Recap: How to stop the rise of heart disease | Peter Attia

Hello, and welcome to Zoey Recap, where each week we find the best bits from one of our podcast episodes to help you improve your health.

Today, we're discussing heart health. The heart is at the center of everything within our bodies, constantly pumping oxygen and nutrients throughout our tissues and organs. We all know if our heart fails, we're in trouble. However, we only tend to start thinking about the health of our heart when we encounter a problem. So how do we prevent a problem from occurring? Dr. Peter Atir is here to explain how by making changes to our lifestyle today, we can take control of our heart health tomorrow.

But let's just talk about cardiovascular disease because it is- It's like heart attacks and strikes. Heart attacks and strokes because that's the number one cause of death globally. And it's the number one cause of death for men and women. So if you're listening to us talk today, chances are this is your number one risk factor.

We know from autopsy studies that are conducted on people in their 20s who have died for unrelated causes that they already have signs of atherosclerosis, which is the technical name for what happens when cholesterol gets inside the artery wall.

and an inflammatory process takes place that ultimately leads to, for example, a heart attack. And this is sort of the furring up of your artery slowly over the timing. Yeah, and what's really happening is the body is attacking the inside of the artery where this cholesterol gets, thinking it's a foreign

adversary when in reality, it's not. But in the process of doing so, it creates more of a problem than is warranted. And you're saying that when they've done autopsies to somebody in their 20s for nothing to do with someone who dies in a car accident. Car accident. You can already start to see the signs. You can see evidence that this process has been a decade in the making.

In other words, this process basically begins at birth. Now, for the average person, that process probably won't reach clinical significance if you're a male until you're in your mid-60s. So 50% of men who go on to have a heart attack, stroke, or die suddenly from one of those two will have that event take place before the time they are 65.

So for women, it's a third of women who will have a heart attack stroke or die of heart attack or stroke will have that occur before they are 65. So when you ask the question, okay, I'm in my late 40s. Is it too late for me? Well, I would say, no, it's not, right? If I get you're sitting here, right? I guess me it's not too late to do anything about it. But where a lot of people get lulled into a false sense of security is

Hey, I'm in my late 40s and everything looks pretty good. Yeah. So how do we change the focus from treating diseases to preventing people becoming sick in the first place? And I guess particularly, I think if you're listening to this, it's not just an abstract question, but maybe for the individual themselves, because I think generally they will find that if they go and see their doctor, if they're not clearly sick with something, then they'll be like,

You're fine. Go away. Come back when you're sick. There's two ways to think about your question, and I think there's one way that I feel qualified to speak, and there's one way that I don't. I'll start with the way that I don't. If you're asking the question from a structural standpoint,

How would we fix the health care system? I would say to do that, you have to go back to the way physicians are trained. When I was in medical school, I only really learned about two tools, which were procedural tools and pharmacologic tools. Those were procedural tools, means like surgery. Yeah, I mean, I would train as a surgeon. So basically, those were the two things that you learned. You basically chop something out or you give someone a drug. That's right.

Those were your tools. And again, I do not want to suggest that those are not valuable tools. I do not want to disparage the remarkable things that those tools have done. Again, they have doubled our lifespan in four generations, right? I'm simply pointing out that all the stuff we are now talking about will require that you understand nutrition and you understand exercise and you understand sleep and you understand emotional health.

And I was not trained in any of those things. And I know that my peers were not trained in any of those things. So some of us have learned those things, but we had to learn them outside. Tim always says that, you know, if you're lucky, you get a half day of training on nutrition and your entire training as a doctor and probably most of the students aren't even there for that like half day on nutrition.

I mean, even if you said, okay, going forward, physicians are going to have to spend an entire semester learning about exercise, nutrition, and sleep, they would have to really understand how to apply those tools. I don't think there's any doctor listening to this, or for that matter, any patient listening to this who hasn't been told by their doctor that they should sleep, that they should eat less, that they should exercise more.

That's relatively unhelpful advice. It's sort of like a patient with cancer being told by their oncologist that they should get chemotherapy. I mean, if the advice ended there, it would be of no value, right? The reason that you see the oncologist when you have cancer is the profound precision that goes into which chemotherapy?

How should it be dosed based on my body weight, based on my kidney function, based on my liver function? How would you monitor for recurrence? How would you modify the treatment if I'm not responding? Think of all the nuance that a physician can provide today within his or her area of expertise and think about the complete and utter lack of that nuance and sophistication that goes into the primary tools of prevention.

And I haven't really answered your question because all I did was tell you the part that I don't know how to fix, which is how do you change the medical infrastructure? Tell me about the bit you can fix it. Well, I think the part that we can fix is where you started with, which is as the individual, we just have that agency to ourselves. That's kind of why I wrote the book, right? I wanted to write

a book that could be an operating manual for the person who acknowledges that maybe the system isn't perfect. But what can I do to say, okay, now I know a lot of this stuff and I don't need a physician for it. I mean, you don't need a physician to help you fix your nutrition or your exercise or your sleep or your emotional health. And I think one of the things that is frustration, I think, is clearly

We're spending almost all of our money on health care in this prevention regime, which I think often some extraordinary fraction of this has spent in the last 12 months of somebody's life. It's sort of got too late to be able to really improve health. It's really infuriating. Frustrating about this. Yeah, and in fact, even if you didn't care one iota about a person's life, even if you were simply counting the beans,

It would make so much more sense to take half of that money that is being spent in the last year or two of a person's life and spend it in the earlier part of their life. And again, I'm just going to use the NHS as an example because we're here. But imagine if the NHS said,

You know what? We're going to slap CGMs on everybody and we're going to pay for it. And you know what? We're going to make sure that there are a lot of really high quality trainers out there who can work with people and get them independently working and exercising. And you know what? We're going to fix the system such that it becomes less expensive to buy high quality foods so that we're kind of subsidizing the right foods instead of the wrong foods. Like I could go on and on.

You would save money as a society and improve the quality of an individual's life. There just has to be kind of, you know, an inertia that has to be overcome to do that. There's an enormous activation energy to make that happen. Thank you for listening to today's recap episode. I want to take 30 seconds to talk about something that's not talked about enough. Menopause.

Over half the people on the planet experienced perimenopause and menopause, yet symptoms are often misunderstood or dismissed. At Zoe, we're moving menopause research forward. We recently conducted the largest study of menopause and nutrition in the world, and our study showed that two-thirds of perimenopause of women reported experiencing over 12 symptoms, symptoms like weight gain, memory problems, and fatigue.

The good news is, the results also show that changing our food habits may reduce the chance of having a particular menopause symptom by up to 37% for some women. We know how important it is for you to be able to take control of your own health journey. So we've created the menoscale calculator to help you score the frequency and impact of your menopause symptoms. Go to zoe.com slash menoscale to get your score. The calculator is free and only takes a couple of minutes.

And by the way, we've spoken about perimenopause and menopause many times since starting the ZOE Science and Nutrition podcast. To find these episodes, simply search ZOE menopause in your favourite podcast player.