#311 ‒ Longevity 101: a foundational guide to Peter’s frameworks for longevity, and understanding CVD, cancer, neurodegenerative disease, nutrition, exercise, sleep, and more

In this special episode, Peter provides a comprehensive introduction to longevity, perfect for newcomers or those looking to refresh their knowledge. He lays out the foundational concepts of lifespan, healthspan, and the marginal decade. Additionally, Peter discusses the four main causes of death and their prevention, as well as detailing the five key strategies in his longevity toolkit to improve lifespan and healthspan. Detailed show notes provide links for deeper exploration of these topics, making it an ideal starting point for anyone interested in understanding and improving their longevity.

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We discuss:

• Overview of episode topics and structure [1:45];
• How Peter defines longevity [3:45];
• Why healthspan is a crucial component of longevity [11:15];
• The evolution of medicine from medicine 1.0 to 2.0, and the emergence of medicine 3.0 [15:30];
• Overview of atherosclerotic diseases: the 3 pathways of ASCVD, preventative measures, and the impact of metabolic health [26:00];
• Cancer: genetic and environmental factors, treatment options, and the importance of early and aggressive screening [33:15];
• Neurodegenerative diseases: causes, prevention, and the role of genetics and metabolic health [39:30];
• The spectrum of metabolic diseases [43:15];
• Why it’s never too late to start thinking about longevity [44:15];
• The 5 components of the longevity toolkit [46:30];
• Peter’s framework for exercise—The Centenarian Decathlon [47:45];
• Peter’s nutritional framework: energy balance, protein intake, and more [58:45];
• Sleep: the vital role of sleep in longevity, and how to improve sleep habits [1:08:30];
• Drugs and supplements: Peter’s framework for thinking about drugs and supplements as tools for enhancing longevity [1:13:30];
• Why emotional health is a key component of longevity [1:17:00];
• Advice for newcomers on where to start on their longevity journey [1:19:30]; and 
• More.

Overview of episode topics and structure [1:45]

• This is a special episode focused on longevity where we will go through lifespan and healthspan and touch on the core frameworks to give people a foundation to think about longevity
• As you listen to this podcast, you can think about how these different pieces fit together
• If you’ve listened since episode one, you might not need to listen to this one
  • But it might be an episode you share with someone as an example of what Peter talks about
• We’re going to hit all 5 tactics and answer some basic questions

How Peter defines longevity [3:45]

How do you define the word longevity? [3:45] new section

• It’s a word that gets thrown around a lot, and it means different things to different people
• Peter tends to think of thing mathematically, and longevity is made up of 2 vectors: lifespan and healthspan
•  Lifespan is much easier to understand because it is discrete, it is binary, it is objective
  • For the most part, you’re either alive or you’re dead
  • Think of it through the lens of a death certificate
  • An edge-case would be an individual who is brain-dead but being kept alive (we could debate whether that person is dead or alive)
• Notice that lifespan says nothing about the quality of a person’s life
• Lifespan is one of the vectors of longevity
• In as much as we want to increase longevity, we presumably want to have something to do with increasing lifespan
• The second vector that makes up this longevity function is the healthspan vector
•  Healthspan is far more complicated to explain
  • It is far more subjective
  • It is analog as opposed to digital, meaning it is not discrete on, off
  • It is variable
  • Peter likes to think about it as having 3 components: a physical component, a cognitive component, and an emotional component
• In an early version of Outlive (not the final version that got published), Peter went to great lengths to describe the cardiorespiratory death as type I death
• Then he went into great machinations to talk about the 3 types of decline in healthspan as physical, cognitive, and emotional death
  • Everybody really pushed back on that (for good reason), and they thought it was a little too morbid to talk about physical death as the death of your exoskeleton and cognitive decline
  • Peter thinks they were right, that death was probably too strong a word there
  • His point was: a person can be robbed of all of those things and still be technically alive, although their quality of life has been sapped
• Thinks of 3 subvectors of the vector of healthspan: physical health, cognitive health, and emotional health
  • There are ways we can quantify each of these
  • Ultimately people will have their own subjective assessment of what it means to be physically healthy or what it means to be cognitively healthy, or what it means to be emotionally healthy
• 2 of 3 of these subvectors decline with age: the physical and cognitive components
  • That doesn’t mean that everybody’s decline at the same rate
  • That doesn’t mean that for everybody, the decline reaches a level that is “pathological”
• Peter was thinking about this in the gym today, “Wow, it is really so obvious to me with each passing day that I am completely past my prime physically and cognitively. And I will never again be as physically strong, fit, flexible, free of pain… I will never again reach the pinnacles that I had reached in my late teens and 20s.”
• Similarly cognitively, he is a moron compared to the person he used to be in terms of processing speed, problem-solving, raw intellectual horsepower
  • Those things are going to decline even further
• Now, there is more nuance to this because there are certain things physically today that he thinks he actually does better than he did before
  • In other words, you take advantage of the fact that as you’re getting less explosive, less powerful
  • You can still maintain strength, and if you learn to move more intelligently, you can actually become more effective
• Similarly, as our intelligence transitions from a more fluid form when we’re young to a more crystallized experiential form when we’re older, we still have remarkable ability to contribute
  • [Peter discussed fluid and crystallized intelligence with Arthur Brooks in episode #226]
• There’s no denying that on some of the prime levers against which you would evaluate these, we’re in a state of decline 
• Conversely, the 3rd part of healthspan (which is emotional health), it actually doesn’t really tie to age much at all
• Depending on how you evaluate it, emotional health almost seems to have a U-shaped curve
  • Not a really big obvious U, but a dip in, I think statistically, probably the late 40s, and then a gradual rising again
• One of the things that Peter always tries to remind himself and his patients is this is something we can really look forward to, provided we do the work: “I can be emotionally better off in a decade than I am today, and I am certainly better off today than I was a decade ago.”

At the highest level, Peter describes longevity as a combination of lifespan and healthspan (comprised of physical, cognitive, and emotional health) 

• If your definition of longevity is “I want to live to be 200,” Peter wouldn’t be able to help you 

“The way I think about it is longevity means how do we live longer? I think that means years longer, a decade longer. It doesn’t mean a doubling of lifespan. And how do we reduce the rate of decline of healthspan?”‒ Peter Attia 

Why healthspan is a crucial component of longevity [11:15]

Why do you think it’s so important for someone to not only care about how long they live (the lifespan side), but also the healthspan side of how well they live? 

{end of show notes preview}