Stanford’s Healthy Aging 50+ Conference

Stanford’s Lifestyle Medicine first Healthy Aging 50+ Conference (Agenda, Videos) was held in Feb 2024 . I was encouraged to find that my understand of what leads to a fit and healthy life has a great deal of overlap with the material they presented. I wish their site existed 12 years ago, it would have saved me countless hours of research.

The conference was broken up into sessions which covered several of the “pillars” the program has identified for a healthy life. No matter which pillar was being discussed, the presenters typically brought up other pillars as providing essential support. The most regularly cited pillars across all the talks:

Eat healthy whole food, not packaged junk
Move your body throughout the day
Get enough sleep

Toward the end of the day it was noted that 70-80% of chronic illnesses are related to lifestyle choices, emphasizing the power of daily decisions on health outcomes.

Movement & Exercise

It was not surprising that the health benefits of aerobic exercise and strength training were discussed. Of equal importance is to have movement a regular part of daily life. Walking is super helpful. General functional movement throughout the day is really good. Sitting around in a chair for hours at a time is not health promoting.

A number of the presenters including the 🔎 Starretts talked about creating a movement rich environment which emphasizes accessibility and ease of adoption. Several people talked about “exercise snacking”, short bouts of health promoting movement through the day which are fun.

Stability

What was striking to me was the emphasis on stability, balance, and range of motion. The ability to move on multiple axes at the same time. I was first introduced to the idea that stability should be one of the pillars of an exercise plan by Peter Attia, but had put off focusing on this. During the conference I was reminded of how devastating injuries from falls are for aging individuals. One person said that while we know we will lose strength as we age, so long as we have enough strength to move, stability doesn’t have to decrease. In fact, through practice we can improve our balance. Two tools to evaluate your stability:

This section had a great influence on me. I have already started to look for opportunities to improve my balance like brushing my teeth while standing on one leg, added jumping rope to my daily activities, and I am now looking for a trainer who specializes in DNS or Pilates.

Breathing

Several people talked about the importance of breathing. The way we breathe affects both our physical and mental states. Breath work can help us focus, prepare us for maximum effort endeavors, and calm us down.

Paying attention to our breathing can be a powerful diagnostic. It was noted that if you think about taking a one rep maximum breath, we will often shift from a bad posture / position to one that is much better. Likewise, when you find yourself holding your breath, or struggling to take a big breath, it is likely because we are struggling with a mobility, range of motion issue.

Strong feet

Feet are the basis of our stability and a key interface to the world. When our feet are weak and sensory deprived, we will lack a solid base. Sensory feedback and strong feet and ankles help us avoid injury producing falls.

It was observed that while shoes with large cushions exemplified by Hoka can help feet recover, you wouldn’t want to have your feet wrapped in an oven mitt all the time. It would be good to spend some time barefoot which is good for foot health.

I personally believe that wearing minimalist/barefoot footwear is extremely helpful for most people.

Periodization and Recovery

Several people talked about how providing the body time to recover after exercise is essential. As people age they need more time to recover. Failure to provide adequate recovery not only retards improving performance but can lead to injuries. The best way to protect against overtraining is to use periodization which mixes hard work outs, rest, and more gentle workouts over a period of several weeks.

Diet

The Standard American Diet (SAD) is likely a significant contributor to many chronic diseases with its high calorie, low nutritional content. This is not just an issue for the omnivores, because there is a vegan version of SAD which over consumes processed foods, grains, and other starchy vegetables without getting adequate nutritional content found in healthier vegetables.

Plant Based Diets

Many of the presenters recommended a plant based diet including Valter Longo and Dean Ornish. There is a growing body of evidence that a healthy lifestyle and a plant based diet not only slows the progression of disease, but can actually reverse a wide range of issues including heart disease, metabolic diseases such as type 2 diabetes, cellular aging (telemeters lengthen?!), and partially reverse Alzheimer’s and other neurodegenerative diseases.

Mediterranean Diet

Everyone seems to agree that the Mediterranean Diet is proven to be healthily. The PREDIMED Study is the most cited study on this topic.

Ironically, no one knows exactly what a Mediterranean diet is. Rather each person imagines what it is. How could that be? The intervention in the PREDIMED study was that families were given nuts or olive oil. How did that change people’s diet and lifestyle? We don’t know. It was thought that it encouraged them to eat in a manner that followed traditional diet in the Mediterranean.

We know that people who live around the Mediterranean have historically been longer lived, and that they share a number of characteristics with other people in “Blue Zones”. What was the diet which enabled so many people to live as long as they have? We don’t know for certain, because their diet was not documented at the time, and people’s memories of eating habits are very unreliable.

Protein Needs

There were some lively discussions about the appropriate amount of dietary protein. Those with a focus on performance (especially who work with athletes) seemed to advocate for 1.2g protein / kg of body weight. Those focused on longevity suggested .5-.8g / kg body weight for people under 65. Everyone noted that people over 65 need more daily protein to slow the loss of muscle. My conclusions on this topic in my protein post.

It’s worth noting that just eating protein does not prevent sarcopenia (losing muscle) in aging populations. Building and maintaining muscle requires exercise (which causes the release of insulin) along with 25-30g of protein to stimulate muscle production.

Fasting and Ketogenic Diets

Valter Longo discussed the health benefits of fast mimicking diets which can be an effective treatment for a variety of metabolic diseases as well as significantly improving the effectiveness of other cancer treatments.

While none of the presentations discussed ketogenic diets, there were a number of hallway conversations which noted that there is evidence that this diet can improvement of a number of chronic conditions.

One of the nutritionists noted that she believes that a plant based (slow carb) diet is the best long term style of eating, but the best diet for someone trying to make short term changes will vary and is dependent on which diet (plant based or keto) a person can stay compliant with.

While not discussed in the conference, I have noticed that there is a vocal group of people who believe that the majority of diseases (physical and mental) have their roots in a maladapted metabolic system (e.g. unhealthy mitochondria) or diet which is causing inflammation.

Unsung Heros: Nutritionist

A number of the doctors at the conference sung the praises of nutritionists. They wanted us to know that nutritionists, not MDs, are the experts when it comes to diet. They spend four+ years focused on this topic, while doctors get a few lectures during med school.

Sleep

I personally didn’t find the panel on sleep particularly helpful. Much of the time was spent making the case that sleep matters which I already knew.

What I found most helpful was the observation that the worst thing you can do at night is to stress about sleep. If you wake up in the middle of the night, don’t get anxious. The worst thing you can do is lie and bed worrying about not sleeping. Find something calming to occupy your time until your are sleepy. Meditate, do some yogi, read or listen to a book. What you shouldn’t do is pick up your phone or do things which make you worry.

Wearables

Many of the presenters see value in trending data from wearables. For example, the overall direction of resting heart rate, heart rate variability, etc.

No one recommends using wearables to determine your daily activity. You should decide on your day’s activities based on how you feel, not on your “recovery” or “readiness” score from one of the wearables. When training, REP is typically more reliable than being in a particular “zone” provided by the wearable. Several people noted that they stopped using wearables because they got overly stressed by the data.

Most wearable “sleep scores” are terrible. It was noted that the best indication that you got good sleep is that you aren’t tired or sleepy before your normal bedtime.