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Foreign. Hey everyone. Welcome to a Sneak Peek, Ask Me Anything or AMA episode of the Drive podcast. I'm your host, Peter Attia. At the end of this short episode, I'll explain how you can access the AMA episodes in full, along with a ton of other membership benefits we've created.

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Or you can learn more now by

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going to Peteratti md.com so without further delay, here's today's sneak peek of the Ask Me Anything episode.

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Welcome to ask me anything AMA episode 87. Today we're talking about environmental pollution. This is a complicated topic because while many of the risks are real, the evidence isn't always as clear cut as you might like. And unfortunately, the public conversation tends to pull in two directions as a result of that. So we're going to go through the evidence for some of the most common environmental exposures and give you a practical and actionable framework for deciding what deserves your attention and just as importantly, what does not. So in this episode, we'll cover what environmental pollution actually means and where it fits into the longevity conversation and hierarchy, why these exposures are so difficult to study, the potential health effects or negative health effects from air pollution, and what you should actually do to improve your air quality, how noise and light pollution can affect your sleep and cardiovascular health, and some practical tips to reduce their impact on you. And finally, an honest look at the science on EMF and 5G and whether the concern is warranted. If you're a subscriber and you want to watch the full video of this podcast, you can find it on the Show Notes page. And if you're not a subscriber, you can watch the sneak peek of that video on our YouTube page. So without further delay, I hope you'll enjoy AMA87.

C

Peter, welcome to another ama. How are you doing?

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Good, thank you.

C

Good. So today we're going to be talking about environmental pollution and all things related to that. So before we do, I think it might be helpful for you to first explain to the listener what exactly do we mean by environmental pollution? And also, why does that even belong in a conversation around longevity?

B

I mean, look, I think at a literal level, environmental pollution is the introduction of harmful substances or harmful forms of energy which, which we'll talk about into the environment. And I think the word harmful is doing a lot of work there. We're not just talking about something being unnatural, man made or detectable that wouldn't kind of rise to the level that we're talking about. We're talking about an exposure that can negatively affect a living system, and I'm going to just pause it for the moment that we are the system of interest for the purpose of this podcast. So the obvious examples which we will discuss are things like air pollution, but also things like water pollution, soil contamination. But other things that we're going to touch on are forms of pollution that can refer to forms of energy or sensory disruption, such as noise and artificial light. Now, we already did an AMA on chemical pollutants like microplastics, pfas, phthalates, and we'll obviously link to that for folks so they can go back and hear that. So I'm not going to obviously repeat that stuff. Instead, I want to focus more on the physical environment and the exposures that people, people encounter every day in their life. And I think the big ones here is basically the air that you're breathing, the noise you're hearing, the light that you're exposed to, and the electromagnetic fields around us. Again, the reason I'm not covering water and even soil right now is a lot of that was captured through microplastics, pfas and phthalates, which is generally the vehicle through which those travel. Okay, then to your second question, like why does this belong in a discussion around longevity? Well, it really comes down to, again, the definition of what harmful is. And some of these exposures are clearly linked to things that we care about, right? Cardiovascular disease, respiratory disease, cancer, sleep disruptions, even cognitive effects and outright mortality. Again, air pollution is probably the clearest example of this. If you've ever been to a city with very heavy air pollution or somewhere during a wildfire event, you don't need a randomized trial to explain to you that breathing there is horrible. And the epidemiology will very quickly demonstrate that, even over a short period of time. But I think the more interesting question is what happens well below the obvious threshold. And I think that's the area where most people, myself included, are interested to understand this. I don't need to know what happens when you live next to Chernobyl and there's a disaster or like I said, when there's a wildfire in your. In your neighborhood. But what about living near a highway where. What about cooking indoors with poor ventilation or sleeping in a noisy urban environment? Those aren't really producing obvious symptoms in any moment. But the question that I think we want to explore today is could those be leading to any chronic and cumulative effects? So a few days of imperfect air probably doesn't matter much. The question we want to understand is what's the area under the curve over years and decades, implying for disease risk and mortality. And then I guess the final point I would make as to why this is interesting is that unlike exercise or nutrition or other more readily modifiable behaviors, these exposures aren't always fully under our control. Obviously, you can choose in some cases where you live, but this is far less under our control, I think, than some of the things we normally talk about in this podcast. But the flip side of that is that the goal can't be to wipe out all possible exposures because that would mean sealing yourself into a hermetically closed bubble. It's rather, I think, to understand which exposures matter most, which ones are overstated, and then where practical interventions can meaningfully reduce risk. So if I were to sum all that up, I would say at the end of this podcast, I would hope that you as a Listener understand the 8020 principle of what you need to do, where I think 20% of the work is going to get you 80% of the benefit.

C

And this is an interesting topic where it's a bit polarizing, right? So on one end you have a group of people who are seemingly entirely unconcerned about any type of pollution, and on the other, you have people who potentially treat any quote unquote unnatural exposure as extremely dangerous. So what is it about this topic that you think creates such disagreement and polarization on those two sides?

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Well, I mean, I have lots of thoughts on that, but I would also argue that I don't want you to imply Nick or I don't want anyone to think that you're implying that that's the only area of health where we see polarizing points of view.

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Right.

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I think almost everything we seem to talk about on this podcast can be looked at through that lens, right? Cholesterol or whatever else. But for the purpose of getting off my soapbox, I think a big part of the problem is that the, the idea, the term, the concept, the field of pollution is very broad. So I think when one person hears it, they might think about smog that affects their breathing. Another person thinks about how urban glow might disrupt migratory birds. Someone else is convinced that cell towers are making them sick. But when you put all of those exposures in the same bucket, it becomes pretty hard to separate signal from noise. So if you see enough outlandish marketing for expensive devices to protect you from your phone's radiation, it's easy to wonder whether there's a whole house air filter that should also be part of your armamentarium. I think on top of that, what makes it hard for people to evaluate this is that these exposures are essentially invisible. Obviously, with the exception of light, they accumulate very slowly and they can take years or decades for the health effects to become apparent. And so the challenge of that from a scientific perspective is it makes the evidentiary standards inherently harder to interpret than for things where the signal is really clear. For example, smoking and cancer, which we've talked about, is one of the best examples of epidemiology being able to very quickly disentangle signal from noise, exposure from disease. So I don't think there's one thing, Nick, that explains this. I think it's just basically all of those things rolled together and potentially some things I haven't even thought of.

C

And on this, what do we know about why environmental exposures can be so difficult to study rigorously to give us much clearer answers around these questions?

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Again, I think there are several reasons, I sort of alluded to one earlier, but I think we can get even more thoughtful on that, which is it's almost impossible to study these exposures in humans the way we study drugs. Again, we think back to the principles of what makes studying drugs so straightforward, even though it's by no means easy, is that you can't randomize groups. The interventions are usually complicated. There's ethical concerns that go to it. So for just consider you couldn't do a randomized group of having one group of people breathe polluted air for 20 years next to a freeway and then another group of people be randomized to move and live as shepherds in parts of Ireland or Scotland near the freshest air possible, and then compare the outcomes. After 20 years, again you can find those groups of people and compare them. But that's not an experiment because you haven't randomized them. So you can't possibly measure all the nuances. To do an experiment, you have to take a group of people and, and separate them randomly into those different groups. So again, it's just, it's the very nature of doing that. That's, that's, that's very difficult. And so because you can't do the randomized experiment, you end up doing the thing that I described, which is you do the observational version of that, which is you find people that are naturally in these settings, so called natural experiments. And we try to understand what's happening there. But of course the challenge with that is unlike smoking, the signal, or the, to use it more technical term, the hazard ratio is so small. Again, when you compared smokers to non smokers, not in A randomized fashion. So admittedly, a smoker might have been more likely to do things that were unhealthy. The hazard ratios were greater than 10. So we're talking about more than 1000% difference between the risk of getting cancer and not getting cancer. If you're a smoker versus a nonsmoker, that's not subtle. You don't actually need statistics to help you understand that. But if the difference between in the natural observed experiment, if the difference between one group and the other is 30%, which would be a hazard ratio of 1.3, that's not within the ability for epidemiology to interpret and apply causality. I think another issue really is this idea of exposure measurement. So if I want to study something like a genetic marker or the phenotype of some known genetic marker like lp, I can measure it. Once I could measure your LP level, and I can be relatively confident that the exposure that you have to that lipoprotein is stable over time. But environmental exposures aren't necessarily like that. You, your exposure depends on where you live, where you work, how you commute, whether you exercise inside versus outside, how well your home is ventilated, and then of course, how do those patterns change over time? So when a scientist or a statistician or an epidemiologist is given access to a zip code or a neighborhood level estimate, it's better than nothing. But based on everything I just said, I think you realize actually there's way too much noise and heterogeneity in this data for me to really understand it. Another issue is that the these exposures rarely travel alone. So it's true, of course, if you live near a highway, you may have more particulate matter, more nitrogen dioxide, more noise, more nighttime light and other exposures all at once. So even if one could demonstrate, notwithstanding the limitations I've stated above, that all of these things are leading to worse health outcomes, how do you disentangle the causality of each one? What if all of the negative health outcomes are coming from one of those things and the others are all irrelevant interlopers?

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We don't know.

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And then I think, finally the flip side of that last point is that many of these outcomes are actually multifactorial. So if someone develops hypertension or has a heart attack, air pollution or noise pollution may have contributed. But we also know that their genetics contributed. Diet contributed, sleep contributed, exercise or lack thereof, smoking, all these things contributed. And it's not to say that the toxin didn't impact those things and that Those things then impacted the disease. So it becomes very difficult to study this rigorously, which is probably why we're

C

talking about it, given all those complexities. Before we start jumping into specific questions around air pollution, noise pollution, light, EMF, 5G, is there anything you want people to think about? Is there any context you want to provide before we get into those details?

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Yeah, I think before we get into specifics, and we certainly will, I do want to reframe or maybe provide context. I want to establish where I think environmental exposure fits into the broader hierarchy of health. I don't want to minimize these exposures. They are real. But for most people, for most of you listening, they sit well, well below the fundamental things that you have control over that impact your health. Sleep, exercise, nutrition, things that flow from these things. Blood pressure, lipids, metabolic health. I am sure that we can all come up with an example of somebody for whom environmental exposure supersedes all of those in magnitude of impact. But that is going to be a very, very rare exception. Now, all of us have a finite amount of time, money and mental energy to spend on our health. So we really want to be thoughtful about making sure we prioritize around the highest yield levers and that we put our time, energy and money into those things first. So, unfortunately, I come across people more often than I care to admit who aren't really exercising, who are sleeping like five hours a night. But they've explained to me that they have a $2,000 air filter in their home. And I just think that that's a complete inversion of priorities. Now, for someone who has everything dialed in, and they happen to live in an area where air pollution is demonstrably higher than it should be, that $2,000 air purifier might be a remarkable use of resources. So when we talk about specific exposures through this episode, I think the practical questions we should keep in mind is how strong is the evidence? How large and serious are the effects? And then can we actually do something about it without upending our lives? And that last point, I think matters a lot. The goal is not to eliminate every possible exposure. That is metaphysically impossible and that needs to be understood. It is to identify exposures that are meaningful, reasonably modifiable, and worth addressing with a small number of low burden but high return interventions.

C

Perfect. So with that said, let's jump into first category of air pollution. So I think it'd be helpful here to just first state exactly what we're talking about when we say air pollution, and more importantly, which pollutants matter most for people to think about.

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Thank you for listening to today's Sneak Peek AMA episode of the Drive. If you're interested in hearing the complete version of this ama, you'll want to become a Premium member. It's extremely important to me to provide all of this content without relying on paid ads to do this. Our work is made entirely possible by our members and in return we offer exclusive member only content and benefits above and beyond what is available for free. So if you want to take your knowledge of this space to the next level, it's our goal to ensure members get back much more than the price of the subscription. Premium membership includes several benefits. First, comprehensive podcast show notes that detail every topic, paper, person and thing that we discuss in each episode. And the word on the street is nobody's show notes rival ours. Second, monthly Ask Me Anything or AMA episodes. These episodes are comprised of detailed responses to subscriber questions typically focused on a single topic, and are designed to offer a great deal of clarity and detail on topics of special interest to our members. You'll also get access to the show notes for these episodes, of course. Third, delivery of our Premium newsletter, which is put together by our dedicated team of research analysts. This newsletter covers a wide range of topics related to longevity and provides much more detail than our free weekly newsletter. Fourth, access to our private podcast feed that provides you with access to every episode including AMAs, sans the spiel you're listening to now and in your regular podcast feed. Fifth the Qualys, an additional member only podcast we put together that serves as a highlight reel featuring the best excerpts from previous episodes of the Drive. This is a great way to catch up on previous episodes without having to go back and listen to each one of them. And finally, other benefits that are added along the way. If you want to learn more and access these member only benefits, you can head over to Peterattiamd.com subscribe. You can also find me on YouTube, Instagram and Twitter, all with the handle Peterattiamd. You can also leave us a review on Apple Podcasts or whatever whatever podcast player you use. This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice. No doctor patient relationship is formed. The use of this information and the materials linked to this podcast is at the user's own risk. The content on this podcast is not intended to be a substitute for professional medical advice, diagnosis or treatment. Users should not disregard or delay in obtaining medical advice from any medical condition they have and they should seek the assistance of their healthcare professionals for any such conditions. Finally, I take all conflicts of interest very seriously. For all of my disclosures and the companies I invest in or Advise, please visit PeterAttiamD.com about where I keep an up to date and active list of all disclosures.