The Peter Attia Drive - Qualy #89 - Cortisol and healthy aging

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00:00:40.600 Talk to me a little bit about cortisol and your views on it. How does cortisol interact

00:00:44.280 with the mitochondria?

00:00:45.360 Yeah, well, I don't know. I see another one that I would love to work on. So it's just

00:00:49.980 a weird observation. I don't know if you have this. I mean, I think maybe in our circles,

00:00:54.180 we have a lot of kind of type A personalities who exercise vigorously. They wash their diet.

00:01:02.040 They do all this sort of stuff.

00:01:03.580 I don't know anybody that does that.

00:01:05.420 No, you don't know anybody that does that?

00:01:07.000 Nobody.

00:01:07.480 But I always wonder if they're stressing themselves out by being so careful about everything.

00:01:14.020 You know me, I am the opposite. You've seen me eat and drink.

00:01:18.040 Yeah, but you're pretty fastidious with your exercise. You play soccer every day.

00:01:21.340 No, I do. And I don't overeat. And I do time feedings, right? I still fast 12 to 15 hours.

00:01:27.160 Most days closer to 15 hours. No, I do watch what I mean. But what I'm saying is I know people

00:01:31.460 who get very, very regimented about these things. And it's like the marathon runners who,

00:01:38.020 you know, the old line that they die, don't run marathons.

00:01:40.960 Yeah, I was with a friend last night and he was joking about this exact concept. And he was

00:01:46.100 talking about his, he's an orthopedic surgeon. He was talking about his partner or someone he

00:01:50.740 knows. And he was like, the guy is so into yoga, but it's become, he's like, the way he described

00:01:57.260 it was really funny. He's like, he's stuck in traffic and he's like, I got to get to my fucking 0.98

00:02:00.780 yoga class. 0.99

00:02:01.400 Yes, exactly.

00:02:02.060 And it's like, yeah, no, of course there's the irony to that.

00:02:04.560 Right. So, you know, your insulin levels might be fine and everything's fine, but you know,

00:02:09.200 what's your cortisol levels? So, I'm fascinated by cortisol. In fact, I'm fascinated by, I would

00:02:14.540 love for you to basically develop a very simple test that you can sell at Walgreens where you

00:02:21.060 take a prick of blood and you can do it as often as you want. And you tell me my thyroid and

00:02:26.960 hormones, you tell me my insulin, my glucagon, my estrogen, my testosterone, my dopamine, serotonin,

00:02:34.020 and obviously cortisol, right? These five or six, seven things that I just said, because it's

00:02:39.000 about a lot of biology or physiology can be explained.

00:02:42.780 Yeah, we're just, we're not going to be able to get it that way because cortisol is

00:02:45.780 mostly bound to albumin and cortisol binding protein. So, it's the free cortisol that exerts

00:02:50.640 its metabolic effects and its physiologic effects. And most of it's not free. So, you

00:02:55.320 can only measure the free cortisol in saliva and urine and then the other, you know, of

00:02:59.660 those other ones.

00:03:00.160 You know what I'm saying? Like, I would love to have those hormones at my disposal. You 1.00

00:03:06.160 know, is my testosterone too low, my estrogen too high, this too high, insulin, you know

00:03:11.260 what I mean? Just having that data points all the time. And then you could sort of modify

00:03:15.680 your diet and your exercise. But I think the cortisol one is, I pay more attention today to

00:03:23.040 stress than anything else. I'll be honest with you. I mean, I still exercise and I watch what

00:03:28.520 I eat. Those things seem intuitive because I've done it for so long. But I've been wondering if

00:03:34.400 myself and many of my colleagues, especially because, you know, we fly, give talks, you have

00:03:38.900 grand pressures, a teenager daughter, she's lovely, lots of different pressures we all have, right? And

00:03:45.080 if that somehow is being manifested metabolically through cortisol, to the mitochondria, just like

00:03:50.780 we think about insulin, right? So, that's all. That's the only reason I want to talk about

00:03:54.520 cortisol. No, I think I agree with that wholeheartedly. I think certainly in the last

00:03:58.620 three years, as I've dug my heels into it, I think hypercortisolemia is a problem. And I think

00:04:05.080 I wish people would think of these hormones through more broad endocrinologic terms. You know, it's

00:04:11.160 very easy for people to think of hypo and hyperthyroidism. We accept those as states. You can be 0.70

00:04:17.840 euthyroid or you can have too much or you can have too little. And yet people have such a hard time

00:04:22.600 thinking of insulin in those terms. You can have too much, you can have too little. There's a range

00:04:26.900 in which this hormone makes sense. And cortisol is probably equally important, if not more important,

00:04:33.340 in terms of the damage that can be done, especially from too much with respect to everything from

00:04:39.800 blood pressure, which would then impact the endothelium, what it does in terms of inhibiting

00:04:44.340 melatonin secretion in the brain. And melatonin obviously plays an immediate role in terms of sleep,

00:04:49.900 but also plays an indirect role in terms of neuro regeneration. So, and that says nothing about what

00:04:55.840 we just talked about, which was the role that cortisol may even play in the mitochondria, which

00:04:59.440 I'm just learning about, you know, literally in the past couple of months. So I don't disagree. I think

00:05:05.100 the challenge in many ways for anyone listening to this, if we're going to be brutally honest, I think

00:05:10.660 for many people, it's easier to control what they eat, how they exercise and exert discipline around

00:05:16.840 taking medications, taking supplements. But in many ways, one of the hardest things to control

00:05:21.220 is our response to stress. And I think that's an important distinction to make. I don't think

00:05:25.280 there's anything that's particularly troubling with being in stressful situations. I think the

00:05:30.040 difference is, is less about the situation you're in and more about the response you have to it.

00:05:35.340 And that's probably where the greatest differences lie between people is there are some people who can

00:05:39.500 be in relatively low stress situations. And yet they're sort of, they're not reacting well to it.

00:05:47.180 They're not coping with it well. And there are others who can be in-

00:05:50.320 They have different set points where they begin from.

00:05:52.580 Maybe. I mean, I guess I just don't understand enough of this stuff. I mean, I think-

00:05:57.720 But it's, I don't, you know, I don't hear too many people talk about it.

00:06:00.760 I don't know. I think it's-

00:06:02.060 No, no. People talk about stress, but, but sort of, like we talk about insulin all the time and

00:06:07.420 glucose levels and for men, testosterone, women-

00:06:10.440 You mean, you mean sort of in longevity circles?

00:06:12.320 Yeah. In longevity circles, like, you know, is that a variable we're missing, you know?

00:06:17.440 No, I see. I agree.

00:06:18.400 That's all I'm saying.

00:06:19.020 You're right.

00:06:19.780 You know what it is?

00:06:20.380 I'm just pitching cortisol.

00:06:21.100 Well, part of it is we don't have a target for it, right? No one's thinking about

00:06:24.380 pharmacologic ways to manipulate this. And we don't have great, obvious ways to curb our

00:06:30.880 behaviors. Like meditation probably is the single most valuable thing I've ever found to help

00:06:35.200 regulate this. But you also don't have the ability to measure cortisol levels that easily. Every

00:06:39.440 time you want to do one of these tests, it's, you know, you're collecting urine over the course

00:06:43.360 of a day and doing a bunch of other things. So it's just, it's involved. You don't have the-

00:06:47.080 Glass of wine?

00:06:48.100 Yeah. You know, it's really funny. I mean, I think there was a paper that came out probably about

00:06:51.760 three months ago that looked at, basically the punchline of the paper was, look, at any loss,

00:06:56.580 alcohol is toxic.

00:06:57.580 But, you know, if you look at those events, it's like 950,000 to 954.

00:07:03.480 The point of it is there's no dose of ethanol where the ethanol becomes valuable. But the

00:07:07.840 toxicity takes a while to kick in. So, you know, for some people, a glass a day seems perfectly

00:07:13.340 reasonable. There's no toxicity. But the flip side of it is, and this is where I kind of try to have

00:07:19.200 this discussion with every patient is, look, I'm not going to tell somebody not to drink. I mean,

00:07:23.460 I'm not going to tell myself not to drink. I probably have four drinks a week. And, you know,

00:07:27.420 I pick and choose my shots. You know, I have this rule called don't drink on airplanes because the

00:07:31.100 alcohol on airplanes sucks. So I'm not drinking alcohol just for the sake of drinking alcohol.

00:07:34.820 But if you're sitting there and the alcohol is really great and it's something you really,

00:07:38.020 the downside of the ethanol, the hepatic toxicity of the ethanol can be offset by the emotional

00:07:44.680 benefit that could come from the enjoyment of having that glass of wine with your buddy.

00:07:48.200 That brings me to another one of those things we should always measure. ALT, you know,

00:07:52.380 the liver enzymes. Yeah. I agree.

00:07:54.880 How well your liver function. How's your ALT this morning, by the way?

00:07:57.740 It's pretty good. Yeah. I haven't checked it.

00:08:01.380 Yeah.

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The Peter Attia Drive - January 07, 2020

Qualy #89 - Cortisol and healthy aging

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