The Peter Attia Drive - Qualy #9 - The importance of exercise for brain health

Episode Date: August 20, 2019

Today's episode of The Qualys is from podcast #02 – Rhonda Patrick, Ph.D.: the performance and longevity paradox of IGF-1, ketogenic diets and genetics, the health benefits of sauna, NAD+, and more. The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive. Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now. Learn more: https://peterattiamd.com/podcast/qualys/   Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/  Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD 

Welcome to the Qualies, a subscriber exclusive podcast. Qualies is just a shorthand slang for a qualification round, which is something you do prior to the race, just a little bit quicker. Qualies podcast features episodes that are short, and we're hoping for less than 10 minutes each, which highlight the best questions, topics, tactics, et cetera, discussed on previous episodes of the drive. We recognize many of you as new listeners to the podcast may not have the time to go back and listen to every episode, and those of you who have already listened may have forgotten. So the new episodes of the quality is going to be released Tuesday through Friday,

and they're going to be published exclusively on our private subscriber-only podcast feed. Now occasionally we're going to release quality episodes in the main feed which is what you're about to hear now. If you enjoy these episodes and if you're interested in hearing more as well as receiving all of the other subscriber exclusive content which is growing by the month you can visit us at pteratiamd.com forward slash subscribe. So without further delay I hope you enjoy today's quality. So without further delay, I hope you enjoy today's quality. That's another change in my belief system, I think, today versus, I don't know, five or six years ago. I think five or six years ago, I didn't think exercise was that important to longevity,

which actually sounds ridiculous for anyone who knows me because I was probably exercising four hours a day, but not because I believed it would make me live longer. It was just sort of soothing my addictions. But I think today I feel I am much more convinced by a lot of the data you've described, certainly the central stuff. When we published this paper earlier this year with Richard Isaacson that you and I were talking about it before we started recording, we wanted to get a sense of like, if you took a completely unbiased approach and look at the literature, what was the single most compelling thing you could do to generate or preserve brain health? And we came away thinking that it was actually exercise. And I remember when the analysts were

kind of going through this and showing me all the data, I was like, come on guys, there's no way exercise could be the most important thing for brain health. And again, I'm saying this is a guy who loves exercise more than anybody, but it just struck me as there for brain health. And again, I'm saying this is a guy who loves exercise more than anybody, but it just struck me as there's no way. And again, I think part of it was I was just thinking about it through the vascular lens. And obviously, you know, I think better than I do, that when you start to think about brain health, you have to think about it through a vascular lens, a metabolic lens, growth factor lens.

I mean, there were overlapping, but distinct pathways that are going to influence brain health. And so, I was kind of humbled by that. And now, I guess in many ways, I'm a little more adamant about it with my patients. Not that I wasn't, you know, adamant before, but this is like, boy, if you're not active every day, we got to change that.

I actually, the main reason I exercise is for my brain. It's certainly just not only for preventing neurogenetic disease and atrophy and all that, but just because it affects my executive function and affects my anxiety levels, it affects my ability to make decisions. I absolutely, if I have something that's bothering me or giving me anxiety or I have to make a really important decision going for a long run really helps me. And there's been studies showing that it helps with executive function, long-term planning, like aerobic exercise, specifically, you know, and the high intensity interval training,

all that stuff. They all do different things. Well, that's the thing we couldn't tease this out of the literature, which again, probably is just a limitation of shitty human clinical trials, but that's the second order question, right, which is if you're gonna take the Tim Ferriss approach, which is what's the minimum effective dose? Cause there are some people like maybe you or I,

who I think just generally like exercise, and also get these other benefits, these endorphin benefits, but there are some people who are like, look, what do I need to do? I'm gonna treat exercise like medicine. And I think in that setting, I'm still not clear. So if you were that person, would I say, Rhonda, as long as you are lifting weights, one hour, three times a week,

like if you can only give me three hours, would that be how I'd want you to spend it? Or would I rather you be doing an aerobic aerobic type thing? Like, I mean, that's, to me, those are where these biomarkers start to become very important because we're not going to generate hard outcome studies with that level of control. Once you, you know, try to control that many variables and be that strict about it, you're going to very much lose a hard outcome prospectively. But if we knew what to measure, right, and that's, you know, would we be measuring an integral

of IGF, for example? So how much it rises, how much it falls, and then what that looks like over time. But I guess that's the funny thing, right? Like the more we learn, the less we know. Yeah, absolutely. I think that we definitely don't know the answer to that question. But I think there's a lot of data out there showing, for example, strength training, you know, there's benefits on the brain that's been shown, published.

This benefits on preventing muscle atrophy. There's benefits on the brain that's been shown published. This benefits on preventing muscle atrophy. There's benefits on preventing cancer. Incident, that's all been shown for strength training, for aerobic, and this high intensity interval training also seems to be making its way as well. There was a study that I found, VO2 max, this is the ability of your body to transport oxygen during exercise, which also is a indicator

of when you're not exercising. And obviously transporting an oxygen to the brain, for example, is extremely important. VO2 max declines with age, like 1% per year. I forgot starting at what age, but, you know, so 10% per decade. So that's almost parallel as the muscle mass decline? It does, it does parallel, exactly. And there was a study showing that 24 sessions of high intensity interval training where it was like a 45 minute session, five minute warmup, five minute cool down, and then, you know,

in between the max intervals, which were like pretty long, like a minute, there was, you know, the 70% of max water. Anyway, so 24 of those increased VO2 max by 12%. So you're literally taking an entire decade of decline and like reversing it with the 24%. So that's actually a point. When I was more active as a sort of competitive, encycling, we would get our VO2 max tested

about twice a year. Ryan Flarity, who we were talking about before, the podcast, who's one of my close friends and you've got to know him as well, I learned from Ryan that actually VO2 max is not the most important indicator as a runner or cyclist. It's VVO2max or PVO2max that matters. In other words, for a runner, VVO2max is much more predictive of performance, which is the velocity

you carry at VO2max. And for a cyclist, it's PVO2max, which is the power output at VO2max. That said, every time you go to test, you want it to test well. So, you know, over time, I learned how to game the system. You know, I want to make sure my VO2 max is in the 70s, which, again, to put that in perspective, like, that's not at the level of professional athlete or something, like the guys that are winning the Tour de France are in the high 80s or low 90s in terms of milligrams per mill per kilogram. But nevertheless, just altering my training for three weeks before a VO2 max test and dropping my weight. So if I shed two kilograms and did those types of intervals, I actually had it down to a science where there was a workout I would do. You know

in Carmel Valley, you've got the 56 that goes out and it's got a bike path next to it. There's a section of that bike path that is 1.6 miles long, and it goes up at about 4%. And just doing repeat intervals of that, which takes about four minutes all out to go one direction, and then about six minutes to cruise back. Four of those, that was it,

twice a week for like three weeks, and your VO2 max exploded. Now of course the question is, is that like, you know, cramming for the test, getting the result but not necessary? Like do you have to keep doing that to get the decade-long benefit? I don't know the answer, but I agree that like

if you can maintain muscle mass and you can maintain peak aerobic performance, it doesn't even matter at that point if you're living longer. You're clearly living better. If you don't budge anything on maximum lifespan, you've dramatically improved median lifespan. Right. For most people, that's what matters. It is. For me, it is. What's the maximum lifespan that a human's lived 120? 124 or something like that?

Is it 124? 121 or 124 maybe? I feel like that, yeah. Living beyond that, I mean, that's, I think the goal is really to, at least for me, I think that's a lot more achievable is increasing my median health span, my health span, you know, so basically preventing,

staving off cardiovascular disease, cancer, Alzheimer's disease, those sorts of things, so that I'm living healthier. And also, you know, a little bit longer, but obviously not 125 or six years. Yeah. I hope you enjoyed today's quality. Now sit tight for that legal disclaimer. This podcast is for general informational purposes only does not constitute the practice of medicine, nursing or other professional healthcare services, including the giving of medical advice. And note, no doctor-patient relationship is formed.

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