Like successful aging, this book is a fascinating read that compiles the latest understandings about our bodies into a compendium of knowledge with many recommendations. Much of this book is summarizing studies about which molecules - proteins, hormones, types of cholesterol, and cellular processes are benefited by eating well, not too much (or too little), exercise, and sleep. However, unlike successful aging, the recommendations can be too specialized at times, and require too many resources (time and money) to execute properly. For example, the discussion about exercise requires a personal trainer, and many hours a week to carry out. Or, to hit the recommended protein levels, one needs to be having a good amount of meat twice per day, every day, on top of a protein shake, and high protein snack. This just doesn’t seem wise for the average person, or doable for the average household income. Having said all of this, the overall book was interesting nonetheless, and stacking this book with successful aging was enjoyable.
I’ll start at the end, with my favourite quote:
“‘I think people get old when they stop thinking about the future,’ Ric told me. ‘If you want to find someone’s true age, listen to them. If they talk about the past and they talk about all the things that happened that they did, they’ve gotten old. If they think about their dreams, their aspiration, what they’re still looking forward to - they’re young.’”
Hoping into other points from the book:
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I liked the part about rucking, as a great way to improve the benefit of simply going for a walk in your neighbourhood or in the forest -> a good goal is to be able to carry a quarter to a third of your body weight, once you develop enough strength and stamina.
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Stability training is all about the “safe and powerful transmission of force through muscles and bones, and not joints or spinal hinge points”. A great way to determine if you’re doing a particular exercise well is to film yourself doing it!
“odds are overwhelming that you will die as a result of one of the chronic diseases of aging that I call the Four Horsemen: heart disease, cancer neurodegenerative disease, or type 2 diabetes and related metabolic dysfunction.”
“when we are slightly deprived of nutrients, or when we are exercising, FOXO3 (a gene) tends to be more activated, which is what we want (it is correlated with longevity)”
“Why do we care about mTOR? Because this mechanism turns out to be one of the most important mediators of longevity at the cellular level. Not only that, but it is highly ‘conserved’ meaning it is found in virtually all forms of life, ranging from yeast to flies, to worms and right up to us humans… this exotic molecule, found only on an isolated scrap of land in the middle of the ocean, acts almost like a switch that inhibits a very specific cellular mechanism that exists in nearly everything that lives. It was a perfect fit, and this fact still blows my mind every time I think about it. The job of mTOR is basically to balance an organism’s need to grow and reproduce against the availability of nutrients. When food is plentiful, mTOR is activated and the cell (or organism) goes into growth mode…when nutrients are scarce, mTOR is suppressed and cells go into a kind of ‘recycling’ mode, breaking down cellular components and generally cleaning house.”
“Reducing the amount of nutrients available to a cell seems to trigger a group of innate pathways that enhance the cell’s stress resistance and metabolic efficiency - all of them related, in some to mTOR.”
“While AMPK (an AMP-activated protein kinase) is activated when it low levels of nutrients are detected it is also activated when we exercise.” -> Its activation leads to a cascade of helpful cellular responses. -> like, “instead of creating new proteins and undergoing cell division, the cell goes into a more fuel-efficient and stress-resistance mode, activating an important cellular recycling process called autophagy, which is basically self-eating”.
“Impaired autophagy is thought to be an important driver of numerous aging-related phenotypes and ailments, such as neurodegeneration and osteoarthritis.” I thus find it fascinating that this very important cellular mechanism can be triggered by certain interventions (exercising and caloric restriction) - and the drug rapamycin. Rapamycin seems to reduce systemic inflammation, perhaps by tamping down the activity of so-called senescent cells, which are ‘older’ cells that have stopped dividing but have not died".
“The various treatment guidelines specify target ranges for LDL-C, typically 100 mg / dL for patients at normal risk, or 70 mg / dL for high-risk individuals. In my view, this is still far too high… [which is] 10 - 20 mg / dL.”
“Some scientists believe there may be something about menopause, and the abrupt decline in hormonal signaling, that sharply increases the risk of neurodegeneration in older women. In particular, it appears that a rapid drop in estradiol in women with an e4 allele is a driver of risk; that, in turn, suggests a possible role for perimenopausal hormone replacement therapy in these women. Menopause is not the only issue here. Other reproductive history factors, such as the number of children the women has had, age of first menstruation, and exposure to oral contraceptives, may also have a significant impact on Alzheimer’s risk and later life cognition. And new research suggests that women are more prone to accumulate tau, the neurotoxic protein.”
“Brain cells metabolize glucose in a different way from the rest of the body; they do not depend on insulin, instead absorbing circulating glucose directly… enabling the brain to take priority when blood glucose levels are low. If we lack new sources of glucose, the brain’s preferred fuel, the liver converts our fat into ketone bodies, as an alternative energy source that can sustain us for a very long time, depending on the extent of our fat stores (Unlike muscle or liver, the brain itself does not store energy). When our fat runs out, we begin to consume our own muscle tissue, then our other organs, and even bone, all in order to keep the brain running at all costs. The brain is the last thing to shut off.”
“It’s easy to overlook, but alcohol should be considered as its own category of macronutrients because it is so widely consumed, it has such potent effects on our metabolism, and it is so calorically dense at 7 kcal / g (closer to the 9 kcal / g of fat than the 4 kcal / g of both protein and carbohydrate)”.
FOR GLUCOSE MONITORING - “I like to keep average glucose at or below 100 mg / dL, with a STD of less than 15 mg / dL. These are aggressive goals: 100 mg / dL corresponds to an HbA1c of 5.1%, which is quite low.”
FOR PROTEIN - “the first thing you should know about protein is that the standard recommendations for daily consumption are a joke. The US recommended dietary allowance (RDA) for protein is 0.8 g/kg of body weight. This may reflect how much protein we need to stay alive, but a far cry from what we need to thrive. There is ample evidence showing that we require more than this - and that consuming less leads to worse outcomes. More than one study has found that elderly people consuming that RDA of protein end up losing muscle mass, even in as short a period as two weeks…. I typically set 1.6 g/kg/day as the minimum, and 2.2 as a good place to start for active people”. -> split up over 4 heavy-protein intakes: 2 protein rich meals, and 2 protein rich snacks.
“Trauma generally falls into five categories: abuse, neglect, abandonment, enmeshment (the blurring of boundaries between adults and children) and witnessing tragic events. Most things that wound children fit into these five categories… dysfunction is represented by the four branches of the trauma tree: addition (not only vices such as drugs, alcohol and gambling, but also socially acceptable things such as work, exercise and perfectionism); codependency, or excessive psychological reliance on another person; habituated survival strategies, such as a propensity to anger and rage; attachment disorders, difficulty forming and maintaining connections or meaningful relationships with others.”
“children don’t respond to a parent’s anger in a logical way. If they see me screaming at a driver who just cut me off, they internalize that rage as though it were directed to them.”
“changing the behaviour can change the mood. You don’t need to wait for your mood to improve to make a behavioural change. This is why cognitive therapies alone sometimes come up short; simply thinking about problems might not help if our thinking itself is disordered.”
4/5.