Aging: How to live a longer and healthier life

Dr. Peter Attia doesn’t want a slow death. He doesn’t want his final years to be defined by poor mental and physical faculties that only worsen as the years roll by.

In today’s episode of ZOE Science & Nutrition, Jonathan and Peter ask: How can you maintain your health as you age?

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Episode transcripts are available here.

Transcript

[00:00:00] Peter: 50% of men who go on to have a heart attack, stroke, or die suddenly from one of those two will have that event take place before the time they are 65.

Where a lot of people get lulled into a false sense of security is, hey, I'm in my late 40s and everything looks pretty good. Therefore, I don't need to do anything about it.

[00:00:18] Jonathan: Welcome to ZOE Science & Nutrition, where world-leading scientists explain how their research can improve your health. 

A staggering 80% of us will have a chronic health condition by the time we're 65. And our guest today explains that the early signs of these conditions often present in our 20s, but we fail to tackle them until it's too late. But there is good news. Enduring decades of poor health is not inevitable.

In this episode, we find out how to improve our health to feel better today and in the long run, and maybe even compete in our own personal Olympic games at the age of a hundred. We're joined by Dr. Peter Attia. Peter is a medical doctor and a leading expert in the fields of longevity and healthspan.

He's also the author of the number one New York Times bestseller, Outlive the Science and Art of Longevity. Peter is going to share with you what actions you can take today. To live a long and healthy life.

Peter, thank you for taking time out of your vacation to come and be with us here today. Well, thank you 

[00:01:22] Peter: so much for making time to sit with me. 

[00:01:23] Jonathan: Now, before we get into everything, we have a tradition here that we always start with a quick fire round of questions. The rules are, you can say yes, no, Or maybe, and if you have to, you can give us one sentence.

Are you willing to give it a go? Absolutely. Alright. Is it true that our body may already be showing signs of aging as early as in our twenties? Yes. Is it inevitable that most of us will have decades of poor health before we die? That's very cheery. Are we at the dawn of a new approach to medicine that can significantly lengthen our lifespans?

Maybe. Okay, that's interesting. Can you predict how long I will live based on the strength of my grip? 

[00:02:06] Peter: Not with great precision, but generally. Sorry. 

[00:02:11] Jonathan: That's almost a yes! Yeah, yeah, yeah, yeah! Can you prescribe an exercise routine that is more effective than drugs to extend my lifespan? Yes. And finally, and...

You can take a few sentences. What's the biggest myth about aging and longevity that you often hear 

[00:02:29] Peter: probably something to the effect that the dye is already cast that there's something sort of predetermined about it that your genes are your destiny and You're sort of along for the ride In other words, there's something about a lack of agency that permeates this myth and I think in many ways, that's actually probably what the book I've written tries to cast doubt on.

[00:03:01] Jonathan: So in other words, we do have control over what's going to 

[00:03:04] Peter: happen to us. We have a lot more control and especially when it comes to our health span. 

[00:03:11] Jonathan: Before we begin, I have a favor to ask. 63 percent of people that watch this podcast haven't hit the subscribe button. And 11 percent haven't yet hit the bell to turn notifications on.

We want this podcast to reach as many people as possible as we continue our mission to improve the health of millions. So if you've ever enjoyed this podcast, please hit the subscribe button and turn notifications on. Doing us a small favor will really help. Thank you. When I think about aging, I particularly think about my grandmother who died from Alzheimer's.

Um, and it's something that had a profound impact on the whole family because I think my father, ever since then, I guess has this terrifying fear that he would have Alzheimer's. I think the central part for many people listening to this show thinking about their health is this concept of health span versus lifespan. But health span is not, I think, very well understood, maybe completely new word for some of our listeners. Could you explain what it is? 

[00:04:04] Peter: Well, I'll start with the medical definition, which I find utterly unhelpful, but at least people will know what the technical definition is. Healthspan is defined as the period of your life in which you are free from disability and disease.

Um, and while that would certainly be included in my definition of healthspan, I, I have a, a, a sort of more, um, I'd like to think practical way to think about it, right? And so healthspan is. About the quality of your life, but I think it encompasses three domains. There's a cognitive piece to this. So what does disability and disease look like cognitively?

Well, it might mean sort of how we're thinking exactly it might you know but when it rises to the level of quote unquote disease, we would think of dementia, but there are many people who Fortunately, don't get dementia, but still have cognitive impairment. Their cognition is still not what it once was. In fact, I'm already in a state of decline cognitively relative to what I was in my 20s. 

[00:05:05] Jonathan: So that's not as extreme as saying, I can't remember where I put anything this morning because you look like you're perfectly capable to get around town, Peter. 

[00:05:13] Peter: Sure. But my processing speed, my problem solving skills are not what they were 30 years ago.

They're not even close. Um, so even though for my age, I think I'm fine. I'm still a far cry from what I used to be. And I'm going to continue to deteriorate in terms of certain cognitive metrics. There are others in which I won't. So my crystallized intelligence, which is more about my ability to, you know, almost have wisdom and, and think of things with better judgment, that, that should actually go up.

So that's one, that's one domain. Another domain is the physical domain. Uh, and again, I'm completely free from disability and disease, but let's be clear. I'm not as strong. I'm not as fit. I'm not as free from aches and pains as I was 30 years ago. And that trend will continue. But again, my goal is to preserve muscle mass, strength, cardiorespiratory fitness as long as possible.

So there's this physical component and then finally there's an emotional component. Now the emotional component actually and most interestingly is the one that isn't tethered to age. That's not really an age dependent variable in the way that the cognitive and the physical piece decline. But the point of this is that healthspan, not only is it, you know, perhaps not something that listeners are thinking of, it's actually not really something that the healthcare system thinks about.

Um, there's a saying that I'm sure everybody listening to us has heard, which is what gets measured gets managed. And part of the problem with our healthcare system is it really fixates on lifespan, which is length of life. And it doesn't really fixate on health span, which is quality of life.

[00:06:57] Jonathan: And so does your health span, because you talked about the components, but if I was thinking about it simply, I mean, does your health span end at the point that you're no longer able to have, like, a high quality of life because of either your physical or mental problems?

Is that the way to think about it? 

[00:07:13] Peter: Health span is, is really quite an analog variable, right? So digital variables are basically on or off. So that's lifespan is really easy to think of that way. You're alive or you're dead health span. really has a lot of gradation to it. And one person's decline in health span or one person's threshold of Reduction is different from another so I probably have a much higher threshold or what I demand or what I want You know being physically active has been an important part of my life for as long as I've known and the things that I want to be able to do in the last decade of my life are probably really extreme compared to what many people would want to be able to do.

And so if I'm unable to do those things, my health span would be compromised. Whereas for another person not being able to do some of the things that I want to do might not constitute that much of a health span compromise. 

[00:08:06] Jonathan: I think you're saying in a sense, the health span is a little bit in the definition of the person, but fundamentally it means that they're still able to have good quality of life and enjoy themselves and feel good.

A lot of what you're talking about is how do we extend that health span rather than have this, I think, very scary idea, right? Which is you might have, you might live to be a hundred, but actually, if you sort of can't get out of your chair from the age of 65, that's not a good. Lost 35 years.

[00:08:33] Peter: That's right. If you have, you know, a profound loss of physical function, a profound increase in pain, loss of mobility, all those things, or a profound reduction in cognitive function. I mean, again, you start, you talked about the example of Alzheimer's disease. I mean, Alzheimer's disease, um, is, you know, a very profound example of robbing somebody of their cognitive health span.

Yes. And as most people who know People who have died of Alzheimer's disease realize, I mean, the disease kills you not through some sudden act in the brain. It's not like it causes a stroke. A person with Alzheimer's disease ultimately dies of some other complication. They, you know, in the most extreme cases, they might, you know, aspirate on their saliva and get an ammonia, or they might just not be able to take care of themselves, or they might simply lose interest in eating.

Um, so they'll spend potentially a decade or even longer in this state where their body could be totally fine until it ultimately succumbs because of their mind. So, I think that the more we can focus on preserving healthspan, two really good things happen. The first is, we actually, again, you, when you focus on something, that's what you tend to achieve.

So, most people actually want healthspan. So, By focusing on it, you actually get what you want. But the second thing, the unintended consequence that I think is beneficial is you also get more lifespan.

[00:10:00] Jonathan: So there's like a, there's a, there's a great kicker by, by trying to increase your years of being healthy, you actually end up living more total years as well.

That's right. So let's talk about what's getting in the way of that. And I think we end up touching on various aspects of this quite often in the podcast about maybe. Things that are happening in this world today that might be different from, um, you know, the way that our bodies evolved. What are the things that are making us sick and making a shift from being in this health span to suddenly, okay, you're sick, but you've still got some more years to live?

[00:10:32] Peter: Well, on the lifespan front, the things that are really getting in our way today are very different from the things that got in our way for most of our existence on this planet as a species. So for, I mean, more than 99. 5 percent of our time on this planet as humans, we died as a result of something I call fast death.

Fast death was really the thing that took our lives. And that was mostly infection and trauma. Those were the things that basically ended our lives, and we did not live very long, right? We would live till our late 30s typically, and that was about the typical lifespan. Um, as medicine made enormous advances in the late, uh, late 19th century, early 20th century, all of a sudden, a lot of tools and technologies came along that enabled us to combat fast death.

And so, In doing that, we've effectively doubled human lifespan, which is wonderful. 

[00:11:30] Jonathan: Which sounds good because I don't think anyone listening to fast death sounds like it's something that they want.

[00:11:35] Peter: Well, yes. Although when you consider the solution has been a net positive, but it hasn't been a pure positive.

Okay. Because now we all die from slow death. So we're still dying. We're living twice as long, but we spend a much greater period of our lives in decline. So you're right. I don't think anybody loves the idea of fast death, but I think what people really don't like is fast death in your thirties. I think most people would be very happy with fast death in their eighties or nineties.

What we have today is slow death where people will typically spend a decade or more in decline. And. That decline again comes back to this real health span decline and again, it's really typically about a decade in which people are functioning at less than 50 percent of their optimal capacity, cognitively, physically in some domain.

And I think that Again, the reason that that's happening is because we're not focusing on healthspan, even if you live longer, it's not clear that that's a better quality of life.

[00:12:38] Jonathan: I think you're basically saying like, well, if you've got a choice between another decade of life, but actually you're slowly getting worse and worse, and, and you can't do any of the things you enjoy, actually that's...

Probably worse than actually just, you know, having, um, the sort of the quick death that you described, uh, before, um, and not having that extra decade because actually there's no quality of life in it. 

[00:13:00] Peter: Yes, and most people listening to that, I think, would probably agree that. On balance, those make sense. But I think there might be some people who'd say, but I really want that extra decade because that's an extra decade with my grandchildren, to which I would say, let's bring it back to the original point.

I think you can have both. Which is very exciting. I think if you put most of your energy towards healthspan, you're going to get the lifespan benefits along the way.

[00:13:26] Jonathan: What are the key diseases that are basically robbing us of that healthspan as we get older?

[00:13:32] Peter: The big four. I call them the four horsemen are cardiovascular disease, cancer, neurodegenerative disease, and then the metabolic diseases that go all the way from insulin resistance, which I'm sure your listeners are very familiar with, up to, you know, fatty liver disease, non alcoholic fatty liver disease and any and ultimately type two diabetes.

So those diseases are really a spectrum or a continuum and while in terms of the absolute number of lives that they take, it's not huge, they’re such amplifiers of the other three that we really have to be thoughtful about what we're doing to address all of them, including these metabolic diseases that I talk about.

[00:14:17] Jonathan: You talk a lot in, in the book about the sense that modern medicine is really failing to keep us healthy and only really starts to do something the point that we get sick, which is something that also I think, you know, we talk a lot about it at ZOE often, particularly through the prism of the food that we eat.

Why is it if it sounds sort of obvious? So why is it that nothing happens until you get this diagnosis of a disease today? 

[00:14:42] Peter: Because we tend to sort of do what we know how to do. So, um, the system of medicine that beat quote unquote beat slow death, uh, I call it medicine 2. 0. And, uh, here's an analogy.

It's sort of like learning to drive a car and learning that in a car, it's okay to wait until you see the thing you don't want to hit to make the turn. And if all you ever did was drive cars, you could drive around London and you could be like, Oh, look, there's a bus in front of me that has stopped. If I don't stop, I'll hit it.

I'm going to stop or I'm going to turn. And you, you could get all through London and that strategy would work wonders. Yeah. But now I put you in the Titanic and say, okay, your job is to get this thing. From the United Kingdom all the way to New York go and in your mind you have this strategy Which is look all I need to do is just keep on chugging along and if I see something that's problematic I should try to turn away and somewhere in the North Atlantic you encounter an iceberg And you finally see it when you're a mile away from it.

Yeah, how is that going to work out for you? You see when it comes to treating slow death that playbook doesn't work The wait till you see it to treat it. fails. Prevention is a much, much earlier game.

[00:16:16] Jonathan: Just to finish with the Titanic metaphor, what you're saying is when it's a mile away, you know, I turn the wheel, but it's way too late.

I'm just going to slam into this iceberg anyway. 

[00:16:25] Peter: Yeah. Yeah. I assumed everybody, I assumed everybody knew how that story is.

[00:16:28] Jonathan: I've never driven a large, you know, uh, boat. So I just want to check that I've understood the, uh, the metaphor correctly. Presumably I needed to turn Like you need to turn miles.

[00:16:38] Peter: Exactly. You need to turn along before the iceberg was visible. You don't want to wait until your blood sugar is 140 milligrams per deciliter on average, which is hemoglobin a one c of 6. 5%, which is the diagnosis for type two diabetes. You don't want to wait until your coronary artery calcium scan shows that you actually have calcification in your coronary arteries, which is indicative of A decades long process of disease. You certainly don't want to wait until you have a stroke. You don't want to wait until you have colon cancer. You don't, you don't want to wait until all these things happen. You have to act much sooner. You have to act before there's a problem. 

[00:17:17] Jonathan: And how much sooner? Cause you had this brilliant answer to the question right at the beginning saying that even in your twenties, you can have signs of, um, you know, The first traces of some, you know, disease that might be happening.

I'm in my late 40s, so if I had to fix it in my 20s, is it too late?

[00:17:34] Peter: Well, it's never too late, um, and it certainly depends on the condition. Um, but I'll certainly give you a very extreme example, and then we can extrapolate from there. So we know, let's start, let's just talk about cardiovascular disease, because it is...

It's like heart attacks and strokes. Heart attacks and strokes, because that's the number one cause of death globally. Uh, and it's the number one cause of death for men and women. So, uh, you know, if you're listening to us talk today, uh, chances are this is your number one risk factor. We know from autopsy studies that are conducted on people in their 20s who have died for unrelated causes that they already have signs of atherosclerosis, which is the technical name for what happens when cholesterol gets inside the artery wall and an inflammatory process takes place that ultimately leads to, for example, a heart attack.

[00:18:29] Jonathan: And this is sort of the furring up of your artery slowly over.

[00:18:32] Peter: Yeah. And what's really happening is the, the body is attacking the inside of the artery where this cholesterol gets, thinking it's a foreign adversary, when in reality it's not. But in the process of doing so, it creates more of a problem than is warranted.

[00:18:52] Jonathan: And you're saying that when they've done autopsies of somebody in their 20s for nothing to do with someone who dies in a car accident accident, you can already start to see the signs.

[00:19:01] Peter: So you can see evidence that this process has been a decade in the making. In other words, this process basically begins at birth.

Now, for the average person, That process probably won't reach clinical significance if you're a male until you're in your mid sixties. So, 50 percent of men who go on to have a heart attack, stroke, or die suddenly from one of those two will have that event take place before the time they are 65. So, for women, it's a third of women who will have a heart attack, stroke, or die of heart attack or stroke, will have that occur before they are 65.

So, when you ask the question, okay, I'm in my late 40s, is it too late for me? Well, I would say, no, it's not, right? The fact that you're sitting here, right, tells me it's not too late to do anything about it. Um, but, where a lot of people get lulled into a false sense of security is, Hey, I'm in my late 40s and everything looks pretty good.

Yeah. And therefore I don't need to do anything about it. 

[00:20:03] Jonathan: Hi, can I share a quick personal story with you? I spent nearly 20 years avoiding lactose, gluten, and many other foods. I thought this was good for my health, turns out it wasn't. Since starting ZOE six years ago, I've slowly improved my gut health and reintroduced lactose and gluten into my diet.

I now eat a huge variety of foods that I never thought I'd see on my plate again. And guess what? I don't feel tired all the time anymore and gone are the constant bloating and bouts of brain fog. So the thing about ZOE is that I knew there wasn't a quick fix to my diet. It took time and a lot of support to get to how I feel today.

We created ZOE membership to offer lasting support. So people like you and I could improve our health and stay that way. Not just tomorrow, but in the longterm. We do realize that not everyone is ready for personalized nutrition and that for others, it's still too expensive. And that's why we put this show out for free each week without ads.

But if you are ready to join us and become a member of ZOE. Then go to joinzoe.com/podcast and get 10 percent off so you can start your own journey to improve your health today. 

So how do we change the focus from treating diseases to preventing people become. Becoming sick in the first place and i guess particularly i think if you're listening to this is not just an abstract question but maybe you know for the individual themselves because i think generally they will find that if they go and see their doctor if they're not clearly sick with something then they'll be like, You Oh, you're fine.  You know, go away, come back when you're sick. 

[00:21:46] Peter: Yeah, I mean, there's two ways to think about your question. And I think there's one way that I feel qualified to speak, and there's one way that I don't. So I'll start with the way that I don't. If you're asking the question from a structural standpoint, how would we fix the health care system and Again, this doesn't really matter if you're talking about the NHS or the US healthcare system or the healthcare system anywhere in the world.

Yeah. It's the same everywhere. Yeah. I would say to do that, you have to go back to the way physicians are trained. When I was in medical school, I only really learned about two tools, which were procedural tools and pharmacologic tools. 

[00:22:32] Jonathan: Those were procedural tool means like surgery. 

[00:22:33] Peter: Surgery. Yeah. I mean, I trained as a surgeon, so basically, You those were the two things that you learned 

[00:22:40] Jonathan: chop something out or you give someone a drug 

[00:22:42] Peter: That's right.

Those were your tools. And again, I do not want to suggest that those are not valuable tools I do not want to disparage the remarkable things that those tools have done again They have doubled our lifespan in a generate and in four generations, right? I'm simply pointing out that all the stuff we are now talking about will require that you understand nutrition And you understand exercise, and you understand sleep, and you understand emotional health.

And... I was not trained in any of those things, and I know that my peers were not trained in any of those things. So, some of us have learned those things, but we had to learn them outside. 

[00:23:25] Jonathan: Tim always says that, um, you know, if you're lucky, you get a half day of training on nutrition, and your entire training as a doctor.

And probably most of the students aren't even there for that like half day on nutrition. 

[00:23:38] Peter: I mean, even if you said, okay, going forward, you know, physicians are going to have to spend an entire semester learning about exercise, nutrition and sleep, they would have to really understand how to apply those tools.

I don't think there's any doctor listening to this, or for that matter, any patient listening to this who hasn't been told by their doctor that they should sleep, that they should eat less, that they should exercise more. That's relatively unhelpful advice. It's sort of like a patient with cancer being told by their oncologist that they should get chemotherapy.

I mean, if the advice ended there, it would be of no value, right? The reason that you see the oncologist when you have cancer is the profound precision that goes into which chemotherapy? How should it be dosed based on my body weight, based on my kidney function, based on my liver function? How would you monitor for recurrence?

How would you modify the treatment if I'm not responding? Think of all the nuance that a physician can provide today within his or her area of expertise, and think about the complete and utter lack of that nuance and sophistication that goes into the primary tools of prevention. And I haven't really answered your question because all I did was tell you the part that I don't know how to fix, which is, how do you change the medical infrastructure?

Tell me about the bit you can fix. Well, I think the part that we can fix is where you started with, which is as the individual, we just have that agency to ourselves. That's kind of why I wrote the book, right? I wanted to write a book that could be an operating manual for the person who acknowledges that maybe the system isn't perfect, but what can I do to say, okay, like, now I know a lot of this stuff, and I don't need a physician for it. I mean, you don't need a physician to help you fix your nutrition, or your exercise, or your sleep, or your emotional health.

[00:25:32] Jonathan: And I think, you know, one of the things that is frustration, I think, is clearly we're spending almost all of our money on health care in this prevention regime, which, you know, I think often some extraordinary fraction of this is spent in the last 12 months of somebody's life. It's sort of got too late to be able to really improve. It's really frustrating 

[00:25:54] Peter: Yeah. And in fact, even if you didn't care one iota about a person's life, even if you were simply counting the beans, It would make so much more sense to take half of that money that is being spent in the last year or two of a person's life and spend it in the earlier part of their life.

And, again, I'm just gonna use the NHS as an example because we're here, but imagine if the NHS said, You know what? We're going to slap CGMs on everybody and we're going to pay for it. And you know what? We're going to make sure that there are a lot of really high quality trainers out there who can work with people and get them independently working and exercising.

And you know what? We're going to fix the system such that, you know, it becomes less expensive to buy high quality foods so that, you know, we're kind of subsidizing the right foods instead of the wrong foods. Like, I could go on and on. You would save money as a society and improve the quality of an individual's life.

It, it, there just has to be kind of, you know... An inertia that has to be overcome to do that. There's an enormous activation energy to make that happen. 

[00:27:05] Jonathan: You've mentioned a couple of times the, the continuous glucose monitors, which for people listening are these blood sugar sensors that you put on your arm. It was one of the first things you mentioned as an intervention. If you were sort of godlike and could reset the, um, the, um, the way the health systems worked around the world. Could you explain? Because I think for a lot of people listening, that was probably the bit that was... surprising saying people should do more exercise or eat better was obvious.

[00:27:31] Peter: So as you said, it's a device that gets inserted. Um, it has a needle that puts a filament into the subcutaneous tissue. We typically insert them on the arm, but I think the abdomen is equally used. And the filament is measuring the concentration of glucose in the interstitial fluid. And it has an algorithm that can measure Impute what the what the value would be in the blood if you were actually measuring the blood, which is what we care about I became completely obsessed with this and of course i'd already been completely obsessed with my nutrition But now for the first time ever I had real time information really remarkable insight into Um, obviously how what you ate impacted your blood glucose, but also how exercise did or certain types of exercise or lack of exercise and how a bad night of sleep impacted your ability to do so.

When we say blood sugar, we really are referring to blood glucose. Glucose is a very, very simple carbohydrate. So if you eat pasta, if you eat rice, if you eat chips when you're having your fish and chips, which, by the way, I've been eating almost every day that I've been here, um, it's all gonna get broken down into glucose.

Glucose is the most important fuel in our body. It's the one that our brain can't survive without, uh, except under very unusual circumstances. And... As such, evolution has given us profound and remarkable tools to regulate it. So, where we have spent most of our energy regulating it is making sure we don't have too little.

So the body has really optimized on the don't ever have too little of this thing problem. Because then you die. And you die quickly. So, if your blood sugar drops to half its normal value, or 40 percent of its normal value, you would be dead within 3 or 4 minutes. What nature was not as concerned with was the opposite problem.

What happens if you have too much glucose? Over time, primarily brought on by inactivity or lack of exercise and excessive nutrition. So too much energy being stored. Our bodies lose the ability to safely put glucose into the muscles. And what happens now is the glucose in the blood starts to get chronically and chronically higher and higher.

And when glucose levels get chronically and chronically higher, the glucose starts to bind to proteins in the blood. And those proteins start to damage The small blood vessels in the body, blood vessels, one of the first blood vessels you see this in, uh, is the eye. So if an ophthalmologist is looking into your eye, they can actually see the damage in the retinal arteries.

The blood vessels in the heart, the blood vessels in the brain, the blood vessels in the kidney, in the penis, in the extremities. That's why a person who's had type 2 diabetes for a long time starts to have damage to all of these organs. They might need amputations, their kidneys begin to fail, they have a much higher risk of stroke, heart attack.

[00:30:46] Jonathan: And hence, like, we want to keep that blood sugar under control, you don't want it to go to this crazy amount. And maybe just to wrap that back up to, why might someone listening to this want to, you know, have this blood sugar sensor on their arm and see it for themselves? 

[00:31:04] Peter: It's not just as binary as, do you have type 2 diabetes or not? In fact, the data are pretty clear that the lower your average blood glucose, even within a non diabetic range, the better your health outcome.

[00:31:16] Jonathan: This is part of, you know, for everybody who does the, the tests that start ZOE, one part of that for everyone who opts into the study, which is, which is most people, they actually get one of these continuous blood sugar sensors, these cgms, and it's normally very eye opening. You know, I remember the first time I had it and I think this is experience that many people have there are all these foods that you're eating because you think they're really healthy for you that you don't even necessarily like that much and they blow your budget blood sugar through the roof, which is sort of rather extraordinary. Yep. So your point is that by seeing this for real, it will really change things. 

[00:31:49] Peter: Yeah, we all of our patients were aware of cgm for I mean, at least a month. And I describe it as two things. One is the insight phase. One is the behavior phase. So everybody has the experience you just described, which is, uh, and I had that too, you know, nearly, you know, eight years ago, which is I was really surprised at the effect of certain foods.

on blood sugar. I was also very surprised for me personally, very surprised at the effect of stress and sleep and how stress and sleep negatively impacted poor stress, like high stress, poor sleep, negatively impacted glucose disposal. And, and I was very favorably inclined to see how much exercise buffered my capacity to regulate glucose.

[00:32:38] Jonathan: If someone was listening to this now, and maybe. You know, they're not someone who's going to the gym all the time. Yes, they understand that exercise matters, but they'd love to understand better what sort of exercise can really make a difference to my health span. Could you help us to, um, to unpick that?

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[00:32:57] Peter: Yeah. If you're really optimizing to be the best version of yourself in the last decade of your life, and this is how I think about it, I, I start with this idea of the marginal decade. So in the last decade of your life, what do you want to be able to do? And I think if most people listening to this reflect honestly on the people that they have known, and they have watched through their marginal decades, I think most people would not want to do that.

[00:33:26] Jonathan: And you have this wonderful book, the thing in the book where you talk about, like, being a hundred years old and sort of doing the Olympics that you would like to do at a hundred years.

[00:33:32] Peter: Well, I, yes, I call it the centenarian decathlon, but I'm also pointing out, of course, that most of us, myself included, will not be centenarians.

But yes, it, I use the centenarian decathlon as a mental model because it forces us to be specific. And one of the biggest challenges my patients have, and I assume... Any listener will have is really being specific and granular about what they want to do in the last decade of their life. It's very easy to say, Oh, I just want to be able to play with my grandkids and travel.

Okay, let's get more granular. How do you want to play with your grandkids? What does that mean for you? Does it mean and by the way, there's no judgment here. It's like whatever it means to you. It means to you. But if it means sitting on the couch playing video games. That requires a different level of training than if it means sitting on the floor playing with Lego.

And that's very different than if it means taking them on a trip where we have to walk. So, so we want to be very clear that we know what you want to be able to do. And once we've defined that, you now have to set in place a training plan. So every sort of athletic. aspiration requires training. And I review this centenarian decathlon and this, the, the activities of your marginal decade as an athletic achievement, one that we're going to spend the rest of our lives training for.

And so you need to be doing a lot of strength training. You need to be doing a lot of cardio training. You need to be doing a lot of stability training. All of these things are going to be important as you Aim to prevent injury and increase functional capacity. And for someone at your age, for example, it's very easy to overlook this because there's probably nothing that you have really come up against yet in your life that you can't do in response to not enough strength or not enough cardiorespiratory fitness. That's going to happen at some point. Our goal is to make that as far away as possible, uh, and or try to minimize it as much as possible. And the way to do that is to have as high enough reservoir. Before we get there. So I, the analogy I use is that of a glider, right? So if a glider wants to go far, it has to be high. And so you want that glider in your forties to be very high to make sure that it goes very far into your eighties, eighties and nineties. 

[00:36:05] Jonathan: Much stronger, much fitter than you might feel you need to be because it's inevitably going to decline. Could you spend, you know, just at a high level to help us understand, cause you talk about cardio and strength and.

Could you explain how you think of like, what's the core components of, of those two things that someone, if you're going to give like the sort of simple tip, you know, simple tip for somebody thinking about that. 

[00:36:25] Peter: Yeah, for, for, for our purposes, you can divide cardio into two broad buckets. One is kind of the aerobic efficiency piece and the other is the peak aerobic output and the.

Cardio efficiency, the aerobic efficiency piece, I write about and I call that zone two and the peak aerobic output Uh is really your vo2 max. So vo2 max is just a technical term For the maximum amount of oxygen you can utilize under, you know, peak Uh stress, but peak physical demand or stress So we want those two energy systems to be as robust as possible.

[00:37:05] Jonathan: Like what type of activity? What is zone two? Um, what is that activity? Because I think that's not something that, you know, I'd never heard of before. Yeah. What is it? 

[00:37:15] Peter: It is a steady state type of cardio where you are from an exertion standpoint, able to speak, but not particularly interested in speaking.

[00:37:26] Jonathan: Because it's a little bit like hard work, but I could do if I had to. 

[00:37:29] Peter: That's right. So because I'm here in London right now and I don't have access to all my normal toys back home, I'm exercising at the gym this morning, and today was a Zone 2 day, so I just did the treadmill. And what I like to do when I'm doing the treadmill is, Uh, it's at 15 degrees.

So it's a pretty steep hill and it's at about five and a half kilometers per hour. So it's a brisk walk up a very steep hill.

[00:37:55] Jonathan: And I think what's interesting is you're not therefore, because I think often people think about exercise like you're pushing yourself as hard as you can go and that's what good exercise is. You're describing something completely different. 

[00:38:05] Peter: Yeah my wife was on the treadmill next to me running, she's a runner, and she was doing a running workout today, and I, I could talk to her, but truthfully, I didn't sound nearly as comfortable as you and I sound right now. So, if, if I'm able to speak it with relative ease, I'm not exercising hard enough, I'm not into Zone 2 yet, I'm in Zone 1.

If I'm at the point where I couldn't carry out a conversation, or I couldn't say more than a couple of words, I'm north of Zone 2. End. There's benefit to that for something we can talk about elsewhere, but this zone two piece is really important. 

[00:38:46] Jonathan: It's a foundational piece. So how often should you be doing this?

[00:38:50] Peter: It depends on the level of fitness you're coming in with. Um, we do pretty quickly want to get people up to three hours a week of that type of training. So typically three 60 minute sessions or four 45 minute sessions.

[00:39:04] Jonathan: So that's a big chunk of your time doing something which is, like, really interesting at like a moderate level of expression, but really not pushing yourself that, that hard.

That's right. And you think that has a profound impact on extending your, your health span.

[00:39:16] Peter: That's a very important piece of the equation. You still need to do the higher end gear. So, And the good news is you don't have to do nearly as much of that by volume. So you might only need 30 minutes a week of where you're pushing that other energy system, the VO2 max system, the peak aerobic system. And to do that, you have to work much harder. Typically the sweet spot for this is doing something this again, you could be on a bike, you could be on a treadmill, you could be running, you could be swimming, whatever it is, where you go as hard as you can for somewhere between three and eight minutes. And then you rest for the same period of time.

So it's a 1 to 1 ratio of work to recovery. So, I like 4 minute intervals. So I would, there's a nice hill near my house, and it takes about 4 minutes to ride up. So I ride my bike up that hill very hard, and I have 4 minutes to recover before repeating it again. And I might do four or five rounds of that once a week.

[00:40:21] Jonathan: So there's a two types of cardio exercise that you're doing. And then you put strength on top. 

[00:40:26] Peter: That's right. And with strength training, there are principles that I talk about in the book. And, you know, the principles are we need to be able to hip hinge. We need to be able to, um, focus on. Eccentric strength training, not just concentric strength training, which means so this is a very important concept, and I think everybody will appreciate it once it's explained, but the words a bit confusing.

So if you imagine doing a bicep curl, you are lifting a dumbbell in your arm as you curl the bicep, the bicep muscle, which is doing the work is When you're curling up, it's getting shorter. I think a person could look at their arm and appreciate that the bicep is getting shorter. So when the muscle is shortening under load, That is called the concentric phase of the movement, but you also appreciate at the top.

You don't just drop the thing I mean think of how much you could damage your elbow your shoulder and everything else if you just dropped the dumbbell instead you let It down. So here you're extra you're exerting strength Less so because gravity is helping you but you're still exerting strength resisting it going back down, but you're resisting it So as the muscle is lengthening It's still contracting, and, um, it's still exerting its strength, and that is the eccentric phase.

So, both of these phases are very important. And as people age, there are a handful of things that are happening. So at the level of the cell, the muscle cell, the type 2 muscle fibers, start to shrink first. So we're losing explosiveness and power, but we're also not focusing enough on that eccentric form of strength.

[00:42:08] Jonathan: Everybody's very focused on like this one direction and not enough about sort of resisting. 

[00:42:12] Peter: That's right. And the eccentric phase is the brakes. If you're walking down the stairs, you're relying mostly on your eccentric strength. If you're going up the stairs, you're relying on your concentric strength.

And most people, when they're aging, are actually at greater risk for injury. going down the stairs or down the hill or off the curb. That's where people get injured. They get injured because they can't slow themselves down. They can't decelerate. And that's why we have to specifically train that type of strength.

And so, that's another principle of my strength training is you want to really be focusing on eccentric movements. 

[00:42:55] Jonathan: Sadly, we have hit time. There are so many more questions I would love to get into, and I'm hoping we can tempt you back, uh, in the future to go a bit further into this. Can I try and do something we always do on this podcast, which is to do a little summary, um, and let me know if I, um, have got any of it wrong as I run through?

[00:43:30] Peter: That would be great. 

So I think we start off by talking about this idea of health span, which is this really powerful idea that we shouldn't really be focused on how many years we live, you know, our lifespan. We want to focus on how many years of healthy life where we can do the things that we want. And we need to define for ourselves what those are.

And you have this wonderful idea of like the hundred year old Olympics, doing the things you want to do, like maybe just sitting on the floor, doing Lego with your, your grandchildren. Then you talked about the way that our current medical system is. Being really good at dealing with this fast death where something really bad happens, you intervene now, but actually what really happens to us is what you described, slow death where potentially, you know, things start even in your twenties and then you finally have your heart attack, um, in your fifties or your sixties or later.

And that there are these four horsemen, as you described, and these four, you know, terrible things that can happen, sort of stuff to do with heart disease and strokes, cancer, these mental issues like Alzheimer's, and finally these metabolic diseases like, like diabetes. And that all of this is happening over this long period of time.

Though you did get this scary statistic that apparently half of men will have their heart attack or stroke before they're 65. So it may happen sooner than, than we realize. And that basically we need to rethink medicine. We can't just wait until we're really sick. And since the medical system isn't going to do this for us, the truth is that all of us need to take this more onto ourselves and start and start doing it.

Um, than the cells. And I think you said, you know, if you could wave your magic wands and take control of, um, the healthcare system, there was sort of four things that you'd sort of immediately get people to do. Interesting. One of them was to actually try their own continuous glucose monitor and discover what's going on with their metabolism, because it will sort of be a shock and help them to change.

And then you talked about obviously nutrition, sleep. And an exercise is these as these key things. Um, and today we've had a chance, I think, to dig a little bit more into into the exercise. And I think the key thing is, it's quite complex, right? There's quite a few pieces here, which is probably not surprising, but it's very different, I think, from how most of us talk, which is like you do a bit of activity, you're done.

And I think if I were to break it, break it up, you said there's this cardio, which is really different from the strength. And that within cardio, interestingly, there's not just how are you pushing yourself really hard for a short period of time, which is this maximum, but I should talk about the zone two where actually you want to get your clients as soon as possible to be doing three hours a week of this level where actually, you know, I could still talk, it's a bit uncomfortable, but I can manage that. And it actually, that's this amazing bedrock of health, which I think I'm going to now go away and do, um, uh, or at least that's my ambition.

And then when you talked about strength, that's incredibly important as well. But again, critically, there's this too. Uh, and interestingly, the bit that I think most of us never think about, which you call eccentric, which is sort of like walking down the hill, which I think I was brought up to believe there is no work walking down the hill, right? It's only walking up the hill is actually incredibly important for preventing illness that, uh, in much later life. 

[00:46:25] Peter: I think that was a pretty remarkable summary. 

[00:46:27] Jonathan: Well, thank you. What I feel is there's lots of other things we haven't touched on. So I do hope we can tempt you back and go into some of those other areas in the future.

[00:46:35] Peter: Well, you know, my wife said the day we got here that my wife runs marathons and loves them. And she said, I really would love to run the London marathon at some point. So, uh, so we might be back for that.

[00:46:49] Jonathan: Brilliant. Well, I hope to do that. And if not, we'll, we'll find an excuse to come to Austin.

Perfect. Thank you very much, Peter. Thanks so much for having me. Thank you, Peter, for joining me on ZOE Science & Nutrition today. If you want to understand how to support your body with the best foods for you to give you many years of healthy life as you age, then you may want to try ZOE's personalized nutrition program.

You can learn more and get 10 percent off by going to joinzoe.com/podcast. As always, I'm your host, Jonathan Wolff. ZOE Science & Nutrition is produced by Yella Hewings-Martin, Richard Willan, and Tilly Fulford. See you next time.