My parents have lived fulfilled happy lives traveling until 75 when my mother had a heart attack a couple weeks ago. They’ve had to cancel their next 3 trips.
If you’re unhealthy at age 65, you’re doing something woefully wrong.
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Or you’re terribly unlucky.
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Clearly he doesn’t get the extended health span aspect of all of this, or maybe that hasn’t been pushed enough. Although I know Attia pushes it.
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Not sure people realize that some people are just genetically dealt a really crappy hand in life. I see patients that are only 45 or 50 and have multiple progressing illnesses that will not dramatically improve. Heart disease, vascular disease, diabetes, obesity, autoimmune disease.
If your 60, or 70 and your out exercising everyday, and you’re generally healthy, be thankful.
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After delving into both articles, it’s clear that Zeke Emanuel’s perspective comes across as grounded and rational. In contrast, Peter Attia appears to be grappling with personal struggles, which may cloud his reasoning. While I do endorse Attia’s concept of medicine 3.0, prioritizing prevention, his overall stance warrants careful scrutiny.
Living a long life is appealing, but it’s essential to ensure that longevity is accompanied by vitality and productivity. Mere survival without quality of life seems to miss the mark entirely.
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It is a false dilemma between these 2. The reality, is 15-20% of outcomes are based on genetic factors and 80% at least based on lifestyle choices. So the 50 year old with CAD that I see in the ER is rarely there due to an awesome lifestyle and having risk factors managed. At least 70% of the current 4 trillion dollars spent on healthcare in the U.S. is on disease that is markedly able to be eliminated by proper life choices and pre-emptive management. We are wasting huge amounts of money, and there is a lot of human suffering.
Needless to say, Americans are living with multiple co-morbidities on average for 15-16 years before death. Each of these co-morbidities likely influences cognition … and yes, staying alive for this long impaired, and increasingly so, is not good.
In Loma Linda - there is compressed time of co-morbidities to death, unlike that stated in the article. We have proof of this - and goal is exactly this, live functional, and then when this changes die quickly. We are doing the opposite right now, and the trend continues.
So it isn’t an impossible goal - it is instead a goal that requires planning, and understanding how to optimize a number of things. Also being realistic. I don’t think but 1% of people are going to be out doing the workouts Attia thinks are so important. The advice and planning for health needs to allow most people to be able to accomplish it. The problem is, the default of fast food, horrible diet, sedentary lives, and lack of pre-emptive care certainly leads to a situation where 75 years old is well beyond the expiration date for many.
The question is what does 75 years old look like? If it is like my mom, and when I visit her, we do 9 mile hikes at 8,000 ft with her leading the way and me having to to work to keep up. That’s great. If it looks like dementia, sarcopenia and a nursing home … then certainly, please sort out how to let me die.
We have people who at 50 years old, who look like 80 year olds, and 95 year olds who are functioning like 65 year olds.
The context is critical; the age isn’t the issue, the functional status … if maintained gives reason to live, and when this is lost gives reason to be done ASAP and not kept alive by well meaning family members in a condition that one wouldn’t subject your pet dog or cat to.
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Is your 20%/80% based on scientific data, observation, or opinion? I would think the genetic portion should be much higher.
No this is based on scientific data. Do a search - you’ll find sources indicating as little as 10% and most around 15-20%. The genetics aren’t that high - everyone likes to complain about this. E.g. - you’ll know as a fellow EM Physician - the family that all of them get CAD. Well they also are all obese, don’t manage their health and smoke … bad health choices run in families (and seem to get worse with each generation, at least lately) – and these individuals seem to often confuse this with the small component genetics is making and ignore the massive control they have over their health outcomes.
If you look at the AHS - diverse genetic populations living a certain lifestyle get massive benefits = the only remaining Blue Zone in the world at this point … that can’t be genetics - it can only be lifestyle. It is based on these observations and many others that assessment of the relationship is made.
However, I’m not going to cite a whole lot of papers on this - simply enough to say - do a search on it - and you’ll find sufficient opinion based on fact to see that this is a reasonable middle of the road estimate.
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Is obesity considered genetic or environmental? I’ve always thought of it as environmental but I’ve changed my mind on that recently.
Isn’t it both? Genetics can play a role in how much appetite you have and how well your body can process nutrients. But in the absence of food, no one can become obese.
Anything genetic requires many generations for DNA to somehow change. So what % of obese people today had obese relatives 4 generations ago?
It is lifestyle, hyperpalatable food, screen time, and learned habits – so heritable from parents - e.g. obese parents - look at their children - increased rate. But based on learned habits, not genetics as the primary driver.
It’s not a blame issue but, it isn’t due to their genes.
Asians moving to the US from native lands rapidly worsen health outcome, diabetes, obesity … did their genes change in 1 generation?
Without the life choices there won’t be obesity. Some people naturally have a more difficult time due to how they grew up and habits.
If I put someone on a glp1/gip agonist and work on lifestyle change, get them to learn new habits and get to IBW then gradually wean them off, and they maintain IBW… no DNA changed, ., gene expression may have based on lifestyle. So what caused them to be obese in the first place if lifestyle modifies it?
I do however agree there are some genetic factors that can make people have a bigger appetite - but it is how they act on this.
@KarlT will hopefully enjoy this … as it gives support to the genetic component - but more on an epigenetic basis: https://youtu.be/3ckimoZ9BW4
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Emanuel, who served as a special adviser to the Obama Administration, told me. “No one’s got that evidence.”
So the guy behind Obama’s decision not to take a statin?
So glad you mentioned this. The goal should be compression of morbidity.
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I would disagree with that part of your comment and agree with later comment about appetite. It’s very clear to me that obesity runs in families. There is almost certainly a genetic predisposition. A genetic difference in hormones or the brain’s reaction to hormones.
GLP1’s make this an interesting argument. After someone starts a GLP1, they lose weight by eating less. Has their environment changed? The same foods are still available. The same type of foods are still eaten.
If someone comes from a family of very tall people, but they starve as a child and don’t end up tall, then height has no genetic factor?
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It mostly comes down to overeating, so I’d argue genetic. The current environment certainly makes it easier though.
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Obesity runs in families due to common behavior. I think there may be some lack of clarity around genetics vs. epigenetics. I’m simply pointing out, and correctly so, that a genetic factor doesn’t suddenly come up in 2 generations - which is what we’ve seen with obesity. It is plainly scientifically incorrect, and impossible to see major changes in DNA in short periods of time across populations. It however is completely feasible (and is the case here) that we can see major changes in behaviors and choices in this time period.
The issue is lifestyle change, which runs in families, processed and hyperpalatable foods, behavioral patterns of inactivity, lack of education and implementation of healthy choices. Naturally these factors run in families. There are epigenetics that come with this, and I think that may be the reason why you think genetics are a factor. Epigenetics are certainly a factor, certain behaviors, including those of your parents while pregnant with you certainly can effect gene expression. This however isn’t genetics -the DNA isn’t changed.
Epigenetics can be modified by behaviors and other factors.
You’ve made my argument perfectly on the GLPs - they lose weight due to interacting with their environment differently on a GLP. Nothing changed with their DNA as a result (their epigenetics certainly do). Yet they lose weight. So eating too much is the cause, not some issue with their DNA. Additionally, GLPs in isolation should not be given as recurrence of obesity is assured if not as part of a comprehensive lifestyle change, which leads to epigenetic changes and patterns that then allow weaning of the drugs along with a change in lifestyle.
At the end when we wean someone significantly or completely off a GLP1 … their DNA is unchanged … what changed? Their lifestyle choices … along with their weight.
Your last point on height of a child - again, the issue isn’t the DNA it is the interaction with the environment. Choices or availability of nutrients … I don’t think that point has anything to do with this discussion on obesity which is partially epigenetic change related to choices/parental choices - but there is no situation in which we see a genetic change in just a few generations - yet obesity has gone for a very rare condition 3 generations ago, to the norm now.
Other factors such as PFAs and BPAs may be affecting this - but again - that is environment, not DNA.
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Is it possible that a specific gene could make people much more susceptible to hyper-palatable foods that weren’t available 2-3 generations ago?
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@DrFraser i didn’t intend to start a long disagreement. We’ll have to agree to disagree. There is no doubt in my mind that most of our physical traits are inherited. I doubt there is any requirement of time, for a predisposed genetic risk factor to show itself when the environment changes in a way to allow it.
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Absolutely. However, we don’t really see this in practicality. Part of my medical practice is my wife, who is certified in nutrition, weight management, holistic nutrition. So this is stuff I deal with every day.
The same folks who brought you Tobacco, moved over to processed foods many decades ago. Their formula is simple - if you’ve not heard of it, it is called SOS (Salt-Oil-Sugar). Essentially, foods in nature will have only one of these or none of these. Mix any 2 of these, and you have a hyper-palatable food.
They work for a high % of the population. It’s simple food science, not some rarity of genetics. It is food addiction, and you will eat more of any given food that has at least 2 of these present in significant quantity.
@KarlT - I agree - I love your input, and love having another EM Physician on the board. Sitting in the ER right now in Nashville TN waiting for the onslaught as I work every Saturday and Sunday - day shift, to avoid the shift work (days and nights) which is a definite killer - probably as bad as smoking.
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Thought I was “lucky” - generally healthy since birth, exercised, ate well (mostly!), escaped teenage epilepsy - but young onset Parkinson’s got added to my dance card last year at 53. Some of you got pocket aces, others were dealt trickier cards. I’m here to make the best of the years I have left with the disease, since I probably will not die from it.
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