#385 - AMA #82: Applying the tools of longevity in the real world: disease prevention, DEXA scans, artificial sweeteners, injury recovery, stability training, habit formation, protein intake and mTOR activation, and more

**Peter Attia** (0:10)
Hey, everyone, welcome to a sneak peek, Ask Me Anything or AMA episode of the Drive podcast. I'm your host, Peter Attia. At the end of this short episode, I'll explain how you can access the AMA episodes in full, along with a ton of other membership benefits we've created. Or you can learn more now by going to peterattiamd.com/subscribe. So without further delay, here's today's sneak peek of the Ask Me Anything episode.
Welcome to Ask Me Anything AMA episode 82 In today's AMA, I answer listener questions across a wide range of topics. Less about deep dives and more about how I think through real world trade-offs and apply the science and practice. So what are we talking about here today? We can talk about how health priorities and strategies should shift across different decades of life, which chronic diseases feel toughest to manage, and how I think about that hierarchy of risk. Which emerging interventions look most promising beyond exercise? Wearables, which consumer metrics are actually useful in practice? DEXA scans, what optimal screening intervals look like and how to interpret the results over time? Behavior change, what patients struggle with most in health routines and how to help changes stick? Training for balance, stability and injury resilience and lessons from some training setbacks. High-protein diets and mTOR, how to think about mechanisms versus outcomes. Diet sodas and non-nutritive sweeteners, how to evaluate them and frankly, what to compare them to. Plus a grab bag of some additional listener questions, including health fads, emotional health and sleep routines. So without further delay, I hope you enjoy AMA number 82

**Nick** (1:56)
Peter, welcome to another AMA. For today's AMA, our goal is to hit a variety of topics and questions that have come through frequently, most commonly. And instead of doing deep dives on some of these topics, what we're going to do is more talk about them, how you would speak with patients about them, if they ask these questions or their questions on how you work with your patients on specific issues. So goal here is to be much less in depth and much more practical and actionable. And with this, we'll cover a variety of topics, including how priorities around health shift as people age, the best tools we have to prevent dementia, what wearable data do you think is actually useful for your work with patients, how you work with patients to make lasting changes in their health routine, how to think about training for stability, recovering from injuries, question on diet soda, mTOR as it relates to high-protein diets, and more. So with that said, I think we'll just jump right into it. First question being, as someone thinks about their trajectory as age, so if someone goes from their 20s to 40s to 60s and beyond, how do you work with patients around how their health priorities, strategies, tactics should shift across those decades as they age?

**Peter Attia** (3:21)
Well, I mean, I think it's a great question and I get asked this in various forms all the time, but also I think in the spirit of full disclosure, I don't work with 20-year-olds typically, and therefore I don't think I have the breadth of experience to really speak intelligently at that age range the way I do for people in their 40s and above because I would bet that the median age of my patient is in the mid-50s with an interquartile range of, call it, 40 to 70 So I think broadly what I would say is that you can get away with so much in your 20s, and again, I don't know that much of our audience even skews that young, but anybody listening to this who's in their 20s or certainly anybody who can remember being in their 20s and even I can knows that what you can get away with is just incredible.
And so one of the things that I talk about with my daughter, for example, who's a teenager is, look, this is the period of time in which you can overtrain, you can expand the envelope of your capacity. I know that the reason to this day, despite the fact that I don't train that hard, I still have a much higher VO2 max than would be predicted, I think by my training volume, I owe that all to what I was doing when I was young. That's one example, but I think we can achieve a lot by pushing in our 20s. I actually would encourage people in their teens and 20s to find their limits a little bit. Again, you're not going to pay the same price that you will in your 50s or 60s in doing so. Now, obviously, that means you still have to be reasonable and don't do things that would cause injuries. But again, I think that's a period of time for exploration and growth. I think when people get into their 40s, most people start to have that first brush with mortality, and part of that is external. You might be watching your parents' age or things of that nature. But I think also part of it is internal, and even though it's not your own mortality that is readily apparent, it is apparent that you are not the person you were before. Probably, and I would say certainly by the late 40s, that becomes true. And again, this manifests itself in many ways, right? So for example, patients will say, look, man, there was a day when I could throw down three drinks a night and feel nothing, and now I just have a headache the next day, or I don't sleep well, and I don't perform well the next day and all of those other things. And so I think that that's an insight into what's happening to us physiologically in our 40s and 50s, which says we really need to start being very deliberate about what we do physically and how we think about ourselves in terms of disease management and training. Again, when you look at a disease like atherosclerosis, rarely, rarely is it going to brush up against somebody in their 40s. You can count the number of cases you see where a person has an MI in their 40s, but it is undeniable that most people, at least microscopically, if they're walking around with high risk factors, don't have a burden of disease. And so really, I would say that by the time you're in your 40s, you really need to be thinking about what am I doing from a prevention standpoint? I don't want to wait too much longer to start taking those steps. And that means, again, looking after the fundamentals and the basics. So, am I metabolically healthy? Because for many people, this is when they start to go off the rails. Am I still faced with dyslipidemia or is hypertension starting to creep up? All of those other things. And of course, I always like to bring it back to physical and exercise. This is really a time where you don't want to start missing workouts. And I know that for some people, it's hard to do, but you're better off doing something very frequently and not getting out of the habit, than you are taking long periods of time off and then coming back and trying to be heroic. Now, I think once you get into your 60s and beyond, the name of the game is maintenance if you've done a good job until that point. But the good news is if you haven't, there's still an enormous opportunity for growth. I think that's an important distinction. So if you've come into the seventh and eighth decade of your life, not particularly healthy, that should not be viewed as a scenario by which you decide, well, the die has been cast and away I go. Rather, it would be, no, look, I can still make gains here. We've seen patients that come into our practice in their 60s with VO2 max in the high teens, low 20s. That doesn't prevent us from training them and getting them to a much higher level of fitness within two or three years. The same is true with resistance training and things like that. Of course, it's never too late to start taking the preventive steps around chronic disease. Alternatively, when a person comes into their 60s and 70s in great shape, our goal is do no harm, right? It's how do we preserve this for as long as possible? And that might mean being a little bit more deliberate in some of the training that we do, maybe trimming a little bit of the work that they do off and adding different types of work to it. But I would say broadly speaking, that would be my approach.