Gwyneth Paltrow x Peter Attia: Data-Backed Ways to Support Cognition As You Age

26:02So the question is why, why does our cognitive function decline with age outside of pathology? So there's, let's put pathology aside. So clearly a person can develop dementia and that will significantly impair cognition. Well, one argument on the memory side, if it's going to make us feel a little bit better, is that, and the analogy is when you're 20, you had a relatively small library. So when you ask the librarian to go and fetch a book, it wasn't that hard. The library wasn't that big. It was the size of this room. Today, your library is the size of this floor. So when you ask that librarian to go and get something, it's going to take a little longer to get it.

26:46That's probably a little bit of the recall issue. That said, in terms of like raw horsepower, processing speed, which might be like the most important thing that we think of as an age dependent decline, the function of the neurons are decreasing. Now what that means exactly, there's probably smarter people than me who can explain that. But just as we see mitochondrial function decrease, energetics decrease, right? So anything that's providing less energy, inducing more inflammation, all of those things will impede function. So just like my muscle function today is not as good as it was when I was 20, so too is my cognitive function.

27:27All of these things at the cellular level don't work as well. Those are the hallmarks of aging, right? All of these things like senescence, cells that basically poison adjacent cells, inflammation, reduction of mitochondrial performance, so less ability to generate energy for a cell. All those things are just ticking away. And are there things that can be done to mitigate that? The big ones are exercise, right? So exercise is hands down the most important drug, if you're going to call it that, intervention as it comes to preserving cognitive performance. And what kind? Because I know you get specific about this.

28:06Both, right? So cardio and strength training. To answer John Griffin. To answer John. Bring it back to John. Both. And also even within cardio, sort of mixing it up between high intensity and low intensity. So, you know, one way that I think about it is if you are really limited in time, if you said, look, I'm only willing to spend three hours a week exercising, how would I want to optimize it? it would probably be an hour and a half of that time doing low intensity cardio, like zone two cardio, like say three 30 minutes zone two cardios. And then one high intensity, one half an hour session of high intensity or two 15 minute high intensities.

28:44And then one hour of strength training. Like if that was the minimum you could do that, you'd probably get the most bang for your buck in three hours of exercise. What do you do? What does your regimen look like? I do like four days a week I'm strength training. Heavy weights? Yep. Four days a week. Low reps? High? No, I vary the reps quite a bit. I mean, I rarely go below five. So I'm probably five to 15. But sometimes like the other day I was doing a last set of squats, feeling very good. And I was like, I'm going to go till I'm one rep away from true failure. And ended up getting like 19 reps.

29:21And then four days a week, I'm doing cardio about an hour block. So nothing like I used to do. I mean, I used to be, you know, exercising 20 plus hours a week. And then I like to rock. I do this thing called rucking. What's that? It's walking around with a very heavy backpack. So it's a backpack that's specifically designed to hold like, I mean, you can do it with any backpack, but the ones I use are, you know, they're designed to hold plates of weight. So I put like, I'll have 60 pounds in the backpack and walk around. This is really awesome. Everybody should be rucking. Really? Oh, yeah. This is the most important training tool the military uses.

29:57And why is it so important? Because it's such a great test of strength. When you're walking up and down hills, it really requires strength. Walking downhill sounds like it should be easy. But when you've got all that weight on your back and you're walking downhill, you have to be able to put the brakes on. You have to be able to control the descent. That's a really important part of aging. Most people, when they're old, this is where they fail. They don't fail stepping up onto the curb. They fail stepping off the curb. That's a great point. I never thought of that. Yeah. People fail with the brakes.

30:31People fail with the brakes. And rucking helps you maintain that. Absolutely. It trains what's called eccentric strength. Eccentric strength. So a muscle, if you think about your bicep, if you do a bicep curl right now, when you are curling up, you're shortening the muscle. That's called concentric strength. We focus a lot on that when we're in the gym. But an equally important component is how strong is the muscle when you're going down, when the bicep is getting longer. So same thing with your legs. When you're stepping up onto something, the quads are shortening. The hamstrings are shortening.

31:05When you're coming down, they're lengthening. And most people don't have any conditioning in that part of the muscle. And as they get older, that really becomes painfully obvious. So with rucking, I'm getting strength in the concentric phase, walking up the hill, and I'm developing muscular endurance that way. And on the downhill, I'm getting all this eccentric strength. And also for me, it's a form of psychotherapy. So when I'm rucking, I don't have my phone. So there's no podcast, no music, no distraction, no email, no text, nothing. It's an hour of pure bliss. And I do it at the hottest time of day in Texas.

31:44So it's like I'm also feel like I'm in the sauna. Wow. Yeah. You bring up a good point around not having the phone. I do the same when I hike just to let the mind wander. I personally am so addicted to my phone and checking in and making sure everything's okay and everyone's okay and then lying in the bath and scrolling Instagram or whatever. I really feel like it's negatively impacting my mental health. Can I give you a tip? Yes. So I was actually going to talk about this on instagram the irony of it and the irony was not lost in me that I was going to do this on instagram but i'll probably still do it at some point so a couple months ago one of my best friends is in town and I I had a super busy day and I was so far behind on crap and he comes over at six and The three of us my wife him me are going to go out to dinner so we all go out to dinner and And I'm just particularly like distracted.

32:44I'm getting chirped all night on text and I'm apologizing. I'm like, guys, I'm so sorry. I just need to make sure it's not, you know, blah, blah, blah. Look, text after text. And then of course, once I'm looking at the text, I'm also checking email. So for me, social media is less the problem. It's just the work. It's the email, the text, the email, the text. And we finished dinner. We went home and I was just so upset at myself because I was like, I was so distracted during that dinner. And yeah, this is one of my best friends and my wife. So it's like, I don't have to have my guard up with them.

33:17Like I can be my naked shittiest version of myself, but it was like, that's a waste. That's awful. That's pathetic. So the next day I called my assistant and I was like, Hey, I want you to go to the Apple store, get me a new iPhone. And it's going to be my bat phone and it's going to be the phone that I go out with. and so she brings it back and we just take everything off it. So the bat phone has nothing on it. It's a phone. Like my wife and daughter have the phone number. It doesn't have email. It has text but it doesn't matter because nobody can text it. Like nobody knows the number. It doesn't have social media.

33:52It doesn't have news. It doesn't have anything. There's nothing you can do on this phone. But it has a camera which turns out to be something I like having when I'm with my kids because I do like to be able to take pictures of things. And it has my calendar. So I know I can take it with me if I need to be somewhere and I can put addresses in Waze or whatever and do that kind of stuff. So it's a super functional phone, except for the fact that I can't check email or text or social media or read the news. And this thing is a game changer. So now I take the Bat phone with me when I really realize I don't need to be connected, which turns out to be a lot of the time.

34:34Could you like go on a long weekend without your phone then? I mean, I haven't done that yet. I'm going to be honest with you. That seems like, like I'd really have to make sure my team was comfortable that they are not going to get a hold of me for two days, three days. But if you had your laptop and. Oh, yes, yes, yes, absolutely. So if I had my laptop with me so I could say, look, I'm going to check email. I'm going to do work for an hour. Oh yeah, absolutely. Holiday PSA from DSW. you. This is a reminder that shoes are a gift, literally. So unwrap something good, like boots that inspire your next big adventure, or cozy slippers that give you an excuse to stay in, or sneakers that feel like pure joy.

35:15Because shoes aren't just shoes, they're exactly what you wanted. Let us surprise you so you can surprise them. Find shoes that get you and everyone on your list at prices that get your budget at DSW stores or DSW.com. So can we just go back to mitochondrial function for a second? So after exercise, what is the next best? For cognitive health? Yeah. For a person who's not sleeping well, fixing that. Fixing sleep? Yeah, fixing sleep. So if you're not in that seven to nine window, seven to nine hours of sleep, that you've got to get that right. And unfortunately, a lot of people are not sleeping well.

35:52So either they're just not sleeping long enough or they're sleeping in a fragmented way or they're using chemicals that are not productive. to sleep to help. So there are chemicals that help you sleep by preserving sleep architecture. There are chemicals that help you lose consciousness that don't preserve architecture. You want to be using the former and not the latter. And what are examples of the former? Like melatonin? No, melatonin is something that one needs to be very careful with above certain levels. So at a low dose, which I think is the data would suggest below about 750 micrograms, I would say even lower than that.

36:28I would say 300 micrograms is a safe dose if you really felt you wanted to use it daily. I personally think it makes no sense to use melatonin on a daily basis. Melatonin should really only be used in extreme cases like severe jet lag. Yeah, that's when I use it. Yeah, that's the only time I use it as well is if I'm going to be going seven time zones and I need to pull out all the stops to make myself go to bed at 2 p.m., then I'm blasting myself with three milligrams of melatonin, which is like, I think 10 times an appropriate physiologic dose. But if you're just saying like, I'm a person who's going to just use melatonin on a nightly basis, I would say, no, use light.

37:06Light is the key to melatonin. So use the appropriate signals of light and absence of light to trigger that melatonin. Your pal Huberman talks about this all the time. Yeah. Andrew, of course, is like, you know, this is his, literally his area of expertise. Other supplements that I think are very helpful. I use glycine. And it was quite a bit of it. I use two to three grams of glycine. And I use probably 600 milligrams of ashwagandha. And that's good for someone like me. You know, it's sort of a way to tamp down cortisol levels. So cortisol, adenosine, and melatonin are basically the three things you're regulating to sleep.

37:39So you have to get cortisol down, melatonin up, and adenosine has to be high so that you can squash it, right? In other words, you want the pressure of adenosine to make you tired. So that's why napping is a bad idea, right? A nap in the middle of a day Even if it's just a 20-minute cat nap can deplete you of adenosine makes it harder for you to sleep at night Rob you have the sleep pressure to go to bed. Everybody says naps are so good for you. I can't nap Yeah, I mean It depends on the context, right? If you're in a situation like let's say you're a mom and you just had a baby and that baby Like then yes, of course by all means like if the alternative to not napping is not sleeping then napping makes sense But but we don't we don't want our patients napping, right?

38:17We want our patients getting the full set of... Yeah. And again, sleep trackers have given people a little bit of visibility into what I guess sleep scientists have known all along, which is if you're in bed for eight hours, you're probably sleeping for seven, a little over seven. Because it's not a perfectly efficient process. And most people are going to be requiring seven to nine hours of sleep. So we think that if you're in bed for eight hours, there's a very good chance that you're getting the right amount of sleep. And then on top of that, you can, you know, there are a bunch of sleep surveys that I think I link to some of them in the book where a person can just go and do an assessment online to get a sense of what their level of sleep quality is.

39:00So like something like the Epworth sleep scale, there's a sleep survey out of Pittsburgh, University of Pittsburgh, that's very well validated. And if you go through these surveys and you're, you know, you're sleeping eight hours a night and you don't score any red flags on those or your scores come out fine, then you're great. You don't need to stress about that. There's, you know, there's no benefit to sleeping more. Right. But if you're, if you're not doing well on that, fixing that is also an enormous part of cognition. But I feel like so many people struggle with this idea of like, I know I should sleep better, but I can't, like I'm not a natural sleeper.

39:31That's a refrain that I hear all the time. Yeah. I think, I think that's probably not correct. I mean, I think that's probably a narrative that more reflects you're not, you as the individual who's saying that are not creating a good enough environment for sleep. it seems counterintuitive that we should have to spend a third of our lives unconscious. Like, it seems like such a bad idea. I certainly rejected it for a long time. But the, you know, the data are overwhelming that sleep is important. And then on top of that, there's just sort of the evolutionary argument, right? Which is there's no species we're aware of that doesn't sleep.

40:04And given how unproductive and dangerous sleep would have been to our species, like you're not mating, you're not foraging for food, and you're not protecting yourself. Those are kind of the only three things evolution cared about. So why did evolution not get rid of the fact that for a third of our time we're doing that? It must be important. It must be too important for evolution to get rid of. So when people suggest today that they don't need to sleep that much or that, yeah, just sleep doesn't work for me. I have a hard time sleeping. Yes, there may be some pathology there that needs to be addressed.

40:37Maybe you have sleep apnea. Maybe have restless leg syndrome. And those absolutely need to be addressed with the proper doctor. But I do think that for most people, it comes down to what are you doing for sleep hygiene? How consistent are you in bedtime and wake up time? How dark is your room? How cold is your room? How much distance are you putting between stimulation and sleep? You have to make the environment conducive to sleep. Okay. And then after that on the list? I would say, so we have much more information around reducing the risk of dementia. That's where we have the most data. And that's not exactly the same thing as the question you're asking, which is improving cognition.

41:16So I think for improving cognition, clearly those two things matter a lot. They also matter a lot on reducing the risk of disease. When you start to also talk about other things that reduce the risk of disease, not having diabetes. And I would have to believe that not having diabetes also improves cognitive performance outside of dementia. And not having diabetes, another way to say that is being insulin sensitive and metabolically healthy. So the brain is a super energy demanding organ. So again, 2 % of your body weight, 20 to 25 % of your energy requirement. It's crazy. It's insane. It's insane that this tiny little organ that weighs nothing is an energy consuming machine.

41:58So by extension, anything that interrupts energy production is going to be bad. Anything that disrupts fuel partitioning, which is just a fancy way of explaining how the body knows what to do with energy, where to put it, is going to be problematic. And diabetes is just the most extreme version of a deficiency or a defective fuel partitioning system. But long before you have type 2 diabetes, you're insulin resistant, you have hyperinsulinemia, all of those things impair the ability to get energy safely and adequately to the brain. So not having those things matters, right? So being metabolically healthy, at least when it comes to, you asked about supplements.

42:34I think the best evidence we have around supplements is around B vitamins in the reduction of homocysteine. So there's a clinical trial done called the VitaCog study that looked at people with what's called mild cognitive impairment, MCI. So this is pre-dementia. So these people do not have Alzheimer's disease or dementia, but they're already demonstrating objective signs of cognitive impairment. So that's the funnel through which people go to dementia. It's also a place where we think there's an ability to stop the train, maybe even some evidence of reversal. And this study looked at using something as simple as methylated B vitamins and B vitamins to lower homocysteine.

43:18And in the people in whom homocysteine was lowered the most, you had the best outcomes. I find it to be one of the most frustrating things that that study, which was a very well done study, did not get more attention. Because there's like a graveyard of drugs that have had no benefit in Alzheimer's disease. And to think that if we just got everybody's homocysteine down to eight or nine, we could reduce their risk of dementia and potentially improve cognition, although that was never tested, you know, I think it's sort of crazy. Again, you know, it's, I don't take a million supplements, but I definitely take methylated B vitamins.

43:54Do you guinea pig on yourself a lot? Do you tend to do that? In some things, I definitely love to guinea pig technology. Right. Right. Like, I mean, I was wearing a continuous glucose monitor starting in 2015. I was wearing, you know EKG leads on my chest all day for like heart rate variability checking in 2013 2014 like this thing was this what was the thing called is called first beat it was so user hostile like you had you literally stuck these leads to your chest and You would wear this thing for days and it would tear the skin off your chest Oh my god So I for a couple of years had these white marks on my chest all the skin being torn off This is not worth it.

44:38Because like if you were someone who exercised a lot, you wanted to wear it. Like they had two versions. They had the not so sticky and the very sticky. But I'm like, dude, I'm exercising all day. You need the sticky. I need the super sticky. And the super sticky just ripped your skin off. Oh my God. So yeah, yeah. I've always like. You're into like data collection. I want to know stuff before it's user friendly. But that said, like I have a pretty low level of confidence in the unregulated supplement market. So, you know, like you mentioned Andrew, one of my closest friends. I mean, Andrew and I will talk about supplements all day long and he'll be like, well, what about this?

45:13And what about this? And I'll be like, Andrew, like, I don't know who's making it. Like, maybe it works, maybe it doesn't, but it's like probably crushed bird feathers. So, and so at best it doesn't work, but at worst it's got something in it that, that could be dangerous. So, you know, I have a slightly higher tolerance for, you know, certain things than others. But I would say, you know, when it comes to supplements, like there's three or four companies that I trust make a good quality product. So I at least feel I'm free of contamination. But I also think like most supplements don't do anything.

45:47If you're lucky, that's the worst thing is that the best case is they're doing nothing. I mean, I guess if you have like a blood panel and it tells you you're low in iron You're low in vitamin b right then in those cases. That's right. So I I definitely am more Optimistic around supplements for which we have biomarkers, right? So for example, like vitamin d which there's actually still a lot of controversy about supplementing vitamin d and whether it has health benefits or not But the reality is that question has not been appropriately tested So I would say we do not know the answer to whether supplementing with with vitamin D is beneficial.

46:20And how do you appropriately test for that? So here's what the problem is. All those studies have been done as, let's just take a bunch of people who have low vitamin D and give them 2 ,000 IU of vitamin D in five years, see if there's any difference in health outcomes. What's the problem with that study? There's a lot. First, do you know who took the test? Do you know who took the vitamin D or not? We never measured the levels again. Was 2 ,000 IU enough? Almost assuredly not. So a way to do that test correctly or to do that experiment correctly would be, let's take a bunch of people whose vitamin D level is low.

46:53Let's define it as below 30 as an example. Let's give them whatever amount of vitamin D is necessary to get their level above, say, 60 and below 80. So we're going to say the treatment group, we're going to give whatever amount of vitamin D is needed to get their vitamin D to 60 to 90. The placebo group will keep below 30. but we're going to check the actual biomarker to know that. And then we run that out for the sufficient period of time. Maybe we think that's five years. And then the question is, what is the population of interest? So I don't, to be honest with you, I don't know enough about vitamin D to know if your best bet is going to be studying perimenopausal woman for whom bone density is the biggest issue.

47:33Maybe that's the right population. Is it going to be some other population? What's your primary outcome? But the way it's been studied to date, I think has never answered the question. That said, vitamin D is at least a supplement where you have a biomarker. The same with B vitamins. B vitamins, you can measure them. You can also measure what you really care about, which is the effect on homocysteine. There's other supplements for which we have no biomarker, or at least we don't have one that matters, like magnesium. I'm a big proponent of magnesium. I think most people are really magnesium deficient.

48:03And I'm not even convinced that the blood tests that we use, which is red blood cell membrane magnesium levels, are the best outcome. But But symptom-wise, most people get better with more magnesium, right? So on the slow-acting side, you get less cramping. On the fast-acting, like poorly absorbed side, you get better bowel function and regularity. So that's one where I don't think I need a biomarker, but I'm sort of comfortable titrating based on the data that we have. And you mentioned ashwagandha earlier, which... Again, this is one where, yeah, it's like, Peter, why are you taking ashwagandha?

48:35I mean, it's empirical to me. It's like, one, I'm taking it from a company that I really like. It's called Gero. I think they make very good supplements, super high quality. And two, just empirically, I tinker so much with my sleep. I do use sleep trackers. And after years and years of tinkering, whatever routine I'm on now, which is not just about any one supplement, but it's working very well. It's giving me the results I want, both in terms of how I feel and whatever objective metrics I can measure. At Goop, we believe the spaces we spend time in shape how we feel and how we connect. That's why we're drawn to Convene, a global hospitality brand reimagining work in meeting spaces centered around design and care.

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50:00Convene for the moments that move your business. okay so i'd like to bring it back around to the book and this idea of outliving and you know for me it would be outliving my father you know that's part of turning 50 and freaking out like when you lose your father my father died when he was 58 and the book is like it's i've not finished with it yet. It's going to take me, it's like the most brilliant academic dense tome, but sort of to summarize, you know, what are the, and I think we've talked about a lot of them here today, right? Kind of like the, because where they're talking about sleep exercise, but are there other things we're missing in terms of like, when you're talking about biohacking, or if you're focused on living the best possible life of the best quality for as long as possible.

50:55What else? Yeah. I mean, look, you know, I think one way to maybe get at that is to talk about the evolution in my thinking over the course of writing this book. So if you go back to everything from the email to John, to the, you know, the, the, the longevity manifesto to the first version of this book, none of that is in this current book, right? The, the, the whole process has evolved and it's, It's a reflection of kind of my thinking about this. So I think that the version of this book that I started writing was the biohacking Silicon Valley how to not die book. Right. And then through stuff that I do write about at the end of the book, there's been a total change in my thinking about this.

51:38And really, this is now a book about living. I know that sounds very cheesy, but it really reflects how I feel. It went from a book of how to avoid dying or at least delay it as much as possible to how to live the best version of your life. And for me, that's really not a biohacking problem. It is about all the things we've talked about. So there's part of living your best life is not dying prematurely. But an equally important part of it is based on the quality of your life, that health span thing. And I think the piece, at least for me, that was the biggest change over the past decade is everything that has to do with emotional health.

52:20Without that, none of this stuff really matters. And that's the squishiest stuff. You don't have biomarkers for that. But if anybody's being really honest with themselves, it's also not something for which there's much confusion if it's not going well, if you can really be honest with yourself about it. So are you talking about kind of, I don't know, creating a rubric for yourself of how to process through things to really be like tools to be your most authentic self? Like, what are your ways of achieving emotional health? I mean, it start, you know, the, there was, you know, an enormous amount of work that had to be done in, in sort of residential care.

52:58I mean, I went into therapy in 2017 for two weeks and then in 2020 for three weeks. So these were places where I was like locked up. Right. And almost against my will, truthfully. And those were probably the two most important, you know, steps in my transformation, if you will. And I would say coming out of, so it's almost exactly three years ago, actually. In fact, exactly three years ago, I was in PCS, Psychological Counseling Services, the place in Phoenix, Arizona that I went to. I was there from like mid-April till early May. And coming out of that, yes, I mean, there were dramatic changes.

53:36So it wouldn't be unlike if you just came out of the hospital having had surgery, what would your care plan look like? It was very intense. Three years later, you're probably still doing, if you're really smart, you're still probably still doing some PT for that injury to make sure you don't get injured again, but you're not doing like the volume of PT you were doing when you came out. So similarly, when I came out of that place three years ago, I mean, I was still doing therapy every single day. I was journaling every day. I was standing in front of a mirror twice a day reading affirmations. I mean I was going through, you know, I was putting hours a week into You know doing the things that were necessary to kind of break the old habits and build new habits Break the old belief system build a new belief system.

54:24I mean just one example, you know changing the inner monologue so Every time I did something that would have previously consciously thrown me into a fit of rage, screaming at myself, I would take out my phone and I would record into it a message as though it was my friend who had made the mistake I made. So I would instead speak very kindly to myself and then send that to my therapist. So like I'm sending five of these messages a day for four or five months and little by little, all of that stuff sort of melted away. So today I don't have to do that. I don't, I don't record anything anymore, but I don't need to cause it, there is like plasticity in that system.

55:06So it's sort of shifted. So today this is still a very important part of how I think about interacting with the world. So I still do therapy. Of course, I, I, I'm, I'm an enormous fan of something called dialectical behavioral therapy. And now I just have better tools to cope with my mistakes and better tools to recognize when I'm not in harmony and better tools to recognize, you know, when I need to repair something. I think I need to go there. Peter, thank you so much for being here today. And it's been such an honor to have you. Well, thank you very much.

55:50Thanks for tuning in to today's episode with Peter Atiyah. I hope you pick up a copy of his fascinating book, Outlive. Thanks for tuning in. This has been a presentation of Cadence 13 Studios. I hope you'll listen, follow, rate, and review all of our episodes, which are available for free on Apple Podcasts, Spotify, Odyssey, or wherever you get your podcasts.