Health and Longevity with Dr. Peter Attia

What would you change in your life if you could live forever?

Ok, let’s be realistic. Not forever. But what about an extra five years? Ten years? Or how far would you go to ensure you would be healthy and vibrant until the day you die? That is the science of longevity. The inexact science I should add.

Starting as a cancer surgeon and researcher, Dr. Peter Attia would never have predicted where his professional career would lead.

After all, surgery is possibly the ultimate medical field for immediate satisfaction. See the disease, feel the disease with your own hands, and remove the disease.

Longevity, on the other hand, is the opposite of immediate satisfaction. You never really know if you got it right. It’s educated guessing at best.

So, why would someone change from specializing in surgery to specializing in longevity?

That is just one of the many fascinating aspects of Dr. Peter Attia.

One thing is clear about Peter. Whatever he does, he goes all-in. Whether it is endurance swimming, endurance cycling, or finding the keys to longevity, Peter wants to know it all and wants to know it now. It is this approach that has helped Peter position himself at the cutting edge of longevity research and practice.

In a field with hundreds if not thousands of unanswered questions, Peter is doing his best to answer them. Whether it is a ketogenic diet, cyclical fasting, weight lifting, sleep patterns, drugs like metformin, and more, Peter has experimented with himself and his patients in his quest for answers. His new podcast, Peter Attia’s Drive is a showcase of his experience and features some of the luminaries in the world of health and wellness. As such, it has quickly become one of the most detailed and educational podcasts around.

As a doctor with a keen interest in longevity myself, I welcome Peter’s philosophy and the intensity with which he approaches the field. Let’s be honest. Longevity practice is hard! Trying to get people to alter their habits for a potential benefit decades down the road is no easy task. We live in a society where we want immediate feedback and immediate results. Delayed gratification does not seem to be in our nature.

Part of the challenge, therefore, is knowing what markers to follow in the short term that will lead to success in the long term. Test, re-test, change the intervention, and then test again. Rinse and repeat. That is the pattern of longevity practice. Peter is on a mission to perfect that science for each individual patient he sees.

I am on a mission to help disseminate that information to the masses so we can all find out an individual path to health and wellness. And that is why I am grateful to have had the opportunity to interview Peter for the Diet Doctor Podcast With Dr. Bret Scher. I just wish I had a few more hours to explore more topics in more details! Hopefully we will have the chance for part two in the future. For now, we have a one hour engaging and open discussion that is the perfect interview for episode number two of the Diet Doctor Podcast.

Enjoy!

Bret Scher, MD FACC
www.lowcarbcardiologist.com

Why a Fasting Mimicking Diet (FMD) is the Key to Longevity

 

I found it! I found the one thing vegans, vegetarians, carnivores, paleo and keto enthusiasts can all agree with.

 

Fasting is possibly the most important intervention for longevity.  The science supports it, and now it is gaining popularity among the masses.

 

Yet the question remains, how do we best accomplish fasting? What’s the best duration, frequency, and does it have to be a complete water fast? Or can it be a calorie restricted fasting mimicking diet (FMD)?

 

Just when I thought I found a consensus; the details rear their ugly heads to divide us once again. But there is hope! The hope comes from realizing that there is more than one way to accomplish a goal.

 

Health Benefits of Long Term Calorie Restriction

Some would say you can accomplish the key to longevity with drugs like metformin, others say time restricted eating is the way to go. All of those have tremendous potential, but when it comes to science backed interventions, longer term calorie restriction takes the cake (sorry for the pun).

 

Even though it is challenging to perform, long term trials with calories restriction in humans, the consensus is clear- some version of calorie restriction helps us live healthier. Calorie restriction increases autophagy, lowers stimulation of key nutrient sensors and growth factors like IGF-1, mtorc1 and AMPK, improves insulin and glucose sensitivity, and more.

 

But who wants to live their life restricting their calories all the time? That is a miserable way to live. Therein lies the power of intermittent fasting. We don’t have the exact methodology down to a science, but it seems that a five day fast 2-3 times per year can have significant health benefits. Now that is something people can do without being miserable!

 

Making Fasting Easy

 

Even then, however, fasting is challenging. Personally, I have a hard time getting past day 3 in a water-only fast and have noticed the same in a number of my Boundless Health Program clients. Then I found the Fasting Mimicking Diet from L-Nutra.

 

They made fasting easy (at least easier)! In brief, for $250 they send you five boxes each with everything you will eat for the day. Day 1 is about 1,000 calories and days 2-5 are around 700 calories. It is a mix of bars, soups, olives, crackers and a glycerin-based drink in addition to a daily vitamin supplement. It is all veggie and nut based, low protein, and fairly palatable as far as processed and packaged “food” goes.

 

And here is the best part. It is backed by research. Valter Longo, one of the world’s leading longevity researchers, happens to be one of the company cofounders.  They have peer-reviewed studies demonstrating decreased IGF-1, improved insulin sensitivity, improved CVD risk factors, and possibly the biggest benefit of all with improved stem cell regeneration.

 

Science backed, convenient, and potential for improved longevity? I was sold and knew I had to try it. Here are some of my take home lessons from the Five-Day Fasting Mimicking Diet.

 

General FMD Takeaways

 

  • Overall I had a positive experience, but I am quick to admit that this isn’t the “best” way to fast. If you can safely do a water only fast for five days, go for it! It’s much cheaper and has all the benefits without any question. Just make sure you are doing it safely, preferably under the guidance of your healthcare provider or experts such as those at IDMProgram.com.
  • You can do your own fasting mimicking diet. I didn’t love how the food was processed, packaged food-like-products. In fact, it freaked out my kids that I was eating packaged food from a box. They have probably never seen me do that before, and they have heard me denounce such fake food for years. You should have seen their faces when I sat down to dinner with my box of “food”! If you have the time and energy, you could likely recreate this program with real food.
  • ProlonMD is the most convenient way to go. Once I got past the processed nature of it, I realized: What could be easier than simply opening the box and knowing exactly what you are eating for the day? No preparing, no planning, no shopping.  This is the biggest benefit to L-Nutra’s program. I loved the convenience. It made it easy to stick with and easy to implement.

 

Day-By-Day Thoughts

 

  • Day one was a breeze. The novelty, the excitement of the experiment, plus 1,000 calories made it easy with minimal hunger or cravings. The bar is tasty (although a little sweet for me), I love the olives, the soups are palatable, and the kale crackers are pretty tasty too.
  • Day two was still pretty easy. The novelty was still there, hunger increased a little but was completely manageable. Since I had started already in ketosis, I found I quickly went deeper into ketosis and noticed improved focus and thinking, and my energy level was still great. Plus, I slept much deeper starting day two.
  • Day three was the toughest. Just as it is for me with water fasts, day three is the big hurdle. But it was a much smaller hurdle since I still had some calorie intake.  The novelty was wearing off at this point and I was tiring of the processed food. Watching my family eat scrambled eggs, veggies and avocado for dinner made me crave real food! I knew for maximal benefit I had to charge through, and thus I was motivated to continue.
  • Day four was pretty easy once again. I was deeper in ketosis, my hunger abated, and I knew the toughest part was behind me.  I even went to the gym and felt pretty good lifting (at about 80% intensity).
  • Day five was again easy during the day, but that evening I was done. It wasn’t that I was overly hungry or tired, I just missed real food! Watching my family eat real veggies, real salmon, real avocado, real nuts… I didn’t want to do it any longer!!! But I only had 12 hours to go so I hung in there.
  • Day six was the refeeding day, and I took it easy and gradual and had no trouble. I did try to go for a mountain bike ride with my usual weekend crew and they kicked my tail feathers! They all thought I was crazy to come out considering my caloric restriction, and they were right. But I am glad I tried, and I’ll be back next week to show them who is boss!

 

Specific Thoughts:

  • We have a complicated relationship with food- The taste, the texture, the enjoyment, the anticipation, and the disappointment are such strong feelings and connect to so many emotions. It’s clear that what we eat is only part of the equation. Why we eat is a much stronger and more difficult issue to understand. I am a big proponent of everyone doing a five day fast or FMD simply for the psychological awareness that results.
  • Our portion sizes are out of control- Really! They are seriously out of control. I pride myself in having already known that and taken steps to make sure my portion sizes are controlled. But eating the tiny portions in the FMD and not being that hungry when I was done brought this in to a whole new light. I have heard it and said it many times. We should eat until we are 80% full and then stop. After doing the FMD, I think we should stop when 60% full. I know that is near impossible to feel and measure, but the point is the same. We need to drastically cut our portion sizes down, get rid of the multiple serving buffet, and understand that we will be just fine with the smaller portions.
  • Hunger is relative- Anyone who practices time restricted eating and short fasts knows that hunger is a feeling we can easily tolerate. Five days of calorie restriction highlights that point even more.  We don’t need to reach for snacks every time we feel a pang of hunger. Rather, we can still perform at high mental levels despite mild hunger.
  • Ketosis is awesome– I have been in ketosis for the better part of a few years, and consistently in ketosis for at least six months, so I went into this experiment thinking I would not get much benefit from the ketosis part of the FMD. But the FMD brought me even further into ketosis, to levels I haven’t achieved on my own. And I felt it. I was hyper-focused, I slept like a baby, and I simply felt sharper.  That has encouraged me to find ways to intermittently go deeper into ketosis to get those benefits on a more regular basis.
  • Athletic performance is better than therapy– The one part that kind of stunk with the calorie restriction was the hit my athletic performance took. The humbling mountain bike ride with my friends was a stark reality check. It was completely expected, but it still hurt. It highlighted for me the psychological importance of feeling great, performing well, and pushing my physical limits. It’s better than therapy. I love it. I thrive off it. And I hate it when I don’t get it. I am now more thankful than ever for my physical abilities, and you can bet I am going to kick @$$ next time I ride with my buddies. They better watch out (I hope they don’t read this)!
  • We can do anything when there is a clear start and stop day– Overall the fasting mimicking diet was not that difficult. That being said, there were definitely a few tough times when I wanted to break it. Knowing that it would only last five days, and I only had to do it 2-3 times per year made it much easier to tolerate. Temporary pain is much easier than pain without an end.

 

Have you tried a fasting mimicking diet? If so, please comment with your experience and what your protocol was. I am searching for the most convenient way to help my Boundless Health Program clients succeed with their intermittent fasts and experience the biggest benefit. The ProlonMD FMD is one easy way to do this, but it is not the only way to do it.

 

Thanks for reading.

Bret Scher, MD FACC

www.LowCarbCardiologist.com

 

 

5 Reasons We All Should Fast, and 1 Reason Why We Shouldn’t

I wanted to write this article to address a question I hear often:

Do I need to Fast to Be Healthy?

 

In short, probably. But what exactly does that mean?

 

Thanks in large part to Dr. Jason Fung and others, intermittent fasting (IF) has emerged from the shadows of the health movement to now being discussed every day on social media, as if we have been doing it for decades.

 

And here’s the secret: We actually have been doing it for decades. In reality, it’s more like centuries.

 

Think of how we evolved. There wasn’t a convenience store, grocery store, restaurant, or fast food joint on every corner.  We had to hunt and forage for our food. That took time and was sometimes unsuccessful. The natural result, therefore was periods of eating interspersed with periods of fasting.

 

Modern society is a far cry from that evolutionary period, as we now have a 24/7 eating cycle with late night taco runs, vending machines and snacks available at a moment’s notice, and misguided advice that we need to eat every two hours to stimulate our metabolism and lose weight (awful advice with no scientific backing, mostly promoted by snack food companies).  We have plenty of reason to believe this constant eating cycle has contributed to our current obesity/diabetes/insulin resistance epidemic.

 

The good news is that we can reverse that trend. We can reverse it by bringing back fasts.

 

What exactly is fasting?

 

First we need to define what fasting means, and what time restricted eating means. Time Restricted Eating (TRE), means eating only in a specific time window, and not eating the rest of the day. For instance 18:6 means not eating for 18 hours straight, then eating over a 6-hour period. This can be 12:12, 16:8, 18:6 or even 22:2. They key is that you have an extended period of time each day when you are not consuming calories.

 

More extensive fasts, 24-72 hours or even longer, are really what we refer to when we say intermittent fasting. For this explanation, I will refer to extended fasts and TRE together as they have similar benefits. I will explore the differences and go into more scientific detail in a future post.

 

Here are the top 5 reasons we should all fast

 

1.    Fasting is the most efficient way to lose weight.

 

Forget the fat burning foods, forget the cleanses and detoxes. Not eating is the key to losing weight. But do it intermittently. That’s why it’s called intermittent fasting. Chronic calorie restriction doesn’t work long term since it forces our bodies to reduce our resting metabolic rate (RMR), thus stalling weight loss and increasing frustration. Intermittent calorie restriction, on the other hand, allows for weight loss without changing our RMR, the key to healthy and successful long-term weight loss.

 

2.    IF is a great way to lower insulin.

It just makes sense. If there is no food coming in, there is no need for insulin to rise. Insulin will stay at its low steady basal rate, and there will be no elevations or spikes. That keeps the area under the curve low, right where we want it. Low insulin means we can mobilize our fat stores, and possibly more importantly, it protects us from the harmful long-term effects of hyperinsulinemia.

 

3.    Intermittent Fasting is the key to longevity.

The one consistent finding in longevity research, from single cell organisms up to primates, is that calorie restriction works. But as we have learned from chronic calorie restriction experiments in humans, it’s not so clear cut. First, its miserable and most people would rather die younger that live longer with chronic calorie restriction. Agree?

 

Second, our bodies adapt to chronic calorie restriction and thus make it difficult to maintain the health benefits. Intermittent calorie restriction, on the other hand, has the promise of all the longevity benefits without all the baggage that comes with it. The fountain of youth only helps if we like how it tastes.

 

4.    It’s easy!

What’s easier than skipping breakfast? No planning, no shopping, no cooking, no cleaning. Simply walk out the door.  In our hectic everyday lives, we should welcome anything that takes less time and makes our lives a little easier. Fasting does exactly that. Just make sure you bring a water bottle with you wherever you go, and maybe some sea salt to put in your water. Stay well hydrated and enjoy the simplicity.

 

5.    There are many ways to make fasting work for you.

 There is more than one way to have a successful fast. As mentioned previously, 18:6 can work wonders for most people. For those who are more adventurous, a 72-hour water fast can have amazing results. And there is everything in between. Just follow the simple rules of staying hydrated, paying attention to how you feel, avoiding anything with calories, and even avoiding calorie-free sweeteners. The rest of the details can be individualized to fit your life and your goals.

 

The Top Reason Why You shouldn’t fast

 

Fasting can work wonders for most people, but it can also be dangerous for others. If you take medications for diabetes, hypertension or other medical conditions and you're trying to fast on your own, don’t do it! Fasting can cause significant harm in these circumstances if not done with proper precaution. That doesn’t mean it can’t be done. In fact, it can still be incredibly beneficial. Just make sure you are working with an experienced clinician who can help coach you through it safely.

 

Here’s one last bonus tip.

 

Don’t give in to temptation once the fast is over.

 

How you break your fast can be just as important as how you fast.

 

  1. Break the fast with a small low carb snack such as bone broth
  2. Have your first meal an hour or two after your snack
  3. Resist the urge to “reward” yourself with high carb foods or junk food. Your gastrointestinal system isn’t ready for that. Plus, why work so hard to keep insulin low if you are just going to spike it when you are done? Stick to your usual, healthy, high quality low-carb fare.
  4. Resist the urge to increase your calorie intake to “make up” for the fast. If anything, the first 12 hours should have fewer calories than your usual eating pattern, slowly returning to normal (not supra-normal) over the next 24 hours.

 

Pretty easy, right? I am a big fan of simple, safe and effective. When done right, intermittent fasting hits all three criteria.

 

Is intermittent fasting right for you? It may just be. Talk to your health care provider to find out more, or sign up for a one-on-one consultation with to me where we can explore the details of your health journey and come up with a detailed, individualized plan to help you reach Your Best Health Ever!

 

Thanks for reading,

Bret Scher, MD FACC

Founder, Boundless Health

www.LowCarbCardiologist.com

 

 

 

Is the Keto Diet Heart Healthy? 7 Reasons Why This Cardiologist Agrees

Is the Keto Diet Heart Healthy? 7 Reasons Why This Cardiologist Agrees

 

I am a board certified, card-carrying cardiologist, and I want my clients to eat more fat, more meat, more cheese, more eggs, more avocado, more, more, more.

 

For decades medical establishments have convinced us to eat low fat, higher carb diets. How has that worked for our health? Here’s a hint, we have record numbers of obesity, diabetes and dementia. Yet, as a cardiologist, that’s the party line I am supposed to support.

 

But I can’t. It’s just wrong, and I can’t support that line of thinking, not for a second.

 

Instead, I am a Low Carb Cardiologist. Here are the top Seven reasons why

 

 

              1-  Reducing Insulin is Essential to Health and Weight Loss.

 

Insulin is a hormone naturally secreted by the pancreas to help regulate blood sugar levels. Everything we eat (except possibly for 100% fat meals) causes insulin to rise. That is normal physiology. The problem occurs when our bodies become resistant to the effects of insulin, thus requiring our pancreas to make more and more and more insulin.

 

The problem? Insulin promotes fat storage, increase inflammation and oxidation, and can even help fuel the growth of cancer cells. Therefore, the healthiest approach is one which reduced the level of insulin to the lowest possible levels. As it happens, a Low-carb High-fat or ketogenic lifestyle (LCHF/Keto lifestyle) dramatically improves your body’s sensitivity to insulin, reduces the amount of insulin secreted, and it allows your body to naturally use your fat stores for what they are designed for: Break them down into energy! Once we see that we need to fight chronic elevations of insulin, it becomes obvious why a low-fat diet is harmful, and why a low carb diet is the true path to health.

 

2-    Eating Fat Improves Your Cholesterol!

 

Wait, what? Eating fat can improve my cholesterol? Sounds crazy, right? That goes against everything we have heard from the medical establishment. Notice I said “cholesterol.” I didn’t say the "bad" low density lipoprotein (LDL), I didn’t say the "good" high density lipoprotein (HDL), or any one specific type of cholesterol. We have over emphasized the solitary variable of LDL for too long. Total cholesterol to HDL ratio, Triglyceride to HDL ratio, lipoprotein size and density, insulin sensitivity, and other metabolic measures are more powerful predictors of cardiovascular health than just LDL.

 

Once again, we see that all these markers improve with a Low Carb High Fat (LCHF) lifestyle. The medical establishment needs to realize that we are more complicated than one lab value. The key is to look at the whole picture, and this picture dramatically improves with a LCHF lifestyle.

 

3-    Higher HDL is Associated with a Lower Risk of Heart Disease.

 

HDL is your friend, but drugs are not. Observational evidence has consistently shown that higher HDL is associated with a lower risk of cardiovascular disease. However, our healthcare establishment does not prioritize HDL for one simple reason- Drugs that raise HDL don’t make you healthier. Trial after trial has failed to show any benefit from drugs that significantly increase HDL. 

 

Instead, it’s the HDL-raising lifestyle that provides the benefit, not artificially increasing it with drugs. What’s the best lifestyle to naturally raise HDL? You guessed it. LCHF/Keto lifestyle. Add in some resistance training and you have your friendly HDL climbing the way it was meant to…Naturally.

 

4-    LCHF Leaves You Feeling Great, Leading to Healthier Decisions

 

What kind of health decisions do you make when you are fatigued, achy, and find it difficult to concentrate? That’s a rhetorical question, I already know the answer. When things look glum and we don’t feel well, it's far too easy to sit on the couch or reach for the chips and cookies. Compare those decisions to those you make when you are well rested, energetic, and seeing the world more clearly. For most people, the better you feel, the better decisions you make.

 

Guess what? The majority of people who change to a LCHF lifestyle feel better! It may take a few days or weeks, but in general, they feel more in control of their health, more energetic, and they are able to make better health decisions. I admit this is difficult to prove in a scientific trial. That is why we all should become our own n=1 scientific trial. How do you feel and how are your health decisions after going to a LCHF lifestyle? What matters most is what works for you, not what works for hundreds of people who are kinda-sorta like you.

 

      5-    Keto helps you with fasting.

 

Eating better helps you not eat. People who eat a high carb diet eat a lot, don’t they? They are always grazing and snacking. Our bodies go through the roller coaster of blood sugar and insulin spikes, making it a challenge to go 24, 18, or even 6 hours without eating. This creates a constant, unwavering supply of insulin in our blood stream.

 

Why is this harmful? For one, it promotes fat storage and keeps us from using our fat as fuel. Secondly, chronically elevated insulin can predispose to heart disease, strokes, cancer, dementia and other devastating health conditions. When people change to Keto, however, they realize they do not need to eat nearly as much or as frequently. Avoiding the carbs and increasing the fats keeps us full longer, and our bodies quickly adapt to longer periods without eating. The result? We can use our fat stores for what they were designed- a source of fuel! It also allows our body to maintain lower insulin levels, and also allows our cells to take care of their health chores, referred to as…..

 

6-    LCHF Promotes Health Through Increased Autophagy.

 

Autopha-What? In medicine we like using fancy words to make us look smart. Autophagy is a big word to describe cellular housekeeping. When we have low enough intake of carbs and protein, or when we do intermittent fasts, our bodies can take care of their “to do” lists.  That list includes breaking down weak or damaged cells, recycling the good parts and discarding the rest, and slowing down the processes that can lead to abnormal cell growth (i.e. excess proteins in Alzheimer’s disease, abnormal cancer cells etc.).

 

Admittedly, long term outcome studies evaluating fasting or LCHF and cancer or dementia risk have not been done. But, on the flip side, drug trials to prevent the same are showing no benefit despite hundreds of millions of dollars invested. If you asked me (which you sort of did since you are reading my article), I’d vote for autophagy as a preventative strategy any day. It makes good physiologic sense, and it is so easy to achieve.

 

7-    With Keto You Will Enjoy Eating Again!

 

That’s right. A way of eating that helps you lose weight, helps you feel better, improves your health and is actually enjoyable! No fake processed soy products, no cardboard tasting rice cakes. True, it also means no more candy, processed snack foods, doughnuts and danishes. But once you swear them off for a few weeks, and you are eating all the eggs, avocados, nuts, fish, steak, cheese etc. that you want, you won’t miss those old crutches any more. Let the enjoyment begin!

I could go on, but since it seems people like “7 Reason” articles, I will leave it at that. 

 

Now you know the secret: Look at the whole picture. Look for a lifestyle, (not a diet) that helps you feel better, increases your enjoyment, and still benefits your overall health.

 

Is LCHF/Keto the right lifestyle for you? It just may be. It is for me, The Low Carb Cardiologist, and it is for most of my patients and clients. Want to learn more about how LCHF lifestyle impacts your health? Visit us at www.LowCarbCardiologist.com

 

Thanks for reading

 

Bret Scher, MD FACC

Founder, Boundless Health

www.LowCarbCardiologist.com

 

ADDENDUM!! Since I have published this article, there has been a windfall of media buzz around low carb diets increasing our risk of heart disease or diabetes. Let's look at where that information came from.

1- A study force feeding mice excessive amounts of industrial omega 6 oils. You can guess what I have to say about that. The article was incredibly helpful, and I immediately stopped force feeding my pet mice industrial seed oils. Thanks goodness for that article. As for how it applies to humans eating real food that contain fat, there is zero correlation. 

2- Epidemiological study suggesting those who ate low carb (40% calories from carbs, which by the way is NOT low carb) as measured by two food journals over 25 years had a higher risk of dying. Oh and by the way, at baseline they were heavier, more sedentary, smoked more, and ate fewer veggies. Yet somehow they concluded it must be the low carb diet that "caused" the harm. Once again, it may not be bad science, but it sure was awful interpretation of the science. 

In light of those two studies and the hoopla surrounding them, has anything happened to change my mind about a LCHF/keto diet being beneficial for our overall health and our heart health?

Absolutely not.

We still need to individualize our care and our lifestyle for who we are and how our bodies respond. That is always the case regardless of our nutrition, our medications, our exercise etc. As long as we do that, then this cardiologist still believes that LCHF IS HEART HEALTHY!

If you liked this post, you'll love my free E-Book on Low Carb/Keto Starter tips to help you get started on your LCHF path!

Thanks for reading. 

The Number One Secret to Living Forever!

OK, maybe not forever, but pretty darn long. Here is the secret to the fountain of youth.

 

Metformin.

 

Maybe.

 

Metformin is a common medication used to treat diabetes and has also been shown to decrease the cellular aging process in mice and other animals. Now it has been approved for human studies to see if it increases our longevity as well. If not, then we will just have a bunch of young mice running around as we continue to age away.

 

The longevity community is full of excitement that this may be the one drug that pans out and makes a real difference. Not just for the high-profile Silicon Valley CEOs who want to live forever, but for masses of people. The hope is that it will drastically delay the onset of cancer, cardiovascular disease and neurodegenerative diseases. We have been down this road before  with resveratrol, so many are tempering their enthusiasm.

 

But this time may be different! Or so we hope.

 

How Metformin Works

 

Metformin helps us lower our glucose production, keep our insulin levels low, and helps our cells respond better to insulin.

 

It works by activating an enzyme called AMP Kinase, which decreases glucose production in the liver. The key point is that it lowers glucose levels without increasing insulin.

 

Insulin is a fat storage and potentially pro-inflammatory hormone. It is also associated with an increase in insulin-like growth factor-1 (IGF1), which has been implicated in cancer promotion over the long term. Safely minimizing insulin, therefore, should have direct health and longevity benefits. 

 

Metformin has other actions that directly improve muscle cell sensitivity to insulin. This means our bodies require less insulin to provide us with energy, thus ultimately reducing insulin resistance.  In addition, metformin can potentially alter the oxygenation of cells, providing the right balance of oxygen to stave off cellular aging.

 

 

Why would this help us live longer?

 

Lower blood glucose and insulin levels mean lower risk for diabetes, cardiovascular disease, and probably neurodegenerative diseases like Parkinson’s and Alzheimer’s. That certainly seems like a reasonable goal.

 

In addition, lower insulin and lower insulin growth factor 1 (IGF1) could mean less risk of developing cancer. In fact, studies have shown that those who take metformin have a lower incidence of most cancers. This does not prove that metformin itself reduces cancers, but it certainly makes for an interesting hypothesis that deserves further investigation.

 

And of course, anything that can slow down cellular aging could be of great benefit for longevity.

 

We have plenty of data to suggest metformin might be a fountain of youth.  Now, we eagerly await the results of the randomized, prospective, placebo controlled trial. The pinnacle of scientific evidence.

 

In the meantime, what can we do to help us extend our lives?

 

What Else Has Shown Promise for Longevity?

 

For starters, don’t smoke. No brainer there.

 

Also, wear your seat belt.

 

Don’t text and drive.

 

Don’t drink and drive.

 

It may sound like glib advice, but if you want the biggest return on your longevity investment, start there.

 

Caloric restriction

 

As the saying goes, caloric restriction may not make you live longer, but it certainly makes your life feel much longer

 

Calorie restriction has different definitions, but in general it means cutting your caloric intake by 30-50% or down to about 1500 kcal per day while avoiding malnourishment. If you have tried this, it can be a challenge to do and remain a social being in modern day society.

 

If living longer means being hungry and grumpy all the time and not being able to socialize, then no thanks. I will pass. As will most of the Silicon Valley elite.

 

But what can we learn from why long term caloric restriction works?

 

It turns out, caloric restriction improves insulin sensitivity, sound familiar? It also reduces our metabolic rate and reduces oxidative stress.

 

Calorie restriction also reduces the activity of a compound called mTorc1. The long name for this compound is mammalian target of rapamycin complex 1. The drug rapamycin has been around for decades as an antifungal and anti-cancer drug, but has now become the new kid on the longevity block. Some believe that the right dosing of rapamycin and/or inhibition of mtorc1 could reduce cellular aging and delay age related diseases.

 

Interestingly, AMP Kinase (the same mechanism stimulated by metformin) also inhibits mTorc1. When mechanisms combine, that gets scientists really excited. And when scientists get really excited, watch out.

 

So, in the end, we want to reduce glucose levels while also keeping insulin and IGF1 levels low. We want to reduce oxidative stress. And we probably want to reduce mTorc1.

 

Metformin can do this. Calorie restriction can do this. Rapamycin might be able to do this.

 

We Don’t Need Drugs

 

But guess what?  We Don’t Need Drugs to do all that!

 

If you are sleeping 4 hours per night, you are stressed out, you eat low quality- high carb fast food, and you sit on your arse all day, do you think metformin will help you live longer? Sorry Charlie.

 

If we have any interest in living longer and living better, we all have to start with the basic and critical elements called lifestyle.

 

Consistent, restorative sleep improves your cortisol levels, thus improving your glucose and insulin levels.

 

Managing your stress likewise reduces your cortisol and adrenaline spikes, again maintaining lower average glucose and insulin levels.

 

High intensity exercise and resistance training increases our mitochondrial activity, which increases glucose utilization, thus decreasing serum glucose and insulin levels.

 

Then there is nutrition.

 

This is a big one, and potentially the topic that is more variable from person to person. The key is to eat the minimum number of calories needed for nourishment, while still allowing you to enjoy your life and thrive. Specifically, we need to choose food that will keep our average blood glucose and insulin levels as low as possible.

 

A few tricks to achieve that:

  1. Avoid/limit added sugars. Hopefully this is obvious to everyone at this point.
  2. Avoid/limit processed simple carbohydrates (white flour, packaged snack foods etc.).
  3. Make low starch veggies (like green leafy veggies, cauliflower, zucchini etc.) the focus of the majority of your meals.
  4. Liberally add healthy fats (nuts, avocado, olives and olive oil).
  5. Don’t overdo it on the proteins. We only need 0.36- 0.5 grams of protein per pound of ideal body weight each day. So, if you weigh 180lbs., you only need 65-90gm of protein per day. If you are overweight and weigh 250lbs (but your ideal body weight is around 180 pounds), you still only need a maximum of 90gm of protein per day. So, don’t worry too much about getting enough protein. Instead, make sure you are not eating too much.

 

Once you have implemented all those lifestyle factors, then and only then should you even start to think about the effects of metformin, rapamycin, or other fountain of youth drugs. The future may be promising for a quick fix to slow the aging process. But one thing will hold true for ever:

 

The best way to live better and live longer is to make your life worth living.

 

Live with a purpose.

 

Take care of yourself emotionally and physically.

 

Take care of others.

 

And don’t forget to take care of the earth as well. Our health may just depend on it.

 

 

Thanks for reading.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com 

3 Simple Breathing Techniques You Can Practice Anywhere

It doesn’t always take a vacation to a private island or a lavish spa day to get some relaxation time in. There are simple, quick techniques you can learn and incorporate into your everyday schedule to help ease that nagging tension and anxiety you might feel, and they take only take 5 minutes or less! Any time you might feel overwhelmed by an upcoming deadline at work or stressed out just coping with everyday tasks, you can try out any of these three breathing techniques. Find a quiet space wherever you are (even at work!) and try one of these out to help you feel more relaxed and ready to tackle the rest of your day. 

Belly Breathing 

Also known as diaphragmatic breathing, this technique requires you to focus on expanding your stomach, rather than your chest, as you take in each deep breath. 

1. Preferably lying on your back, place one hand over your stomach and another over your chest. 

2. Breathe in slowly through your nose and through your stomach so that you feel your stomach rise against your hand as your abdomen fills with air. 

3. Exhale completely and as you exhale through your nose, feel your stomach deflate to its neutral position. 

4. Repeat this process for 5-10 minutes, focusing on the sensation of your stomach rising and falling with each breath. 

The 4-7-8 Method

This exercise helps you breathe more deeply while putting your mind into a meditative state as you focus on counting the seconds during each breath in and out. 

1. Sit in a comfortable position and start by slowly inhaling through your nose on a count of 4 seconds.

2. After the fourth second, hold your breath for a count of 7 seconds*

3. After 7 seconds, exhale your breath for a count of 8 seconds. Repeat this exercise 3-4 times. 

*If 7 seconds feels too long, lower the count to a number of seconds that feels more comfortable for you. 

Progressive Relaxation

Your entire body will take a role in this breathing exercise as you coordinate each breath with the tensing and relaxing of your toes and feet all the way up to your shoulders and head. 

1. Lying or sitting, start by tensing the muscles in your feet as you breathe in through your nose. Hold the breath for a moment as you experience what the tension feels like in your feet and toes. 

2. As you relax your feet, release your breath and exhale through your nose. Take another moment to appreciate the feeling of your feet no longer tensing and contracting. 

3. Continue the process throughout your whole body, including your legs, abdomen, arms, hands, shoulders, jaw and eyes. 

4. Finish the exercise by tensing the entire body as you take a final deep breath in, and as you release your breath make sure to focus on the sensation of each muscle returning to a relaxed state. 

Taking the time to breathe deeply not only helps remind your brain to calm down but it can help remind you to be mindful and present in the moment.  Just by taking 5 to 10 minutes out of your day to try any of these breathing techniques you’ll notice a difference in how you cope with your stress, negative thoughts and the tension you’re holding in your body. Give it a try and let us know which one works best for you! 

Our Best Medicine- Pills Not Required

“Walking is man’s best medicine”- Hippocrates (Greek physician 460 BC-377BC). That is one of my favorite all-time quotes. I can’t say it enough or hear it enough. Hippocrates didn’t have scientific studies, he didn’t have fitness trackers, yet it was inherently obvious to him that physical activity and simply moving our bodies provided unparalleled physical and psychological benefits.

 

Combine that with more modern observations from Dan Buettner’s book The Blue Zones, and it becomes clear that regular physical activity is an essential key to our health and longevity. Mr. Buettner evaluated the most common personal habits in societies where they routinely live into their 90s and 100s. He found that they didn’t hit the gym every day, they didn’t train for marathons. They simply moved their bodies consistently. They worked in the garden, they walked to do their errands, they walked for social purposes.  They moved their bodies.

 

Don’t get me wrong. I am a big proponent of regular exercise, including high intensity interval training and resistance training (more on this in another post), but it is becoming clear that the basis for health is moving our bodies.  But why is this a challenge?

 

Technological Advances = Health Disintegration

 

Our society does not encourage regular physical activity. Most of us work desk jobs sitting in front of computers for hours at a time. We live as part of urban sprawl with longer commutes. And what minimal leisure time we have is spent on computers, tablets and video games. The days of centralized communities encouraging regular physical activity are largely gone.

 

This isn’t necessarily all bad. The technological advancements in the past few decades are unprecedented. It just hasn’t been good for our health. The priority has shifted. Now it’s time to shift it back!

 

It is time to re-examine all our unconscious habits. Why do we automatically go to the elevator or escalator? Why do we instinctively look for the closest parking spot? Why do we automatically sit on the couch instead of going outside for a walk?

 

Don’t just read these questions and keep going. Stop. Think. Answer the questions in your mind and resolve to re-examine those reasons and change them! Look at your daily habits and find places to purposely add more physical activity.

 

As I frequently say, you don’t have to try to be perfect. Just try to be better. If you can change one unconscious habit today that helps you move your body more, then you have a major success. If you can change another one tomorrow…even better!

 

Activity Trackers

 

My advice: Get an activity tracker and use it!

“But wait! Didn’t I just read a story about activity trackers being useless? Doesn’t that mean being active isn’t helpful?” I’m glad you asked.

 

There was a study in JAMA that asked a specific question: When it comes to weight loss, is a simple pedometer better than a program with regular encounters and encouragement from research staff? The answer, not surprisingly, was no (read a more detailed analysis of this study here).

 

Regular human interaction and encouragement is one of the most important factors when it comes to successful lifestyle changes. In this study, those in the activity tracker group didn’t have that interaction. It’s no surprise that they didn’t fare as well.

 

It is important to realize that activity trackers are one part of an overall health program. They are not an end-all tool for weight loss. And remember, weight loss is not the best marker for health. Healthy habits themselves should be the goal, the weight loss will follow.

 

So, don’t throw out your Fitbit, Jawbone or Apple watch just yet. When used correctly, activity monitors are a powerful tool to get you moving.

 

You may feel like you did a good job being active today. But then you glance down at your wrist and see a measly 4000 steps for the day. Now you know it is time to get moving. You can’t talk your way out of that one!

 

Or you may notice you hit your 10,000 steps and you are feeling good about yourself. You log in to the computer and see your good friend is already at 12,000 steps today. Time to put down your remote control and get another 2,001 steps in just to show him that you can!

 

That’s the power of activity monitors. Objective motivation day after day. Get one. Use it. Listen to the motivation.

 

Exercise Lowers Risk of Death

 

Ok. So, it’s well established that being consistently physically active is important for our health. But what about exercise? Aside from being physically active, how much exercise should we try to get?

 

It turns out, we don’t need that much to save our life.

 

A 2015 study in JAMA followed 661,000 Middle Aged adults over 14 years. They found the highest risk of death in those who did not exercise at all. Even a “little amount” of exercise (less than the official guidelines but more than no exercise) reduced the risk of death by 20%. The benefit continued to increase linearly with increasing exercise duration until it plateaued at 450 min per week.  The following table summarizes the results.

 

Amount of exercise per week

Cardiovascular/Mortality result

Sedentary

Highest mortality and cardiovascular risk

Less than 150min

Reduced death by 20% over sedentary

150 min

Reduced death by 31%

450 min

Reduced death by 39%

More than 450 min

No additional benefit, but no increased harm either

 

In addition, the Copenhagen City Heart Study  showed that “light” running, even just 20-minutes once per week, resulted in reduced risk of death. The maximal benefit was in those who jogged at a slow or average pace between 1-2.5 hours per week.

 

So, although the official recommendation is 150 minutes of moderate exercise per week, even minimal amounts of exercise provides some benefit. And it wasn’t an obscure benefit that you may or may not care about. It was reducing the risk of dying! That’s something we can all get on board with.

 

Move Your Body

If your goal is to reduce your risk of death, move your body.

 

If your goal is to improve your health, move your body.

 

If your goal is to feel better, move your body.

 

Be active, and add in at least small amounts of exercise.

 

The science supports. Hippocrates supports it. Now it is your job to get out there and do it.

 

(Read more about Resistance training and high intensity interval training Here)

 

Thanks for reading.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

 

 

Action Item:

 

Tomorrow, wake up and set your intention to seek out ways to move your body. Spend the entire day parking further away, taking the stairs, walking or biking to do your errands, go for a walk with your kids, and anything else you can find. Make it the focus for your day. You will be amazed at how many ways to can improve your activity level. Then, if you can do it once, you can incorporate it into your life and make it a new healthy habit. But you have to start with the first step. Wake up tomorrow and set that intention!

 

 

Bret Scher, MD FACC

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