Health Podcasts: Whats your 10-15-20 year plan?

Peter Attia, MD: Biological Age.

So, I came across a comment on social media the other day. It said biological age versus real age is a total scam. If you want to see your real age, look at a masters category of athletic feats such as a one mile run time, not some scammy algorithms. If the body can’t physically express a performance, then you’re the age seen on your birth
certificate. I reposted that and said, “Yep, totally agree with this”, and a lot of interesting comments and questions came in.
The comment that I wanted to chat about was one that said, “Peter, I mean, yeah, this kind of makes sense. But like, why would physical tests be a better measure of biological age than fancy biomarkers?”. And I reflected on and I said is “ultimately, physical performance is indeed the best metric of the limits of capacity. There are non-
physical performance metrics that we can look at as well. I could look at your kidney function, I could look at your glomerular filtration rate, and that would certainly be a marker of age, but honestly, it’s only in an extreme case would that give me an insight. In other words, only if somebody is 50 and they have a glomerular filtration rate of somebody who's 80, would I say the negative, but the positive isn’t really there. If you look at my glomerular filtration rate, it’s over 100 and that doesn’t really tell you much about me, even though Iam over 50 years old. It tells you that my kidneys are in great
shape, but it doesn’t tell you that I have the kidneys of a 20 year old, because, quite frankly, they haven’t really deteriorated in any measurable way since I was 20. The same would be true of my ejection fraction. It’s really good today. Now, of course, there
are certain other factors that invariably go down, for example, resting heart rate goes up, heart rate variability goes down. But ultimately, if you really want to understand biological age, I really like this idea of we should look at physical metrics. We should be looking at VO2 max. We should be looking at strength. We should be looking at
hardcore performances, including other things, by the way, that are a little more subtle than the aggregate pieces. We would want to look at things like balance, for example, how well can you stand on one leg with your eyes closed? How long can you do that?
And can you even do more challenging things, like turn your head, do push ups, pull ups, all of these things really matter. And there’s here you start to see an enormous gradation between people even at the same age, be it 30, 40, 50, 60, 70 etc.

Dr. Stacy Sims: So inherently, women don’t need to be cold.

Dr. Stacy Sims: So inherently, women don’t need to be cold.

When we are looking at stress responses, because that’s how I view all the environmental and exercise data -what kind of stress does it put on the body when a woman gets into ice cold or cold water. It invokes such a severe, strong stress response, much stronger than a male’s response, that her body goes into more of a shutdown phase, where it invokes a sympathetic drive, and it doesn’t create the metabolic changes that we see with men. If you were to take a woman and put her in 15 or 16 degrees Celsius, which is around that 55 degree mark, she will end up with the same responses that a man has, because it’s not as severe a shock to a woman’s body as it is for a mans. Why is that? Because we have more body fat, we tend to vasodilate and vasoconstrict first for controlling our temperature.

Dr. Stacy Sims: Do women do better in the heat:

When we look at sauna exposure, women can tolerate heat a lot more than men. A woman can sit in there, sit up high, 20 minutes or so, not sweating yet absorbing heat and vasodilate – it’s great. So, we’re heating ourselves, our body’s responding to it by what we call heat shock protein responses which are these little proteins that will uncouple and then re-coup and be better for it. It’s creating a whole cellular change that then is stimulating better responses within the muscle. The muscle can use glucose a lot better and can use fat a lot better. Were also increasing blood flow to the brain. We’re also improving our blood vessels,so they respond to constriction dilation a lot faster, which is important as we get older and start hitting peri-menopause where we start having blood pressure problems. It also allows us to hit higher temperatures on the outside, like summer times without having undue stress. When you’re in the sauna sitting there, it takes time for the body to heat up, because of our thermos-regulatory differences between what men do when they get in and they start sweating profusely, and then they get dehydrated, and they don’t have time to adapt as well to the heat as women do. Again, women vasodilate first, and then we start sweating.

Do you recommend Sauna?

Yes, I do. If we are doing 10 to 15 minutes twice a week, at bare minimum, you get health benefits, better cardiovascular health, so better blood flow, better blood pressure. We have metabolic responses, so we have better blood glucose control and better fatty acid metabolism.

Are you going to burn more fat in a sauna?

Yes, if you sit in a sauna, you will use the circulating fat as a fuel instead of storing it.

Dr. William Li, MD: Five things to eat to burn body fat

Peter Attia: Muscle Aging and Activity
Let’s just talk a little bit more about what we know about how we gain and lose muscle as we age, and why muscle is so important when were older, and why that means that you can’t wait until you’re at a certain age to start caring about it. So there’s a schematic
here that talks about how look age on the x axis, relative function muscle mass, put whatever proxy you want on the Y axis. It’s going to peak at about the age of 30. And you will see in this figure, basically three levels of decline, and the levels of decline are going to be dependent on the level of activity. So, a very active individual has a lower level of decline however is still declining.

A population average has a quicker level of decline, and a sedentary individual again has a much quicker level of decline. And where does it become relevant? It probably becomes relevant in the 70’s and in the eighth decade of life, where you really start to see the difference. And the problem is, you don’t want to be on that red curve in this figure that Iam showing, when all of a sudden everything is taken away from you, right? If you’re on the red curve today, you know, get to that blue, get to that green curve by increasing activity.

One of our previous guests, Luke Van Loon, really made a point that I thought was so interesting, which is, when you look at these curves that represent a decline in muscle mass, a decline in strength and a decline in activity level, they look physiologic, which means they look beautiful and smooth. But he said that is just because you’re looking at population based averages. When you look at this at the individual level, for most people, it’s relatively slow decline, punctuated by rapid periods of decline with inactivity. So, the key here is avoiding inactivity, avoiding time without training. One of the greatest things that leads to that inactivity is injury. So that’s why, as far as I am concerned, once you reach my age, in your 50s, rule number one of training is don’t get injured. Let me just talk a little bit more about what we know about how we gain and lose muscle as we age, and why muscle is so important when were older, and why that means that you can’t wait until you’re at a certain age to start caring about it.

Peter Attia, MD: Muscle Aging and Activity

So, I came across a comment on social media the other day. It said biological age versus real age is a total scam. If you want to see your real age, look at a masters category of athletic feats such as a one mile run time, not some scammy algorithms. If the body can’t physically express a performance, then you’re the age seen on your birth
certificate. I reposted that and said, “Yep, totally agree with this”, and a lot of interesting comments and questions came in.
The comment that I wanted to chat about was one that said, “Peter, I mean, yeah, this kind of makes sense. But like, why would physical tests be a better measure of biological age than fancy biomarkers?”. And I reflected on and I said is “ultimately, physical performance is indeed the best metric of the limits of capacity. There are non-
physical performance metrics that we can look at as well. I could look at your kidney function, I could look at your glomerular filtration rate, and that would certainly be a marker of age, but honestly, it’s only in an extreme case would that give me an insight. In other words, only if somebody is 50 and they have a glomerular filtration rate of somebody who's 80, would I say the negative, but the positive isn’t really there. If you look at my glomerular filtration rate, it’s over 100 and that doesn’t really tell you much about me, even though Iam over 50 years old. It tells you that my kidneys are in great
shape, but it doesn’t tell you that I have the kidneys of a 20 year old, because, quite frankly, they haven’t really deteriorated in any measurable way since I was 20. The same would be true of my ejection fraction. It’s really good today. Now, of course, there
are certain other factors that invariably go down, for example, resting heart rate goes up, heart rate variability goes down. But ultimately, if you really want to understand biological age, I really like this idea of we should look at physical metrics. We should be looking at VO2 max. We should be looking at strength. We should be looking at
hardcore performances, including other things, by the way, that are a little more subtle than the aggregate pieces. We would want to look at things like balance, for example, how well can you stand on one leg with your eyes closed? How long can you do that?
And can you even do more challenging things, like turn your head, do push ups, pull ups, all of these things really matter. And there’s here you start to see an enormous gradation between people even at the same age, be it 30, 40, 50, 60, 70 etc.

Dr. Tara Swat, Neuro-scientist MD: Cortisol stress and the Body

Dr. Tara Swat, Neuro-scientist MD: Cortisol stress and the Body

In 2023, the first thing I came up against, because this was around the time of the financial crisis, was the lack of understanding of the brain body connection. I was working with high performing executives that were kind of acting like their body was just the vehicle that was moving their brain around from meeting to meeting, and both disrespecting their physical health, but also not understanding that what they were actually really being paid for was to use their brain, and they weren’t creating the best conditions for that brain to operate in. And I am talking about really basic things like sleep and a good diet and hydration and not being sedentary and managing your stress, etc.
This tiny organ, if it is not in an environment that is giving it the best chance of doing its job, it is not going to, and a crack is going to appear somewhere. And the first time I really had a big confrontation with the bank, who employed me, was when people were dropping dead on the trading floor of heart attacks and they asked me to work more, in my capacity as a former medical doctor, to help with these physical ailments. I said to them, I cannot do that if we do not address the mental and emotional pieces, because that is what is causing this. And they just could not get that.

Dr. Tara Swart, Neuro-Scientist: Understanding that everything stressful that you are experiencing, like mentally and emotionally challenging circumstances for example, doing a lot of travel, which is challenging on your body, raises levels of the hormone cortisol, which comes from your adrenal glands. Cortisol courses around your blood, through your entire body and brain. And the brain has receptors for understanding what is going on in terms of threat to your survival. So, in a 24 hour cycle, depending on your age and your gender, there is a normal range for cortisol. It can go up and down
when something challenging happens. We need to adapt and rise to meet that challenge. But when that level is above the top range all the time, these receptors in your brain basically think that there is an imminent threat to your survival. When this happens, there is a whole cascade of hormones and the cortisol basically causes inflammation in the body. So, inflammation of your vascular system, inflammation around your heart and everything else, gut and other things. During this time, we were seeing a lot of heart attacks caused by stress. This was in the absence of high blood pressure, high cholesterol and smoking – it was all stress.

Dr. Charles Yeo: Aging and Weight gain

Dr. Charles Yeo: Aging and Weight gain

Charles Yeo: The numbers we have on weight gain as a person ages are that between age 20 and 50 years old, those 30 years intervening, the average person will gain about 15 kilos in weight, which is 32 pounds, which is about one to two pounds a year – 15 kilos in weight is gained over 30 years on average. Some gain very little, others gain a hell of a lot more.

Dr Charles Yeo: What can you do to avoid weight gain. There are two elements here. First of all, there is doing the things that we want to do, for example, I can still walk up a mountain or down a mountain, because I am still fit enough to do that, and I want to stay as fit as long as I can and weight will inhibit that, undoubtedly. But then there is a second element to actually consider, which is the amount of muscle you have. It is your muscle mass as you age, independent of how much fat you have, that will determine how healthy you are as you age. Now I am talking about going into the 60s, into the 70s. As you get older, the most crucial bit of information is to maintain resistance training, not lifting. The amount of muscle mass you have really marks the level of health that you get as you age. And the science is startling. It is completely related, independent of weight. So, muscle mass is the most important thing for healthy aging the moment you get to 60-70 plus years of age.

Charles Yeo: Should you keep doing resistance training. Correct! Always keep resistance training and lifting weights as long as you can. At some point you wont be able to lift weights. Just you wont be able to lift the weights of your youth.

Charles Yeo: Many people are always trying to find ways that they can cut fat and create some sort of sustainable weight loss. The first is the amount of protein you eat, and you need to try and focus on trying to keep to about 16% of the energy in your day. Okay, from protein 16% – and there is a sweet spot. If you eat too much and you are not lifting, you are stressing your kidneys, because your kidneys have to get rid of the nitrogen from the protein. Okay, so 16% is a sweet spot, and it does not mean steaks, only. It can mean beans, tofu, any kind of protein from anywhere. Second, is fiber. We need to eat as much fiber as physically possible. 30 grams we want to aim for. Although we're looking, at the moment on average in this country, we are probably only eating 15 grams. We need to double the amount of fiber we actually eat. Third, we need to limit the amount of added sugars into our diet, added sugars, meaning sugars not tied up in fiber, powdered stuff, maple syrup, Agave nectar etc. All those are added sugars you put in, keep it to 5% or less of the of the energy content in your day. And those are the three numbers that I want you to think about. So, 16% of protein, 30 grams of fiber, 5% or less of added sugars. Apply that to whatever you want. For example, a Keto diet, whatever you want to apply that to, and I think that will be a sustainable, healthy way to eat.

Dr. William Li MD :Five things to do to burn body fat

Dr. William Li MD :Five things to do to burn body fat

So a lot of people don’t know this, but there are certain foods that will fire up your body’s extra fat burning machinery. You’ve got white fat, which is the will fire up your body’s extra fat burning machinery. You’ve got white fat, which is the wiggly, jiggly kind you see in the mirror. So visceral fats, the fat that grows around our guts. The more you load up that extra fuel, the more that fat grows, starts to strangle your organs, and when it becomes inflamed, it is really dangerous. That is dangerous kind of fat. When you want to burn that fat down, brown fat is important to know about. Brown fat is not wiggly, jiggly. Brown fat is close to the bone. It is not even near the surface. It is around our necks, under our breast bone, a little bit between our shoulder blades, and scattered in our belly a little bit. When you activate brown fat, it burns away the jiggly fat. If you turn on brown fat, you burn down the white fat. Interviewer: So what are the top foods we need to eat to turn on the brown fat, to burn the jiggly fat so I can lose weight?

Dr. William Li, MD: Let us go to the produce section and take a look. Okay, so apples. It turns out that apples have something called chlorogenic acid inside the flesh of the apple. This chlorogenic acid turns on your brown fat, and it is will start to burn down your white fat. Broccoli, kale, or bok choy. I love bok choy. You cut off the bottoms, you wash the leaves. Take a wok or a skillet, little extra virgin olive oil, garlic and fry it up. Obviously, how you cook makes a difference, right? I said olive oil. I did not say butter. Because if you actually use olive oil, you have got hydroxytyrosol and oleocanthal. These are two things are mother natures natural brown fat trigger which triggers metabolism. Activating fat burning substances you saute with olive oil now you actually have the greens and the olive oil, that will trigger your brown fat to turn it down

Peter Attia, MD: Optimizing Bone Health when aging

Find me one example in the history of our species where a 90 year old said, I wish I had less strength, I wish I had less muscle, I wish I had weaker bones. It turned out that studies looking at resistance training found them to be significantly better at retaining BMD (bone mineral density) when compared to anything aerobic. You’re applying force
to the receptors there. Those receptors are translating that tension into signals that, say, lay down more bone.

To put it into perspective, even the swimmers, or, you know, the resistance training females and females tend are going to be a little bit lower than men, they still have excellent BMD. We do not want to be suggesting that some sports are bad for BMD. That is;s not the take home message here.

The take home message here is, if you really
have to juice it, what do you want to be doing, right? So what’s the sweet spot here? To me, the sweet spot is resistance training. All of these things come with risk if you don’t do them correctly. I mean, hell, if you don’t swim correctly, you’re going to tear your
shoulders apart. So, we just have to think about this through a risk – reward lens. Notice that walking isn’t on here, and gardening is not on here, and golf is not on here. So I just want people to understand that if they're in the business of trying to increase their BMD,
they have to put wicked forces on their muscles.