Tuesday, May 23, 2023

Outlive: The Science and Art of Longevity by Peter Attia, MD

I, hereby, declare war against four horsemen of chronic diseases - Cancer, Cardiovascular Diseases (heart diseases), Type 2 Diabetes (I am already a pre-diabetic patient) and Neurological Degenerative Disease like Alzheimer’s. This declaration stems from reading a new book that came out in March named Outlive: The Science and Art of Longevity by Peter Attia, MD. I finished it a few weeks ago and found it very relevant as I have been working on the mission of solving root cause of chronic diseases in an AI-first health tech startup Twin Health.

In this book the author suggests longevity = function (lifespan, healthspan) and thus emphasizing that it's not good enough to live long (lifespan) but we also need to focus on living well (healthspan). One without the other, long lifespan with poor healthspan or short lifespan with rich healthspan, isn’t what most people want. The idea is to build a strategy to prevent chronic diseases instead of treating them after their onset. In other words, the author wants to focus our thoughts around slow death rather than fast death that are caused by accidents, injuries, and infectious diseases. Healthspan, in its most distilled form, is about preserving three elements of life as long as possible: 

  1. Brain - namely, how long can you preserve cognition (i.e., executive function, processing speed, short-term memory)
  2. Body - specifically, how long can you maintain muscle mass, functional movement and strength, flexibility, and freedom from pain
  3. Spirit - how robust is your social support network and your sense of purpose

Over the years, medicine has undergone significant transformations. The era of Hippocrates marked Medicine 1.0, which acknowledged that nature, and not the gods, was responsible for causing diseases. In Medicine 2.0, researchers began experimenting and testing hypotheses to develop cures. This approach primarily focused on the germ theory and treating diseases to avoid or reduce the risk of fast death. Although it increased lifespan, it did not prioritize health span. Medicine 3.0, on the other hand, prioritizes preventing the root cause of diseases and maintaining health span, rather than just treating them. This approach highlights the importance of lifestyle changes such as diet, exercise, and stress reduction to prevent chronic diseases.

The process of regulating blood glucose levels within a healthy range is known as Glucose Homeostasis. The A1C blood test is utilized to determine the average blood glucose level over the past two to three months. An A1C level of 5.1% indicates a normal blood glucose level of 100 mg/dL, whereas a level of 6.5% or greater indicates a diabetic blood glucose level of 140 mg/dL.

In addition, the author discusses the difficulties of conducting long-term experiments on a large scale, which is why Mendelian Randomization is often preferred in many medical studies. Mendelian Randomization is a methodology employed to investigate the causal association between a risk factor and a disease by analyzing genetic variations that impact the risk factor and assessing their impact on the disease.

While consulting for Dexcom on their innovative continuous glucose monitoring (CGM) device, the author encountered the Hawthorne Effect. This is a form of human behavior reactivity in which individuals modify an aspect of their behavior in response to their awareness of being observed.

Metabolic Syndrome (medsyn) is a group of risk factors that increase the likelihood of developing heart disease, stroke, and diabetes. Meeting three of the following five criteria indicates signs of medsyn:
  1. High blood pressure - greater than 130/85
  2. High triglycerides - greater than 150 mg per deciliter
  3. Low HDL cholesterol - less than 40 mg per deciliter for men and less than 50 for women
  4. Central Adiposity - weight circumference greater than 40 inches for men and 35 for women
  5. Elevated fasting glucose - greater than 110 mg per deciliter
To prevent cancer, it is recommended to avoid smoking and maintain metabolic health by exercising regularly and eating a healthy diet. Unfortunately, 77% of the US population does not exercise regularly, which is a significant risk factor for developing chronic diseases. Falls are also a leading cause of death after age 65, and regular exercise can increase muscle mass, reducing the risk of falls.

Incorporating strength training and endurance exercises like hiking with a backpack, cycling, swimming, and boxing can be beneficial for enhancing muscle mass and promoting overall well-being. In terms of nutrition, our understanding is based on either epidemiological or clinical studies. Nonetheless, it is important to note that there is no amount of alcohol consumption that is considered healthy for the body. As a guideline, it is recommended to limit alcohol intake to no more than seven servings per week, with a maximum of two servings per day.

Dietary Restriction can be divided into three categories: caloric restriction (CR), dietary restriction (DR), and time restriction (TR). Caloric restriction involves reducing the amount of food intake, while dietary restriction involves limiting the consumption of meat, sugar, and fat. Time restriction involves reducing calorie intake by practicing intermittent or multi-day fasting. Among these three methods, caloric restriction is the most effective but also the most challenging, while time restriction is the latest trend and the easiest to implement.

Sleep is critical for overall health, and it is recommended to avoid eating at least three hours before bed. Go to bed with a little bit of hunger, and avoid using electronic devices at least two hours before rest. Spending time in a sauna, hot tub, or taking a shower before bed can also promote relaxation. Avoid doing anything anxiety producing 1 hour before bed, for example, reading work email. The room and bed should be cool, ideally in the mid-60s, and darken the room enough that you can’t see your hand. Sleep 8 hours (preferably 9) before when you need to wake up.

After reading the book, I feel strongly inspired to create a personal plan for preventing or delaying chronic diseases and leading a long, healthy, and joyful life. My grandfather lived up to 105 years, and if it is the will of the universe, I aim to surpass that and live until 106 years old.

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