Health Theory: Peter Attia Podcast Notes

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Peter Attia discusses being healthy at 100, risk vs reward, benefits of fasting, career moves, insecurity, and more with host Tom Bilyeu.

Peter Attia (@PeterAttiaMD) is a Canadian-American physician focusing on the applied science of longevity. He is the founder of the Attia Medical, PC, a medical practice with offices in San Diego and New York City focusing on improving lifespan while simultaneously improving healthspan (quality of life). Peter spent five years at the John Hopkins Hospital as a general surgery resident where he was the recipient of several prestigious awards, including the resident of the year. He later spent two years at the National Institutes of Health (NIH) as a surgical oncology fellow at the National Cancer Institute researching immune-based therapies for melanoma.

Peter has an M.D. from Stanford University and a B.Sc. in mechanical engineering and applied mathematics from Queen’s University. He is also the host of “The Peter Attia Drive” Podcast featuring guests and experts with insights on health, performance, critical thinking, longevity, and life.

Enjoy the takeaways of the conversation concisely drafted in this Health Theory Peter Attia Podcast Notes.

Key Takeaways

  • At the moment, taking into account the knowledge acquired and advancements in the field of medicine, living forever is not possible.
  • Peter Attia mentions that the ability to tie one’s shoes is used as a metric to evaluate flexibility and other physical components.
  • The most common problem while exercising is disproportionately loading joints over muscles.
  • According to Peter Attia, the goal for the rest of the population, apart from the very small percentage of athletes, should be to figure out how to be the most kick-ass 100-year-old that ever lived.
  • To live to 100 years, one must delay the onset of every major chronic disease by almost two decades.
  • Peter Attia mentions that while deadlifts and squats are good exercises, you are one wrong lift away from harming yourself. He talks about how incorporating certain alternate exercises to deliver 80 percent of the results with only 20 percent of the risk involved.
  • Peter mentions that VO2 max is more of a muscle issue than a heart-lung issue.
  • High endurance athletes who have high VO2 max numbers have muscles that are very efficient at aerobic metabolism that enable them to extract more oxygen out of the blood.
  • Peter Attia mentions that he feels safe in a race car than in a streetcar because driving in the street, he has to navigate drivers who are sometimes not focused and under the influence of alcohol.
  • Peter says that people underestimate the risk vs reward when it comes to alcohol. He mentions that beyond 1-2 drinks, alcohol is really harmful to the liver.
  • Even one drink can compromise one’s abilities behind the wheel. Even if the BAC (Blood Alcohol Content) is well below the legally safe 0.08%, it is not a reasonable strategy.
  • Peter Attia says that the short-term discomfort of not eating for 5 days anywhere between one to five times a year is trivial compared to its potential benefit.
  • The dietary/caloric restriction should always be some component of a healthy nutrition strategy.
  • Peter Attia attributes his constant career jumps to the power of evaluating things on how much time is left for him to do it rather than how much investment was already made into an earlier thing.
  • A lot of Peter Attia’s drive is insecurity.
  • Out of Exercise, Sleep, Nutrition, and Management of Stress, a catastrophic interruption to Sleep will have the greatest detriment on your health.

Peter Attia Quotes

  • “In an ideal world, you’d want to figure out a way to exercise where you can maximally load the muscle while minimally loading the joint.”
  • “If you want to live to a 100 it basically means you have to delay the onset by about two decades of every major chronic disease.”
  • “The bottleneck is not in how much oxygen can you get in your lungs, the bottleneck is how much can your muscles utilize?”
  • “I think we’re in a different world now, I think the days are long gone of you do one thing for your whole life.”
  • “If you’re not growing, if you’re not constantly being reminded of how much higher you have to climb, I suspect life becomes a lot less fun.”

Being a Kick-ass 100-year Old

Peter Attia mentions that the race the rest of the population, apart from the athletes, should be running is to be the most kick-ass 100-year-old that ever lived.

  • You have to protect your joints if you want to live to be 100 years old.
  • Most people disproportionately load their joints over muscles while exercising.
  • Peter Attia mentions a few things a kick-ass 100-year-old should be able to do
    1. able to carry two 25 lbs bags from a grocery store
    2. able to lift 30-40 lbs bag overhead to put into an airplane compartment
    3. able to dip down into a squat and lift a 25 lbs child
    4. able to get down on the floor and play with toys and stand up without assistance
  • To live to 100 years you should delay the onset of every major chronic disease by about two decades.
  • Peter Attia’s guess for things to do for someone who is willing to spend only 10-12 hours a week preparing for the race to be the most kick-ass 100-year-old would be to have a routine involving,
    1. maintenance of muscle mass
    2. joint integrity
    3. flexibility
    4. functional movement and
    5. balance

Movement, VO2 max, and Orthopaedic Injuries

Peter Attia mentions that one cannot hide poor form on deadlifts and squats. However, one has to realize that he/she is one lift away from causing harm to self in these movements. He talks about the over-credited VO2 max numbers, and how ensuring that joints are minimally loaded will increase one’s chances of winning the kick-ass 100-year-old race.

  • While deadlifts and squats are good exercises, one must be careful with the form of these exercises.
  • Peter Attia mentions that a movement like the military press does not have a role in his life and if he can get 80 percent of the benefit at 20 percent of the risk from the exercise from loaded activities below the shoulder line and using more static loaded movements above the shoulder, he is willing to make the compromise.
  • Peter Attia mentions that contrary to the belief that VO2 max is a heart-lung issue, it is more of a muscle issue. VO2 max is the maximum extraction or utilization of oxygen from the blood by muscles.
  • High endurance athletes who have high VO2 max numbers have muscles that are very efficient at aerobic metabolism, enabling them to extract more oxygen from the blood.
  • Talking to Orthopaedic Surgeons, Peter Attia has come to realize that there are two types of Orthopaedic injuries that result in death. The first type is fast death like when a patient falls, breaks the femur bone, has a fat embolism, and is dead in one or two days. The second type is slow death which is usually not talked about but is more tragic. Here a patient is not able to do the things they like to do for prolonged periods of time (sometimes many years) before they die. The overall consensus from these talks is ensuring one’s joints are minimally overloaded in activities that will result in better health with aging.

Risk vs Reward

Peter Attia mentions how he feels safe in a race car than in his streetcar. He talks about the harmful effects of alcohol on the liver and how even one drink can compromise one’s abilities behind the wheel.

  • Peter Attia feels safe in a race car than in his streetcar because he knows that he would encounter drivers who are not focused, who check their phones while driving, and even a few who are under the influence of alcohol.
  • Beyond 1-2 drinks, alcohol is really harmful to the liver. People underestimate the risk of poor long-term health versus the reward of a short-term high when it comes to drinking alcohol.
  • Even one glass of wine can compromise one’s abilities behind the wheel. You can be well below the legally safe BAC (Blood Alcohol Content) of 0.08%, but it is not a reasonable strategy.

Fasting and Caloric Restriction

Peter Attia mentions that the short-term discomfort that comes with a fast is trivial when compared to its potential benefits. He abbreviates the Standard American Diet as SAD and insists that caloric restriction should be some component of a healthy nutrition strategy.

  • The short-term discomfort of not eating for 5 days for anywhere between one to five times a year is trivial compared to its potential benefits.
  • The two introductory moves for someone who wants to move away from the Standard American Diet (SAD) are
    1. Time-Restricted Feeding – No restriction on what you eat but the restriction on when you eat
    2. Dietary-Restricted Feeding – No restriction on when you eat, no restriction on how much you eat, but only restrict certain elements of what you eat
  • The ketogenic diet is one of the demanding subsets of dietary-restricted feeding
  • A hypocaloric diet for transient periods of time or a water-only diet for limited periods of time will ensure that the defective cells – specifically the ones with defective mitochondria are cleared and when the normal caloric intake happens we will expect to see the selective repopulation of better cells.
  • The caloric restriction should always be some component of a healthy nutrition strategy.

Peter Attia’s Constant Career Jumps

Peter Attia has made a lot of jumps in his career, from starting out with Engineering and Mathematics to moving into medicine, then into consulting, then into research and non-profit work, and then again into medicine. He credits the jumps to his power of evaluating an option based on the time left to do it rather than the amount of investment made into an earlier thing.

  • Peter Attia thinks that we are in a different world and the days are long gone where one does one thing for a whole life.
  • According to him, if one is not constantly reminded of how much higher one has to climb, then life becomes a lot less fun.

Insecurity as a Driving Force and Getting Better

Peter Attia says that insecurity is his driving force. He credits David Foster Wallace’s Commencement Speech to Kenyon College’s 2005 graduating class that opened his eyes for knowing himself better. In the speech, Wallace mentions that if a person worships intellect he/she will forever feel like a fraud. Peter Attia is marveled by intellect and has the fear that people might find out how much he doesn’t know.

How Peter Attia is Actively Getting Better?

  1. Showing up every day
  2. Surrounding himself with people who don’t take his shit (his therapists who don’t let him get away with anything)
  3. Surrounding himself with people who are patient (his spouse who is forgiving of his mistakes and believes he can be the person he is setting himself up to be in five years)

One Thing People Can Do to Have the Biggest Impact on Health

Peter Attia believes that the biggest change for a person will depend on where they stand in one of the following four components,

  1. Exercise
  2. Sleep
  3. Nutrition
  4. Management of Stress

The biggest impact on health will be improving the area in which a person lacks the most.

However, out of the four, Peter Attia picks sleep as the most important metric because a catastrophic interruption to sleep, when compared to the other three metrics will cause the greatest detriment to health.

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