Heart Of Darkness Analysis Chapter 1
Maryanna Vernia
For those who either do not like to read, are intimidated by the technical aspects of the topic, or merely time-starved, here is an overview and summary of key nuggets of the book along with some personal points as well.
Longevity thinking also needs to start early - like in your twenties, if not sooner. As a fifty-three year old, I feel the downward slope of biological function! So, what's your plan for bending the healthspan curve for cognitive & physical function and emotional health? What are your Objectives, Strategies, and Tactics? A hint: do the key lifestyle factors brutally well and consistently.
In terms of the science, unfortunately there are no long-term RCTs (randomized clinical trials) incorporating all of the key lifestyle factors that examine the prevention of chronic disease/expanding healthspan. Instead, we need to rely on studies of centenarians, animal models, human studies of risk factors, mechanistic studies of disease, etc.
So, how can we have absolute certainty? Attia writes "living systems are messy and confounding and complex ... the best we can hope for is reducing our uncertainty .. and think in terms of probabilities and risk."
What makes a centenarian? Is it in the genes? a healthy lifestyle? Several researchers are engaged with this question including The New England Centenarians Study, the largest and most comprehensive study of centenarians and their families in the world!
Get a handle on glucose metabolism probably going beyond fasting glucose; what is your A1C (90-day glucose), how does your body respond to eating/exercise/stress? Get an oral glucose tolerance test or try continuous glucose monitoring (CGM) if possible.
The human genome of our ancestral hunter-gatherer was not intended for our contemporary toxic built environment where our genes no longer match the environment. Therefore, we must be cunning with our tactics to adapt & thrive in this new & hazardous environment.
Similar to evaluating your nutrition, physical activity, body composition, and CVD risk factors, you should assess and monitor your sleep. Several commercial devices, wearable technology and beds, are available - some better than others.
In past posts, I\u2019ve mentioned Peter Attia, MD. And I\u2019ll state it again that I am so glad that I finally tuned into his podcast The Drive about 6 months ago. Despite being a guest on several podcasts myself, I actually never listen to them\u2026. until one of my inner circle friends kept urging me to give this one a listen. He knows me well - curious, evidence-based and interested in the science and art of health, fitness, functional capacity and wellness \u2026. so Peter Attia and The Drive was an excellent choice.
In late March, Attia published his first book - Outlive: The Science & Art of Longevity which largely reflects the podcast. Both the podcast and the book can get fairly technical. I\u2019ve had graduate coursework in biochemistry, human physiology, epidemiology, etc. and still find myself re-winding or re-reading \u2026 and still this sometimes is not enough as I need to search other elementary sources to try to learn and figure things out. Nonetheless, in my opinion, Attia along with Bill Gifford, do an excellent job of storytelling and translating research, science and medicine. If you are scientifically literate and/or curious and growth mindset, and interested in the science and art of living well, this is a good read.
Books tell a story - from cover to cover - chapter 1 to the final sentence. As Seinfeld\u2019s George Costanza once declared \u201CI\u2019m going to a read a book - from start to finish - and in that order.\u201D Well, sometimes I have a bit different sequence than the author had in mind. In this book, I start with the Intro chapters and then cover the chapters on Centenarians and Heart Disease (1 of the Four Horsemen) before grouping the chapters on Nutrition and Exercise, and then finally covering Sleep and Emotional Health.
When I think about lifespan, I start with the end in mind. What\u2019s my expiration date? And how do I get there via quality years of life. How do I play the long game? As Attia likes to say - healthspan instead of lifespan.
Many chronic diseases like type 2 diabetes, atherosclerotic cardiovascular disease, cancer, and Alzheimer\u2019s Disease (which Attia refers to as the \u2018Four Horsemen\u2019) are quite prevalent in contemporary societies. One important point that Attia makes is that they should not be thought of as \u2018binary\u2019 like a cold (you have it or you don\u2019t). Instead, they operate along a continuum. Indeed, there are several more people on the brink of diagnosis - a clinical cutpoint like a line in the sand - and in today's unhealthy society, being on this side of the line - normal or average - is not necessarily the same as optimal. And herein lies the issue with modern medicine and even \u201Cpreventive\u201D medicine. Instead, we should be seeking proactive medicine, or what Attia has termed \u2018Medicine 3.0\u2019. In Medicine 3.0, the major tenets are:
So, how can we have absolute certainty? Attia writes \\\"living systems are messy and confounding and complex ... the best we can hope for is reducing our uncertainty .. and think in terms of probabilities and risk.\\\"
100 years. 36,500 days. A modern-day centenarian would have been born in 1923. It\u2019s the Roaring Twenties and Prohibition is in order. Yankee Stadium opens and Babe Ruth wins his first MVP award. This person will graduate high school amidst World War II.
There are a few candidate genes for longevity, but no perfect centenarian genome. In terms of lifestyle, well\u2026 some drink excessively, smoke, eat poorly \u2026. but it appears the key is resiliency.
The statistics for heart disease morbidity and mortality are alarming. Here\u2019s one - in the United States, someone has a heart attack every 40 seconds - and a link to the 2022 Heart Disease & Stroke Statistical Update Fact Sheet Global Burden of Disease for those who want to explore more.
Given the rate of obesity or overfatness in many Americans and others around the World, caloric overload is an important issue. Obesity, and specifically central or truncal obesity, is linked to high blood pressure, cholesterol, and glucose and what is called the Metabolic Syndrome. However, it\u2019s just not obese individuals that have health issues as 22% of non-obese people meet criteria for the Metabolic Syndrome. Think about that - outward bodily appearance or physique is not everything! They are the \u201Cskinny\u201D metabolically unhealthy. They also likely suffer from low muscle mass.
Attia writes \u201C\u2026the logical first step in our quest to delay death is to get our metabolic house in order.\u201D A major culprit is fructose, especially sugar-sweetened beverages. Consumption of fructose leads to dysfunctional metabolism via abnormal insulin response to feeding which leads to insulin resistance and fatty liver and ultimately elevated glucose levels and the diagnosis of type 2 diabetes, which in turn increases the risk of CVD (6x), cancer (12x), and Alzheimer\u2019s disease (5x). Metabolism matters!
Nutrition 3.0 is based on data and feedback instead of labels, trends, and dogmatic ideology. Attia stresses that in general, diet and nutrition are poorly understood by science .. and definitely muddled by misinformation. He advises to \u201Cthink instead of figuring out what works for your body (your nutritional biochemistry) and goals and what you can stick with.\u201D
As an exercise scientist, I want to thank Peter Attia for promoting \u2018Exercise is Medicine\u2019. Indeed, it\u2019s a polypill and Attia is adamant about this statement as I\u2019ve heard him state it several times on the podcast.
The Standard American Diet (SAD) is pretty sad and pathetic \u2026. but so are our movement habits. 47% of U.S. adults meet the aerobic physical activity guidelines (150 minutes of moderate-intensity physical activity per week) and even fewer lift heavy shit and do resistance training. In combination, only 24% meet both aerobic and strength training recommendations.
Here\u2019s the good news: a little goes a long ways. Moving from being a couch potato to just doing a little reduces the risk for morbidity and mortality. It's obvious that exercise is good for you .... that's not the revelation; what's amazing is the MAGNITUDE of the ASSOCIATION/EFFECT on health outcomes. In a side-by-side comparison of exercise vs. drug trials, exercise trials perform as well or better than drug interventions for CVD, diabetes, and stroke outcomes. Exercise IS medicine!