now, casein is also great because it's also from dairy. So whey or
00:37:54.880
casein probably stand out a little bit above, but so does egg protein supplement. So what I tell people
00:38:00.700
to do is figure out what works best for you, because there's some people that just can't do dairy
00:38:05.700
proteins. Remember, just because you can't tolerate dairy doesn't mean you can't tolerate a dairy protein.
00:38:11.320
Most people who can't tolerate dairy can't tolerate the carbohydrate in the dairy, but they're totally fine
00:38:17.900
with the protein. So give it a try. Anything else? Yes.
00:38:23.040
So you're saying a few years ago, he did a genetic test and it did not show a genetic...
00:38:28.540
Okay. So let's assume that the test was correct. What it was screening for was very likely a gene
00:38:34.940
called the APOE4 gene. And this is a gene, the APOE gene that exists in three types. There's the number
00:38:44.440
two, the number three, and the number four. Now, every one of us has two copies of every gene
00:38:49.520
because you got one from your mom and one from your dad. So if there's three types of a gene and
00:38:54.320
there are two copies, there's six combinations where you can go through them all. You could be a 2-2,
00:39:00.380
you could be a 2-3, you could be a 2-4, you could be a 3-3, a 3-4, or a 4-4. Okay. Why is that relevant?
00:39:07.540
One of those types is higher risk than the other two, and that's the 4. So people who have two
00:39:15.200
copies of the 4 are at significantly higher risk for Alzheimer's disease, about 10 times higher risk.
00:39:22.320
Now, it doesn't mean that they're guaranteed to get it, but their risk is significantly higher.
00:39:27.100
People who have one copy, typically a 3 and a 4, are at about a 2 times risk. And so what that study
00:39:34.920
told you was, what I'm assuming it said was, you did not have a copy of the 4 gene. So you might be
00:39:40.360
a 3-3, which by the way, most of you probably are. 60% of the population is a 3-3. That's the good
00:39:47.360
news. The bad news is it doesn't mean you're free of risk because the only people who can't get
00:39:53.640
Alzheimer's disease are people who don't have brains. I mean, I'm being glim. Everybody with a brain is at
00:39:59.600
risk. And unfortunately, women are at almost twice the risk of men. And we don't have a great
00:40:07.020
understanding of why. There are lots of theories. I won't expand on them now for the sake of time,
00:40:13.000
but this is one of the areas where women are disproportionately affected to men. The other
00:40:19.360
one, by the way, being osteoporosis and falls. So we've touched on both of the areas where women
00:40:24.880
are at higher risk. Of course, men have a higher risk of cardiovascular disease. So the takeaway
00:40:30.100
for me is I'm a 3-3 as well, but I don't rest on it. I act as though I'm high risk, meaning I take
00:40:37.460
all the steps possible. Exercising being the single most important thing we can do to preserve brain
00:40:43.620
health, managing nutrition, sleep, all of the things that I can do. Yes. Okay. So the question was
00:40:51.000
talking about how your mom had a fall, she broke her hip, had a long protracted recovery,
00:40:58.220
managed to survive, but was never the same again, and basically slipped into a state of cognitive
00:41:04.420
decline. And your question was, is there a relationship there? Very good question. My
00:41:09.820
intuition is that there is a relationship there. In other words, we don't have the parallel universe
00:41:15.620
experiment where we could see how she would have been had she never had that fall. So what we're
00:41:20.460
trying to understand is, is there any causality between the fall and her cognitive decline?
00:41:25.620
And my intuition is that there is. And it's exactly what you said. It's that with the period
00:41:31.460
of profound inactivity, and probably with it, not just the physical inactivity, but also I would
00:41:38.440
suspect some cognitive inactivity. If nothing else, it may have sped up by a period of years,
00:41:45.340
something that may have ultimately happened, but I think probably was happening sooner than it should
00:41:50.820
have. It would be a very difficult thing to prove that. That's what my intuition says. And I think
00:41:55.640
that's just yet another reason to think about all these things we've talked about as far as like,
00:41:59.740
what are the steps we can take to minimize our risk of a fall?
00:42:02.400
Awesome. Well, I think that's all we have time for, but do you have anything else to add?
00:42:07.320
I like that I was on the hot seat from you today. So it's pretty fun.
00:42:10.460
Yeah. Well, thank you guys all so much for coming.
00:42:14.700
Thank you for listening to this week's episode of The Drive. Head over to
00:42:18.800
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00:42:25.700
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