we at the National Lipid Assn are very proud to have presented BOTH Peter Attia and Tom Dayspring achievement awards at last year s Scientific convention. See us at www.lipid.org.
Like nearly all books that claim to educate on controversial topics, they start with truth and end with speculation, not just in health, but in all other topics like climate, archaeology, psychology (the worst), even sometimes biology.
If we eliminated speculation in books, I think we'd have no non-fiction books left!
The trick here would be for authors to be extremely clear about what is evidence-based, and what is speculative. That would be nice.
It is hard to know where to begin with this. Probably should start with the author's claims about the pathophysiology of atherosclerosis. This is a degenerative disorder that is that is found in practically all long lived animal species including many that have an almost exclusively vegetarian diet (e.g. parrots, chimps, and gorillas). A degenerative disorder is one that comes with age. Best evidence is that atherosclerotic plaques begin with a proliferation of smooth muscle cells in the middle layer of the arterial wall and, as they enlarge, push the thin endothelial layer into the lumen of the artery. If the endothelial layer is broken the blood is exposed to the underlying collagen and a cascade of blood clotting may occur. This can bring about the well known sequelae of atherosclerosis---heart attacks and strokes. The point is that, in this process, nothing is deposited on the inside of endothelial layer as is commonly believed by many---including, unfortunately, many physicians. Nowhere in this process does blood cholesterol or any other biological lipid play any role. The obsession with cholesterol started when chemical analysis of plaques revealed a significant amount of cholesterol; but this will be true of any cluster of cells since most of the cell components are derived from cholesterol and related compounds. The intense focus on cholesterol always reminds me of the famous joke about the drunk at midnight looking around beneath a streetlight for his car keys. A passerby asked him where he dropped his keys and he pointed to a spot some distance away down a dark alley. Then why are you looking here? Because the light is better. I wish Dr. Attia well in his search for the keys to longevity but I doubt he will find any in his drive to lower his cholesterol with multiple medications.
Then there is the issue of longevity. Over the years this has attracted a multitude of scam artists along with some well-intentioned researchers. But that would require extending this comment well beyond a reasonable limit.
I figure the years I have left are up to God. And though I do weight lifting, I run a few miles a few times each week, and try to avoid the food that most of us here think is garbage, I do all that to feel good with the time I have left. If I don't make it to 90, well that's alright. I'm trying now to avoid the obsession with health and diet that seems to afflict all old farts, because that obsession could make me feel like I'm trapped in a closet. It puts my focus on myself instead of on helping other people. And this article, with its suggestion that going for LDL-C as low as 10 is a good goal, makes me feel for the author and for Attia.
That says it all. If you could package that and sell it, you would die a rich woman. When my daughters asked me about the secret to happiness, I said "Always be grateful for what you have and never let the poison pill of envy into your heart or mind."
When you are as smart as he is, it may be perceived as egotistical. My beef is with the preoccupation with recounting one's own personal health stories during interviews which should be looking at the overall science in a topic rather than anecdotes.
It will be interesting to see Attia’s autopsy one day, of course if he doesn’t look any ours first. In a past 200 years we managed to extend our average life expectancy for few decades so I doubt that any other intervention will have significant impact. Therefore Peter’s, or anyone else’s attempt, will be doomed to failure. I must also note that his efforts reach almost pathological levels. He is spending hours a day in the gym and probably tens of thousands of dollars for special diet and medications. Honestly whatever the benefit of this is it is not a lifestyle achievable by majority of population.
His approach is for those with much money and time on their hands and for those who like to take lots of unproven supplements and be poked , prodded and tortured in the hope for an extended healthspan
I would love to hear from a cross-section of his current and former patients. Given his prior obsession with fasting, I assume that was part of his treatment. Continuous glucose monitoring he is devoted to. I assume most of his patients without or without diabetes are using CGMs. etc......
What Attia’s prescription lacks….is data. What he has in spades is biologic plausibility, exuberance, and hubris.
He’s within his rights to do whatever he wants, to himself. But it’s borderline irresponsible to preach this stuff to the masses without outcome evidence.
He’s no doubt a learned individual….with a bit of snake oil salesman mixed in.
This is interesting. What would you say to a 56 year old woman who checks all the ‘correct’ lifestyle boxes, NO family history of sudden death OR heart disease, a cardiac calcium score of zero, excellent HDL and triglycerides, but super high LDL (140 ish) and apo(a) (142)?
How about the option of just enjoying life and maintaining those healthy habits and "balance" in life? If family history is significant for longevity (on top of the other features you describe) I'd find it hard to believe there will be any "medication" or other intervention that will do much to improve the odds
I see quite a few women in their 70s (and even 80) who have high LDL (180s), but family history significant for longevity (parents lived into 90s) and cardiac calcium scores of zero. By that time, most do give into statins, which seems ok. But will it change anything in the long run? No idea.
I just wanted to thank you for your input. I saw my cardiologist yesterday, he did a heart ultrasound which was perfect, and he said that combined with my perfect 0 on the cardiac plaque test means we can adopt a wait and see before going on meds. This makes me happy. I don’t want to go on meds, especially ones I can’t get off of,) until I really need to.
My doc wants me to take a PCSK9 inhibitor, but from your article and those I’ve read it sounds like that’ll bring my numbers down but doesn’t really correlate to reduced cardiac events.
The medical community/public health/world governments were SO WRONG from the beginning of Covid. From the 2 week lockdowns to slow the spread, closing schools, small businesses, churches? 6' distancing, masks, pcr tests, telling people don't come to the hospital until you turn blue/can't breathe, ventilators, remdesivir ALL WRONG. Denying proven protocols that worked, MATH+, IVM/HCQ? NEVER EVER FORGET!
Like you, I very much appreciated Attias writing, especially when I first set out on educating myself about longevity. I grew tired of his ego, over time, and found many others who complimented and then replaced his writings for me.
I’m curious your thoughts on the LMHR study that was done recently (I was one of the study participants), indicating that elevated LDL-C is not the bad boy that we’ve been told; at least not on its own and not in the LMHR phenotype.
Seeking knowledge from some of the world's best experts.
Researching, in some detail, the topics on his podcast.
Sharing that knowledge on his podcast.
Open about his family and personal history, including mental health.
Willing to change his opinions.
Making people aware he is practicing what he preaches.
Promoting his blueprint to live better, longevity is secondary.
Those are not things I think of as egotistical or self-centered. I don't think he expects all of us to mimic or worship everything he promotes. On the other hand... Eating better, exercising more, take your meds where appropriate, get appropriate mental health care and enjoy your family and your life sounds like reasonable advice.
It's funny how you and several others see Attia as egotistical and self-centered, but I view him as having a high degree of Openness (Big Five Personality trait), which includes a willingness to self-experiment and report the results. I also speculate (and this is truly speculation) based on a number of things he's said, combined with his engineering background, he might be on the mild end of the ASD spectrum, which might explain why some see him as egocentric. I'm a psychologist with lots of experience with ASD for what it's worth, but I'm NOT diagnosing him, as I have not done an assessment!
I enjoy the post and I believe Dr. Attia is a very smart doctor. However, after having practiced nearly 40 years he leaves out some practical points that most of us have learned the hard way.
1. Given the choice of being lucky or Smart in patient care most of us would choose lucky.
2. if the best medical student and the radiologist sees the nodule on the x-ray. It's not there.
Flecainide for post MI PVCs, monoplax an IV dobutamine seem like a good idea at the time.. not so much now
3. I had a screening colonoscopy and then 10 days later five pulmonary emboli as a result of being rear ended stopped next to a school bus- coming back from an outreach clinic no less .
4. There's a lot to be said about enjoying life and not being crazy about trying to extend it an extra day or two.
5. If you have an adult, that is a non-smoker, moderately exercising, has a good social support network, financially stable and laughs a lot- That's probably as good as you are going to get. Get your labs where they need to be , check your blood pressure, your PSA and your colon occasionally. Wear your seatbelt.
And don't cross the bridge at one in the morning. You're on three drugs for LDL and you're filling in a pothole decent honest work and then you're 180 feet dropped into Coldwater.
Enjoy your life don't overthink it
PS my family had other health scares on the same level both of which were no fault of theirs....
Here we go again...keep lowering the thresholds so that more and more people can be put on more and more drugs sooner than ever and for an entire lifetime. This is why I refer the medical community as being the modern stone age medical mafia. Keeping people on drugs forever is NOT real medicine and healing. It's the opposite as the causes for diseases are never fully explored or understood. Why? That would put a gigantic dent in the revenues of the medical establishment.
I know! I find it interesting that the US is accused of "medicalizing" health by focus on disease and medication. Who knew that the true key was simply - more medication! I tend to see "medicine" (as in the practice of) as having a goal of preventing an earlier-than-expected death if possible and to limit the effects of 'disease' if possible. Beyond that, encouraging healthy habits and life balance is good. simply extending life does not make as much sense. Even if life is extended, the other factors of the aging body will come into play - poor eyesight; decreased hearing; joint problems; balance problems; limited independence. As of now, you can't outrun all those things.
Is it a coincidence that this article came one day after Dr. Cifu's amusing critique of "celebrity doctors?" I haven't read "Outlive," but I have been listening to "The Drive" from the beginning. I don't consider Attia the "typical" celebrity doctor for several reasons. That's not to say he doesn't have his biases, but you can tell his degree was in engineering, as I've never observed a more logical mind, and he usually remembers to state when he's citing established research vs extrapolating/speculating. One can never know for sure, but I believe he is not doing what he does for ego or money. Anyway, his website and podcasts, especially the one with Thomas Dayspring, is what convinced me to finally get a CAC, and based on that, start a statin. According to Dayspring, "Numerous clinical trials have demonstrated that there is no danger in lowering plasma LDL-C too low. LDL-C is the cholesterol circulating in plasma and is not a measure of tissue cholesterol (all cells synthesize all the cholesterol they need). LDL-C has no relation to brain, adrenal or gonadal cholesterol." (link #1 below). However, he also said this: "Low desmosterol, a biomarker related to cholesterol synthesis & low levels predict AD. When using statins at any dose in patients with AD risk (apoE4, family history) I reduce statin dose when absolute concentrations of desmosterol hits or is < 20th %tile cut point. This is not a common occurrence but bears watching. If needed lower apoB by adding other Rx - No other lipid lowering Rx inhibits brain cholesterol synthesis. This is outside of the box thinking." (link #2) Note he's not saying LDL-C levels can get too low, since he recommends other medications to lower it, and only statins can potentially reduce desmosterol. Patients can test their own desmosterol at home through Empower Dx's cholesterol Dx test (link #3). For now, I doubt many folks will get their cholesterol down to neonatal levels due to the expense of using PCSK9 inhibitors. But CRISPR has already demonstrated effectiveness in primates knocking out PCSK9, and clinical trials in humans will be next. (link #4) Who will volunteer? Probably folks with FH who lost a parent to heart disease in their 40's. And Peter Attia! :)
I can always "spot" a patient who is an engineer. They are extremely logical, systems-based thinkers (which is great!) but very focused on the body and health as a "system" or machine that can be "figured out and managed". And it generally doesn't work like that. I would imagine Dr Attia considers good health to be much more "controllable" than I have observed it to be over 30 years of watching the aging process up close. Primary care (for adults only, otherwise known as Internists) gives a great overview of life and aging that cardiologists do not see. The specialists are always going to see things from their vantage point.
The statins make most sense in preventing early death due to CAD, but I don't see them as the key to healthy aging and longevity. Of all my 90+ year old "outliers" - which a functional, independent 90-something will be, they are almost never taking a statin - or much medication at all!
and nobody's intentions are that pure. I would believe Dr Attia does have a strong personal interest in all of this as well as a physician's motives to help people - but, you can believe he is making money on book sales, supplements (if he sells or is sponsoring), podcast ads, etc. "Health" is big business these days.
I don't mean to say Attia is perfect, but here are a few thoughts in response to your comment. I don't know if you've listened to all his podcasts as I have, but he is more holistic than you'd think, as he focuses on many aspects of health, including mental health. I think he is very much aware that good health is not under anybody's complete control, but he thinks we can control it more than we generally do, and he's interested in exploring that topic with a variety of experts in their field and exploring varying perspectives. Based on a few things he has said, it seems like his shift to extending healthspan occurred when he first had kids at an age when he wasn't all that young, and it just hit him that he wanted to not only be around to see his grandkids, but to actually be able to lift and play with them, even in his geriatric years. He doesn't sell supplements, doesn't have ads (you can pay for AMA episodes, which I never have) and he always discloses potential conflicts of interests (e.g., if he mentions a company in which he has invested). Now he is going to sell a course called "Early." It's pricey, and maybe he's just in it for the money, but I think if that were his primary motive, he would have stuck with surgery, or his job at McKinsey and Company. I like hearing what he and his interesting guests have to say, and then doing my own research on what they said if it might apply to me. As for your 90+ patients who don't take statins, maybe they're super-agers, and genetics can certainly play a role in that. You didn't mention whether any of them have high LDL-C, and if not, they don't need a statin. Maybe naturally low LDL-C is why they lived so long! But I have high LDL-C and a CAC score showing atherosclerosis, despite a healthy lifestyle, so I will take my advice on statins from the Skeptical Cardiologist and highly respected Lipidologist Thomas Dayspring. The latter is 78 years old, sharp as a tack, and takes statins. My biggest fear is actually not a CVE, but dementia, which my mother had. Know what else she had? Uncontrolled high cholesterol. Same story with my mother-in-law. I know the data on that is mixed, but I'm not taking chances, so long as I have no side effects from Pravastatin. (My blood sugar is still good.)
Thank you for the helpful summary on Dr Attia! My general (medical) personality seems a bit different than his, which is probably why he strikes me as over the top from my broad (and very limited) sense of him. I appreciate your insight! It makes me more interested in checking out some of his podcasts.
And I am totally behind statins. Metformin seems like it should have some potential here (though studies have been ongoing for decades and I have not seen definitive recommendations). With family history and already indicators of LDL-C and CAC score risks - I'm all for statins!
Agree that Attia addresses all aspects of health. And I really like his concept of centennial decathlons. Think about what you want to be able to do when you are 90 and target your diet, lifestyle, exercise to achieve those goals.
Yes, I do know he also espouses lots of exercise, strength-training, etc - which I agree makes sense in our goals for healthspan. All I can give are my direct observations over a 30-year career (thus far!) in internal medicine that the "outlier" 90-somethings are not typically the engineer-types with laser focus on daily goals of long and active life. They are more typically people with general healthy habits, who typically were just good, consistent walkers, didn't smoke etc. For those extremes (> 90), good luck seems to be as big a factor as anything else. I think the "Blue Zones" approach seems more balanced.
I love to ask 90+ year olds what are their secrets to healthy, active long life - the most memorable reply was a 97 y/o who told me "smoking! It kept me calm and relaxed!" (and I certainly don't suggest smoking is a + factor in any way - but her answer, and her as an active, bridge-playing, 'spicy' 97 y/o just showed how random extreme longevity and healthspan can be.
Yes, gene mutations are often random, and inheritance is also a luck of the draw that we don't control. I think the goal is to make the most with the hand you were dealt, and since none of us has perfect execution, aim high! I love hearing stories about "spicy" 90+ year olds! If I live that long, I hope to be very spicy! 🤣
It ain't lack of love, it's his extreme need to control life. Maybe one of his kids will become an adult who challenges his ego, otherwise, everyone else kneels in worship.
we at the National Lipid Assn are very proud to have presented BOTH Peter Attia and Tom Dayspring achievement awards at last year s Scientific convention. See us at www.lipid.org.
Like nearly all books that claim to educate on controversial topics, they start with truth and end with speculation, not just in health, but in all other topics like climate, archaeology, psychology (the worst), even sometimes biology.
If we eliminated speculation in books, I think we'd have no non-fiction books left!
The trick here would be for authors to be extremely clear about what is evidence-based, and what is speculative. That would be nice.
Read Dr Cifu's earlier commentary about all of this. His opinions pretty much the same as mine on all of this!
It is hard to know where to begin with this. Probably should start with the author's claims about the pathophysiology of atherosclerosis. This is a degenerative disorder that is that is found in practically all long lived animal species including many that have an almost exclusively vegetarian diet (e.g. parrots, chimps, and gorillas). A degenerative disorder is one that comes with age. Best evidence is that atherosclerotic plaques begin with a proliferation of smooth muscle cells in the middle layer of the arterial wall and, as they enlarge, push the thin endothelial layer into the lumen of the artery. If the endothelial layer is broken the blood is exposed to the underlying collagen and a cascade of blood clotting may occur. This can bring about the well known sequelae of atherosclerosis---heart attacks and strokes. The point is that, in this process, nothing is deposited on the inside of endothelial layer as is commonly believed by many---including, unfortunately, many physicians. Nowhere in this process does blood cholesterol or any other biological lipid play any role. The obsession with cholesterol started when chemical analysis of plaques revealed a significant amount of cholesterol; but this will be true of any cluster of cells since most of the cell components are derived from cholesterol and related compounds. The intense focus on cholesterol always reminds me of the famous joke about the drunk at midnight looking around beneath a streetlight for his car keys. A passerby asked him where he dropped his keys and he pointed to a spot some distance away down a dark alley. Then why are you looking here? Because the light is better. I wish Dr. Attia well in his search for the keys to longevity but I doubt he will find any in his drive to lower his cholesterol with multiple medications.
Then there is the issue of longevity. Over the years this has attracted a multitude of scam artists along with some well-intentioned researchers. But that would require extending this comment well beyond a reasonable limit.
I figure the years I have left are up to God. And though I do weight lifting, I run a few miles a few times each week, and try to avoid the food that most of us here think is garbage, I do all that to feel good with the time I have left. If I don't make it to 90, well that's alright. I'm trying now to avoid the obsession with health and diet that seems to afflict all old farts, because that obsession could make me feel like I'm trapped in a closet. It puts my focus on myself instead of on helping other people. And this article, with its suggestion that going for LDL-C as low as 10 is a good goal, makes me feel for the author and for Attia.
That says it all. If you could package that and sell it, you would die a rich woman. When my daughters asked me about the secret to happiness, I said "Always be grateful for what you have and never let the poison pill of envy into your heart or mind."
When you are as smart as he is, it may be perceived as egotistical. My beef is with the preoccupation with recounting one's own personal health stories during interviews which should be looking at the overall science in a topic rather than anecdotes.
It will be interesting to see Attia’s autopsy one day, of course if he doesn’t look any ours first. In a past 200 years we managed to extend our average life expectancy for few decades so I doubt that any other intervention will have significant impact. Therefore Peter’s, or anyone else’s attempt, will be doomed to failure. I must also note that his efforts reach almost pathological levels. He is spending hours a day in the gym and probably tens of thousands of dollars for special diet and medications. Honestly whatever the benefit of this is it is not a lifestyle achievable by majority of population.
His approach is for those with much money and time on their hands and for those who like to take lots of unproven supplements and be poked , prodded and tortured in the hope for an extended healthspan
I would love to hear from a cross-section of his current and former patients. Given his prior obsession with fasting, I assume that was part of his treatment. Continuous glucose monitoring he is devoted to. I assume most of his patients without or without diabetes are using CGMs. etc......
This article is a fair summary.
What Attia’s prescription lacks….is data. What he has in spades is biologic plausibility, exuberance, and hubris.
He’s within his rights to do whatever he wants, to himself. But it’s borderline irresponsible to preach this stuff to the masses without outcome evidence.
He’s no doubt a learned individual….with a bit of snake oil salesman mixed in.
It's easy to do.
This is interesting. What would you say to a 56 year old woman who checks all the ‘correct’ lifestyle boxes, NO family history of sudden death OR heart disease, a cardiac calcium score of zero, excellent HDL and triglycerides, but super high LDL (140 ish) and apo(a) (142)?
How about the option of just enjoying life and maintaining those healthy habits and "balance" in life? If family history is significant for longevity (on top of the other features you describe) I'd find it hard to believe there will be any "medication" or other intervention that will do much to improve the odds
I see quite a few women in their 70s (and even 80) who have high LDL (180s), but family history significant for longevity (parents lived into 90s) and cardiac calcium scores of zero. By that time, most do give into statins, which seems ok. But will it change anything in the long run? No idea.
I had a long conversation yesterday with a patient who had characteristics similar to those.
But LDL of 140 is not considered super high (I'd say >180).
Also, do you mean lipo (a)?
Options we considered run the gamut from
-empirically start treatment (a la Attia and cardiology 3.o)
-no drug treatment but monitor with serial CAC
-Obtain CCTA (ideally with CLEERLY AI quantitation)
I just wanted to thank you for your input. I saw my cardiologist yesterday, he did a heart ultrasound which was perfect, and he said that combined with my perfect 0 on the cardiac plaque test means we can adopt a wait and see before going on meds. This makes me happy. I don’t want to go on meds, especially ones I can’t get off of,) until I really need to.
I probably do mean lipo(a)… I’m always mixing those two up because of the little a.
My doc wants me to take a PCSK9 inhibitor, but from your article and those I’ve read it sounds like that’ll bring my numbers down but doesn’t really correlate to reduced cardiac events.
Stopped listening to Attia when he recommended the untested/warp sped covid jabs. Said, The FDA is gold?
The medical community/public health/world governments were SO WRONG from the beginning of Covid. From the 2 week lockdowns to slow the spread, closing schools, small businesses, churches? 6' distancing, masks, pcr tests, telling people don't come to the hospital until you turn blue/can't breathe, ventilators, remdesivir ALL WRONG. Denying proven protocols that worked, MATH+, IVM/HCQ? NEVER EVER FORGET!
Like you, I very much appreciated Attias writing, especially when I first set out on educating myself about longevity. I grew tired of his ego, over time, and found many others who complimented and then replaced his writings for me.
I’m curious your thoughts on the LMHR study that was done recently (I was one of the study participants), indicating that elevated LDL-C is not the bad boy that we’ve been told; at least not on its own and not in the LMHR phenotype.
His ego and self-centered approach have become irritating I agree.
The LMHR study is interesting. I'd like to see longer term results, preferably with AI-quantified CCTA plaque characteristics.
I have long been a keto-friendly cardiologist.
Seeking knowledge from some of the world's best experts.
Researching, in some detail, the topics on his podcast.
Sharing that knowledge on his podcast.
Open about his family and personal history, including mental health.
Willing to change his opinions.
Making people aware he is practicing what he preaches.
Promoting his blueprint to live better, longevity is secondary.
Those are not things I think of as egotistical or self-centered. I don't think he expects all of us to mimic or worship everything he promotes. On the other hand... Eating better, exercising more, take your meds where appropriate, get appropriate mental health care and enjoy your family and your life sounds like reasonable advice.
It's funny how you and several others see Attia as egotistical and self-centered, but I view him as having a high degree of Openness (Big Five Personality trait), which includes a willingness to self-experiment and report the results. I also speculate (and this is truly speculation) based on a number of things he's said, combined with his engineering background, he might be on the mild end of the ASD spectrum, which might explain why some see him as egocentric. I'm a psychologist with lots of experience with ASD for what it's worth, but I'm NOT diagnosing him, as I have not done an assessment!
I enjoy the post and I believe Dr. Attia is a very smart doctor. However, after having practiced nearly 40 years he leaves out some practical points that most of us have learned the hard way.
1. Given the choice of being lucky or Smart in patient care most of us would choose lucky.
2. if the best medical student and the radiologist sees the nodule on the x-ray. It's not there.
Flecainide for post MI PVCs, monoplax an IV dobutamine seem like a good idea at the time.. not so much now
3. I had a screening colonoscopy and then 10 days later five pulmonary emboli as a result of being rear ended stopped next to a school bus- coming back from an outreach clinic no less .
4. There's a lot to be said about enjoying life and not being crazy about trying to extend it an extra day or two.
5. If you have an adult, that is a non-smoker, moderately exercising, has a good social support network, financially stable and laughs a lot- That's probably as good as you are going to get. Get your labs where they need to be , check your blood pressure, your PSA and your colon occasionally. Wear your seatbelt.
And don't cross the bridge at one in the morning. You're on three drugs for LDL and you're filling in a pothole decent honest work and then you're 180 feet dropped into Coldwater.
Enjoy your life don't overthink it
PS my family had other health scares on the same level both of which were no fault of theirs....
With 10 more years under my belt I fully agree, except the PAS (see USPSTF review.)
lol.. I am 67 and between letting the dogs out and me . It's on my mind
Here we go again...keep lowering the thresholds so that more and more people can be put on more and more drugs sooner than ever and for an entire lifetime. This is why I refer the medical community as being the modern stone age medical mafia. Keeping people on drugs forever is NOT real medicine and healing. It's the opposite as the causes for diseases are never fully explored or understood. Why? That would put a gigantic dent in the revenues of the medical establishment.
I know! I find it interesting that the US is accused of "medicalizing" health by focus on disease and medication. Who knew that the true key was simply - more medication! I tend to see "medicine" (as in the practice of) as having a goal of preventing an earlier-than-expected death if possible and to limit the effects of 'disease' if possible. Beyond that, encouraging healthy habits and life balance is good. simply extending life does not make as much sense. Even if life is extended, the other factors of the aging body will come into play - poor eyesight; decreased hearing; joint problems; balance problems; limited independence. As of now, you can't outrun all those things.
Is it a coincidence that this article came one day after Dr. Cifu's amusing critique of "celebrity doctors?" I haven't read "Outlive," but I have been listening to "The Drive" from the beginning. I don't consider Attia the "typical" celebrity doctor for several reasons. That's not to say he doesn't have his biases, but you can tell his degree was in engineering, as I've never observed a more logical mind, and he usually remembers to state when he's citing established research vs extrapolating/speculating. One can never know for sure, but I believe he is not doing what he does for ego or money. Anyway, his website and podcasts, especially the one with Thomas Dayspring, is what convinced me to finally get a CAC, and based on that, start a statin. According to Dayspring, "Numerous clinical trials have demonstrated that there is no danger in lowering plasma LDL-C too low. LDL-C is the cholesterol circulating in plasma and is not a measure of tissue cholesterol (all cells synthesize all the cholesterol they need). LDL-C has no relation to brain, adrenal or gonadal cholesterol." (link #1 below). However, he also said this: "Low desmosterol, a biomarker related to cholesterol synthesis & low levels predict AD. When using statins at any dose in patients with AD risk (apoE4, family history) I reduce statin dose when absolute concentrations of desmosterol hits or is < 20th %tile cut point. This is not a common occurrence but bears watching. If needed lower apoB by adding other Rx - No other lipid lowering Rx inhibits brain cholesterol synthesis. This is outside of the box thinking." (link #2) Note he's not saying LDL-C levels can get too low, since he recommends other medications to lower it, and only statins can potentially reduce desmosterol. Patients can test their own desmosterol at home through Empower Dx's cholesterol Dx test (link #3). For now, I doubt many folks will get their cholesterol down to neonatal levels due to the expense of using PCSK9 inhibitors. But CRISPR has already demonstrated effectiveness in primates knocking out PCSK9, and clinical trials in humans will be next. (link #4) Who will volunteer? Probably folks with FH who lost a parent to heart disease in their 40's. And Peter Attia! :)
https://www.linkedin.com/posts/thomas-dayspring-md-facp-fnla-3aaa876_knowfh-activity-7111752996786470913-I0z3/
https://twitter.com/Drlipid/status/1670796947337236482
https://empowerdxlab.com/products/product/cholesterol-dx-test
https://www.nature.com/articles/s41586-021-03534-y
I can always "spot" a patient who is an engineer. They are extremely logical, systems-based thinkers (which is great!) but very focused on the body and health as a "system" or machine that can be "figured out and managed". And it generally doesn't work like that. I would imagine Dr Attia considers good health to be much more "controllable" than I have observed it to be over 30 years of watching the aging process up close. Primary care (for adults only, otherwise known as Internists) gives a great overview of life and aging that cardiologists do not see. The specialists are always going to see things from their vantage point.
The statins make most sense in preventing early death due to CAD, but I don't see them as the key to healthy aging and longevity. Of all my 90+ year old "outliers" - which a functional, independent 90-something will be, they are almost never taking a statin - or much medication at all!
and nobody's intentions are that pure. I would believe Dr Attia does have a strong personal interest in all of this as well as a physician's motives to help people - but, you can believe he is making money on book sales, supplements (if he sells or is sponsoring), podcast ads, etc. "Health" is big business these days.
I don't mean to say Attia is perfect, but here are a few thoughts in response to your comment. I don't know if you've listened to all his podcasts as I have, but he is more holistic than you'd think, as he focuses on many aspects of health, including mental health. I think he is very much aware that good health is not under anybody's complete control, but he thinks we can control it more than we generally do, and he's interested in exploring that topic with a variety of experts in their field and exploring varying perspectives. Based on a few things he has said, it seems like his shift to extending healthspan occurred when he first had kids at an age when he wasn't all that young, and it just hit him that he wanted to not only be around to see his grandkids, but to actually be able to lift and play with them, even in his geriatric years. He doesn't sell supplements, doesn't have ads (you can pay for AMA episodes, which I never have) and he always discloses potential conflicts of interests (e.g., if he mentions a company in which he has invested). Now he is going to sell a course called "Early." It's pricey, and maybe he's just in it for the money, but I think if that were his primary motive, he would have stuck with surgery, or his job at McKinsey and Company. I like hearing what he and his interesting guests have to say, and then doing my own research on what they said if it might apply to me. As for your 90+ patients who don't take statins, maybe they're super-agers, and genetics can certainly play a role in that. You didn't mention whether any of them have high LDL-C, and if not, they don't need a statin. Maybe naturally low LDL-C is why they lived so long! But I have high LDL-C and a CAC score showing atherosclerosis, despite a healthy lifestyle, so I will take my advice on statins from the Skeptical Cardiologist and highly respected Lipidologist Thomas Dayspring. The latter is 78 years old, sharp as a tack, and takes statins. My biggest fear is actually not a CVE, but dementia, which my mother had. Know what else she had? Uncontrolled high cholesterol. Same story with my mother-in-law. I know the data on that is mixed, but I'm not taking chances, so long as I have no side effects from Pravastatin. (My blood sugar is still good.)
Thank you for the helpful summary on Dr Attia! My general (medical) personality seems a bit different than his, which is probably why he strikes me as over the top from my broad (and very limited) sense of him. I appreciate your insight! It makes me more interested in checking out some of his podcasts.
And I am totally behind statins. Metformin seems like it should have some potential here (though studies have been ongoing for decades and I have not seen definitive recommendations). With family history and already indicators of LDL-C and CAC score risks - I'm all for statins!
Agree that Attia addresses all aspects of health. And I really like his concept of centennial decathlons. Think about what you want to be able to do when you are 90 and target your diet, lifestyle, exercise to achieve those goals.
Yes, he doesn't just say, "take a pill;" his approach is comprehensive. And who doesn't want to "kick ass" at 90?! 🤣
Yes, I do know he also espouses lots of exercise, strength-training, etc - which I agree makes sense in our goals for healthspan. All I can give are my direct observations over a 30-year career (thus far!) in internal medicine that the "outlier" 90-somethings are not typically the engineer-types with laser focus on daily goals of long and active life. They are more typically people with general healthy habits, who typically were just good, consistent walkers, didn't smoke etc. For those extremes (> 90), good luck seems to be as big a factor as anything else. I think the "Blue Zones" approach seems more balanced.
I love to ask 90+ year olds what are their secrets to healthy, active long life - the most memorable reply was a 97 y/o who told me "smoking! It kept me calm and relaxed!" (and I certainly don't suggest smoking is a + factor in any way - but her answer, and her as an active, bridge-playing, 'spicy' 97 y/o just showed how random extreme longevity and healthspan can be.
Yes, gene mutations are often random, and inheritance is also a luck of the draw that we don't control. I think the goal is to make the most with the hand you were dealt, and since none of us has perfect execution, aim high! I love hearing stories about "spicy" 90+ year olds! If I live that long, I hope to be very spicy! 🤣
Attia needs a hug. Poor guy.
It ain't lack of love, it's his extreme need to control life. Maybe one of his kids will become an adult who challenges his ego, otherwise, everyone else kneels in worship.
I figured the need to control probably comes from fear.
Just one other point WRT Fructose (and I'm writing from memory)
Fructose is converted to glucose in cells using ATP
There's no feedback mechanism in human cells to slow this down, so paradoxically your cells can get starved of ATP by eating fructose.