The Peter Attia Drive - #342 ‒ Aging well： Peter shares strategies for improving longevity with residents at a senior living center

00:00:00.000 Hey, everyone. Welcome to the Drive podcast. I'm your host, Peter Atiyah. This podcast,

00:00:16.540 my website, and my weekly newsletter all focus on the goal of translating the science of longevity

00:00:21.520 into something accessible for everyone. Our goal is to provide the best content in health and

00:00:26.720 wellness, and we've established a great team of analysts to make this happen. It is extremely

00:00:31.660 important to me to provide all of this content without relying on paid ads. To do this, our work

00:00:36.960 is made entirely possible by our members, and in return, we offer exclusive member-only content

00:00:42.700 and benefits above and beyond what is available for free. If you want to take your knowledge of

00:00:47.940 this space to the next level, it's our goal to ensure members get back much more than the price

00:00:53.200 of the subscription. If you want to learn more about the benefits of our premium membership,

00:00:58.020 head over to peteratiyahmd.com forward slash subscribe. Welcome to a special episode of

00:01:06.200 The Drive. This conversation is a bit different from our usual format, as my daughter, Olivia,

00:01:11.420 trades places with me to take this seat as the interviewer as we visit a senior living center

00:01:16.300 to discuss all things longevity as it relates to an aging population. A bit of background,

00:01:21.600 Olivia spent part of her summer last year volunteering at this center, where she connected

00:01:27.040 with a number of the residents who had an interest in curiosity about healthspan, lifespan, and

00:01:33.200 strategies for living well as they age. And through that experience, they invited me to speak with their

00:01:40.000 audience, and we decided to record it and release it to you as well. In this conversation, we speak

00:01:45.560 about all of these topics, but with a particular focus around an aging population. So we talk about

00:01:50.780 what longevity really means, not just adding years to life, but life to years. We talk about

00:01:55.620 the four horsemen of chronic disease, talk about why it's never too late to start making changes for

00:02:00.300 better health, talk about the critical role of exercise, especially strength training in maintaining

00:02:04.720 mobility, preventing falls, and preserving independence, and how to approach exercise

00:02:09.040 later in life. Talk about the importance of protein intake and nutrition principles for aging. Talk about

00:02:15.160 sleep optimization. And we talk about emotional health and social connection purpose and why

00:02:20.760 relationships matter as much as physical health. So without further delay, please enjoy this special

00:02:25.740 episode of The Drive. Welcome, everyone. My name is Olivia Atiyah, and I'm here with my dad,

00:02:36.500 Peter Atiyah. We are here to talk to you today about longevity. So over the summer, I volunteered

00:02:42.480 at a senior living center called Querencia, which is where I met Sally, who unfortunately couldn't be

00:02:47.840 with us today because she's sick. But we got to talking, and I discovered that she's very interested

00:02:53.420 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

00:02:59.260 doing 45 minutes of conversing between us two to keep it interesting, and then a little bit of time at the

00:03:04.960 end for you guys to ask him things that you're interested about. So with all that being said,

00:03:09.440 are you ready? As I'll ever be. Okay. I think it'll be helpful to start talking about the actual

00:03:14.820 word longevity, because it can mean different things to different people. When you talk about

00:03:19.360 longevity, are you talking about living forever, or how are you defining it? Definitely not living

00:03:25.460 forever, although understandably, that's probably what some people think of when they think of longevity.

00:03:30.720 I'm talking about it in terms of two things. One of them is called lifespan, and the other is called

00:03:37.880 healthspan. And lifespan is the part that I think most people think of. It's the how long you live

00:03:46.320 part. But then there's healthspan, which is the how well you live part. And both of these things are

00:03:53.260 important. I would argue that they're of equal importance, and an extreme of one without the other

00:04:00.280 is not ideal. In other words, I don't think there's anybody sitting here who says, I'd love to live

00:04:04.400 to 100, but I want to spend the last 20 of those years unable to move. I mean, that wouldn't be

00:04:09.940 ideal. And similarly, I think the idea of living an amazing, healthy life, but that life being cut

00:04:16.880 short prematurely at 50, nobody would think that that's ideal. So when I think of longevity, what I'm

00:04:22.460 really thinking about is maximizing both the length of life and the quality of life. And again, quality

00:04:31.060 could be further broken down into sort of a physical piece. So am I free of pain most of the time?

00:04:38.520 Am I able to physically do the things I enjoy doing? And that could range from just the activities of

00:04:44.980 daily living and self-care to recreational activities. If you like to garden, how long do you want to be

00:04:51.340 able to do that? If you play golf, if you like to go for walks and hikes or swim. And then there's a

00:04:58.080 cognitive piece. So I don't think anybody would fully expect, even at my age, that my brain is kind of

00:05:06.180 as sharp as hers is. But I still want to believe that my mind is pretty sharp. And I think we all sort of

00:05:12.660 want that for as long as possible. And then the final piece is an emotional piece that deals with

00:05:18.700 happiness, sense of purpose, connection to others. And again, you can imagine a scenario where somebody

00:05:24.720 has perfect physical health span, meaning they can do anything they want to do physically.

00:05:30.380 Their brain is sharp, but they have no friends and no relationships. And I think we would all agree

00:05:35.240 that that's not really an ideal life. And I don't think anybody would aspire to that.

00:05:38.440 So that's a lot there. But when you put all those things together, to me, that's what longevity is.

00:05:43.580 If some people here are wondering, is it too late to start caring about longevity and living longer,

00:05:49.180 what would you say to them?

00:05:50.460 I would say that that's not the case. I would say that on the one hand, sure,

00:05:55.880 the earlier a person begins to take steps to increase their longevity, the more opportunity

00:06:03.960 they have. It's sort of like investing. When is the best time to start saving for retirement?

00:06:09.500 Probably the minute you start earning your first paycheck in your teens or 20s. But does that mean

00:06:15.780 you shouldn't save money when you're older? No, it doesn't. There's also a lot of data that we have

00:06:22.380 from clinical trials that are done with seniors that demonstrate that, for example, people who have

00:06:29.320 never lifted weights in their life before, who start lifting weights for the first time when they're in

00:06:34.480 their 60s and 70s, have a remarkable benefit. This is not just true of weight training. It's true of

00:06:39.360 any sort of exercise. So the short answer, I guess, is that no, it's never too late to really start

00:06:45.240 thinking about this. But obviously, the best time to plant the tree is yesterday, if not today.

00:06:52.140 Why do they have a benefit if they haven't done it before?

00:06:55.060 Well, there's an effect of training. So specifically thinking of exercise, the body is really a use it or

00:07:01.500 lose it organ or collection of organs. And the muscles are a great example of that. So it's actually

00:07:08.020 true of young people and old people. The greatest effect of exercise is generally seen in the person

00:07:14.440 who goes from being completely sedentary to even a mild amount of training. So if you look at somebody

00:07:19.800 like me who exercises all the time or someone like you who exercises all the time, if we added three

00:07:25.940 hours a week to your training or to my training, it actually wouldn't have an enormous impact. If you took

00:07:32.580 an individual who did zero exercise and you took them to three hours a week, which let's be honest,

00:07:38.800 guys, 30 minutes a day, six days a week is not a huge ask. The impact is enormous.

00:07:44.960 That's strange. That's not what you'd think. Can you talk about the importance of adding life to

00:07:50.000 years rather than just years to life and what that means to you?

00:07:53.400 Yeah, it means a lot to me. I think it will mean a lot to people here because the metric that most

00:08:00.500 people think of is life expectancy. How many times have you heard it? Life expectancy is increasing.

00:08:05.820 Life expectancy is decreasing. And I think the reason for that is, frankly, it's just the easiest

00:08:11.140 thing to measure because it's objective, it's quantitative, and it's a single number. It's a

00:08:15.920 number that shows up and it can be measured from a death certificate. We know exactly how many years

00:08:20.040 to the day that a person lived. And if we keep track of that, we certainly know something about

00:08:24.880 them. But my argument would be that it is not the most important thing. And I would challenge us to

00:08:32.580 find an individual who would, if given the choice, and I don't think one ever has to make this choice,

00:08:38.520 but for the purpose of the thought experiment, if you said, look, you could live to 80 in remarkable

00:08:44.180 and perfect health. And then when your life is over, it ends very quickly and suddenly versus you could

00:08:50.580 live to a hundred, but you spend that last 20 years in a painful state of decline. I think very

00:08:56.600 few people would choose the latter, even though they're living longer. And I think what most people

00:09:00.940 want is quality of life over quantity outside of these extreme examples, which are common and tragic

00:09:09.760 where people die and they're young. But I think when you really start to think about pushing those

00:09:14.060 things, most people in my experience are more interested in quality of life.

00:09:19.220 When it comes to someone's risk of dying, you characterize the biggest risks as the four

00:09:24.320 horsemen. Could you explain what those are?

00:09:26.940 Yeah. You can't have a discussion on this topic without talking about the four horsemen, which

00:09:31.460 might seem a bit grim, but there's no reason to avoid talking about the inevitable, which is

00:09:37.360 every one of us in this room is not going to be alive at some point. And I think to confront the how

00:09:44.100 is important. So statistically speaking, all of us in this room are going to succumb to one of four

00:09:51.660 processes or disease processes. So in rank order, the first of those would be cardiovascular and

00:09:58.040 cerebrovascular disease. That's the leading cause of death in the United States. That's the leading

00:10:02.620 cause of death globally. It's the leading cause of death for men and it's the leading cause of death

00:10:06.880 for women, full stop. So that's a heart attack, a stroke. The number two, and it's not that far 0.96

00:10:12.020 behind in the United States, is cancer. And of course, cancer isn't just one disease. We lump it

00:10:17.760 all together. But of course, prostate cancer and breast cancer are frankly as different as a pickup

00:10:23.460 truck and a Corolla. They both have four wheels, but that's about where the similarity ends.

00:10:28.520 Number three would be the diseases of dementia and the neurodegenerative diseases. And there's a lot of

00:10:34.340 things in here. So you have Alzheimer's disease, which is the most common form of dementia, but you

00:10:39.780 also have lots of other types of dementia that are not neurodegenerative, such as vascular dementia.

00:10:45.040 And then the fourth horseman is kind of a spectrum of diseases that we call metabolic diseases.

00:10:51.780 The most extreme version of this would be type 2 diabetes. But of course, all along the way,

00:10:57.040 you have conditions like fatty liver disease and insulin resistance. And all of these conditions

00:11:03.180 form a continuum. And the most important thing to know about them is while not that many people

00:11:09.840 will die directly from those diseases, if you have anything along that continuum, it's increasing your

00:11:17.780 risk by about 50% of the other three horsemen. So we really want to think about a strategy at

00:11:24.960 mitigating all four of these conditions and delaying them as long as possible.

00:11:28.900 What would you say to someone that may already be navigating these chronic diseases that come

00:11:34.420 with aging? And what advice would you give them on how to manage a high quality of life and keep

00:11:40.200 hope during these times?

00:11:41.700 You know, it would matter very specifically on which one we're talking about. I certainly won't ask for a

00:11:47.020 show of hands, but just based on the age of everyone in this room, it's impossible for me to imagine

00:11:53.340 that nobody in this room hasn't already faced some of these diseases. So if you're sitting in this room

00:11:59.820 and you already had a stent placed in your coronary arteries, that says, look, you've already had a

00:12:04.600 brush with coronary artery disease. Maybe someone in this audience has already had a heart attack and

00:12:09.180 you're fortunate enough to have survived it. Well, the short answer is, look, the fact that you've

00:12:14.280 survived it is great. And that means you get a second chance. Many people don't. So many people's

00:12:19.200 first brush with heart disease is death. In fact, on average, about 50% of people, one in two people

00:12:25.660 that have a heart attack, it's immediately fatal. So if you're in that group where you've had that

00:12:30.220 heart attack or you know somebody who has, and they've lived to tell about it, they're in the

00:12:34.160 lucky camp. And what they should be doing is everything in their power to not only prevent it

00:12:38.580 from happening again, but to strengthen their body. And so the first thing I do is I ask myself,

00:12:44.200 what were the conditions that I had that led to this heart attack in the first place?

00:12:48.660 Now, some of these conditions, you don't have a lot of control over. Genetics play a strong role

00:12:52.640 here. But there are many things that can be controlled, such as cholesterol levels,

00:12:56.920 blood pressure, smoking. Those would be the big three. And we have ways to manage all of those

00:13:03.700 things. Also, we know that exercise plays a very important role, as does metabolic health.

00:13:08.880 So I've met many people who have had that near brush with death from that point of a first heart

00:13:14.220 attack. They survive it. And what do they do? They turn it around and they say, look, I'm going to lose

00:13:17.960 30 pounds. I'm going to stop smoking, or I'm going to manage my blood pressure, cholesterol better.

00:13:22.180 I'm going to take up exercise. And I know people that have gone on to live 30 years after that

00:13:26.660 event that might've happened when they were 60 and they live until they're in their 90s.

00:13:30.080 So I guess I would always frame it through the lens of, hey, am I fortunate enough to have

00:13:34.500 survived this thing? And if so, what am I going to do going forward?

00:13:38.200 So someone here asked, what happens to our balance as we age? Falls seem to be so prevalent here in

00:13:44.500 our senior community. Can we help these problems from increasing as we age?

00:13:49.020 Yes. If there's a fifth horseman out there, it's accidental death. Now, what constitutes accidental

00:13:56.360 death varies a lot by age. So when we're talking about people that are Olivia's age, the most common

00:14:03.900 cause of accidental death is going to be car accidents and overdoses, drug overdose. When you

00:14:10.580 talk about people my age, the most common cause of accidental death is overdose by far. When you talk

00:14:17.060 about people your age, it's a total flip and the prevalence of accidental death goes up by five or

00:14:25.320 six fold and it is virtually all related to falling. So I guess there's two questions. Why are falls so

00:14:31.560 lethal? And maybe more importantly, why do people above the age of 65 fall so much more? And by the

00:14:38.260 way, why do women fall disproportionately more than men? And why are women more injured by falls than

00:14:45.180 men? These are the questions that I think we should spend a moment on. So let's start with the why do

00:14:51.100 falls happen? You touched on it a moment ago. As we age, we don't just lose our balance, but we're losing

00:14:58.220 something else that people my age and certainly her age take for granted, which is called reactivity.

00:15:05.880 So the other day I was in the woods because one of my kids accidentally kicked the soccer ball down

00:15:13.020 into the woods. So I had to go and get it. And as you can imagine, the ground is very uneven and

00:15:19.480 it's covered in leaves and twigs and branches. So you can't even see what you're stepping on. I'm sure

00:15:24.940 you can all picture exactly what this is like. Every step is a sprained ankle waiting to happen.

00:15:31.440 And sure enough, at one point I step into something that wasn't as it appeared and I got jolted and I

00:15:38.140 had to react very quickly with my leg to put it in the right place so I wouldn't fall. And I did.

00:15:44.800 And I'm here sitting here talking about it and I don't even remember which leg it was. That's how

00:15:48.540 insignificant this was. But the type of muscle fiber that was necessary to do that, which if we want to

00:15:55.560 get technical, is called a 2A muscle fiber, is the type of muscle fiber that is responsible for

00:16:00.980 explosive movement. It's the type of muscle fiber that is the most powerful muscle fiber. Well, those

00:16:06.760 muscle fibers start getting weaker and weaker and shrinking at about the age of 25. So I'm long past

00:16:15.320 my peak in my early 50s, but I still have enough to hold me on. But at some point they really,

00:16:21.300 really start to diminish. And by the time someone's your age, you got threads of those things left. So

00:16:27.680 you're losing those things. Now, the good news is you can train these muscle fibers, but the only way

00:16:34.320 to train them is to move very heavy weights. It sounds crazy, counterintuitive, but that's what we have

00:16:41.880 to do. We have to move really heavy weights and we have to train in movement patterns like that,

00:16:47.540 which means, for example, bouncing, moving side to side, jumping rope. Things like that are necessary

00:16:54.380 for our feet to have the reactivity that you had when you were young. A second obvious issue as we age

00:17:02.260 is a reduction in bone density and a reduction in muscle mass. And this is the reason why women are more 1.00

00:17:10.340 susceptible than men to these injuries because for obvious reasons, women have less muscle mass on 1.00

00:17:16.680 average and have lower bone density on average, in part due to the fact that many women didn't receive 1.00

00:17:23.920 hormones after menopause. And as their estrogen levels went down after menopause, their bones got

00:17:29.880 disproportionately weaker relative to men because estrogen turns out to be the most important hormone

00:17:35.680 in preserving bone density. And so all of these things taken together are what mean that falling

00:17:42.380 is something we have to be very mindful of at any age, but boy, does it play a bigger role above the

00:17:49.080 age of 65. And again, I won't ask for a show of hands, but I would be shocked if no one in this

00:17:55.280 audience knew somebody, if not personally, who hadn't experienced a significant fall that resulted in a

00:18:01.160 broken hip or a broken femur. And the tragedy of that type of accident is that in many cases,

00:18:07.600 it's not fully recoverable. So you have the proportion of people that will die as a result of

00:18:14.160 that. But even the people who live, often about 50% of them never regain the same level of mobility

00:18:21.720 they had before. So all of this to me points back to the idea that we want to be exercising as much

00:18:29.060 as possible. I'm going to sound like a broken record saying this, but you're going to want to

00:18:33.340 have your body as prepared as possible because that physical piece is so important in preventing

00:18:39.140 these types of injuries. Is there anything that people of this age can do now to preserve that

00:18:44.400 muscle or strengthen it? Or did it have to be done while it was still like in their 20s?

00:18:49.580 Obviously, if you could go back in time and I put you all in a time machine to when you're 20,

00:18:53.700 knowing what you know today, maybe you would exercise more. But that's sort of an irrelevant point.

00:18:58.560 I would say the point is what we do today is what matters. There's a woman named Belinda Beck that I

00:19:05.700 interviewed on my podcast a few months ago. She's a researcher in Australia. And she did a study there

00:19:12.040 that I really was fond of called the Liftmore Study. So this is a study that was done with a group of

00:19:18.280 women, all of whom were over 65 years old, and all of whom had a disease condition of very,

00:19:24.920 very low bone density. So there's a group of 65 and plus year old women who had very brittle bones, 1.00

00:19:32.280 who didn't exercise beyond yoga and walking. So it's not like they were inactive, but they'd never

00:19:38.560 lifted weights. And these women were randomized into two groups, one that continued with that type 1.00

00:19:44.180 of exercise, and then one that engaged in really, really heavy strength training. And I love that

00:19:50.760 there's a video of this on YouTube that is easily one of my 10 favorite videos of all time,

00:19:55.440 because these women who look so frail by the end of the study are able to, in some cases,

00:20:02.680 pick up their own body weight off the ground, do a deadlift with their own body weight.

00:20:07.040 And they are coached on how to do this safely, and they gain strength. And they really do hardcore

00:20:13.680 powerlifting exercises. Like they're not holding the little two pound dumbbells doing curls.

00:20:18.520 They're doing squats, they're doing deadlifts, getting to pull-ups, bench press, all sorts of

00:20:22.820 things. By the end of this study, they defied something that we thought was possible, which is

00:20:28.760 we never thought it was possible to increase bone density. We thought the best you could do was

00:20:34.080 maintain bone density or maybe slightly prevent the rate of decline. But amazingly, in these women, 1.00

00:20:41.660 based on the CT scans of their bones, they actually increased bone density. I find this to be one of

00:20:50.020 the most uplifting and important findings with respect to aging. And I think it speaks to how

00:20:57.820 the idea that lifting weights is a young person's thing, or a male thing, I think both of those are

00:21:03.240 just incorrect. Lifting weights is something every person on this planet should be doing.

00:21:06.720 Moving from risks into action, do you want to quickly walk through the tactics in your longevity

00:21:12.420 toolkit? And then from there, we can go into detail on each of them.

00:21:15.700 Broadly speaking, there are five buckets of things that we have control over to impact all of these

00:21:22.360 things we're talking about. So one we just talked about, exercise. And you can probably tell my bias

00:21:27.280 is that that's the single most important one for the most part. So the second in no particular order

00:21:33.800 would be nutrition. So what you eat matters. We'll talk about that, I'm sure, in more detail.

00:21:38.400 The third one would be sleep. So the difference between sleeping well and not sleeping well has

00:21:43.140 an enormous impact on your brain, but also on your metabolic health, which then indirectly plays a

00:21:47.980 great role in other diseases. The fourth would be all of the medications and supplements, drugs,

00:21:54.640 anything that your doctor prescribes or that you can buy over the counter. And these are of varying

00:21:59.300 degrees of efficacy. Some of them are incredibly dubious. Some of them can be life-saving. But

00:22:04.060 again, all of those things we'd want to think about. And then the final bucket would be kind of all the

00:22:08.720 tools that we would have at our disposal to improve our emotional health and well-being.

00:22:14.360 So we've already touched a little bit about why exercise is important, but for people in this

00:22:19.400 audience, how can they start to safely exercise while also managing physical limitations?

00:22:23.820 It's hard to provide a blanket statement on that because everybody's going to be different. But I

00:22:29.700 think it's safe to say that people are less fragile than they believe. And I meet many people,

00:22:36.480 for example, who have back injuries and say, look, I have a back injury. I can't really do anything.

00:22:41.340 And the reality of it is when you sort of probe a little bit further, what you realize is nothing

00:22:45.760 tends to make their back hurt more than inactivity. I don't remember who made the statement. I loved it

00:22:51.540 and I paraphrased it or plagiarized it many times. Sitting is to lower back pain what bourbon is to

00:22:57.720 alcoholism. Any of you whose back has hurt will probably think about that and go, you know,

00:23:02.060 he's kind of right. When my back hurts, sitting is the one thing I don't like to do. Or after a long

00:23:06.840 drive, it hurts worse. And for most people, actually being active makes them feel better. Now, let's be

00:23:13.260 clear. There are certain activities, like if you have no cartilage left in your knee, more walking won't

00:23:19.720 make you feel better. You're going to have to see an orthopedic surgeon. They might need to do a knee

00:23:23.780 replacement. But boy, I will tell you in this day and age, in 2025, what can be done with a knee

00:23:31.220 replacement, a hip replacement, even a shoulder replacement? I mean, these operations have come

00:23:35.180 along so far and they have restored so much quality of life to individuals. So every one of these cases

00:23:41.640 has to be managed individually. But if you have a really good PT or rehab professional who knows

00:23:47.720 what's fixable with more training or more conditioning versus, hey, this actually does need some medical

00:23:53.540 attention, I think the aspiration should be, what can I do to get as active as possible?

00:23:59.000 Moving from exercise into nutrition, we saw questions come through that different diets are being talked

00:24:05.320 about and they aren't sure which one they should follow. So is there a diet that you think is best or does

00:24:09.940 it depend on the individual?

00:24:11.980 I don't think there's a diet that is best. I think there are principles that matter and everyone should

00:24:17.140 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 0.72

00:24:31.780 reality of it. And I think everyone struggles with a different end of that spectrum. There are some 0.97

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. 1.00

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 0.55

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 0.50

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 0.94

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 0.80

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 peteratiyamd.com forward slash show notes. If you want to dig deeper into this episode,

00:42:25.700 you can also find me on YouTube, Instagram, and Twitter, all with the handle peteratiyamd.

00:42:30.920 You can also leave us review on Apple podcasts or whatever podcast player you use. This podcast

00:42:37.500 is for general informational purposes only and does not constitute the practice of medicine,

00:42:42.180 nursing, or other professional healthcare services, including the giving of medical advice.

00:42:47.220 No doctor patient relationship is formed. The use of this information and the materials linked to this

00:42:53.040 podcast is at the user's own risk. The content on this podcast is not intended to be a substitute for

00:42:58.960 professional medical advice, diagnosis, or treatment. Users should not disregard or delay

00:43:04.120 in obtaining medical advice from any medical condition they have, and they should seek the

00:43:08.540 assistance of their healthcare professionals for any such conditions. Finally, I take all conflicts

00:43:14.160 of interest very seriously. For all of my disclosures and the companies I invest in or advise,

00:43:19.500 please visit peteratiyamd.com forward slash about where I keep an up-to-date and active list of all

00:43:26.940 disclosures.

The Peter Attia Drive - March 31, 2025

#342 ‒ Aging well： Peter shares strategies for improving longevity with residents at a senior living center

Episode Stats

Summary

Transcript