Health #1: Outlive, Peter Attia
- Substrat: take 30y time frame + aggressive precaution
- ~300 supercentenarians (>=110 ys) worldwide; fitter than peers throughout life?
- stack tests: don't rely on single test
- 3 key qs: 1) overnourished?, 2) undermuscled?, 3) metabolically healthy?
- 4 Horsemen: heart disease; cancer; neurodegenerative disease; t2 diabetes
- metabolic derangement often at heart; background inflammation disease precursor
- 3 vectors of deterioration: cognitive/physical/emotional decline
- medicine 3.0: proactive prevention of disease (asymmetric risks, active patient)
- 5 domains: exercise, nutrition, sleep, emotional health, exogenous molecules
- exercise > rest; aerobic fitness, strength, stability
- aerobic fitness: zone 2 (strained talking ok) activates slow-twitch muscle fibre + mitochondrial biogenesis; with exercise glucose uptake up to 100x rest (2021 study); VO2 max (peak aerobic) as proxy for aerobic fitness: 25pctl 4x likely to die than 75pctl (2018 study); declines 10-15% per decade; 4-6x 4 mins. all-out pace + 4 mins. cooldown;
- strength: with low muscle mass ~50% more likely to die (2018 study, 2011 study); grip strength proxy for strength; farmer's carry: walk >=1 min w weights (100% body weight, women 75%), shoulder blades down/back; dead-hang from pull-up bar: hang >=2 mins. at age 40 (women 1.5 mins); squat, deadlift, step-up, hip-thruster, pull-up, pull-down, row; rucking: carry 1/3 of body weight, esp. uphill;
- stability: most acute injuries not acute; DNS models how babies learn movement (video library); breathing: on back w one hand on belly, one on chest, both hands ideally rise/fall; 4 corners of feet ideally always on ground; 1 foot in front of other, close your eyes, balance (>=10 secs); spine: 3 parts (lumbar, thoracic, cervical), proprioceptive awareness: feel extension/flexion in each vertebra, go on hands+knees and very slow cat/cow sequence (inhale on cow, exhale on cat); Barry-get-up: stand up with at most 1 hand
- nutrition: most to reduce energy while adding lean mass (i.e. less calories, more protein, more exercise); cast on healthy arm causes atrophy; high quality diet + metabolically healthy: restriction maybe not necessary; reduce avg. blood glucose & variability; higher insulin sensitivity in mornings; he eats protein 4x per day (1 as protein shake); add EPA/DHA & MUFAs (e.g. avocado, nuts, olive oil)
- sleep: disruption impairs glucose disposal; if glucose increases at night, indication of psychological stress (high cortisol); Lebron James 9-10 h + 1 h nap; brain waste disposal system; darkness, cultivating sleep pressure (e.g. exercise, no devices, meditation), long-enough sleep opportunity important;
- emotional health: he dreaded twice-daily group check-in most; clinic enforced "no minimisation" rule; trauma tree: adult behaviour adaptation to childhood trauma (4 tree branches: addiction, co-dependency, habituated survival strategies, attachment disorders); 5 trauma categories (abuse, neglect, abandonment, enmeshment, witnessing tragic events); trauma from dramatic single event or multiple smaller events; DBT to learn to regulate emotions; increase distress tolerance window (e.g. by saying no); 4-secs-inhale-6-secs-exhale; opposite action: do opposite of what you want to do in emotional situation;
- body markers:
- once: APOE (1 e2 & no e4: +30% to reach ~100 ys; 2 e4s: -81%), lp(a); 23andme (?)
- annually: apoB (lower target with high lp(a)) & LDL-C (target: 10-20 mg/dL); oral glucose tolerance test & CGM (avg. glucose <100 mg/dL; insulin is canary in coal mine); uric acid; ALT (liver enzymes; NAFLD risk at >30 (>19) for men (women)); tryglicerides/HDL (target: <1:1); vLDL; calcium score via CT scan or CT angiogram; toxic visceral fat, bone mineral density, lean mass (annual DEXA scan); colonoscopy + liquid biopsy (esp. after age 40); homocysteine (indicates chronic inflammation); EPA/DHA (target: ~8-12% of red blood cell membranes)
- Alois Alzheimer performed autopsy in Frankfurt in 1906
