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In this episode of the podcast/newsletter, we decided to review a book I recently finished reading titled “Outlive, The Science and Art of Longevity” by Dr. Peter Attia. Dr. Attia is someone that we have referenced previously on the podcast and is someone we greatly respect. This book offers a great playbook for anyone looking to take their quest for longevity more seriously and not only increase the number of years you live, but increase the number of years you live healthy.
The book begins by making the case for a significant change in the medical mindset. Currently, medicine is stuck in a wait and see if anything develops style of thinking. This is likely because of the success that medicine has had in treating infectious disease where you are either sick or your not. The development of antibiotics and the scientific method has definitely helped prolong life, but only by combating infectious disease. It has made little progress against the long, slow killers of today (cardiovascular disease, neurodegenerative disease, metabolic disease, and cancer). Therefore waiting until you have one of these issues puts you in a very poor position. If we are to make further progress, prevention needs to be the name of the game.
We then discuss the book’s review of the centenarians (people who live to 100 plus). The key is that these people seem to develop the 4 big killers (if they develop them at all) much later in life. The general population has about a one in five chance of having a cancer diagnosis by age 72. Among the centenarians, this threshold is not reached until age one hundred, almost 3 decades later. About one in four people will have cardiovascular disease by age 75. Among centenarians, they do not reach this prevalence until 92. Most of us will not be lucky enough to have the genes that these people do, but if we know what these genes do, perhaps we can develop a strategy in our own lives to produce similar outcomes.
Next came our discussion on metabolic health. This is a great example of too commonly in our current healthcare system we wait too long to intervene. Most of us know that once our blood sugar passes a certain point, we have diabetes. What may be less known is that you pass many stops along the way. Some of the stops may include: high insulin, elevated liver enzymes (even if technically in the “normal” range), steadily increasing blood glucose, and fatty liver. We also discuss a collection of findings that together represent what is known as Metabolic Syndrome. If you have 3 of the following 5 findings, then you have Metabolic Syndrome: high blood pressure, high triglycerides, low HDL cholesterol, high fasting glucose, and abdominal adiposity. About 90% of the US population has at lease one of the above. It’s another way of saying that a large percentage of the population is already on the train to metabolic disease, which if it gets there will significantly increase your odds of the other three big killers (cardiovascular disease, neurodegenerative disease, and cancer).
We then discuss heart disease, the deadliest of the killers. The book does a great job of tracing the process of how a plaque develops and how it can eventually become calcified and show up on a regular calcium scan. However, the familiar theme emerges yet again. This calcified plaque represents the end of a long line of events that had been in the works. Without getting lost in the weeds, the bottom line is that Dr. Attia argues for aggressive monitoring of something called apoB. This references all LDL (or VLDL, or IDL) particles which are wrapped in something called apolipoprotein B. These are particles that can get stuck in the blood vessels and kick off the while process. Keeping this number on the low end over a lifetime (along with proper diet and exercise) is a cornerstone of heart disease prevention.
We end by discussing the overall value of exercise. Most people probably know that exercise is good for you, but I don’t think most people know how good for you it is. To put it in perspective, poor cardiorespiratory fitness carries a greater risk of death than smoking, by quite a bit. The book ends by discussing having a well rounded exercise plan that hits Zone 2 cardio, VO2 max training, strength training, stability training, and prioritizing getting great sleep (among other things). This presents the best attempt at reducing the odds of getting one of the big 4. Overall the book was a great read!
Simplified Takeaways…
To combat the 4 big killers, shift your mindset to that of prevention rather than reaction.
Centenarians have proven that it is possible to delay the onset of the 4 big killers.
Monitor the following: blood pressure, fasting glucose, HDL levels, triglyceride levels and abdominal adiposity as having poor scores on 3 of those 5 classifies you as having Metabolic Syndrome.
Also monitor your liver enzymes. Guidelines have been recently revised to recommend a clinical evaluation for liver disease with ALT levels above 33 for men and 25 for women (these levels will often fall within the reference range).
Check you apoB levels and have a heart disease risk reduction discussion with you doctor.
Be on top of your cancer screenings as treatment is getting better for cancers caught early, but has not improved much for cancers caught late.
Exercise regularly and get great sleep!
Further Reading…
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