92 - AMA #12： Strategies for longevity (which don't require a doctor)
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Summary
In this episode, we discuss all things related to longevity that you don't need a doctor for. We focus on nutrition, exercise, sleep, and stress tolerance, and telomeres. We also cover the 5 Tactics of Longevity, which cover a huge range of questions that come from the listeners.
Transcript
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Hey everyone, welcome to a sneak peek, ask me anything or AMA episode of the drive podcast.
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I'm your host, Peter Atiyah. At the end of this short episode, I'll explain how you can
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access the AMA episodes in full, along with a ton of other membership benefits we've created,
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or you can learn more now by going to peteratiyahmd.com forward slash subscribe.
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So without further delay, here's today's sneak peek of the ask me anything episode.
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Welcome to AMA episode number 12. In this episode, we discuss all things related to longevity that
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you don't need a doctor for. This actually came out of a discussion I was having with Bob and Nick
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about how much of the stuff that I do with patients I think people could do on their own
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if they had sort of the right guidance. So we focus by looking at nutrition, exercise physiology,
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and sleep physiology for the most part. If you enjoyed this conversation, we're happy to have
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a follow-up AMA based on any more questions that come out of it. And of course, if the reception to
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this is positive, we can certainly go into other things that we didn't have time for in this
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episode, which would include, for example, things around supplements, techniques around distress
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tolerance, things like that. I'm once again, joined and hosted by my head of research, Bob Kaplan.
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So without further delay, here is today's AMA episode.
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So welcome to another AMA episode. I'm Bob Kaplan. And with me is full-time shepherd and part-time
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race car driver, Peter Atiyah. Peter, how are you doing?
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I'm good. I was thinking today, I've never done anything as bad as I do driving. It is actually
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the worst thing I do. I'm a much better everything than I am driver.
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That's why you're a full-time shepherd and a part-time race car driver. We wouldn't want to
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Yeah. And today I just was really frustrated in the simulator at how bad I was. It is definitely
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the hardest activity I've ever tried. It's infuriating.
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So in another life, you know, a thing or two are about longevity and lifespan and health
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span. So we might get to a few questions on those and not just shepherd related topics
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today. So despite all the questions we do get around shepherds and race car driving, which
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we actually do of the latter, we thought a great theme for today's AMA is all things related
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to longevity that you don't need a doctor for with a focus on the five tactics of longevity,
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which this covers a huge range of questions that come from the listeners. And to remind
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the listeners what those five levers are or five tactics are nutritional biochemistry, exercise
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physiology, sleep physiology, distress tolerance, and telomeres. Wait, sorry, exogenous molecules.
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Which includes drugs, hormones, and supplements, and maybe telomeres. So I thought we would just
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go down the list and start with nutritional biochemistry. We get a lot of questions around
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these. And if we just start with nutrition, I would say that people are asking a lot of
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different questions. Should I eat this? Should I not eat that? But I think in some ways they're
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asking the same thing, which is what or how should I be eating or not eating in order to live
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better now and or in the long run. So Peter, how do you approach this question? Maybe how
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about personally? And what do you think is the answer to that question? Or how do you even
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approach that question? Well, before even getting into that, I would say that this is a great place
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to start for the theme as you've laid it out, which is we're really going to focus today on things that
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one can do that specifically does not require the help of a physician. Because I know that it's just
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difficult for people depending on where they are geographically or otherwise to find physicians who
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are thinking about the problem this way. So I think there are lots of physicians who do think about
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the problems this way, meaning they think long and hard about the long tail of longevity and what the
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long arc of prevention needs to look like. But I also realize that a lot of people don't happen to
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be in an area where they're going to be able to find a doctor that can help them with that. And so
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what I've been thinking about and what I think we'll talk about today is, okay, imagine for a moment,
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you absolutely have no access to medical care. You have no access to a physician who can help
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navigate you through this. What could you do on your own? And I think the good news is you can do
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more on your own than you require the help of a physician for. So to your question, I think of
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all of these tactical domains, I think in some ways nutrition is the most complicated. And I think it
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might be the most complicated because I think it has the most variable response for a given individual
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to a given stimulus. So if the things that you put in your mouth to eat, the molecules you put in your
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mouth to eat are the inputs or the stimuli, the responses can be totally variable. So you and I,
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Bob could eat the same thing at the same time under the otherwise same conditions. And it produces
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a very different output. One of us might have a favorable response to that. The other one might
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have a lukewarm or even an unfavorable response to that. And I think that's where a lot of frustration
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comes from. I can sense that frustration in people's questions at times. I feel it in myself. I feel it in
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my patients. It can be infuriating when you are doing everything quote unquote right, because you're
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listening to someone who sounds like they know what they're talking about. You're reading something
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that seems reasonable. You try to adhere to that prescription, that dietary prescription,
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and you don't get a result or you don't get the result that you were promised or you think you
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should get. So we think the overarching principle of nutritional biochemistry is you have to be
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malleable. You have to be empirical and you have to assume that if it doesn't work and you've tried
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it correctly, that that's okay. And that there's another approach. So I don't want to harp on the
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framework because I think we've talked about it quite a few times, but the framework that I find helpful
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is to be thinking about the three things that you can restrict within nutrition. You can do what's
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called dietary restriction, which is restricting some type of macro molecule. So examples of
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dietary restriction would be something quote unquote as simple as restricting sugar, restricting
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carbohydrates, restricting animal protein, animal product in general, fats, one type of fat like
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polyunsaturated fat. It's basically anytime you're saying I'm not going to eat from certain food groups
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or certain macros or certain subsets of food. The second type of restriction is time restriction.
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This says I'm going to limit the window during which I eat. Again, you and I have talked about
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this a lot, written about it recently. This gets lumped into the broader terminology of intermittent
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fasting. I've never liked that term. And so I try to steer people away from the term intermittent
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fasting towards time restricted feeding or time restricted eating. But I think this is an
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idea that a lot of people are familiar with. So 16, eight, as an example means a 16 hour window when
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you are not eating anything or being exposed to nutrients other than water or tea, and then an
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eight hour window in which you are consuming food. And that number tends to shrink as you become more
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extreme. So 16, eight is less extreme than 18, six, which is less extreme than 21, three, as you open the
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non-feeding window and close the feeding window. The third and final lever that I think of in
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nutrition is caloric restriction. This is when you actually reduce the input. Obviously these three can
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be combined, but they don't have to be. So as an example, since my last fast now ended about two weeks
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ago, I have been only utilizing one of these levers. I have been exclusively going down the rabbit hole of
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dietary restriction with absolutely no caloric restriction and absolutely no time restriction.
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So what that translates to is I'm pretty much eating whenever the hell I want. In fact, I seem to be
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eating constantly. The first thing that goes in my mouth is five in the morning. And the last thing that
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goes in my mouth is like seven at night. It's like a 14 hour window in which I'm feeding. I'm also
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making no effort whatsoever to restrict how much I'm eating, but where I'm really strict. In fact,
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at this point, maniacally strict is what I'm eating. I hate using the word clean, but people would
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understand what that means. I'm basically completely restricting carbohydrates outside of vegetables.
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I think I had three berries the other day, but I'm pretty much having no fruit. I'm having no starch
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whatsoever. I'm eating not a single crumb off my kids' plates, which is kind of my new
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year's resolution. I'm eating vegetables like my life depends on it, meat, eggs, things like that,
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avocado, nuts, but otherwise quite restricted when it comes to most carbohydrates. So another point I
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want to make here is I've learned over many years that that approach works very well for me when I want
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to lose a few pounds. And I wrote about this earlier in the year. One of my goals this year is to lose
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about seven pounds, which is sort of an arbitrary number, but there's actually a reason behind that.
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And I just know that dietary restriction is the lever for me that tends to result in weight loss,
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provided it's this form of dietary restriction. I'm positive that I could prescribe the same
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dietary intervention to another person and it would not produce the effect. In fact, I have many
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patients for whom they say the only thing that really results in weight loss for them is time
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restriction. It's making that feeding window narrower and narrower and narrower. And so it's
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neither good nor bad. One isn't right. One isn't wrong. The idea is approaching this problem through
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the lens of being malleable enough to A, know what it is you're trying to address, B, figuring out how to
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measure that when possible. In the case of something as trivial as weight, it's very easy to measure,
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but for other things, it's potentially impossible to measure. Sticking with a plan long enough to
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assess it and being ready to abandon it if it doesn't seem to work. So I don't think I fully
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answered your question because I think there's a lot there, but I'll pause for a moment and let you
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digest and ask more if you feel like I could shed more light on that.
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Yeah. I think one of the things that you brought up is essentially a goal or some type of marker to
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look at in terms of whether your diet is successful or not, where you say, I want to lose
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seven pounds. And I think that's an important question to ask when the original question is,
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what should I be eating or how should I be eating in order to live better?
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And that may mean a number of different things for somebody. And I was thinking in that context,
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what are some of the tools that people can use to help guide them in answering this question
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for themselves? I mean, I often think of like a continuous glucose monitor, but that might be where
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you're crossing that line between whether you need a doctor or not. Or on the flip side,
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sometimes I think in medicine, we look at randomized controlled trials and wonder
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whether something was efficacious or not. But when you think about it in the clinic,
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I think an important question to ask the patient or ask another doctor about the patient is,
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well, how does the patient feel? So I think in terms of a diet, maybe somebody just wants to
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feel better, feel like they have more energy, feel less lethargic, or it is losing weight,
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or lowering their glucose or something like that. So how can people keep track of that?
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