#328 — Health & Longevity

Welcome to the Making Sense podcast. This is Sam Harris. Today I'm speaking to my friend Peter Atia. Peter is a doctor and the founder of Early Medical. He received his medical degree from Stanford University and then he trained at Johns Hopkins in general surgery. He also trained at the NIH as a surgical oncology fellow and at the National Cancer Institute. And he's also the host of his own podcast, the Drive. But today we focus on his new best selling book. The title is outlive the science and art of longevity, and that really is our focus. We talk about health span as opposed to mere lifespan. The lessons that can be learned from centenarians and supercentenarians, diet and nutrition, including topics like sugar and macronutrients, alcohol, fasting and time restricted eating, exercise, heart disease, blood pressure, cholesterol, cancer, brain health, metabolic disorders, proactive medical testing, medication side effects, esoteric drugs like rapamycin, emotional health, and other topics. The full conversation runs 3 hours, so it is a fairly comprehensive look at most of the variables we might control to maximize the chances of living a long and healthy life. And I bring you Peter Atiya. I am here with Peter Atiya. Peter, thanks for joining me.

Yeah, Sam, thank you so much for having me.

So you have written this amazing book, which we are going to talk about. The title is outlive the science and art of longevity. And first of all, congratulations on the book. It really appears to have been trumpeted from the ramparts everywhere, from Oprah on down, and it's really getting out there. So it's got to be gratifying, because when you publish any book, to say nothing of a first book, you really have no idea what's on the other side of that printing press. And this is really about as good of an outcome as I can imagine. So that's got to feel good. It does, yeah.

And I think this time a year ago, I guess, effective at least when we're recording this was when I really had the thing ripped out of my hands by the publisher. And I remember sort of thinking to myself like, I'm not happy about this, it's not perfect, blah, blah, blah. I'm sure the same thing that you've thought of many times as you've obviously written a number of successful books. But then I had this thought that sort of calmed me, which was, look, is it at the point now where I will be proud if my kids read this in 20 years, and if I can answer yes to that question, then the rest is sort of out of my hands, and maybe people will hate it and maybe people will find a bunch of mistakes in it and all of the sort of insecurities that I'm sure every author goes through. But I know that once I kind of got to that point of saying, as long as my kids will one day be proud of it, which I know that sounds a bit corny, it'll be okay. And then I think the rest sort of took care of itself.

Yeah, well, it's quite a useful book, and it's a very candid book, too, which you really go into your story in considerable depth. Before we jump into the topics at hand, we're going to sort of track through your book. Obviously, there's much more detail in the book, and I recommend people read it if they want more detail on any of the topics we touch. I should also say that you have a podcast, the drive, which really goes into extraordinary detail on all of the topics we'll touch and many others. So if we're going to talk for ten minutes about lipids for cardiovascular health, your podcast probably has 10 hours on that topic. I don't think I'm exaggerating, underdoing it.

I think I have more than ten podcasts on 30 hours.

Yeah. So there's quite a wilderness of detail awaiting anyone who wants to follow you into it. But before we jump into the topics, perhaps you can summarize your background and career in medicine, because you've had kind of an interesting story of how you have come to emphasize the kinds of topics you have focused on.

Yeah, so I didn't want to go to medical school at any point during my life. I was not a premed or anything like that. In fact, I'd already sort of finished engineering when I had a change of heart, decided to go back and do medicine. And in medical school, like many others, I'm sure I was a little undecided about what to do. Always had an interest in oncology. And when I showed up in med school, kind of thought I might do pediatric oncology, but by the end of medical school, realized I had more of a surgical personality, and so decided to do surgery with the plan to then go on and specialize in surgical oncology. And after five years of my residency, for a number of reasons, some of which I write about in the book, I just became quite frustrated with what I've later come to call medicine 2.0. Although at the time, of course, I had no idea that that's what was really frustrating me. Then I just decided to kind of leave. I sort of felt like the last ten years had sort of been not a good use of my time, frankly, and I wanted to go back and get another degree, probably an MBA, felt I already had enough debt. And so instead I joined a company called McKinsey Company, which is a consulting firm, and sort of went down the path of corporate finance and risk there, which was very appealing to me and to my sensibilities around quantitative things. I missed my background in mathematics and was sort of happily marching along doing that, and sort of spent six years completely away from medicine until my own health became of a high enough priority to me and a high enough interest that the endless pursuit of trying to understand that better kind of gradually led me back into the notion of practicing medicine again, but obviously doing it in a very different way, which is through this lens of prevention, as opposed to last minute treatment.

Right. And you've gone very deep into topics like diet and nutrition and exercise more than the average physician, I would say, and we will cover that. So let's start with what would be our first chapter here on the topic of longevity and really, health span, I think, is your preferred word, because it's more than a matter of just not dying. How do you think about the main causes of mortality and the main causes of reduced health span? And maybe we should define health span at the outset here.

Yeah. So I think longevity is best explained, at least for me, conceptually. I think of longevity as a function of these two things, lifespan and health span. Lifespan being the easier to understand because it's the binary one. You're alive or you're dead, you're respiring or you're not. And the current medical system is really focused mostly on lifespan. It's the metric that gets measured, and it's the metric, obviously, that therefore gets managed. Health span, which is obviously not binary, is somewhat subjective as well, really speaks to quality of life. And while I think that everybody intuitively gets that certainly. I'm sure if you ask a person, would you want to live to 100 if the last 20 years of your life you were cognitively or physically debilitated? I think most people would immediately say, no, not really. So very long lifespan in the absence of health span is not desirable. But similarly wonderful health span with insufficient lifespan is also undesirable. Sam, if I said you're going to die at 60, but you're going to be from now until 60, you're going to be as strong and cognitively sharp as you were in your twenty s, I still think we would view that as tragic as, well, your lifespan was cut short. So what we're really trying to do is optimize both. But I think the biggest insight I've had in the past five years is that if you focus relentlessly on health span, you get the lifespan benefits typically along the way. If you do the reverse. That's not necessarily true.

So what can we learn from centenarians, and I guess you call them super centenarians, people who live to be 100 and beyond and in many cases really thrive. I mean, it's almost like their health span is extended by two decades or more. With respect to the average population, what have we learned from them? To what degree do you think they're the correct lens through which to look at the goal here and the strategy and tactics we might use to extend longevity and healthspan?