Moment 142: These Daily Habits Are Slowly Hurting Your Lifespan: Peter Attia

00:00Today, most people listening to us are going to die from cardiovascular disease, cancer, dementia, other neurodegenerative diseases, or complications of diabetes. On one hand, that's a sign of progress. It means we're living long enough to die from those things. But we've made scant progress against them.

00:23In fact, if you go back and strip out the top eight causes of infectious death or communicable death today, our life expectancy is not much better than it was in the 1800s. If we want to really figure out a way to live longer and, I would argue more importantly, live better—meaning when we're in the last decades of our life, we aren't in a state of total decline—we need a totally different playbook.

00:53That playbook is Medicine 3.0, and it involves real prevention. That means taking true steps at prevention very early in life. It also involves being very personalized in how you do things. You can't just do paint-by-numbers or say the same thing to everybody. Clearly, there are certain things that make absolute sense across the board, such as sleep and exercise, but the way you might use medications is going to have to be much more tailored to an individual.

01:30You say that there are four points to Medicine 3.0, which is the prevention, being unique in your treatment to each individual, an honest assessment, and the acceptance of risk.

01:46One of the things that I don't think we think enough about as doctors sometimes is risk. Now, I think doctors are very good at thinking about the risk of doing something. Usually, a doctor is pretty good at understanding that if you have this surgical procedure, there's a risk of an infection, bleeding, or all of these things. If you take this medicine, there's a risk of this side effect or that side effect.

02:13But I don't think we spend enough time thinking about the risk of not acting or the risk of not acting when we do. This is where I think it gets a bit more nuanced. Prevention doesn't come without risk. I mean, you're still going to have to do something in the state of prevention.

02:33The question is understanding the time horizon upon which you're considering risk. I'll give you one very specific example. At least in the U.S., and it might be the same in the UK, we only really think about the risk of heart disease over a 10-year time horizon. Look at someone like you; you're 30 years old. What is your 10-year risk of having a heart attack? I can tell you without knowing anything about you: it's really low. It's as close to zero as we could have in medicine.

03:07Good.

03:09But what if I did a blood test on you and I found biomarkers in there that were predictive of very high risk later in life? That would be quite possible. There's about a one-in-ten chance you might have a biomarker called LP little 'a', for example, which is just a certain lipid in your body. There's about a one-in-ten chance you have that, which dramatically increases your risk of cardiovascular disease.

03:38My uncle died very early, I believe in his 50s, of cardiovascular disease.

03:45Knowing that could be helpful because that would prompt me to ask you more questions and want to know more about all the people in your family. So, here we have a one-in-ten chance—and by the way, we wouldn't leave it to chance, we would just check it. Let's say we checked your level and you had that lipoprotein, or you had an elevated level of another lipoprotein, Apolipoprotein B. Again, these are technical terms, but they're very common things and they're easy to measure.

04:19The Medicine 2.0 view here would be: "Well, there's nothing wrong with you now and there's not going to be anything wrong with you for the next 10 years, so we don't need to do anything about it." Conversely, if I take a lifetime view of risk, I would say: "Yeah, but the risk of something happening in the next 40 years is actually quite significant." So, my risk of doing nothing is probably much higher than my risk of doing something today. My risk of doing something today would be non-zero but small, but my risk of doing nothing, if I take the appropriate time horizon, is much bigger.

04:53This is one of the things in your book that really got me thinking. I have to say, and I believe a lot of people probably feel the same way, I've gone through my life thinking, to some degree, I'll worry about avoiding these diseases later. When I get to 45, then I'll start taking this thing seriously because then I'm getting into that territory where most people I know that get cancer, Alzheimer's, or all of these cardiovascular things—that's when it tends to happen. So, I'll think about it then.

05:25Totally understandable. I'll frame this in the context of a question I get asked all the time, which is: "Hey Peter, when is the best time to start thinking about this stuff?" I say, "Look, I can't answer that because there are two competing issues that are crossing."

05:46When I meet somebody who's in the last decade of their life, do you know how much they are thinking about this? It's all they're thinking about. Every minute of every day is a confrontation with their own mortality. The problem is, they don't have much time to change the direction of the ship.

06:08You may recall in the book I use the metaphor of the Titanic. It's not that the Titanic didn't see the iceberg; it's that it didn't see the iceberg in time. It didn't have enough runway to really move out of the way, and that's why the Titanic gashed the side of the boat.

06:29Now, at the other end of the spectrum, a 30-year-old like you has unbelievable potential to change the arc of your life. You have so much runway to, through manipulating nutrition, exercise, sleep, stress, and all of these things, completely alter the disease trajectory of your life. The problem is, and I'm not just speaking to you personally but more broadly to someone as young as you, it's harder to find the motivation because there are no reminders of your own mortality. You're Superman. The worst thing that happens to you is a hangover.

07:07So I always get asked when is the right time to start worrying about this. The short answer is: as soon as possible. But then there's a reality that says for most people, it's not until they're in their 40s, maybe once they have kids, that they start to appreciate their own mortality and that provides some of the motivation to say, "You know, maybe I'll be a little less focused on optimizing everything for today and I'll start thinking a little bit about tomorrow." Another way to think about this is saving for retirement. A lot of people in their 20s and 30s who are making good money aren't necessarily taking the most prudent financial steps to ensure financial freedom when they're in their 70s. Because, let's be honest, it's more enjoyable to spend money today than to set some of it aside. But there are a lot of people later in life who think, "I wish I was a little bit more responsible earlier on."

08:02How early do some of these... if you looked at my metabolic health or if you were able to look inside my body, which I'm sure you're able to do, how early do some of these diseases begin in my life? At what age do you see some of these things coming?

08:18It's super interesting because there are some elements of you as a person that are going downhill the minute you're born, and there are others that are not. Let's use two examples. Let's start with something where your body is getting better and better and you're probably only peaking now, but you haven't really started to age: your muscle quality.

08:48When you were five years old, your muscle quality was nothing like it is today. But as you enter your 20s, the quality of those muscle fibers—these type 1 and type 2 muscle fibers—slow-to-fatigue but high-endurance fibers are the type 1 fibers; the type 2 fibers are very powerful but quick to fatigue. The quality of both of those fibers is very high, and the more you train them, the higher quality they will be.

09:21But as you enter your 30s, you will now start to experience a shrinkage of those type 2 muscle fibers. You will be less powerful in your 30s, in your late 30s especially, than you were in your mid-to-late 20s. That's a form of aging. You are declining. It's not an accident that the most powerful athletes in the world are at their peak in their late 20s and early 30s—sprinters, for example, that's a prime example of a pure power sport. We look at other things like your muscular endurance; that will peak even a little bit later. You can keep that going a little bit longer.

10:01We look at certain forms of cognition. If we look at something called fluid intelligence, this is raw horsepower processing speed. You have more of it right now than I do. You're going to have faster processing speed, better memory; all of these things are going to be better when you're 30 than at my age—I'm 50. Because that's already started to decline in me.

10:29There are some things, however, that began aging in you the minute you were born. One of them is actually going back to this idea of atherosclerosis or cardiovascular disease. Well, that's an example of a disease process that begins right away at birth. Even though it almost never rears its head as far as death before you're 50, make no mistake about it, it's starting on day one.

10:59We know this, by the way, because when we look at studies of people who die for completely unrelated reasons—somebody who dies in a car accident or soldiers dying in war—and we look at the arteries of their heart, we already see quite advanced disease.

11:15Really?

11:16The truth of it is, you already have pretty significant disease in your coronary arteries. It hasn't risen to the level of ever causing a heart attack, and it's unlikely to do so for another 20 years, maybe even another 30 years.

11:32But it's compounding.

11:33It is compounding, exactly. If you want to live to be 90 free of cardiovascular disease, it makes a big difference if you can slow it down when you're in your 20s and 30s.

11:46Medicine 3.0, as we talked about earlier... you talk about these five core things that help to increase our chances of longevity as it relates to our health span. What are those five things?

11:58Exercise. Again, we can talk a lot about it if you want, but the point is, it is not remotely given anything beyond lip service by Medicine 2.0. If you go to your doctor here at the NHS and say, "Okay, tell me what my workouts should be," good luck. How much time should I be spending in Zone 2 versus Zone 5? What type of lifting should I... there's no way they're going to give you that type of insight or specificity.

12:30The third one is nutrition. Again, sure, every doctor is going to tell you "eat less, exercise more," but they're not really, for the most part, going to be able to help you manage nutrition. Certainly, I didn't learn anything about nutrition or exercise when I was going through my medical training, and most physicians don't. So, I'm not saying that there aren't doctors out there who don't understand these things; what I'm going to say is they had to learn that stuff on their own outside of their traditional training.

13:00That's so crazy.

13:02The fourth one is sleep, and that fits in the same category. Sleep is an essential pillar of health, but we learn nothing about it in our medical training. In fact, most of our medical training is paradoxically sleep-deprived.

13:17Sleep's really important to you, isn't it?

13:19For sure.

13:20Super important to me as well. It's been life-changing. This little Whoop thing here has absolutely changed my life.

13:26Yeah, I see that.

13:27And you've probably noticed how your Whoop score changes with and without alcohol in your system. One glass, and it's all flashing red. The first time that happened, I had one glass of wine and I woke up the next day and my vital signs, my heart rate variability, was flashing red. It literally says, "Did you have a drink last night?" It changed my life forever. Honestly, I'm absolutely obsessed with sleep in a very healthy way. Some people think, "Oh, you might be waking up and feeling bad." No, I look at it, and if I have not slept well, I'll adjust my day accordingly. You share some stats around sleeping in the book. What is the stat, or the two stats, that changed your perspective on sleeping or that you would tell someone if you're trying to convince them of the importance of sleep?

14:13It's so interesting. I'll tell you, it's not even a stat. I think it almost goes back to the type of discussion you'd have with somebody like a Daniel Lieberman, thinking about this through the lens of our ancestors. So, I was always someone who deprioritized sleep. Very busy person, high energy, didn't really seem to need that much of it, even in high school. I was sort of always "go, go, go."

14:48At one point, I was having a discussion with a colleague about sleep and I was making the argument that I didn't really need any of it. I almost made a point like, "It's almost a shame we can't just work our way out of it." And he posed to me in a very Socratic way: "Well, given how evolutionarily unwise sleep would be... you are unconscious for a third of your life, and we know that our ancestors slept an average of about seven to eight hours every 24 hours. They didn't do it all at once always, but we know they're sleeping basically a third of their life."

15:31That's a time when you can't forage for food, you can't defend yourself against predators, you're not mating. There's nothing from an evolutionary perspective you're doing. Those are the three highest priorities of evolution, and you're not doing them. Why would evolution have kept this thing around? And by the way, why has no species figured out a way out of it?

15:53I think through that lens I was sort of like, "Huh. Yeah, interesting. Maybe this thing does matter." So in some ways, I think that's probably one of the most powerful things that you can hear.

16:09And sure, there are lots of statistics about how fragmented sleep, broken sleep, or short sleep can increase your risk, in particular, of cardiovascular disease and dementia. I think there's a less clear relationship to cancer, but I think the relationship is quite clear to cardiovascular disease and dementia, in addition to insulin resistance and obviously, therefore, weight gain. So for people even if you're just coming at this through the lens of weight or excess body fat, I mean, that's probably motivation enough for many people. And then, of course, there's how you feel and how you perform.

16:51Oh my god, yeah. And your creativity, and your ability to articulate yourself—which I notice—and your mood. Huge one for me, especially when you're running teams. Unslept days are my worst days.

17:07The fifth and final thing that you have as a tool in the longevity toolkit is all the molecules: drugs, hormones, supplements. And there, that's the one thing you sort do learn in traditional medicine is you at least learn about the pharmacological side of it. You don't really learn anything about supplements, so most doctors don't really understand much about supplements. And interestingly, most doctors don't really understand a lot about hormones as well.

17:39Medicine 2.0 is good at what it does, but it's very limited. So it's kind of like having a contractor that only has one tool instead of five tools. And as we discussed earlier, I think they're applying those tools too late in the game.

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