After the birth of his daughter, Dr. Peter Attia , who hosts one of my favorite health podcasts, The Peter Attia Drive, began examining how he could live a longer life. He discovered centenarians tend to smoke more, eat worse, and exercise less than the rest of us. What?? It’s apparently all in the genes. But even if you don’t have the right stuff, “we can look at what those genes code for and try to mirror the benefits.” Read below for the first in our ‘Living Longer’ series…
Katie Couric: You started out as a cancer surgeon and researcher. How did you evolve to become a specialist in longevity?
Dr. Peter Attia: I did start my medical training in surgery and specifically surgery pertaining to cancer and always had an interest in cancer. In fact, when I went to medical school, I had planned to become a pediatric oncologist. So, cancer and cancer patients always seemed very near and dear to my heart. However, before completing my training I became pretty disillusioned with medicine in general and in particular the complete lack of prevention that went into the way we practiced it. It seemed that we could do so much in terms of last-minute efforts, but it was often too late and too often didn’t seem to impact how much longer or better a person could live. When I left medicine, I actually left it for good, I thought, and went as far as possible from it and went into consulting where I worked primarily in risk management within the financial services industry. It was only after the birth of my daughter when I began to examine my own health that I become obsessed with the idea of trying to figure out how to delay the onset of disease so that I might live as long as possible to spend as much time with her as possible. Through that experience, I became more and more obsessed with the science of longevity and sought out the greatest research and teachers in this space, many of whom have mentored me to this day.
You have done a lot of research studying centenarians. Are they doing something different than the rest of us?
In preparing and doing the research for my book, which will be out in the spring of 2021, I looked as much as possible into everything that could be gleaned from the study of centenarians. They certainly seem like a very important population to study given that they have already achieved what many of us would like to achieve, at least to the extent that they have lived to the age of a hundred or more. Much to my surprise, and I think to the surprise of many of those who have studied them before me, centenarians on average, do not do anything better than the rest of us. In fact, according to one of the most notable cohorts studied by longevity researcher Nir Barzilai, on average, they tend to eat worse, smoke more, and exercise less than average people.
Digging into this further, it becomes clear that the advantage that centenarians have is clearly a genetic one. As one researcher jokes, as it stands today, the most important thing you can do to increase your odds of living to 100 is to pick the right parents. However, a deeper look at this idea reveals something quite interesting, which is that there are a cluster of genetic differences that offer the advantage of longevity to the centenarians. While those of us who don’t have those genes, which is to say most of us, will not have the luxury of inheriting that protection, we can look at what those genes code for and try to mirror the benefits of those genes.
For example, a common genetic variant found in people who are centenarians is a mutation for a gene called APOC3. APOC3 in these people tends to be hypoactive and that gives them great protection from cardiovascular disease. Now, a person who is very insulin sensitive will also have very low APOC3 and this gives us some confidence that by working a little harder in terms of our behaviors, we can mimic some of the phenotypes of these genetic gifts bestowed on centenarians.
Can we really overcome our genes when it comes to lifespan? How much can we actually influence our longevity with our habits and behaviors?
It turns out that only when you look at extreme longevity, do genes tell the majority of the story and that really refers to people living into their 10th decade and beyond, but for people who live to an average lifespan, which is now approximately 80 in the United States, genes tend to play a very small role, which is not to say the genes don’t matter, and which is not to say that there aren’t certain conditions that definitely travel in families such as heart disease, cancer, or Alzheimer’s disease, but the genes that contribute to these are virtually never single genes. They are virtually never deterministic genes. There are genes that simply increase our susceptibility, and it is clearly the case when you examine the literature that a healthy lifestyle, which in and of itself is a loaded and complicated term, can indeed offer tremendous or conferred tremendous longevity to even those of us who are average, or of average genes.
What’s a habit or behavior you often see people do that they perceive as healthy and is meant to increase their lifespan but is actually misguided?
Perhaps one area where I think people with the best of intentions are probably doing things slightly incorrectly is with respect to exercise. I usually make it a habit of asking someone why they exercise, and I’m often surprised at the lack of specificity that goes into that answer. Usually, people say things like, “It makes me look good,” or “It makes me feel good,” or “It gives me more flexibility with what I can eat after I exercise.” While all of those seem like reasonable concepts, I think there’s a lack of focus on what is a much more important concept: how is your exercise planned to increase your lifespan? Secondly, if not more importantly, how does exercise improve your healthspan? In other words, how is the exercise you are doing today preparing you to live as you age in the most functional manner possible? Too often I see people who are exercising in a way that might provide some short-term benefit but is increasing their risk of injury as they age. They are fostering asymmetries, doing things that they don’t have the stability, or otherwise ability, to do correctly that will come back to haunt them later in life.
Another example of this is people who probably spend far too much time focusing on very intense, long duration, cardiovascular fitness. It is becoming evident that while relative to doing nothing, such activity is beneficial, but relative to doing more moderate levels of such activity, it is actually producing a diminishing return, and potentially causing harm—or certainly increasing the risk of cardiac dysrhythmia later in life.
What are the downsides to an increased lifespan?
In many ways, I think the most obvious example of the downside to an increased lifespan is any mismatch with healthspan. Lifespan of course means how long you live—your lifespan terminates in a binary moment when you die. But healthspan deteriorates not so much in a binary or digital fashion, but rather in an analog fashion. It is a gradual process. What most patients say to me, and I think this is completely understandable, is I don’t want to extend my lifespan if it does not come with a commensurate increase in my healthspan. In the extreme case, it’s like they are referring to the curse bestowed upon Tithonus, who was granted immortality, but not eternal youth. I do think that so many aspects of medicine today focus more on delaying death than they do on increasing the healthspan—the cognitive capacity for life, the physical capacity for life, and the emotional capacity for life. Also, if an individual is increasing her lifespan beyond her friends and peers, she loses all of her friends, peers, and many loved ones over time.
Does studying longevity affect the way you choose to live your own life? Do you think you’re more acutely aware of the time you have to live and how to spend it?
Yes, I absolutely feel that way. I think much of this came from spending so much time around cancer patients and being with them when they died. Cancer, unlike heart disease or Alzheimer’s disease, does not discriminate as much by age. Therefore, being around patients who were young and old and seeing them die gave me a privileged perspective on the fragility of life. I think the same was true from even taking care of patients in a trauma setting, which I was exposed to a lot in my training.
The number of times I saw somebody die in a car accident, who obviously that morning when they left their home had no idea that this would be their last day, gave me a great sense of how much is out of your control and how life is really quite short in the grand scheme of things with respect to our universe and our more broader place in it. None of this is to say that I have figured out a way to completely master how I think about this or come to terms with my own mortality, but I know that every day that I can take actions to extend my life in a functional capacity is worth whatever I need to do today to reap that benefit tomorrow.