Dr. Peter Attia on how to make your final decade of life as enjoyable as possible

Dr. Peter Atiyah spends a lot of time thinking about the last years of his life and yours too. He's declared war on what he calls the marginal decade, the final years of life that are plagued by sickness and immobility. It's not often that 60 Minutes does a story on a physician who has fewer than 75 patients, but the Stanford-trained Atiyah has become both a pioneer

and a star in the growing field of longevity medicine. His stark diagnosis and advice on what to do about it have attracted millions of followers and billionaire patients who pay hundreds of thousands of dollars to hear the words, Dr. Atiyah will see you now.

The story will continue in a moment.

At 75, both men and women fall off a cliff.

At 75.

At the population level, it's unmistakable what happens at the age of 75. That's what we're up against. That's what I'm thinking about in the practice, is how do I create an escape velocity that gets somebody another 15 years there?

And so is your goal to minimize or essentially erase that marginal decade?

The marginal decade's not going anywhere. We will all have a final decade of life. My goal is to make the marginal decade as enjoyable as possible. The way I explain it to my patients is that last 10 to 15 of your years, if you don't do anything about it, you will fall to a level of about 50% of your total capacity, cognitively, physically.

And when people hear that, you're like, I don't want to be that.

That's not how I want to spend the last decade of my life. A lot of people respond that way as though they're hearing this for the first time. Although if you ask them, haven't you seen people in this state? They'll say, well, yeah, I guess I have.

Likely their own relatives.

Sure, their own parents even.

So do you consider yourself a new kind of doctor?

No, I don't think so. What we're doing is creating a framework that fits directly into this idea of how to train for the marginal decade.

That training begins here in Austin, Texas, where Atiyah is based. This is where his patients go through two days of physical evaluation, and where we found, after just a few hours, how intense the 52-year-old doctor and his methods are.

Just show me what you got. Just show me what you got. I think this is the neglected part of medical testing, is how fit are you? How strong are you?

All right.

How well do you move? And up overhead. And in many ways, these tests are even more predictive of how long you're going to live than what I might get out of your blood work. How do we know that? The data are pretty clear. When you look at things like cardio-respiratory fitness, when you look at muscle mass, when

you look at strength, they have a much higher association than things like even cholesterol and blood pressure.

Dr. Atiyah and his team say the key indicator of overall health and longevity is a test called VO2 Max.

Everything you got, everything you got.

It sounds like the name of a sports car, but essentially it's a measurement of the size of someone's engine.

Really good maximal test here.

And their capacity to use oxygen to generate power with their muscles, heart, and lungs.

There you go. That's the hardest part of your day done.

Even though you say I scored fairly well on my VO2 max.

There we go, 42.1.

Okay, that's good.

You said I'm still not good enough for Dr. Peter Atiyah.

Yes, your VO2 max was gonna place you at the 85th percentile for women your age. And I think it's worth taking a victory lap. But tomorrow we should come back and plan on what we're going to do.

You think anyone, whether they're 45 or 65, should be training like athletes, not for the Olympics, but essentially for advanced age?

Absolutely.

Life is a sport.

Dr. Atiyah says the best drug to delay physical and cognitive decline is exercise, and he takes it in large doses. He aims for about 10 hours a week, cardio to burn fat, intense intervals for VO2 max, and weightlifting to maintain strength and muscle mass. He developed his program after turning his back on the medical establishment nearly 20 years ago. While training to be a cancer surgeon at Johns Hopkins, he got burnt out caring for so many terminal patients.

He quit his residency and became a management consultant. After becoming a father and discovering he was at risk of developing diabetes, he made big changes, personally and professionally.

After my daughter was born, all I could think about was, oh my God, like, I wanna have as much time as possible on this planet with this

baby. That's when he decided to become his own first patient in a new specialty, longevity medicine. Today, he considers himself neither a primary care physician nor a provider of concierge care. We could quantify how that lowers your risk of cancer or heart disease. What Dr. Atiyah is prescribing is a radical change in how Americans think about their own health care, driven by the patient, focused on prevention, a practice he calls Medicine

3.0. We're dying of heart disease, we're dying from stroke, cancer, dementia, type 2 diabetes, and we, I think, have sort of come to realize that, hey, the playbook of medicine 2.0, which is treat a disease when a disease is present, doesn't seem to work as well. And so the first principle of medicine 3.0

is you have to take a much longer arc on the prevention of chronic disease.

That means using existing diagnostic tools in novel ways.

I'm going to have you lay down with your head facing that way,

feet facing this way for me.

Like the DEXA scan that checks bone density, as well as muscle mass and body fat. It typically costs under $300, and Atiyah says it's, quote, almost criminal negligence. Most women don't get one until they're 65. Another scan he employs is more costly

and not covered by insurance. There are certain things that you recommend that are controversial like regular preventive full body MRIs.

Early detection matters. The earlier you can treat a cancer, the smaller the burden of the tumor at the time of treatment, the greater your odds of success. Now let's talk about the flip side of that, because it is going to detect a lot of things that are not cancer.

That means you have a lot of false positives. If you're not willing to go through that experience, as traumatic as it is, you should not engage in this level of screening.

Do you get them?

I do.

He also suggests patients get tested for the ApoE gene, related to risk for Alzheimer's. In 2019, Dr. Atiyah oversaw genetic testing for actor Chris Hemsworth, who learned he was 8 to 10 times more likely to develop Alzheimer's than the average person. In total, Dr. Atiyah sees fewer than 75 patients, and there's a long waiting list. And how much does it cost?

It is a six-figure program.

Like $100,000 or $500,000 or $800,000? Because it's a big range. Much closer to $100,000 than $500,000. That's a lot of money. I mean, what do you get for that? You don't get, I mean, you don't live forever.

Nope. You're getting access to me, a team of a couple other physicians, a strength and conditioning team, a nutrition team, and what you're really getting is a path to help you achieve your goal of living longer and living better.

Welcome Dr. Peter Attia and Dr. Peter Attia. The pitch has proved extremely popular.

This is kind of a turning point.

His book, Outlive, part memoir, part medical manifesto, has sold nearly 3 million copies and made him a top draw at longevity medicine events like this one. When you give women information about how their bodies work, they make great decisions for themselves. And his podcast that's been downloaded over 100 million times tackles a wide range of topics including menopause and nutrition.

Let's talk about protein.

Dr. Atiyah wants his patients to eat a lot of protein, more than double what the current nutritional guidelines recommend. The doctor and a handful of his patients have also taken a drug called rapamycin that's FDA approved for use by transplant recipients. The drug has extended the lifespan of mice but Dr. Atiyah stopped taking it for now

because it gave him mouth sores which can be a side effect. There are physicians including a respected professor of public health we spoke to who are skeptical that his extraordinary regimen will result in an extra decade of healthy life.

When a fellow physician calls some of what you're talking about hocus pocus.

People are entitled to think what they want. And just because someone is a physician doesn't mean they're even remotely equipped to evaluate the merits of exercise physiology. Remember, I went to Stanford Medical School, right? How many hours of education do you think I received on exercise?

Probably a few hours.

Zero hours. And how many hours did I receive on nutrition? Zero hours. It was 25 years ago, so maybe things have changed, but I'm pretty sure that if you're talking to other esteemed physicians,

they're in the same bucket as me. So, you know, they might not be the ones that are best equipped to be my critics.

Our last morning in Austin, Dr. Atiyah took us for a ruck, a hike with weighted backpacks.

This to me is as much about mental health and socialization, being in nature, and rucking is simply a vehicle to get that.

How much work do you do on your emotional and mental health?

A lot. I mean, it's as much a practice as what I put into exercise or, you know, blood work and cancer screening and all the other things that make up physical health.

Atiyah has been open about dealing with depression and anger stemming from abuse he suffered as a child. Through therapy, including two stays at inpatient care facilities, he says he turned a corner about five years ago.

By working hard on our physical health, we can reduce the rate of decline. But if we're being deliberate and active on our emotional health, it can actually improve.

He says progress was only possible because his wife of more than 20 years, Jill, stood by him. There is plenty of data on longevity and people living long that have very strong relationships.

Yes. Just like the exercise data, I don't think this is just a correlation. I really think that there is also some causality that flows from the end of having great relationships to living a longer life.

What's the point of living long if you don't have people to share it with?

What's the purpose of living longer if you're unhappy?

Dr. Atiyah plans on launching a new digital health app next year. He says that 80% of his program does not require a physician and is adamant it's never too late to begin delaying the inevitable. How long do you want to live?

You know, I want to live to be old enough to have a meaningful relationship with as many as my grandkids as I can. That probably means making it into my nineties.

Because you must be plotting that with your VO2 max.

Yeah, you know, it's funny. We do an exercise with our patients, which is called the timeline exercise. So if we were doing this for you, we would draw a line for Nora. So you're 51.

And then I would draw a ticket 61, 71, 81, 91, 101. And then we would draw all three of your kids. And then we would start to extrapolate, when do you think they're going to have kids? And so you're going to draw their first grandkid, and we're going to map your life out according to this timeline. And you're going to see pretty quickly what it's all about.

That really kind of puts it in great perspective for me.

So, yes, I've mapped my life out in that regard. And I know that the difference between being 80 and 90 is huge in terms of what I can have with those kids.

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