Want to live a long, healthy and happy life? Exercise is “the most potent tool you have” according to a leading expert on the science of longevity.
Peter Attia has had a long career in medicine, specialising in cancer. Over the years, his focus has shifted from treating people with life-threatening cancer to understanding how we can avoid “the four horsemen”: the big killers of cancer, heart disease, diabetes and Alzheimer's.
Attia tells Susie Ferguson that he’s not just concerned with helping people to live longer, but to focus on their ‘health span’, or living well. His new book, Outlive: The Science & Art of Longevity, draws on the latest research on what we can do to live better.
“I think everybody understands that as you age, you get weaker, you ache more, you have more pains, your cognition tends to decline. But there's another component to health span which is less tethered to your age and that's maybe something about the quality of your life with respect to emotional health, the quality of your relationships, happiness, joy, things of that nature. All of these things taken together, make up health span. Without some attention to those things, I think longevity with a focus on lifespan is actually quite meaningless.”
Up until about 100 or 150 years ago, most people died of ‘fast deaths’ caused by infections or trauma. Attia says modern medicine has done an excellent job of reducing these kinds of deaths, but it’s reached its limit.
“We need a new approach, if we're going to live any longer, and certainly if we're going to live better.”
If we want to live longer and better lives, we need to delay the onset of chronic diseases rather than figure out ways to live longer with them, Attia says.
Having high levels of insulin is the “canary in the coal mine”, Attia says. In the first instance, it points towards insulin resistance, fatty liver disease and type two diabetes, but it has a marked impact on the other serious diseases too.
“Your risk of those other three horsemen - cancer, heart disease, dementia - your risk of those things goes up by anywhere from one and a half to two times, meaning 50 to 100 percent increase in the risk of those other diseases.
“So therein lies a very important principle of medicine 3.0, which is you must remain metabolically as healthy as possible in order to take the first step at reducing your risk of those others.”
Lifestyle interventions probably have a far greater impact on health and quality of life than medical treatments, Attia says, but doctors aren’t taught how to apply them.
“When I went to medical school… we learned a great deal about how to make a diagnosis and how to offer a treatment vis a vie pharmacologic intervention or procedure. But what we didn't learn with any specificity was how to apply exercise or nutrition or sleep or stress management as tools. And it turns out, those things probably have a much greater impact than pharmacologic things.
“Exercise, just to give you one example, is hands-down the most potent tool you have, if your aim is to live a longer, better life."
How much exercise do you need to do? It depends on what you’re doing now, Attia says. Someone who does no exercise at all now could reduce their mortality from all causes by about 50 percent by doing three hours of exercise a week.
“As a general rule, we would advise a patient to say look, half of that time should be spent doing cardio, half of that time should be spent on strength and stability. And that half that is put into cardio, a percent of that should be at a modest level of intensity.”
While humans have lived in a very food-scarce environment for most of our evolutionary history, we now have too much food, Attia says.
“The fundamental problem that's facing most people today is we're metabolically unhealthy because of excess energy.”
Most people need to reduce their total energy intake while keeping their consumption of protein high because it's an essential macronutrient for the maintenance of muscle mass.
“It's not about being on this type of diet or that type of diet. It turns out that those things are far less important than being in energy balance and getting sufficient protein.”
It doesn’t matter what exercise you do or what diet you follow, consistency is key, he says.
“It's one thing to realise that if you went to the gym tomorrow and had the best workout of your life and then didn't work out anymore, that really wouldn't produce any lasting effect.
“The only way that exercise works is if you keep doing it, the only way nutrition works for you is if you continue to stick to it. It’s far less relevant what particular diet you're on, it’s more important that you find one that works for you.
Sleep and emotional health are also crucial pieces of the puzzle, Attia says.
“If you're unhappy, if you don't feel connected to anything, anyone or if you don't have a sense of purpose or reason to exist beyond perhaps yourself, does it really matter how long you live?”
Improving your health requires daily “practice” Attia says, describing it as “a sort of recovery journey”. When treating patients in the past, he used to want to address all their health issues at once.
“There's the odd patient for whom that works, but I think for most people that becomes more overwhelming than helpful. So today, we try to optimise around two things.
“The first is, which of these things meaning nutrition, exercise, mental health, etc, will produce the greatest benefit?
“Secondly, which do you feel most able to put time and energy into right now? Let's just pick one. If you start with that, you're going to get a benefit. And this is building a new habit. Part of this is developing confidence around the ability to change a habit and experience a benefit in response to that change. And it's much easier, I think, to do these things in some sort of serial succession than to try to bang all of them out in parallel.
“It might take a little bit longer to get the desired result, but it tends to be much more durable.”