The Peter Attia Drive - #231 - AMA #41: Medicine 3.0, developments in the field of aging, healthy habits in times of stress, and more

Episode Date: November 14, 2022

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter answers a wide variety of questions, starting with a discussion on the evolution of medicine and the hopeful transition to “Medicine 3.0.” Peter recounts his unique career path and explains how he assesses risk and utilizes frameworks for decision-making. He also describes how he prioritizes his health while navigating the stresses of life, and he reviews the most exciting developments in the aging and longevity space. He finishes with some rapid-fire questions on cold plunging, strategies for lowering apoB levels, designing an exercise program for beginners, and more. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #41 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: The evolution of medicine and the transition to “Medicine 3.0” [3:00]; Peter’s unorthodox career arc and what led him to this point [11:45]; What does Peter consider to be his superpowers? [22:15]; How Peter thinks about risk and explains it to his patients when making medical decisions [26:45]; The advantage of using frameworks for decision-making [37:00]; What advice would Peter give his 30-year old self? [42:15]; Why longevity is such a hard problem to solve [42:30]; The most impactful developments in the field of longevity and aging in the last 5 to 10 years [46:15]; What is Peter most excited to see develop in the health and longevity space in the next few years? [51:30]; Prioritizing healthy habits while navigating the stresses of life and time constraints [53:45]; How Peter navigates periods of high stress [58:00]; What fitness watch did Peter recently purchase? [1:03:45]; Potential benefits of cold plunging [1:05:15]; Advice for someone beginning an exercise program [1:07:30]; Strategies and tactics to lower apoB levels [1:09:00]; Interesting studies and books Peter has recently read [1:11:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

Hey everyone, welcome to a sneak peek, ask me anything, or AMA episode of the Drive Podcast. I'm your host, Peter Atia. At the end of this short episode, I'll explain how you can access the AMA episodes in full, along with a ton of other membership benefits we've created. Or you can learn more now by going to PeterittiaMD.com forward slash subscribe. So without further delay, here's today's sneak peek of the Ask Me Anything episode. Welcome to Ask Me Anything episode 41.'m once again joined by Nick Stenson. Today's episode is a little different than the episodes of the past year. You've probably noticed over the past year, we've been doing AMAs around a lot of questions

that have come in around the same topics. And then we go super deep dive on one topic, for example. Today we do more of what we used to do traditionally with an AMA. We just noticed we had so many questions that we hadn't been addressing. And so we really batched them. And at the beginning of the episode, Nick is going to kind of walk you through what the questions are. So I'm not even going to really try to repeat that here. So if you're a subscriber and you want to watch the full video of this podcast, you can find it on the show notes page, which of course, we'll rekeep all the notes for this podcast. If you're not a subscriber, you can watch a sneak peek of the video on our

YouTube page. So without further delay, I hope you enjoy AMA number 41. Peter, welcome to another AMA. How are you doing? Doing well. That's good. We got a little bit of a different vibe for this AMA. You know, in the past. That's good. We got a little bit of a different vibe for this AMA. You know, in the past, handful that we've done, we've kind of focused on a few big topics or a collection of topics under one larger topics. And so, what we've been doing is, in that time, is just collecting a lot of questions that we think are really good,

really interesting, that maybe haven't fit in one of the past AMA topics. Also, maybe that are, as a fit in one of the past AMA topics. Also maybe that are as a result of one of the past AMA topics. And so what we did is we kind of flagged them all and we're going to try and get through as many as we can get through here. So it's kind of going to be a little more of an old school AMA on a variety of topics. And when we look at what we're hoping to cover, it's everything from medicine, aging, longevity, questions about your background where it led you to where you are today. Also, questions around how people should think about prioritizing all the various things in their

life. We get a lot of questions where it's you guys talk about A, B, B, you talk about labs, you talk about screenings, you talk about sleep, exercise, and you treat like all these tactics and it can get overwhelming for people. And so we'll hopefully have a good conversation on how you think about that in your life and also with patients as people just trying to sort through everything. And then if we have time, we're going to do an old school two-minute drill, which is have a variety of questions, put two minutes on the clock and see if you can answer it in two minutes. The last time we did this was long ago with you and Bob, and I don't know if we answered

any question under two minutes. So we'll see if it's any different here today, but with all that said, anything you want to add before we just get into it. I don't know at all. Let's just do it. But we're not on a two minute clock until you tell me, right? Yeah. These first questions aren't two minute clock. That's much like football and of the game, two minute drill. So we have some time to ease into it. So the first question we got is one of the

phrases that people have often heard you reference throughout the podcast and interviews with other people is this idea of medicine one, two, three point, oh, I also know this is part of the book you're writing. And so it's a topic and a thought experiment that you think about a lot. And we received a lot of questions about people just saying, hey, can you dive into that a little more, explain more about what you mean and why it's important for people to think about

as it relates to their own medical journey. I think this would be a really good foundation for our conversation today. So maybe you can just walk people through what is that and how you think about it. I don't know where the idea really came from or when it came to me, but it was sometime writing the book, which started in 2016. But I don't think it was in the first version of the book. So the book has really three versions.

So I kind of wrote, there's a 2016, 2017 version that of which I don't think anything is preserved. And then there's a second version, which is sort of 2017 to 2020, of which some is preserved. And then there's the version of the book that ultimately will become the book is kind of the 2020 to 2022 writing. So I'm positive, I'm nearly positive that the medicine 1.0, 2.0, 3.0 thing came from the second version of that book. And it was and remains this idea that says, look, we basically exist in three different phases of medicine, one of which we're, I think, not quite into yet, but we're in the transition. So these transitions are far from discrete, and they take, in some cases, I think the transition from medicine 1.0 to 2.0 took, I don't know, I would argue from the beginning to the end, 300 years. Okay, so what are they? So medicine 1.0 is when we had no idea of science.

Kind of keep in mind, science is what? It's such a political term at the moment that that's really unfortunate. But science is a way of thinking. Science is not a person. Science is not an answer. Science is a process. It's a way that we look at the natural world around us. We formulate hypotheses about what explains them based on the physical principles of the universe. universe, we design experiments to test those hypotheses and we measure the results of those experiments against the predictions of the hypotheses and then we iterate and correct. It's important to understand that we're not naturally wired to do that. So evolution didn't prepare us to do that. It had no interest in us doing that. I've written at length about this. I think I've written at length about this I think I wrote a blog post on this

Seven or eight years ago called why we're not wired to think scientifically I think we should link to that because I go into much more detail about the time scale of evolution and the process of our thinking so prior to the invention of this idea nothing that Existed in medicine could be tethered to science. So anytime something happened, you had to come up with an explanation. That's why we have these wonderful brains that we do. We use them to come up with explanations for things that we see happening. But none of it could be linked to scientific fact or verifiable or testable hypotheses.

So this is where you had sort of all sorts of crazy ideas, you know, if you were sick, it was due to bad humors and was bad spirits and bad luck and all these sorts of things. But there was no sort of scientific basis for that. That kind of started to change in the late 17th century with Francis Bacon. But I would argue that the full transition to medicine 2.0 didn't actually take place until the advent of germ theory in the late 19th century. So that's about 300 years if I'm doing the math right. No, no, no, no, it's about 200 years. So we've got about this 200 year period where Joseph Lister, all the way

up to Fleming and the discovery of penicillin and antibiotics, that to me is the breakthrough of medicine 2.0. So medicine 2.0 comes from basically three things. One is the advent and acceptance of germ theory, the process of scientific thinking, and then really the crown jewel of medicine 2.0, which doesn't come along until much later, is the statistical machinery to enable randomized control trials. So again, because we're trying to be a little bit quick, I won't go into all the details and Bernard Fisher

and all of these people who played such an important role in this, but that's basically the trifecta of medicine 2.0. And to be clear, medicine 2.0 has been an amazing development. Like I don't think any of us would be sitting here today without medicine 2.0. And to be clear, medicine 2.0 has been an amazing development. Like I don't think any of us would be sitting here today without medicine 2.0. So I don't want to minimize it, but I want to acknowledge and just pass on and the book talks more about this

so we don't have to get into the great detail. Medicine 2.0 has really peaked. It's been very good at dealing with acute conditions. You know, you get hit by a car, you have a life threatening infection, you suffer an MI, a cardiocardial infarction, and you want to make sure someone doesn't die, and you want to keep somebody alive as long as possible, in that acute phase, medicine 2.0 is amazing for those things. What I argue is that we have reached the limits of medicine 2.0's capacity,

and if longevity is something we are aspiring for, we need a new strategy, we need a fundamental a shift as 2.0, Western 1.0, and that is to 3.0. And 3.0 is basically predicated on evidence informed as opposed to evidence-based guidelines. It is predicated on absurdly early preventative measures for chronic conditions, which are now the dominant source of morbidity and mortality. It's no longer acute conditions. And it has to be highly personalized.

So I'll stop there because again, I could probably spend the hour now talking about that, but I think people now get the sense of what this is. And I'm arguing that we're not, of course, yet in medicine 3.0, but we're now in that transition. And what I'm arguing is we should be accelerating that. And so it's interesting, right? Because you're a medicine 3.0 isn't necessarily people are going to live forever. It's more so just a shift to the three things, like you said, which is personalized medicine, early prevention, and evidence informed. Have you ever thought about what medicine 4.0 looks like? Is that even on your radar? Or is it more of the focus is how do we make this huge shift to 3.0, which is going to create so much benefit for people? I don't think I have enough clarity as to

what medicine 4.0 would look like yet. Versus things that I don't think I have enough clarity as to what medicine 4.0 would look like yet. Versus things that I don't think I will experience in my lifetime that will just be a part of medicine 3.0 if that makes sense. And when you think about that transition which you mentioned were slowly and now, do you have an idea of how far out you think medicine 3.0 is not necessarily at the individual level? So so like you know There's always a difference when people could access it versus the standard of care Do you have an idea or any rough idea on when that turn to the standard of care becomes? No, I think it's too soon to say it's really going to depend on how quickly people adopt and sort of basically

Demand change and I don't think that's possible to predict let's use an example that's on how quickly people adopt and sort of basically demand change. And I don't think that's possible to predict. Let's use an example that's completely different, but I think if you could go back in a time machine, you wouldn't know, right? So if you went back in a time machine to 1850, slavery is the law of the land. The country is completely segregated. I don't think anybody could have reasonably predicted the events of the 1860s and the events of the 1960s, which were two very important pillars in time as it pertained to slavery and ultimately segregation. You just couldn't

have predicted that, even though those are both very social changes. Now maybe there's a historian that will argue, no, it was crystal clear in 1850 that we were 15 years away from a civil war and a hundred years away from a civil revolution. But I don't believe that and I certainly don't think we can do the same here. On the book piece, I know you've been working on the book for a long time because I've known you during that stretch, but I wasn't necessarily aware of the 2016 to 2017 initial book that nothing made it really into the final copy. Not nothing. All of it went straight into the waste basket. So for everyone who's been anxious, kind of banging at the door, good thing we waited a little bit to get that out, huh? Yeah. Love it.

So, the next set of questions we receive in one form or another almost weekly, which is even people who followed you for a while and people who are kind of newer to follow on you, they often will ask a variety of questions. They either might be in school, med school, really interested in longevity, might be doctors, and they're really trying to understand like where your knowledge on this came from and how you've put into practice, what you're trying to do with your patients

in medicine 3.0, because it seems like from knowing you, a lot of what you do with your patients didn't necessarily come from what you learned in med school and or what you did in residency. And so I think what might be helpful to people is just if you want to give people a walk through your background and how it's led to where you are today,

which is ultimately practicing medicine three-point out with your patients. Thank you for listening to today's Sneak Peak AMA episode of the Drive. Thank you for listening to today's sneak peak AMA episode of the drive. If you're interested in hearing the complete version of this AMA, you'll want to become a member. We created a membership program to bring you

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