Longevity and Healthy Aging: Two Competing Visions (Part 3 of 5)
Diet and Metabolic Health; also, a New Theory of Mental Illness
Diet and Metabolic Health
Previously, in the first two posts of this series on Longevity and Healthy Aging, we covered the major topics of Healthspan and Exercise as discussed by our four medical doctors, Sullivan (2016), Luks (2022), Hyman (2023), and Attia (2023), and as confirmed or challenged by other qualified experts and peer-reviewed sources.
Our four experts agree that regular exercise — that increasing your muscular strength and cardiorespiratory fitness – will help extend your Healthspan across your natural Lifespan. This is the “squaring off the curve” as Luks (2022) puts it — the slowing of age-related decline, and the compression of morbidity. A vast body of research strongly — undeniably, in fact — confirms this general claim.
Image copyright Luks, 2022. Cited under Fair Use.
All good, although we have not cracked yet neither the mystery of biological aging nor that of biological death — at least according to Sullivan (2016), Luks (2022), and Attia (2023). Hyman (2023) seems more optimistic we can reverse biological aging.
Yet even if “forever young” is not in the current deck of cards, we can postpone chronic illnesses or delay their debilitating effects until near the very end of our natural Lifespans.
The Four Horsemen
But the “odds are overwhelming,” as Attia (2023) points out, “that you will die as a result of one of the chronic diseases of aging that I call the Four Horsemen: heart disease, cancer, neurodegenerative disease, or type 2 diabetes and related metabolic dysfunction.”
In broad strokes, as this does not apply to all forms of cancer or dementia, the “Four Horseman” have a common etiology — a shared root cause: poor metabolic health.
Poor Metabolic Health — the Common Etiology
In the words of Sullivan (2016) [his citations expanded]:
People with metabolic syndrome or its components are more likely to become frail (Barzilay, et al., 2007; Ottenbacher, et al., 2002), to suffer from stroke, cardiovascular disease and heart attack (Roger, et al., 2013), to develop heart failure (Horwich and Fonarow, 2010), to develop kidney failure (Peralta, et al., 2006), and to suffer from erectile dysfunction (Chughtai, et al., 2011), depression (Rasgon and Jarvik, 2004) , loss of independence, and premature death (Rana, et al., 2006).
In the words of Luks (2022):
Heart disease, metabolic syndrome, stroke, dementia, type 2 diabetes, and many cancers all have poor metabolic health in common as a root cause.
In the words of Attia (2023):
The metabolic derangement that leads to type 2 diabetes also helps foster and promote heart disease, cancer, and Alzheimer’s disease.
And in the words of Hyman (2023):
A 2018 study found that 88 percent of Americans are in poor metabolic health—meaning they are on their way to heart disease and diabetes and dementia and cancer.
88% of Americans. On their way. To heart disease and diabetes and dementia and cancer. Likewise, as we reviewed earlier, according to the CDC, 6 in 10 adult Americans — 60% of the adult population — already suffer from at least one chronic disease. What to do?
We know that “exercise transforms the metabolic landscape” (Sullivan, 2016) and “has the greatest power to determine how you will live out the rest of your life” (Attia, 2023). But what about diet and nutrition? Can we combat poor metabolic health by changing what we eat and how we eat?
Does Diet Make a Difference?
We have no shortage of diet plans and nutrition guidelines — and yet we still have widespread failure in improving metabolic health. Rising rates of obesity, type 2 diabetes, et cetera and so on. What do our four longevity experts think? What does the research indicate?
Our four medical doctors are NOT all in agreement. But we can shift through it all and find some useful recommendations.
Steak and Eggs?
Sullivan (2016) offers marvelously a deep dive on the human metabolic system in chapter 4 of The Barbell Prescription, but saves his advice on diet and nutrition until chapter 16. Since Sullivan (2016) is about building muscle and strength, he declares “the best nutritional plans start building out the diet with the protein sources first.” His sample menus are big on scrambled eggs, grilled chicken breasts, whey protein shakes, and sirloin beef steaks — all in one day.
Sullivan (2016) recommends consuming “most dietary starches and sugars around the training sessions” — although he does recognize that “too much dietary carbohydrate may promote fat accretion and possibly even the development of metabolic syndrome and insulin resistance.” Yes, indeed. Much more on this shortly.
Otherwise, Sullivan’s (2016) comments on the relationship between metabolic health and diet strike your author as perhaps the weakest part of his Barbell Prescription. But his emphasis that older adults need more quality protein in their diets is shared by our other three experts — and two additional expert sources.
Whole food plant-based (WFPB) diets?
Luks (2022) fully recognizes how highly processed foods and an abundance of refined carbohydrates and sugar contribute directly to poor metabolic health:
I recommend that you stick with real food, cook and prepare your meals, and leave the food industry’s junk in the supermarket. ... Head to your kitchen with an oversized garbage bag or two [and toss all the ultra-processed food items].
Although “diets rich in natural foods, including vegetables, fruit, lean meat, complex carbs, and grains” are what appears best to Luks (2022), he realizes that each person will need to experiment to find an enjoyable and sustainable healthy diet. So Luks (2022) offers a simple strategy to get started:
Consume less sugar.
Favor unsaturated fats vs. saturated fats.
Eat more plants.
Avoid ultra-processed carbohydrates (think cereal, instant oatmeal, white rice).
Include more fiber from vegetables and fruits into your body.
If more Americans just followed the above advice, our population would have significantly better metabolic health.
His highly actionable, commonsensical advice notwithstanding, Luks (2022) does recommend for his patients “whole food plant-based (WFPB) diets” and provides detailed suggestions in chapter 6 of Longevity … Simplified for getting enough quality protein if one chooses to avoid meat sources.
SAD is Failing!
Although NOT a fan of the Keto diet, and strongly preferring “whole food plant-based (WFPB) diets” instead, Luks (2022) does fully recognize the failure of the SAD (Standard American Diet). “Since the low-fat craze began,” Luks (2022) points out, “several things have happened”:
Obesity rates have skyrocketed.
The incidence of type 2 diabetes has increased.
Systemic inflammation within our body has become the norm.
So for Luks (2022), “ultra-processed carbohydrates are not okay,” “water should be the primary beverage we choose throughout the day,” and the “food industry will try very hard to convince you that the opposite is true.”
Good Nutrition ~ Transformative Healing
Hyman (2023) has definite ideas about the relationship between diet and metabolic health, and the influence of Big Food. His claims are generally similar to Luks (2022), but stronger and developed in much greater detail. Based upon his clinical experience, Hyman (2023) is passionate about the transformative effects of good nutrition:
Janice was sixty-six when she came to see us, severely obese, suffering from clogged arteries that needed stents, heart failure, high blood pressure, fatty liver, failing kidneys, and type 2 diabetes on insulin. Her blood tests were scary, and she was on her way to a heart and kidney transplant. She was on a pile of medications for which her co-pay was $20,000 a year.
So co-morbidly obese with several chronic conditions, and poly-pharmaceutical to boot. A near-perfect example of what Sullivan (2016) has described as the “sick-aging phenotype.” What to do?
Hyman (2023) focused on diet and related life-style changes:
Within three days of joining our group program, by changing her diet from a lifetime of junk food to using food as medicine, consuming a very low-glycemic, high-fiber, good-fat, phytonutrient-rich, plant-rich diet, and following a simple vitamin regimen (multivitamin, fish oil, and vitamin D) she was able to get off her insulin.
Off her insulin in only three days? Almost miraculous, but Gary Taubes (2020), in The Case for Keto, interviewed numerous medical professionals who related similar stories of positive transformation once their patients got off crap food and starting eating clean. Such seeming miracles do happen.
Janice: No Surgeries, No Prescriptions Needed
There is more. Hyman (2023) further reports:
Within three months she [Janice] was off all her medication and her numbers were all normal (heart failure gone, kidneys and liver normalized, and blood pressure and blood sugar normal). After a year she lost 116 pounds and was able to fully return to a vibrant, active life as a leader in her community.
No organ transplants needed, and that former $20K a year prescription co-pay also considerably reduced. “Food is the key lever” for Hyman (2023), and the bottom line as far as diet goes:
Cut the sugar and starch and processed food. Eat lots of phytochemicals from colorful fruits and vegetables, good fats, and high-quality protein.
But the problems with the SAD (Standard American Diet) go well beyond just our nation. “The United States,” Hyman (2023) asserts, has “created the worst diet in the world and exported it to nearly every country on the planet, which is why 31 million of those global deaths from chronic disease are in low- or middle-income countries, double the deaths from infectious disease.”
The Big Business of Exporting Death by Metabolic Syndrome
Your author strongly agrees with Hyman (2023) on this claim, outrageous as it might first seem. To learn more, please consider the work of Dr. Suneel Dhand, and the following documentary “How the U.S. is Exporting Obesity.”
In chapter 5, “Dying of Too Much or Too Little: Why Balance Matters,” Hyman (2023) explains in detail his case against the SAD. This chapter is both a delight and horror to read, and the section on nutrition closes as follows: “All in all, if we were to design the perfect diet to create an epidemic of chronic disease and a shortened life span, it would be our current industrialized, toxic diet.”
Praise the truth when you hear it spoken.
Robert H. Lustig, MD, in Metabolical (2021) has no issues assigning blame to “Big Food, Big Pharma, and Big Government”:
As people get sicker, Big Pharma benefits from complicity, the food industry is protected from the costs of its actions, and the government profits from tariffs on processed food shipped to other unsuspecting countries.
Not to mention the revolving doors of consultancy, lobbying, corporate directorship, and public officialdom between elite members of Big Food, Big Pharma, and Big Government.
A Direction to Go Forward
Whether one agrees with such geo-political analyses or not, we have on the topic of nutrition from Luks (2022) and Hyman (2023) strong agreement on some basics:
Cut the sugar as much as possible — including and especially the added sugars in highly processed foods.
Cut out highly processed foods.
Cut out all the junk carbs — which simply promote insulin resistance and poor metabolic health.
Eat a rainbow of vegetables and fruits.
Eat good fats.
Eat quality protein.
Pay attention to your microbiome — your gut health.
Hyman (2023), again, goes into considerable details on certain concerns — please considering purchasing his book or tracking down his many interviews if these deeper dives appeal to you.
But No One Path to Travel
Similar to Sullivan (2016), Luks (2022), and Hyman (2023), Attia (2023) holds that (italics his) “protein becomes critically important as we age.” Attia (2023) was a devout supporter and promoter of the Keto diet, but his clinical experience has led him in another direction as some of his clients responded wonderfully to the Keto diet whereas others did not.
As a result, Attia (2023) has become in a sense diet-agnostic:
Almost all “diets” are similar: they may help some people but prove useless for most. Instead of arguing about diets, we will focus on nutritional biochemistry—how the combinations of nutrients that you eat affect your own metabolism and physiology, and how to use data and technology to come up with the best eating pattern for you.
This does NOT mean he endorses the SAD (Standard American Diet). In fact, Attia’s (2023) key discussion on nutrition, chapter 15 — “Putting Nutritional Biochemistry into Practice: How to Find the Right Eating Pattern for You”— provides a comprehensively damning indictment of the SAD.
The Evil that is the SAD
To quote just four highlights from Attia (2023) [numbers mine]:
The SAD foils our key objectives with regard to nutrition: it induces us to eat more than we need to, becoming overnourished, while its preponderance of low-quality, ultraprocessed ingredients tends to displace other nutrients that we need, such as protein, to maintain optimal health.
The SAD disrupts the body’s metabolic equilibrium. It places enormous strain on our ability to control our blood glucose levels, and causes us to store fat when we should be utilizing it.
The elements that constitute the SAD are almost as devastating to most people as tobacco when consumed in large quantities, as intended: added sugar, highly refined carbohydrates with low fiber content, processed oils, and other very densely caloric foods.
The farther away we get from the SAD, the better off we will be.
So what does Attia (2023) propose instead?
Your Bespoke Alternative?
Customized diet plans for each of his individual clients. Since Attia (2023) calls his general approach Medicine 3.0, he extends the upgrade here:
The real art to dietary restriction, Nutrition 3.0–style, is not picking which evil foods we’re eliminating. Rather, it’s finding the best mix of macronutrients for our patient — coming up with an eating pattern that helps them achieve their goals, in a way that they can sustain.
Good luck with scaling that approach. Following Luks (2022) and Hyman (2023), your author believes that individuals should begin “eliminating” certain food products. Full stop. Or, to quote Attia (2023): “The farther away we get from the SAD, the better off we will be.” Then the individual can experiment with what diet rich in natural foods will prove sustainable, enjoyable, and almost invariably more nutritious.
Attia (2023) does qualify that most of his Type A (and often enough, A-list) clients “are already on some sort of ‘diet’ when they come to me” and hence have renounced the SAD. But obviously the majority of adult Americans have not.
Just Start by Cutting the Crap
These qualifications notwithstanding, we are not quite done with elimination diets, including Keto — the diet Attia (2023) once advocated but has now put aside. Because — as Attia would surely appreciate — we have more and new information about metabolic health and how it affects mental health.
Enter Christopher Palmer, MD, a practicing and board-certified Psychiatrist, Director of the Department of Postgraduate and Continuing Education at McLean Hospital, and an Assistant Professor of Psychiatry at Harvard Medical School.
Similar to Hyman (2023), Palmer has his own stories to tell — his own patient case studies — about transformative healing initiated primarily with diet and related life-style changes.
Good Nutrition ~ Transformative Healing Yet Again!
The breakthrough for Palmer occurred in 2016 with a patient named Tom, a thirty-three-year-old man with schizoaffective disorder, who tried seventeen different medications which did not stop his hallucinations or delusions, but did cause him to gain over 100 pounds. Tom wanted to lose weight.
Gone Keto, Got Functional
Thinking that this would at least help Tom feel a greater sense of control over his own life, Palmer (2022) reports: “we decided to try the ketogenic diet — a diet low in carbohydrates, moderate in protein, and high in fat.”
Tom lost weight, but much more happened. Palmer (2022) reports that within weeks:
I began to notice remarkable and dramatic changes in his [Tom’s] psychiatric symptoms. He was less depressed and less sedated. He began making more eye contact, and when he did, I saw a presence and spark there that I had never seen before. Most astonishingly, after two months, he told me that his longstanding hallucinations were receding and that he was rethinking his many paranoid conspiracy theories. He began to realize that they weren’t true and probably never had been. Tom went on to lose 150 pounds, move out of his father’s home, and complete a certificate program. He was even able to perform improv in front of a live audience, something that would have been impossible for him prior to the diet.
I was flabbergasted. I had never seen anything like this in my entire career.
This experience set Palmer on a research and clinical practice which still continues. [He discusses the same experience on the Huberman Lab podcast (Nov 21, 2022), starting at 00:27:52].
Mental Disorders are Metabolic Disorders of the Brain?
What has Palmer (2022) discovered — or, in some cases —rediscovered? That (italics his) mental disorders are metabolic disorders of the brain. Moreover, nutrition is emerging as a major tool in treating mental illness — by fixing poor metabolic health to start.
As Palmer (2022) well states:
What we eat, when we eat, and how much we eat have direct effects on metabolism and mitochondria. Everyone knows that diet plays a role in obesity, diabetes, and cardiovascular disease. What most people might not know is that diet also has profound effects on mental health and the brain.
So there it is: “diet also has profound effects on mental health and the brain.”
Diet also has profound effects on mental health and the brain. ~ Chris Palmer, MD
So what is the SAD (Standard American Diet) contributing to the state of American mental health? We have no direct answer to this question, but according to the National Institute of Mental Health (2023 March), “more than one in five U.S. adults live with a mental illness (57.8 million in 2021)” and the prevalence of any mental disorder among adolescents is 49.5% — of which “an estimated 22.2% had severe impairment and/or distress.” The NIMH report is not good.
Perhaps not surprising given that — according to a 2018 study — “88 percent of Americans are in poor metabolic health” (Hyman 2023). American Exile has likewise presented the data.
Bottomline: the state of American metabolic health is horrible; the state of American mental health, on road to horror.
The state of American metabolic health is horrible; the state of American mental health, on road to horror.
As a psychiatrist, Palmer has treated dozens of patients and heard from hundreds more, many of whom experienced a complete remission of symptoms and so were able to significantly reduce or even get off their medications. How? By changes in diet and related lifestyle factors — by fixing their poor metabolic health.
The SAD and Mental Illness — Questions, Questions
What does Palmer think about the SAD? In a fairly recent interview, Palmer (Jan 18, 2023) observed:
Our current food supply is a lot of non-food. It’s a lot of chemicals and highly-processed food things that are formulated to be addictive. Even though the American Psychiatric Association doesn’t recognize food addiction, the Director of the National Institute of Drug Abuse has done a lot of research studies that have found that some highly-processed foods are in fact addictive and use the exact same reward pathways as cocaine addiction and nicotine addiction.
Our current food supply is a lot of non-food. Check. But highly palatable and designed — formulated — to be addictive. Double-check. So to quote Attia (2023) once more: “The farther away we get from the SAD, the better off we will be.”
Elimination Diet and the “Mildred Miracle”
Let’s hear one more success story resulting from in large part from an “elimination” diet. Summarizing from Palmer’s (2022) Brain Energy, we turn to the case of Mildred, who was diagnosed with schizophrenia at age seventeen and by age seventy, after decades of psychiatric medication and several suicide attempts, found herself combatting obesity. (Weight gain is a common side-effect of many psychiatric medications — and so is metabolic harm).
Mildred joined the weight-loss clinic at Duke University and was put on the ketogenic diet. She lost weight. Her symptoms improved. She was able to taper off her psychiatric medications as her symptoms went into full remission. Even thirteen years later, having lost 150 pounds and kept it off, Mildred remained symptom-free, off medication, and learned how to take care of herself — to live independently. She no longer had or needed a court-appointed guardian.
As Palmer (2022) poignantly notes:
Stories like Mildred’s . . . just don’t happen in psychiatry. Even with the best traditional treatments that we have to offer, this is unheard of. Mildred’s story and the theory of brain energy say it is possible.
Right. Let’s hear from Thomas Insel, MD and neuroscientist, a former Director of the HIHM (National Institute of Mental Health).
Our Mental Health Status Quo
In an interview shortly after leaving the NIMH, Insel admitted that after spending $20 billion dollars on research and related: “I don’t think we moved the needle in reducing suicide, reducing hospitalizations, improving recovery for the tens of millions of people who have mental illness” (May 11, 2017). Oopsie. Insel should have added: “Not that any of that stopped us from playing GOD.”
Your author knows people with mental illnesses who have been in treatment for years with no improvement — if anything, they have experienced deterioration. Your taxpayer dollars at work. So please find some entertainment in this. To quote some select lines from MIA’s “Paper Planes”:
Lethal poison for the system ... All I wanna do is- And a- And take your money... Some, some, some I, some I murder, Some, I some I let go ... And take your money…
If Palmer has even a piece of puzzle, or a partially better solution, we should be all over it on a national level. Because what we are currently doing only works for Big Pharma/Big Medicine, and not for the people suffering from mental illnesses.
Palmer: Three Key Points
So three key take-aways from Palmer’s Brain Energy (2022):
Diet has profound effects on mental health and the brain.
All mental states, even normal ones, relate to metabolism.
Mental disorders are metabolic disorders of the brain. (So Palmer explicitly argues).
Let’s sum up our discussion of metabolic health, diet, and nutrition in regard to Healthspan and Lifespan.
Summary of Key Points on Diet and Metabolic Health
Poor metabolic health is a shared root cause for the chronic diseases of aging. A shared root cause for what Attia (2023) calls the Four Horsemen: heart disease, cancer (many kinds), neurodegenerative disease, and type 2 diabetes and related metabolic dysfunction.
Poor metabolic health has now been directly implicated in many forms of mental illness (Palmer, 2022). Obviously, mental illness can and often does significantly and negatively impact Healthspan and Lifespan.
Poor metabolic health is almost guaranteed by the SAD (Standard American Diet).
Metabolic health can be improved. Diet and Exercise are the two primary interventions. Exercise alone will likely not be sufficient because the full benefits of exercise cannot be realized without proper nutrition. Casey Means, MD (Sep 30, 2022) provides an excellent general overview for people seeking to learn more about and to improve their metabolic health.
People who were severely ill with chronic disease(s), or with major mental illness(es), have experienced transformative effects when getting off of the SAD and moving to the Ketogenic or other Low-Glycemic diets. Diets based on natural foods (i.e., natural foods as opposed to highly-processed food products). For this, Taubes (2020), Palmer (2022), and Hyman (2023) in toto provide numerous case studies — not extrapolations from lab mice, but real-world examples of people getting better. In many cases, these people experienced near-miraculous improvements in health — improvements beyond what the best conventional medical treatments would allow one to hope for or expect. In other words, improving your metabolic health can have tremendously beneficial downstream consequences for Healthspan and Lifespan — and this holds true almost regardless of your current condition.
To improve metabolic health and get away from the SAD, the generic nutritional advice offered by Luks (2022) and Hyman (2023) provides an excellent starting place for many Americans:
Cut the sugar as much as possible — including and especially the added sugars in highly processed foods.
Cut out highly processed foods.
Cut out all the junk carbs — these directly promote insulin resistance.
Eat a rainbow of vegetables and fruits.
Eat good fats.
Eat quality protein.
Pay attention to your microbiome — your gut health.
But as Palmer (2022) warns us, similar to Attia (2023), there is “no simple cure” or “any single treatment.” You will need to personalize your diet to find what is sustainable, enjoyable, and nutritious. This will require some experimentation. If you can afford to do so, consider getting a comprehensive blood panel to identify possible nutritional deficiencies and to map out your current state of metabolic health as indicated by the standard bio-markers.
In particular regard to metabolic health and mental health, Palmer (2022) does NOT recommend that psychiatric patients simply drop their medications should their new diets start producing beneficial effects. This caution is vital! Because the majority of psychiatric medications when used long-term create dependency conditions in their users, Palmer (2022) holds that withdraw from such medications should be carefully managed while under professional supervision.
I lost a good friend
At Christmastime when folks go off the deep end
His woman took the kids and he took Klonopin
Enough to kill a man of twice his size
~~ Jason Isbell, “Relatively Easy” from Southeastern (2013)
Finally, our experts cited in this section engage in detailed and nuanced discussions about intermittent fasting (generally recommended), mitochondrial health, microbiome health, metabolic processes and pathways, and much more. The dialogic synthesis presented above does not attempt to capture the entirety — only some key actionable points.
Necessary Disclaimer: American Exile does not offer medical advice, and none of our five posts in this series on Longevity should be understood as such.
Sources are cited in text. The six primary books discussed above: Sullivan (2016), The Barbell Prescription: Strength Training for Life After 40; Taubes (2020), The Case for Keto: Rethinking Weight Control and the Science and Practice of Low-carb/High-fat Eating; Luks (2022), Longevity…Simplified. Living A Longer, Healthier Life Shouldn’t Be Complicated; Palmer (2022), Brain Energy: A Revolutionary Breakthrough in Understanding Mental Health—and Improving Treatment for Anxiety, Depression, OCD, PTSD, and More; Hyman (2023), Young Forever: The Secrets to Living Your Longest, Healthiest Life; and Attia (2023), Outlive: The Science & Art of Longevity.