Longevity

From the Annals of Good Questions

© Photo by Daniel Cohen

The other day a patient asked me what I think about Peter Attia, the longevity guru, podcaster, internet celebrity, darling of Silicon Valley, and bestselling author of the book, Outlive. Since my patient had a traditional Jewish background, I took the liberty of using a little Yiddish in my response.

Half is common sense, I said, the other half is bitul Torah.

Bitul Torah is a great expression. The literal translation is, nullification of Torah. Colloquially, it means wasted time - time that could have been better spent doing something else - something more useful, productive, and worthwhile.

The common sense half of Peter Attia is the obvious stuff that has been proven - overwhelmingly and beyond a shadow of a doubt - to increase health, wellness, and longevity. Let’s call these the four noble truths - noble because they are backed by science, truths because they are true.

I’m sure you could list them without me, but here they are: diet, exercise, sleep, and… this one may not be on the tip of everyone’s tongue, social engagement.

Diet means whole, unprocessed food, mostly plants. Exercise means activity involving some mix of strength, endurance, flexibility, and agility. Sleep means 7 hours a night. And social engagement means interacting with a range of people in a meaningful way.

I’ve devoted blogs to each of these areas so I’m not going to go into more detail here - except to say that every little bit counts, and don’t let the great be the enemy of the good.

The bitul Torah half of Peter Attia (and by “half” I’m underestimating) is all the rest of it - the vitamins, and minerals, and potions, and creams, and hormones, and all the exotic practices you encounter when you venture down the rabbit hole of “longevity” on the internet.

Some are off-label medications like metformin, statins, ezetimide, rapamycin, naltrexone, testosterone, thyroid hormone, hyperbaric oxygen, aspirin, and now, microdosing glp1 agonists.

Others are OTC supplements like vitamin D, vitamin K2, magnesium, creatine monohydrate, omega-3 fatty acids (EPA/DHA), and exogenous ketones.

Others yet are tests like full-body MRI or sonogram, multiomic blood screening, and methylation age testing.

Still others are protocols like fecal transplants, cryotherapy, and Zone 2 training with Vo2 max testing - not to mention more outlandish practices like plasma exchange or heterochronic parabiosis (transfusing young blood into older organisms).

To be honest, I’m painting longevity with a pretty broad brush here.

And to be fair, Attia does his best to parse the evidence and doesn’t endorse it all.

And to be clear, many of these interventions - especially the medications - have on-label indications and off-label uses for which they have medically proven benefits (yes, including fecal transplants!).

Nevertheless, the one thing they all have in common is this: when it comes to simple wellness and longevity, we don’t know if they work, and even if they do, the benefits appear to be marginal at best.

So what do I think of Peter Attia? I think if you’re not already doing the common sense stuff - diet, exercise, sleep, and social engagement - then do that instead and don’t bother with Attia.

And if you are already doing the common sense stuff, then good for you! Now go do something else - something better than Attia, less dubious, more real.

Studying Torah not for you? How about this poem, by Charles Simic (I always recommend to read a poem out loud):

"Couple at Coney Island"

It was early one Sunday morning,
So we put on our best rags
And went for a stroll along the boardwalk
Till we came to a kind of palace
With turrets and pennants flying.
It made me think of a wedding cake
In the window of a fancy bakery shop.

I was warm, so I took my jacket off
And put my arm round your waist
And drew you closer to me
While you leaned your head on my shoulder.
Anyone could see we'd made love
The night before and were still giddy on our feet.
We looked naked in our clothes

Staring at the red and white pennants
Whipped by the sea wind.
The rides and shooting galleries
With their ducks marching in line
Still boarded up and padlocked.
No one around yet to take our first dime.

Spend a day like that. Or record a memory like that. Or even just read a poem like that. Focus more on how to live than how to stay alive.