1: “Most people tend to go to the doctor when they are sick or think they might be,” Peter Attia writes in his powerful book Outlive: The Science and Art of Longevity.
He refers to this approach as Medicine 2.0, which treats disease once it occurs.
Peter practices Medicine 3.0, focusing on preventing or reducing the risk of disease.
“Nearly all my patients first come to see me when they are relatively healthy,” he writes, “or think they are.”
Which was the case with Stephanie, a forty-year-old woman who showed up at Peter’s office for her initial visit in 2018 with no symptoms or ailments. She was simply “interested” in longevity.
“Her family history was not remarkable,” he writes. “Three of her four grandparents had died from complications of atherosclerosis in their late seventies or early eighties, and the fourth had died from cancer. Pretty much par for the course for the Greatest Generation.”
There was, however, one red flag. Stephanie’s seventy-year-old mother, who was otherwise healthy, was showing some early signs of memory loss.
Peter conducts comprehensive blood work on all his patients. Stephanie’s results surprised him. She was only the fourth patient he had encountered with two copies of the e4 marker. Which means her risk of Alzheimer’s disease was up to twelve times greater than the norm.
“Now I faced a double challenge,” he recalls: “How to break the news to her, directly but gently; and even more tricky, how to explain what it meant and what it didn’t mean.”
Stephanie was shattered. “She was dealing with a lot of stress to begin with: a divorce, a difficult work situation, and now this,” he writes.
“It’s tough to explain the nuances of genes and risk to somebody when their eyes are wide with fear and they are hearing only I’m doomed. It took several discussions over the course of many weeks before she began to understand the rest of the message, which was that she was not, in fact, doomed.”
2: For those of us above age 50, over 80% of us will die due to heart disease, cancer, type 2 diabetes, or neurodegenerative disease (typically Alzheimer’s disease).
Peter calls these four killers “The Four Horsemen.”
“Alzheimer’s disease is perhaps the most difficult, most intractable of the Horsemen diseases,” he explains. “We have a much more limited understanding of how and why it begins, and how to slow or prevent it, than we do with [heart disease]. Unlike with cancer, we currently have no way to treat it once symptoms begin. And unlike type 2 diabetes and metabolic dysfunction, it does not appear to be readily reversible.”
Peter says of his patients: They “fear dementia more than any other consequence of aging, including death. They would rather die from cancer or heart disease than lose their minds, their very selves.”
Neurodegenerative diseases include Alzheimer’s (6 million cases in the U.S.), Lewy body dementia (1.4 million cases), Parkinson’s disease (1 million cases), and a variety of less common but also serious conditions such as ALS, or Lou Gehrig’s disease, and Huntington’s disease.
3: Stephanie was 40. These diseases rarely progress to the clinical stage before the age of 65.
Which is where Medicine 2.0 and Medicine 3.0 take radically different paths.
“To a typical doctor, Stephanie’s case would have seemed pointless,” Peter writes. “She had no symptoms, and she was still relatively young, in her early forties, a good two decades before any clinical dementia was likely to develop.
“Medicine 2.0 would say there was nothing for us to treat yet.”
The problem with this approach?
“Once dementia is diagnosed,” Peter writes, “it is extremely difficult to slow and maybe impossible to reverse. . .
“The point at which Medicine 2.0 steps in, the point of diagnosis, is also likely near the point of no return for most Alzheimer’s patients, beyond which little or nothing can be done,” he notes.
Medicine 3.0 takes an entirely different tact.
In fact, Stephanie is “an ideal patient, and her case an urgent one,” he writes. “If there were ever a disease that called for a Medicine 3.0 approach—where prevention is not only important but our only option—Alzheimer’s disease and related neurodegenerative diseases are it. . .
“Doing nothing,” Peter suggests, “is actually the riskiest course of action.”
More tomorrow!
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Reflection: Have I had blood work to screen for the e4 marker?
Action: Discuss with my doctor.
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