April 26, 2022


Lessons from centenarians: why prevention of chronic disease is critical

"To me, the takeaway for us, as physicians or people who want to have an extra five years of life or 10 years of life... is nothing matters more than prevention of chronic disease. And by the way, you don't get to prevent it once you have your heart attack. Secondary prevention is not prevention." - Peter Attia, M.D.

Read Time 2 minutes

This video clip is from episode #204 – Centenarians, metformin, and longevity with Nir Barzilai, M.D., originally released on April 25, 2022.


Show Notes

Lessons to take away from centenarians

  • Peter comments, these centenarians have a gift, which is their great-grandchildren will know them
    • With a preserved healthspan, you can go to concerts (or on vacation) with your great-grandchildren
      • That’s amazing
      • Think about the implication of how much of their life you’ve been a part of
    • Most of his patient’s can’t tell them the names of any of their great-grandparents (we all have 8)
    • Centenarians will have lost many people in their life but they will also get to know more people
  • Peter also notes that he’s never really met somebody who is dying at the age of 75 who didn’t wish to have another year of life

If we want to live an extra year (or 5), what are the most important lessons we can take away from centenarians?

  • Nir recalls the wrong lesson, from one of his darkest days in research
    • Jay Leno in The Tonight Show said, “There’s those people at Einstein and they said, ‘The secret for longevity is don’t exercise, don’t … be obese.’… If you die, you don’t care anyhow.”
  • Nir knows a woman who smoked for 90 years and died at age 110
    • He wonders if she could have been the next Madame Calment (person with the longest, documented life; she died at age 122) if she didn’t smoke

So the lesson for most of us is still exercise and nutrition”— Nir Barzilai

  • This not the lesson from centenarians
  • The lesson from centenarians is that there are longevity genes that could be translated into drugs and Nir believes that they could afford years of health span
    • This is the clinical lesson, not the emotional lesson
  • Peter notes, the superpower he sees in the centenarians is simply delaying the onset of bad things

Bad things just happen to them 20 to 25 years later”— Peter Attia

  • The distribution of death for centenarians is shockingly similar to that of non-centenarians, with a couple of differences
    • They tended to have a little more atherosclerosis, a little more heart attacks, a little less Alzheimer’s disease, and a little more pneumonia
    • But directionally, they had the same actuarial table of death as people dying in their 80s
    • It’s just a time shift
  • Nir reviewed the paper from Germany where they looked at pathology in 1000 centenarians who died in their homes
    • The title was funny because it was something to the effect, “there’s nothing special about the centenarians
    • They’re dying for the same thing, but 30 years later
    • This misses the point; it’s like a negative study
  • You can look at the resiliency of centenarians or the fact that their aging was slow
  • Peter is interested in ultra primary prevention and how to live an extra 5 or 10 years
    • Not preventing the second heart attack
    • Preserving healthspan
Nir Barzilai, M.D.

Born in Israel, Dr. Barzilai graduated from The Ruth and Bruce Rappaport Faculty of Medicine at the Technion-Israel Institute of Technology in Haifa and completed his residency in internal medicine at Hadassah Medical Center in Jerusalem. He served in a refugee camp during the war in Cambodia (1979-1980) and built a nutritional village in the homeland of the Zulu (1983 – Kwazulu). He has completed 2 fellowships at Yale (metabolism) and Cornell (Endocrinoology and molecular Medicine). He  served as chief medic and physician in the Israel Defense Forces. He was an invited speaker to the 4th Israeli President Conference (2012) and a Vatican conference on efforts to enhance cures (2013, 2016). He has also taken part in Global initiatives and spoke at The Milken Global Institute, Asian Megatrends and is an advisor for the Prime Minister of Singapore on Aging. Dr. Barzilai has been on the ‘Forward 50, top 50 influential Jews in the US (2011). His work has been profiled by major outlets, including the New York Times, the BBC and PBS’ NOVA science now, TEDMED and several TEDx talk is the leading feature on the Ron Howard/Jonathan Silberberg/National Geographic film about the Age of Aging. He authored Age Later (2019).

Dr. Nir Barzilai is the director of the Institute for Aging Research at the Albert Einstein College of Medicine and the Director of the Paul F. Glenn Center for the Biology of Human Aging Research and of the National Institutes of Health’s (NIH) Nathan Shock Centers of Excellence in the Basic Biology of Aging. He is the Ingeborg and Ira Leon Rennert Chair of Aging Research, professor in the Departments of Medicine and Genetics, and member of the Diabetes Research Center and of the Divisions of Endocrinology & Diabetes and Geriatrics at Albert Einstein College of Medicine.

Dr. Barzilai’s research interests are in the biology and genetics of aging. One focuses on the genetic of exceptional longevity, where we hypothesize and demonstrated that centenarians have protective genes, which allows the delay of aging or for the protection against age-related diseases. In a Program he is leading we take full advantage of phenotypes, DNA, and cells from the Ashkenazi Jewish families with exceptional longevity and the appropriate controls and his group have established at Einstein (over 2600 samples of which ~670 are centenarians) and discovered underling genomic differences associated with longevity. Longevity Genes Project (LGP) is a cross-sectional, on-going collection of blood and phenotype from families with centenarian proband. LonGenity is a longitudinal study of 1400 subjects, half offspring of parents with exceptional longevity, validating and following their aging in relationship to their genome. The second direction, for which Dr. Barzilai is holding an NIH Merit award that focuses on the metabolic decline of aging, and his team hypothesize that the brain leads this decline. His lab has identified several central pathways that specifically alter body fat distribution and insulin action and secretion by intraventricular or hypothalamic administration of several peptides that are modulated by aging including: Leptin, IGF-1, IGFBP3, and resveratrol.

He has received numerous grants, among them ones from the National Institute on Aging (NIA), American Federation for Aging Research, the Ellison Medical Foundation, and The Glenn Medical Foundation. He has published over 280 peer-reviewed papers, reviews, and textbook chapters. He is an advisor to the NIH on several projects and serves on several editorial boards and is a reviewer for numerous other journals. Dr. Barzilai is in the Scientific Director and on the board of the American Federation for Aging Research, is its co-scientific director, and has served on several NIA study section. He is also a founder of CohBar Inc., a biotech that develops mitochondrial derived peptides as therapy for aging and its diseases and of Life Biosciences biotech. Dr. Barzilai has been the recipient of numerous prestigious awards, including the Beeson Fellow for Aging Research, the Ellison Medical Foundation Senior Scholar in Aging Award, the Paul F. Glenn Foundation Award, the NIA Nathan Shock Award, the 2010 Irving S. Wright Award of Distinction in Aging Research and the IPSEN Longevity Prize (2016).

He is currently leading an international effort to approve drugs that can target aging. Targeting Aging with METformin (TAME) is a specific study designed to prove the concept that multi-morbidities of aging can be delayed by metformin, working with the FDA to approve this approach which will serve as a template for future efforts to delay aging and its diseases in humans. 

[Albert Einstein College of Medicine]

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