Moment 142 These Daily Habits Are Slowly Killing You Peter Attia

Summary Notes


In a conversation about redefining healthcare for longevity, the speakers discuss the limitations of current medical practices and the need for a proactive, personalized approach to disease prevention, termed Medicine 3.0. They highlight the importance of early intervention in cardiovascular health, citing the risks of both action and inaction in medical decisions. The speakers, including one with medical expertise, emphasize the significance of understanding individual risk factors, such as genetic predispositions, and the role of lifestyle choices in disease trajectory. They outline five core elements for extending health span: exercise, nutrition, sleep, mental resilience, and the judicious use of medications and supplements. The discussion underscores the necessity of addressing these factors from a young age to alter the course of aging and improve quality of life in later years.

Summary Notes

Prevalence of Chronic Diseases and the Need for Medicine 3.0

  • Chronic diseases like cardiovascular disease, cancer, dementia, diabetes, and their complications are leading causes of death.
  • Despite progress in medicine, life expectancy without infectious diseases has not significantly improved since the 1800s.
  • Medicine 3.0 emphasizes real prevention and personalized treatments to improve longevity and quality of life in later years.
  • Common beneficial practices include sleep and exercise, but medication use should be tailored to individuals.

"Today, most people listening to us are going to die from cardiovascular disease, from cancer, dementia or other neurodegenerative diseases, complications of diabetes."

This quote highlights the common causes of death in modern society, emphasizing the importance of addressing chronic diseases.

"If we want to really figure out a way to live longer, and I would argue, more importantly, live better... we need a totally different playbook."

This quote introduces the concept of Medicine 3.0, which is focused on improving both the length and quality of life through prevention and personalized care.

Four Pillars of Medicine 3.0

  • Medicine 3.0 includes prevention, personalized treatment, honest risk assessment, and acceptance of risk.
  • There's a need to consider the risks of inaction or delayed action in medical treatment.
  • Risk assessment should consider long-term horizons, especially for conditions like heart disease.
  • The approach to risk in Medicine 3.0 is more nuanced, taking into account individual factors and biomarkers.

"You say that there are four points to medicine 3.0, which is the prevention. Being unique in your treatment, to each individual, an honest assessment and acceptance of risk."

This quote outlines the four key points of Medicine 3.0, emphasizing a comprehensive and individualized approach to healthcare.

Risk Assessment in Medicine

  • Doctors often focus on the risks associated with medical interventions but may neglect the risks of not taking action.
  • Preventive measures also have associated risks that need to be understood and managed.
  • Medicine 3.0 requires considering risks over a longer time horizon, such as the risk of heart disease beyond a ten-year window.

"Right now, I think doctors are very good at thinking about the risk of doing something... But I don't think we spend enough time thinking about the risk of not acting or the risk of not acting when we do."

This quote points out the imbalance in how medical professionals assess risks, highlighting the need for a more comprehensive understanding of risk, including the risks of inaction.

Personalized Risk Factors and Family History

  • Family history of diseases like cardiovascular disease can prompt further investigation into an individual's risk factors.
  • Specific biomarkers, such as lipoprotein(a) and apolipoprotein B, can indicate a higher risk of cardiovascular disease later in life.
  • Medicine 3.0 would advocate for early detection and management of these risk factors instead of waiting for symptoms to manifest.

"My uncle died very early, I believe, in his fifty s of a cardiovascular disease."

This personal anecdote from Speaker A underscores the relevance of family history in assessing individual health risks.

"Let's say we checked your level and you had that lipoprotein, or you had an elevated level of another lipoprotein. Apo lipoprotein, little b... The medicine 2.0 view here would be, well, there's nothing wrong with you now... We don't need to do anything about it."

This quote from Speaker B illustrates the contrast between Medicine 2.0 and Medicine 3.0, where the latter would not dismiss early indicators of future health risks and would instead take proactive measures.

Perception of Risk and Action

  • Risk assessment is crucial when considering long-term health outcomes.
  • Taking action today is seen as less risky compared to inaction, especially over a significant time horizon.
  • Inaction over a long period, like 40 years, poses a greater risk to health than taking preemptive measures.

"So my risk of doing nothing, if I take the appropriate time horizon, is much bigger."

This quote emphasizes the importance of considering the long-term implications of health choices. Inaction is riskier over time compared to taking steps to mitigate health risks now.

Approach to Preventive Health

  • People often postpone serious health considerations until middle age.
  • The metaphor of the Titanic illustrates the importance of timely action.
  • Younger individuals have more potential to positively impact their health trajectory.
  • Motivation can be a challenge for younger people due to a lack of immediate health concerns.

"You have so much Runway through manipulating nutrition and exercise and sleep and stress and all of these things to completely alter the disease trajectory of your life."

This quote highlights the potential younger individuals have to influence their long-term health through lifestyle choices, drawing an analogy to the concept of a runway providing the space needed for significant change.

"But then there's a reality that says, for most people, it's not until they're in their 40s, maybe once they have kids, that they start to appreciate their own mortality."

The speaker points out that life events, such as reaching middle age or having children, often trigger a realization of mortality and a corresponding increase in health-related motivation.

Financial Analogy for Health

  • Comparing health investment to financial savings for retirement.
  • Short-term enjoyment can often overshadow the benefits of long-term planning, both financially and health-wise.
  • Regret over not taking earlier action is common in later life.

"A lot of people in their, who are making good money aren't necessarily taking the most prudent financial steps to ensure financial freedom when they're in their 70s, because, let's be honest, it's more enjoyable to spend money today than to set some of it aside."

This quote draws a parallel between financial planning and health, suggesting that just as people might spend money now rather than save for retirement, they may also neglect long-term health for immediate gratification.

Onset of Diseases and Metabolic Health

  • Diseases can begin to develop at different stages of life.
  • Certain aspects of health, like muscle quality, improve until a certain age before declining.
  • The state of one's metabolic health can be indicative of disease onset.

"Yeah, it's super interesting because there are some elements of you as a person that are going downhill the minute you're born, and there are others that are not."

The speaker acknowledges the complexity of aging and disease onset, noting that while some health aspects deteriorate from birth, others improve over time before eventually declining.

Aging and Muscle Fiber Quality

  • In your twenties, muscle fibers, both type one and type two, are of high quality.
  • Type one muscle fibers are slow to fatigue and high in endurance.
  • Type two muscle fibers are very powerful but quick to fatigue.
  • Training improves the quality of these muscle fibers.
  • Entering your thirties, type two muscle fibers begin to shrink, resulting in less power.
  • Peak performance for power athletes is typically in late twenties to early thirties.
  • Muscular endurance and certain forms of cognition peak later and can be maintained longer.

"But as you enter your thirty s, you will now start to experience a shrinkage of those type two muscle fibers."

This quote emphasizes the natural decline in muscle power as one ages into their thirties, particularly with type two muscle fibers.

Aging and Cardiovascular Health

  • Atherosclerosis and cardiovascular diseases begin aging from birth.
  • These diseases are often not symptomatic until after age 50.
  • Studies of individuals who died from unrelated causes show advanced cardiovascular disease at a young age.
  • It's important to manage cardiovascular health early for longevity.

"And we know this, by the way, because when we look at studies of people who die for completely unrelated reasons... we already see quite advanced disease."

This quote highlights evidence that cardiovascular disease can develop early in life, even if symptoms do not appear until much later.

The Compounding Nature of Cardiovascular Disease

  • Cardiovascular disease is a progressive condition that worsens over time.
  • Early intervention can significantly impact long-term cardiovascular health.
  • The concept of "Medicine 3.0" implies a more proactive approach to managing health.

"But it's compounding." "It is compounding, exactly."

These quotes confirm the progressive and accumulative nature of cardiovascular disease and the importance of early intervention.

Five Core Longevity Factors

  • Exercise is crucial but often only given lip service by conventional medicine.
  • Doctors typically do not provide detailed workout guidance.
  • Nutrition is key, but most doctors lack training in this area.
  • Sleep is an essential pillar of health, yet medical training often neglects it.
  • These factors are often learned outside of traditional medical training.

"Exercise. Again, we can talk a lot about it if you want a little about it, but the point is, it is not remotely given anything beyond lip service by medicine 2.0 medicine."

This quote stresses the lack of emphasis on exercise in traditional medical practices and the need for a more detailed understanding of its role in health.

The Shortcomings of Medical Training

  • Traditional medical training often omits practical education on exercise, nutrition, and sleep.
  • Physicians who are knowledgeable in these areas have usually acquired their expertise independently.
  • There is a disconnect between what doctors are trained in and the pillars of health that contribute to longevity.

"Certainly I didn't learn anything about nutrition or exercise when I was going through my medical training, and most physicians don't."

This quote reveals the speaker's personal experience with the gaps in medical education regarding nutrition and exercise, reflecting a broader issue in the medical field.

Impact of Alcohol on Sleep and Health Monitoring

  • WHOOP fitness trackers can indicate the negative effects of alcohol on vital signs.
  • A single glass of wine can trigger alerts about heart rate variability and overall health.
  • These health insights lead to lifestyle changes and increased sleep awareness.

Your one glass, and it's all flashing red. And the first time that happened, I had one glass of wine and I woke up the next day and my vital signs, my heart rate variability was flashing red and it literally says, did you have a drink last night?

This quote illustrates the immediate feedback provided by health tracking devices like WHOOP, which can detect and alert users to the impact of alcohol consumption on their physiological state, leading to increased awareness and potential behavior change.

Evolutionary Perspective on Sleep

  • Sleep is an evolutionary necessity despite its apparent disadvantages.
  • Our ancestors slept for about a third of their lives, indicating its importance.
  • Sleep's persistence throughout evolution suggests it has critical functions.

Well, given how evolutionarily unwise sleep would be, right. You are unconscious for a third of your life... Why would evolution have kept this thing around? And by the way, why has no species figured out a way out of it?

The quote challenges the notion that sleep is unimportant by highlighting the evolutionary cost of being unconscious and vulnerable for extended periods. It suggests that since sleep has been preserved across species, it must serve essential functions that outweigh its risks.

Health Risks Associated with Poor Sleep

  • Fragmented or insufficient sleep is linked to increased risk of cardiovascular disease and dementia.
  • There is a possible but less clear link between poor sleep and cancer.
  • Poor sleep contributes to insulin resistance and weight gain.
  • Sleep quality affects mood, creativity, and the ability to articulate oneself, impacting personal and professional life.

So for people, even if you're just coming at this through the lens of weight or excess body fat, I mean, that's probably motivation enough for many people.

This quote emphasizes the connection between sleep quality and physical health outcomes, such as weight management, which can serve as a motivating factor for individuals to prioritize sleep.

The Role of Sleep in Daily Functioning

  • Sleep significantly influences mood, cognitive functions, and leadership abilities.
  • Lack of sleep can lead to decreased performance and negative mood, affecting team dynamics.

Creativity and your ability to articulate yourself, which I notice. And your mood, huge one for me, especially when you're running teams. Unslept days are my worst days.

The quote underscores how sleep deprivation can impair cognitive functions like creativity and communication, as well as mood, which are crucial for effective leadership and team management.

Longevity Toolkit: Molecules as Tools

  • Traditional medicine focuses on pharmacology but often neglects supplements and hormones.
  • Understanding and utilizing drugs, hormones, and supplements can be vital for health and longevity.
  • A broader set of tools, including knowledge about supplements and hormones, can enhance medical practice.

The fifth and final thing that you have as a tool in the longevity toolkit is all the molecules. So drugs, hormones, supplements... most doctors don't really understand much about supplements. And interestingly, most doctors don't really understand a lot about hormones as well.

This quote points out the gap in traditional medical education regarding supplements and hormones, suggesting that a more comprehensive understanding of these molecules could improve health outcomes and contribute to longevity.

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