#342 ‒ Aging well: Peter shares strategies for improving longevity with residents at a senior living center

Hey everyone. Welcome to the Drive Podcast. I'm your host Peter Attia. This podcast, my website and my weekly newsletter all focus on the goal of translating the science of longevity into something accessible for everyone. Our goal is to provide the best content in health and wellness and we've established a great team of analysts to make this happen. It is extremely important important to me to provide all of this content without relying on paid ads to do this. Our work is made entirely possible by our members and in return we offer exclusive member only content and benefits above and beyond what is available for free. If you want to take your knowledge of this space to the next level, it's our goal to ensure members get back much more than the price of a subscription. If you want to learn more about the benefits of our premium membership, head over to peterattiamd.com subscribe welcome to a special episode of the Drive. This conversation is a bit different from our usual format as my daughter Olivia trades places with me to take this seat as the interviewer as we visit a senior living center to discuss all things longevity as it relates to an aging population. A bit of Background Olivia spent part of her summer last year volunteering at this center where she connected with a number of the residents who had an interest in curiosity about healthspan lifespan and strategies for living well as they age. And through that experience they invited me to speak with their audience and we decided to record it and release it to you as well. In this conversation we speak about all of these topics, but with a particular focus around an aging population. So we talk about what longevity really means, not just adding years to life, but life to years. We talk about the Four Horsemen of chronic disease. Talk about why it's never too late to start making changes for better health. Talk about the critical role of exercise, especially strength training, in maintaining mobility, preventing falls and preserving independence, and how to approach exercise later in life. Talk about the importance of protein intake and nutrition principles for aging. Talk about sleep optimization. And we talk about emotional health and social connection, purpose and why relationships matter as much as physical health. So without further delay, please enjoy this special episode of the Drive.

Welcome everyone. My name is Olivia Attia and I'm here with my dad, Peter Attia. We are here to talk to you today about longevity. So over the summer I volunteered at a senior living center called Querencia, which is where I met Sally, who unfortunately couldn't be with us today because she's sick. But we got to talking and I discovered that she's very interested in my dad's work, as I'm sure all of you are. So we decided that we'll be here today and we'll be doing 45 minutes of conversing between us two to keep it interesting, and then a little bit of time at the end for you guys to ask him things that you're interested about. So with all that being said, are you ready?

As I'll ever be.

Okay. I think it'll be helpful to start talking about the actual word longevity because it can mean different things to different people. When you talk about longevity, are you talking about living forever or how are you defining it?

Definitely not living forever. Although understandably, that's probably what some people think of when they think of longevity. I'm talking about it in terms of two things. One of them is called lifespan and the other is called healthspan. And lifespan is the part that I think most people think of. It's the how long you live part. But then there's healthspan, which is the how well you live part. And both of these things are important. I would argue that they're of equal importance. And an extreme of one without the other is not ideal. In other words, I don't think there's anybody sitting here who says, I'd love to live to a hundred, but I want to spend the last 20 of those years unable to move. I mean, that wouldn't be ideal. And similarly, I think the idea of living an amazing healthy life, but that life being cut short prematurely at 50, nobody would think that that's ideal. So when I think of longevity, what I'm really thinking about is maximizing both the length of life and the quality of life. And again, quality could be further broken down into sort of a physical piece. So am I free of pain most of the time? Am I able to physically do the things I enjoy doing? And that could range from just the activities of daily living and self care to recreational activities. If you like to garden, how do you want to be able to do that? If you play golf, if you like to go for walks and hikes or swim. And then there's a cognitive piece. So I don't think anybody would fully expect, even at my age, that my brain is kind of as sharp as hers is. But I still want to believe that my mind is pretty sharp. And I think we all sort of want that for as long as possible. And then the final piece is an emotional piece that deals with happiness, sense of purpose, connection to others. And again, you can imagine a scenario where somebody has perfect physical health span, meaning they can do anything they want to do physically, their brain is sharp, but they have no friends and no relationships. And I think we would all agree that that's not really an ideal life. And I don't think anybody would aspire to that. So that's a lot there. But when you put all those things together, to me, that's what longevity is.

If some people here are wondering, is it too late to start caring about longevity and living longer, what would you say to them?

I would say that that's not the case. I would say that on the one hand, sure, the earlier a person begins to take steps to increase their longevity, the more opportunity they have. It's sort of like investing. When is the best time to start saving for retirement? Probably the minute you start earning your first paycheck in your teens or twenties. But does that mean you shouldn't save money when you're older? No, it doesn't. There's also a lot of data that we have from clinical trials that are done with seniors that demonstrate that, for example, people who have never lifted weights in their life before, who start lifting weights for the first time when they're in their 60s and 70s, have a remarkable benefit. This is not just true of weight training, it's true of any sort of exercise. So the short answer, I guess, is that, no, it's never too late to really start thinking about this. But obviously the best time to plant the tree is yesterday, if not today.

Why do they have a benefit if they haven't done it before?

Well, there's an effect of training. So specifically thinking of exercise, the body is really a use it or lose it organ or collection of organs, and the muscles are a great example of that. So it's actually true of young people and old people. The greatest effect of exercise is generally seen in the person who goes from being completely sedentary to even a mild amount of training. So if you look at somebody like me who exercises all the time, or someone like you who exercises all the time, if we added three hours a week to your training or to my training, it actually wouldn't have an enormous impact. If you took an individual who did zero exercise and you took them to three hours a week, which, let's be honest, guys, 30 minutes a day, six days a week, is not a huge ask. The impact is enormous.

That's strange. That's not what you'd think. Can you talk about the importance of adding life to years rather than just years to life and what that means to you?

Yeah, it means a lot to Me, I think it will mean a lot to people here because the metric that most people think of is life expectancy. How many times have you heard it? Life expectancy is increasing, life expectancy is decreasing. And I think the reason for that is, frankly, it's just the easiest thing to measure because it's objective, it's quantitative, and it's a single number. It's a number that shows up, and it can be measured from a death certificate. We know exactly how many years to the day that a person lived. And if we keep track of that, we certainly know something about them. But my argument would be that it is not the most important thing. And I would challenge us to find an individual who would if given the choice. And I don't think one ever has to make this choice. But for the purpose of the thought experiment, if you said, look, you could live to 80 in remarkable and perfect health, and then when your life is over, it ends very quickly and suddenly, versus you could live to a hundred, but you spend that last 20 years in a painful state of decline, I think very few people would choose the latter, even though they're living longer. And I think what most people want is quality of life over quantity, outside of these extreme examples, which are common and tragic, where people die and they're young. But I think when you really start to think about pushing those things, most people, in my experience, are more interested in quality of life when it comes.

To someone's risk of dying. You characterize the biggest risks as the Four Horsemen. Could you explain what those are?

Yeah. You can't have a discussion on this topic without talking about the Four Horsemen, which might seem a bit grim. But there's no reason to avoid talking about the inevitable, which is every one of us in this room is not going to be alive at some point. And I think to confront the how is important. So statistically speaking, all of us in this room are going to succumb to one of four processes or disease processes. So in rank order, the first of those would be cardiovascular and cerebrovascular disease. That's the leading cause of death in the United States. That's the leading cause of death globally. It's the leading cause of death for men, and it's the leading cause of death for women, full stop. So that's a heart attack, a stroke. The number two, and it's not that far behind in the United States, is cancer. And of course, cancer isn't just one disease. We lump it all together. But of course, prostate cancer and breast cancer are, frankly as different as, you know, a pickup truck and a Corolla, they both have four wheels. But that's about where the similarity ends. Number three would be the diseases of dementia and the neurodegenerative diseases. And there's a lot of things in here. So you have Alzheimer's disease, which is the most common form of dementia, but you also have lots of other types of dementia that are not neurodegenerative, such as vascular dementia. And then the fourth horseman is kind of a spectrum of diseases that we call metabolic diseases. The most extreme version of this would be type 2 diabetes. But of course, all along the way, you have conditions like fatty liver disease and insulin resistance. And all of these conditions form a continuum. And the most important thing to know about them is, while not that many people will die directly from those diseases, if you have anything along that continuum, it's increasing your risk by about 50% of the other three horsemen. So we really want to think about a strategy at mitigating all four of these conditions and delaying them as long as possible.

What would you say to someone that may already be navigating these chronic diseases that come with aging, and what advice would you give them on how to manage a high quality of life and keep hope during these times?

You know, it would matter very specifically on which one we're talking about. I certainly won't ask for a show of hands, but just based on the age of everyone in this room, it's impossible for me to imagine that nobody in this room hasn't already faced some of these diseases. So if you're sitting in this room and you already had a stent placed in your coronary arteries that says, look, you've already had a brush with coronary artery disease. Maybe someone in this audience has already had a heart attack and you're fortunate enough to have survived it. Well, the short answer is, look, the fact that you've survived it is great, and that means you get a second chance. Many people don't. So many people's first brush with heart disease is death. In fact, on average, about 50% of people, 1 in 2 people, that have a heart attack, it's immediately fatal. So if you're in that group where you've had that heart attack, or you know somebody who has, and they've lived to tell about it, they're in the lucky camp. And what they should be doing is everything in their power to not only prevent it from happening again, but to strengthen their body. And so the first thing I do is I ask myself, what were the conditions that I had that led to this heart attack in the first place. Now, some of these conditions you don't have a lot of control over, genetics play a strong role here. But there are many things that can be controlled, such as cholesterol levels, blood pressure, smoking. Those would be the big three. And we have ways to manage all of those things. Also, we know that exercise plays a very important role, as does metabolic health. So I've met many people who have had that near brush with death from that point of a first heart attack. They survive it. And what do they do? They turn it around and they say, look, I'm going to lose 30 pounds, I'm going to stop smoking, or I'm going to manage my blood pressure, cholesterol better. I'm going to take up X exercise. And I know people that have gone on to live 30 years after that event that might have happened when they were 60, and they live until they're in their 90s. So I guess I would always frame it through the lens of, hey, am I fortunate enough to have survived this thing? And if so, what am I going to do going forward?

So someone here asked, what happens to our balance as we age? Falls seem to be so prevalent here in our senior community. Can we help these problems from increasing as we age?

Yes. If there's a fifth Horseman out there, it's accidental death. Now, what constitutes accidental death varies a lot by age. So when we're talking about people that are Olivia's age, the most common cause of accidental death is going to be car accidents and overdoses, drug overdose. When you talk about people my age, the most common cause of accidental death is overdose by far. When you talk about people your age, it's a total flip. And the prevalence of accidental death goes up by five or six fold. And it is virtually all related to falling. So I guess there's two questions. Why are falls so lethal? And maybe more importantly, why do people above the age of 65 fall so much more? And by the way, why do women fall disproportionately more than men? And why are women more injured by falls than men? These are the questions that I think we should spend a moment on. So let's start with the why do falls happen? You touched on it a moment ago. As we age, we don't just lose our balance, but we're losing something else that people my age and certainly her age, take for granted, which is called reactivity. So the other day I was in the woods because one of my kids accidentally kicked the Soccer ball down into the woods, so I had to go and get it. And as you can imagine, the ground is very uneven, and it's covered in leaves and twigs and branches, so you can't even see what you're stepping on. I'm sure you can all picture exactly what this is like. Every step is a sprained ankle waiting to happen. And sure enough, at one point, I step into something that wasn't as it appeared, and I got jolted, and I had to react very quickly with my leg to put it in the right place so I wouldn't fall. And I did. And I'm here sitting here talking about it, and I don't even remember which leg it was. That's how insignificant this was. But the type of muscle fiber that was necessary to do that, which, if we want to get technical, is called A2Amuscle fiber is the type of muscle fiber that is responsible for explosive movement. It's the type of muscle fiber that is the most powerful muscle fiber. Well, those muscle fibers start getting weaker and weaker and shrinking, and at about the age of 25, so I'm long past my peak, in my early 50s, but I still have enough to hold me on. But at some point, they really, really start to diminish. And by the time someone's your age, you got threads of those things left, so you're losing those things. Now, the good news is you can train these muscle fibers, but the only way to train them is to move very heavy weights. Sounds crazy, counterintuitive, but that's what we have to do. We have to move really heavy weights, and we have to train in movement patterns like that, which means, for example, bouncing, moving side to side, jumping rope, Things like that are necessary for our feet to have the reactivity that you had when you were young. A second obvious issue as we age is a reduction in bone density and a reduction in muscle mass. And this is the reason why women are more susceptible than men to these injuries. Because for obvious reasons, women have less muscle mass on average and have lower bone density on average, in part due to the fact that many women didn't receive hormones after menopause. And as their estrogen levels went down after menopause, their bones got disproportionately weaker relative to men, because estrogen turns out to be the most important hormone in preserving bone density. And so all of these things taken together are what mean that falling is something we have to be very mindful of at any age. But, boy, does it play a bigger role above the age of 65. And again, I won't ask for a show of hands, but I would be shocked if no one in this audience knew somebody, if not personally, who hadn't experienced a significant fall that resulted in a broken hip or a broken femur or. And the tragedy of that type of accident is that in many cases it's not fully recoverable. So you have the proportion of people that will die as a result of that. But even the people who live, often about 50% of them, never regain the same level of mobility they had before. So all of this to me points back to the idea that we want to be exercising as much as possible. I'm going to sound like a broken record saying this, but you're going to want to have your body as prepared as possible because that physical piece is so important in preventing these types of injuries.

Is there anything that people of this age can do now to preserve that muscle or strengthen it, or did it have to be done while it was still like in their 20s?

Obviously, if you could go back in time and I put you all in a time machine to win your 20, knowing what you know today, maybe you would exercise more. But that's sort of an irrelevant point. I would say the point is what we do today is what matters. There's a woman named Belinda Beck that I interviewed on my podcast a few months ago. She's a researcher in Australia and she did a study there that I really was fond of called the Lift More Study. So this is a study that was done with a group of women, all of whom were over 65 years old and all of whom had a disease condition of very, very low bone density. So it was a group of 65 and plus year old women who had very brittle bones, who didn't exercise beyond yoga and walking. So it's not like they were inactive, but they'd never lifted weights. And these women were randomized into two groups, one that continued with that type of exercise and then one that engaged in really, really heavy strength training. And I love that there's a video of this on YouTube that is easily one of my 10 favorite videos of all time. Because these women who look so frail by the end of the study are able to in some cases pick up their own body weight off the ground, do a deadlift with their own body weight. And they are coached on how to do this safely and they gain strength and they really do hardcore powerlifting exercises. Like they're not holding the little two pound dumbbells doing curls, they're doing squats, they're Doing deadlifts, getting to pull ups, bench press, all sorts of things. By the end of this study, they defied something that we thought was possible, which is we never thought it was possible to increase bone density. We thought the best you could do was maintain bone density or maybe slightly prevent the rate of decline. But amazingly, in these women, based on the CT scans of their bones, they actually increased bone density. I find this to be one of the most uplifting and important findings with respect to aging. And I think it speaks to how the idea that lifting weights is a young person's thing or a male thing, I think both of those are just incorrect. Lifting weights is something every person on this planet should be doing.

Moving from risks into action. Do you want to quickly walk through the tactics in your longevity toolkit? And then from there we can go into detail on each of them.

Broadly speaking, there are five buckets of things that we have control over to impact all of these things we're talking about. So one, we just talked about exercise, and you can probably tell my bias is that that's the single most important one, for the most part. So the second, in no particular order would be nutrition. So what you eat matters. We'll talk about that, I'm sure, in more detail. The third one would be sleep. So the difference between sleeping well and not sleeping well has an enormous impact on your brain, but also on your metabolic health, which then indirectly plays a great role in other diseases. The fourth would be all of the medications and supplements, drugs, anything that your doctor prescribes or that you can buy over the counter. And these are of varying degrees of efficacy. Some of them are incredibly dubious, some of them can be life saving. But again, all of those things we'd want to think about, and then the final bucket would be kind of all the tools that we would have at our disposal to improve our emotional health and well being.

So we've already touched a little bit about why exercise is important. But for people in this audience, how can they start to safely exercise while also managing physical limitations?

It's hard to provide a blanket statement on that because everybody's going to be different. But I think it's safe to say that people are less fragile than they believe. And I meet many people, for example, who have back injuries and say, look, I have a back injury, I can't really do anything. And the reality of it is when you sort of probe a little bit further, what you realize is nothing tends to make their back hurt more than inactivity. I don't remember who made the statement, I loved it and I paraphrased it or plagiarized it many times. Sitting is to lower back pain what bourbon is to alcoholism. Any of you whose back has hurt will probably think about that and go, you know, he's kind of right. When my back hurts, sitting is the one thing I don't like to do. Or after a long drive, it hurts worse. And for most people, actually being active makes them feel better. Now, let's be clear. There are certain activities, like if you have no cartilage left in your knee, more walking won't make you feel better. You're going to have to see an orthopedic surgeon. They might need to do a knee replacement. But, boy, I will tell you, in this day and age, in 2025, what can be done with a knee replacement, a hip replacement, even a shoulder replacement. I mean, these operations have come along so far, and they have restored so much quality of life to individuals. So every one of these cases has to be managed individually. But if you have a really good PT or rehab professional, who knows what's fixable with more training or more conditioning versus, hey, this actually does need some medical attention. I think the aspiration should be, what can I do to get as active as possible?

Moving from exercise into nutrition, we saw questions come through that different diets are being talked about, and they aren't sure which one they should follow. So is there a diet that you think is best, or does it depend on the individual?

I don't think there's a diet that is best. I think there are principles that matter, and everyone should find the diet that best allows them to adhere to the principles. So what are the principles? The principles are not to eat too much and not to eat too little. That sounds dumb, but it's just the reality of it. And I think everyone struggles with a different end of that spectrum. There are some people who just don't like to eat that much. They're like little birds. And as they get older, that becomes a huge problem. They are too frail. At the other end of the spectrum, you have people like me who like to eat too much. And we will spend most of our life fighting against the urge to eat too much. And that also becomes a problem as you get older, because the heavier you are, the more weight you're putting on each and every one of those joints. And again, we're thinking about all these things that are working against us as we age, not to mention other complications that come from eating too much. But I would say that in an Aging population. The most important thing I want to emphasize is getting enough protein. First of all, I just think for many people, it's kind of hard to get enough protein in even I have to pay attention to it, and I don't have a problem eating, but I need to be mindful of, hey, did I get enough protein? It's really easy for me to get all the carbs in the world. I don't have to go out of my way to eat more fat, but I do have to be cognizant of getting enough protein. And enough protein is a pretty big number. It's about one gram per pound of body weight. So I would challenge each of you to pay attention to, hey, if you weigh 150 pounds, are you getting 150 grams of protein a day? And I would bet that especially for the women here, that's even harder. Now, if you fall a little bit short of that, it's okay, but if you're at half of that, you're really not getting the optimal amount of protein. And as we age, we develop something called anabolic resistance, which means that it is harder and harder for our muscles to synthesize and grow new muscle cells with the given amount of amino acids, which are the building blocks in protein that we get by eating protein. And therefore, we actually need more and more protein to overcome that. So we talk a lot about obesity, we talk a lot about osteoporosis and osteopenia. But there's another condition of aging called sarcopenia, which is the condition of muscle loss. And that's a huge problem. And there's really two ways in concert, two ways to address that. One is consuming enough protein, and the other is doing enough resistance training. So, again, doesn't matter if you're a vegetarian, doesn't matter if you like a Mediterranean diet, doesn't matter if you like steak and potatoes. If you can adhere to those principles, that's going to make your life easier. Is it harder to adhere to those principles if you're a vegan? Yeah, it's a lot harder, but it's not impossible. I know lots of people who have done it. But looking at a food tracking app in your phone is a great way to spend a week evaluating how many grams of protein you're getting. And I think you'll be surprised that for many of us, we're probably underdoing it.

Now, moving on to sleep. Sleep is something that you've written a lot about, and you said that you didn't used to take it very seriously. But now you do take it very seriously. And that's true. He goes to bed at like 8 every night. Why do you think it's so important?

I think I'm up till 9 these days. Sleep is important. And you're right, I used to. Probably until 12 years ago, I think my mantra was I'll sleep when I'm dead. And I just would try to sleep as little as possible. But the evidence are pretty overwhelming, especially for both near term and long term function of the brain, that sleep is very important. Now, I think at your age, a couple of unique challenges emerge. Again, I think most people, once they're over 65 or 70, they're not fighting the will to sleep because they want to be out partying all night. It's more that other things are getting in the way. So we know that as a person ages, they tend to sleep a little bit lighter and their sleep architecture tends to change a little bit. We also know that other things get in the way, especially for men, which is it gets harder and harder to make it through a night without having to get up to pee. I'm already at that stage where at least two out of the seven nights a week, if I am not mindful about when I had my last glass of water, I'm going to be up at 2 or 3 in the morning to pee. And sometimes that's harder to go back to bed after. So what are the things that we have under our control? Well, one of them is absolutely timing of water. Now, again, water is super important. The older a person gets, the more susceptible they are to dehydration. The older a person gets, the less reliable thirst is as an indicator for fluid status. So at Olivia's age, you don't really believe it or not, need to pay attention to how much you're drinking. Thirst will be the guide, but that becomes less and less true as you age. So you're juggling a narrow problem, which is on the one hand you have to be mindful about drinking enough, but at the other hand you can't drink too much too close to bed and that's going to keep you awake. Another thing that makes a huge difference in sleep quality is timing of food. So the longer you can have between when you have dinner and when you go to bed, the better. So we eat dinner really early because we have young kids in our house. That's why I can get away with going to bed at nine because it's still been three and a half hours or three hours since I ate. Another thing is Alcohol. So some of you probably drink alcohol. The less alcohol you have in your system when you sleep, the better you're going to sleep. Having a super dark room, having a super cold room is going to make a big difference. And perhaps the biggest thing to make a point about here is consistency of timing, especially on the wake up. So if you could tether yourself to one time, it's what time do I wake up? And if you force yourself to wake up at the same time every day and don't allow yourself to take a nap during the day, and this is a big ask, because I know naps can be tempting. It's going to regulate when you end up going to bed by building up enough sleep pressure. So if a person tells me I'm struggling to sleep at night and I find out they're napping during the day, the first thing I want to do is get rid of the nap. I'm going to fix the wake up time, eliminate the nap, and then actually let them get into a better sleep cycle that way.

Are there any good sleep supplements that you recommend taking and that are, like, not damaging to you?

Yeah, there are. I mean, and I think one has to be very careful with this stuff. There's certainly evidence to suggest that as we age, melatonin levels go down and therefore melatonin can aid at least with sleep initiation. But it's important to know that melatonin really is only the signal to initiate sleep. It's not gonna necessarily keep you asleep all night. So if you're not doing all of the other things correctly, melatonin is going to be limited in its efficacy. So before I go down the route of supplements, I want to get everything we just talked about vis a vis the hygiene completely dialed in. And then, yeah, if there's still an issue falling asleep, I think melatonin can be a viable tool. Although I really want to make sure it's the lowest dose you can buy. They tend to sell this stuff in high enough doses to kill horses. It's not necessary. The lowest dose, which is maybe 300 micrograms, is probably all you need. At most twice that dose. But you don't need anything north of a milligram. I think one has to experiment a little bit with other things. I find ashwagandha a little bit helpful. For others, maybe not so much.

Okay. And then we'll quickly touch on the last one, which is emotional health. A lot of people think that this is not really something that matters in longevity. But you talked about this in the last chapter. Of outlive and how it's really important to you and that you've recently discovered it. So do you want to talk a little bit about that and how it's important as people are aging?

I think it's actually important at any age. And I think that what I imagine is so appealing about living at a place like this is you have a built in system of friendship. I would imagine that that's probably a great source of well being that many of your peers would be missing out on if they were living alone. I think about how little I see my parents because we live in a different country. So I can imagine that things that we take for granted when we're young, like being close to our children or our grandchildren, aren't guaranteed when we grow older. Now, of course, she's signed a contract that says she can't leave Austin, so this won't be a problem for me. I think a social support network and some sense of purpose might be the single most important part of the emotional health toolkit as it pertains to living longer. Every one of us knows the story of the couple that have been married for 70 years. One of them passes away and then the other one dies within a year. I don't think these are just anecdotal. I really think there's an understanding of why that happens.

So you can do everything right. You can eat the right diet, you can sleep right, you can exercise. But if your emotional health is lacking, then it's like you won't live as long.

It's possible, I would say even more than that. Regardless of how long you live, if it's unhappy, why bother? Let's say you do live a long time, but you're alone or you're miserable. In some ways, that would be the ultimate purgatory.

Is there anything else you want to add before we hop into the Q and A?

No. Let's turn it over to you guys.

Okay. Yes. So why did you decide to start focusing in longevity?

I guess there's sort of two things. The first was when Olivia was born. She's my oldest. I bet all of you can appreciate this. Those of you that have kids, which I'm guessing is most of you, something about your mortality kicks in. There are many stages to mortality, but I think having a kid is one. I think losing a parent is one. As we gain and lose things throughout life, we become aware of its finitude. And her birth was a moment where I was like, huh? This is amazing. I'm not going to be around forever. To be a part of her life. So that kind of got me thinking about it, and that coincided with me also coming to the realization that there are lots of things in my family history that might otherwise suggest a short life for me, and I wanted to get very serious about it. So my own journey into this space was actually very selfish and was strictly geared towards me figuring out things for myself.

Yes.

Awesome. Okay, I'm gonna repeat that question. So there were two questions there. The first was an update on Clotho, and I'll explain what that is for everybody else. And then the second was on the gram of protein per pound of body weight. Is it ideal body weight if a person is overweight? I'll start with the second question. The short answer is, it depends on how overweight. So if a person came to me and said, Look, I weigh 260 pounds, I probably should weigh 200 pounds, I would tell them, if I agreed with that assessment, I'd say being closer to the 200 is probably fine. You don't need to be at the 260. Okay. This gentleman was asking about a podcast I did. So I don't know how many months ago it was six, nine months ago, I had an amazing scientist on my podcast. Her name was Dina Dubal. She's a neurologist at University of California, San Francisco, and she studies a protein called Clotho. This is a protein that is made by the body. It is made in response to exercise, but it also is just made endogenously and declines with age for reasons we don't understand. So children make six times more of this than adults. But, of course, any one of us can transiently increase it by exercising. What's special about this protein is it seems to be one of the most important proteins that protects the brain. And so in both mice and monkeys, when you inject this protein, if these are animals that have signs of dementia or cognitive decline, it reverses. If these are normal animals, they seem to get superpowers, like supercognitive powers. So that protein is going to be tested over the next three years in humans. And if the results of that look promising, then a larger clinical trial will take place. So I would say the best case scenario here would be that in seven to 10 years, this could be an actual drug that humans take either to prevent cognitive decline or to treat it.

So what is the best type of protein supplement you recommend to get to your grams?

So I always ask people, if possible, and it's not always possible. Whatever you can get from food is great, but I Understand that for many people, and again, especially for women, it's really hard to just mash through that much protein. So we turn to supplements. Now, when it comes to foods, the three that stand out the most are dairy products, beef, and eggs. Because there's a quantitative way that you measure both the type of amino acid and the what's called bioavailability of the amino acid. So how complete are the sources of amino acids and how readily can the body access them? So again, if you're thinking about eating beef, eggs and dairy are the big ones. You can get lots of amino acids and lots of other proteins. I'm not saying don't eat chicken or fish or vegetable proteins, but those are big ones. Therefore, when you're supplementing, whey protein, which comes from dairy, tends to be the winner. Now, casein is also great because it's also from dairy. So whey or casein probably stand out a little bit above, but so does egg protein supplement. So what I tell people to do is figure out what works best for you, because there's some people that just can't do dairy proteins. Remember, just because you can't tolerate dairy doesn't mean you can't tolerate a dairy protein. Most people who can't tolerate dairy can't tolerate the carbohydrate in the dairy, but they're totally fine with the protein. So give it a try.

Anything else? Yes.

So you're saying a few years ago, we did a genetic test and it did not show a genetic. Okay, so let's assume that the test was correct. What it was screening for was very likely a gene called the APOE4 gene. And this is a gene, the APOE gene that exists in three types. There's the number two, the number three, and the number four. Now, every one of us has two copies of every gene because you got one from your mom and one from your dad. So if there's three types of a gene and there are two copies, there's six combinations. We can go through them all. You could be a 2, 2. You could be a 2, 3. You could be a 2, 4. You could be a 3, 3, a 3, 4 or a 4 4. Okay, why is that relevant? One of those types is higher risk than the other two, and that's the four. So people who have two copies of the four are at significantly higher risk for Alzheimer's disease, about 10 times higher risk. Now, it doesn't mean that they're guaranteed to get it, but their risk is significantly higher. People who have one copy, typically a three and a four are at about a two times risk. And so what that study told you was what I'm assuming it said was you did not have a copy of the 4 gene, so you might be a 3 3, which by the way, most of you probably are. 60% of the population is a 3 3. That's the good news. The bad news is it doesn't mean you're free of risk because the only people who can't get Alzheimer's disease are people who don't have brains. I mean, I'm being glim. Everybody with a brain is at risk. And unfortunately, women are at almost twice the risk of men. And we don't have a great understanding of why. There are lots of theories. I won't expand on them now for the sake of time, but this is one of the areas where women are disproportionately affected to men. The other one, by the way, being osteoporosis and falls. So we've touched on both of the areas where women are at higher risk. Of course, men have a higher risk of cardiovascular disease. So the takeaway for me is I'm a 33 as well. But I don't rest on it. I act as though I'm high risk, meaning I take all the steps possible. Exercising being the single most important thing we can do to preserve brain health, managing nutrition, sleep, all of the things that I can do.

Yes.

Okay. So the question was talking about how your mom had a fall. She broke her hip, had a long protracted recovery, managed to survive, but was never the same again and basically slipped into a state of cognitive decline. And your question was, is there a relationship there? Very good question. My intuition is that there is a relationship there. In other words, we don't have the parallel universe experiment where we could see how she would have been had she never had that fall. So what we're trying to understand is, is there any causality between the fall and her cognitive decline? And my intuition is that there is. And it's exactly what you said. It's that with the period of profound inactivity, and probably with it, not just the physical inactivity, but also I would suspect some cognitive inactivity. If nothing else, it may have sped up by a period of years, something that may have ultimately happened, but I think probably was happening sooner than it should have, it would be a very difficult thing to prove that that's what my intuition says. And I think that's just yet another reason to think about all these things we've talked about as far as like, what are the steps we can take to minimize our risk of a fall?

Awesome. Well, I think that's all we have time for, but do you have anything else to add?

I like that I was on the hot seat from you today, so it was pretty fun. Yeah.

Well, thank you guys all so much for coming.

Thank you for listening to this week's episode of the Drive. Head over to peterattiamd.com shownotes if you want to dig deeper into this episode. You can also find me on YouTube, Instagram and Twitter, all with the handle Peteratti MD. You can also leave us review on Apple Podcasts or whatever podcast player you use. This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional healthcare services, including the giving of medical advice. No doctor patient relationship is formed. The use of this information and the materials linked to this podcast is at the user's own risk. The content on this podcast is not intended to be a substitute for professional medical advice, diagnosis or treatment. Users should not disregard or delay in obtaining medical advice from any medical condition they have, and they should seek the assistance of their healthcare professionals for any such conditions. Finally, I take all conflicts of interest very seriously. For all of my disclosures and the companies I invest in or Advise, please visit PeterAttiamD.com about where I keep an up to date and active list of all disclosures.