Chapter 27
Lifestyle+ — 18
The National Institutes of Health is investing $189 million to study ten thousand participants as part of the All of Us Research program. Called the Nutrition for Precision Health, the data being collected are similar to the Israel and British studies but also include dual-energy X-ray absorptiometry scans, grip strength, and photos of all the participants’ food via an automatic ingestion monitor attached to eyeglasses. About five hundred people will live at a clinic site for six weeks for close monitoring.
The work using AI to determine an optimal diet for individuals is still in its early stages. In 2019, I wrote on the potential merits of AI, conveying my own multilayered data collection and the predictive algorithm directing me to many foods that were not just unalluring but, for my preexisting condition of kidney stones, potentially dangerous. It’s also challenging because it’s not likely a one-off determination; your optimal diet will likely change with stress, weight loss, and significant changes in your physiology. Eventually we will get there, with all of a person’s data integrated, but whether it will be adopted or change clinical outcomes, such as preventing heart attacks or diabetes, will take years to determine. Worsening health inequities across society might seem more urgent for the health of our species.
EXERCISE
Turning to a factor that seems more within our control with a profound impact on health outcomes: physical activity. Nothing surpasses regular exercise for promotion of healthy aging! Exercise can be viewed as the single most effective medical intervention that we know. If you could design a drug that exerted diverse potent salutary health impacts across all our organ systems, it would be considered a miracle breakthrough. Regular exercise leads to favorable adaptations of the cardiovascular system, brain, pancreas, skeletal muscle, gastrointestinal tract (enhanced production of short-chain fatty acids, SCFA), liver, adipose tissue, gut microbiome, and peripheral blood vessels. The metabolic trifecta of three organ systems—pancreatic, skeletal muscle, and adipose tissue—leads to increased insulin sensitivity. Further, exercise protects against atherosclerosis and improves cardiovascular function through multiple pathways, including reducing lipids in the blood, increasing lipid oxidation by skeletal muscle, reducing bone marrow output of white blood cells that lessens body-wide and brain inflammation, improving our immune system responsiveness, and, at the subcellular level, enhancing mitochondrial function. A randomized trial showed inflammation biomarkers were suppressed more with exercise than with a GLP-1 drug. A major NIH initiative to understand the effects of exercise, the Molecular Transducers of Physical Activity Consortium (MoTrPAC), has provided multiomic data, in the experimental model and in people, that validate protective effects of physical training across multiple organs, such as the immune system, and confirm sex-specific effects, particularly for adipose tissue biology. When I discussed this with Euan Ashley of Stanford University, one of the leaders of MoTrPAC, he interpreted the body of evidence based on a London bus conductor versus bus driver study from 1958, along with many recent reports, as “one minute of exercise bought you five minutes of extra life. And, actually it’s a little more. If you did high intensity exercise, one minute would give you seven or eight minutes of extra life.” He tells this to his patients when they come in and say they don’t have enough time to exercise.