How to think about nutrition for longevity

Moving from exercise to your second favorite, nutrition, I think it'd be helpful to start kind of, what's your framework for how you think about nutrition? Because you don't necessarily think about nutrition as some people talk about it, which is this diet's best or this diet's best. You kind of look at it a little bit of a different way. And so do you want to walk people through your framework and how you assess nutrition and where someone is at in their nutritional state? Yeah, I mean, I would say that nutrition is a very complicated thing to study. I would say it's the messiest of all the pillars to study, probably even messier than emotional health, although maybe that's debatable. But the reasons for it are obvious and not worth restating. But it's for that reason that there are very few things that can be stated in this field with a high, high degree of certainty. So unfortunately, the challenge in nutrition is you have a lot of people that speak with such insane conviction and they talk about something as though it is absolutely correct, even though if you were putting an error bar on their statement, it would dwarf anything they're saying. And truthfully, I have been guilty of this, right? I think 12 years ago, I was talking about nutrition with a level of certainty that I don't think was warranted. And so as the adage goes, the further you get from the shore, the deeper the water. And I think in my older age, I'm actually quite far out from the shore. And I realized the water is awfully deep out here. And there aren't a lot of things that can be stated at a high enough degree of certainty that you should act on them with, you know, almost blind faith. So here are the two that I can tell you with a very, very high degree of certainty. The first is that the single most important input from nutrition to a person's overall health is energy balance. Stated another way, the energy input of food is the first order determinant of health. Maybe stated another way, the total calories you consume would be the most important thing. Not the only thing. I do not want to suggest that a thousand calories of Tic Tacs is the same as a thousand calories of broccoli. It is not. But I'm also talking about this through the lens of common sense. And the truth of it is, if you subside on a diet of Tic Tacs, you're going to eat a lot more than a thousand calories of them because they're not satiating and they're junk and they're hollow. So I want to be very clear that the primary input is total energy, but it is also impacted by many other things, including diet quality, processing, and macronutrient distribution. The second thing that is abundantly clear is that protein is the macronutrient we should be least flexible on. Stated another way, we can be quite flexible on how much carbohydrate and fat we consume to fill our energy needs. But because protein is not consumed for the purpose of ATP generation, which is the principal reason we consume carbohydrates and fats, although fats are also essential for some structural purposes, we cannot be too flexible or compromising in our protein requirements. In other words, if you really wanted to just come up with a single number to give people, I would say on average about 1.6 grams of protein per kilogram of body weight should be consumed by everybody. Now again, I hate saying that because there's truly nothing that you can say across the board. There are clearly people who based on what they're eating will need more protein and there are probably people who can get away with a little bit less. You know, if you took a perfectly high quality PD-Cas1.0 protein in a person who's not over the moon active, they could probably get away with 1.2 grams or even 1 gram. But boy, anything below that and you're starting to really miss out. And by the way, as you age, those requirements go up due to anabolic resistance. So again, we can talk all day about every diet under the sun and every religion and every faction of every religion around every dietary tribe. But the truth of it is, it's really hard to find a scientist, an actual nutrition scientist. I'm not talking about an influencer, I'm not talking about a health blog, I'm talking about actual people who work in labs doing nutrition who will kind of disagree with that statement. There are some, but they are in the huge minority and interestingly, they tend to avoid using human data when they talk about those things. But when you limit yourself to the species of interest, which is humans, not rodents, and you talk about experimental data coupled with other insights, those two things seem to matter the most. How many calories are you getting? Not too much, not too little. Are you getting enough protein? Obviously there are other terms. We certainly want to make sure you're getting enough micronutrients as well and that you're avoiding toxins. That tends to be less of an issue today than it was 100 years ago. But of course that's also really interesting. But a lot of the other stuff, Nick, is details, right? So when I'm looking at a patient, given how important those things are, to me it makes sense to be evaluating those things at the outset. So when we do a DEXA scan on somebody on day one and we can see how much subcutaneous fat they have, how much visceral fat they have, how much muscle mass they have, and we can do a lot of advanced blood work and see how metabolically healthy they are, how well they dispose of glucose, all these other things, I can very quickly answer three questions, literally on first contact. Are you overnourished or undernourished? And that really comes down to energy balance. How much fat do you have on your body and how well is it distributed throughout your body? Where is it distributed? Second question, are you adequately muscled or are you undermuscled? Third question, are you metabolically healthy or not? And when you can answer those three questions, which you can in a very short period of time with a relatively small amount of data, that tells you, does this person need to eat more, less, or the same total energy, the same amount of protein or less, and how important and what type of exercise should they be doing to augment our findings? Now, because we're talking about nutrition, I'll close this out by saying most people when they do this come out slightly in the overnourished category. That's just another way of saying most people are overweight or obese, right? I think the numbers are probably 70% of the population are overnourished or significantly overnourished. Therefore, most people, when you go through that whole treatment algorithm, are going to be in the I-need-to-eat-less camp. If you are in the I-need-to-eat-less camp, you now have three ways to do that. Three strategies, if you will. The first is directly reducing caloric intake. That says, agnostic to what or when I eat, I will simply eat less. This is the most direct way to do it. It has lots of pluses and minuses, which I've discussed in so much detail in other podcasts that we'll link to. The second method is, I will identify something or some set of things in the diet that I will remove from the diet. I will restrict them. This is called dietary restriction. The more restrictive the elements of your diet, the more effective this technique is. If you only choose to restrict lettuce, this will have no effect. If you restrict everything but potatoes, meaning if the only thing you allow yourself to eat is potatoes, this will have an enormous effect. Again, the more you restrict, the better that works. The third strategy is time restriction, where you limit the window in which you eat. The narrower and narrower that window, the greater the likelihood that you will overall induce a caloric deficit. There's a lot more I can say about nutrition. We could get into the nuances of which type of fats are better. Saturated fats, monounsaturated, polyunsaturated fats. Is a Mediterranean diet more efficacious than a low-carb diet or a low-fat diet? All of those things, again, I've written about, I've spoken about, but I think from the standpoint of what are the most important things, I think you've got it. Have you remembered what you ate for lunch yet? That's I think the only thing from the nutrition conversation that's missing. I scarfed down some leftover spaghetti squash that we made yesterday and what else did I have? Oh, I had like a container of blackberries and I had some venison.