Boost Vitality, Health, and Lifespan with Dr. Peter Attia | Huberman Lab 

Peter Attia, MD (@PeterAttiaMD) is a former ultra-endurance athlete and renowned physician in the field of longevity and performance. His practice and interests lie in optimizing nutrition, sleep, exercise, physical and mental health, and pharmacology to increase lifespan and health span. Peter is also the host of the popular podcast The Drive and the author of his new book Outlive: The Science And Art Of Longevity .

Andrew Huberman and Peter Attia dive deep into leading causes of death and ways to mitigate risk, biomarkers to track and related behavioral measures and interventions, as well as aspects of emotional health that impact our physical health. Host: Andrew Huberman (@hubermanlab)

Lifespan is binary, whether you are dead or alive – versus – healthspan which takes into account physical health, cognitive health, and emotional health The medical definition of healthspan is, the period of time by which you are free from disease and disability

Four horsemen of death: (1) Diseases of atherosclerosis – cardiovascular disease and cerebrovascular disease accounts for 18-19 million deaths globally per year (barring embolic phenomena) (2) Cancer accounts for about 11-12 million deaths globally per year (3) Neurodegenerative disease (4) Metabolic disease (won’t kill you but will lead to other diseases)

Major risks for clots: blood pressure is the main driver of hemorrhagic stroke (the more aggressively you manage blood pressure, the better – you really want to be at 120/80)

“There are too many people walking around with high blood pressure who don’t know it.” – Dr. Peter Atttia – the right way to measure blood pressure is using a manual cuff and sitting still 5 minutes before measuring Measure blood pressure regularly at home: a good manual cuff is about $40 and a good stethoscope is about $100 – but you can start with an electronic one and measure twice per day, once in the morning and once in the evening

Continuous blood pressure monitoring will arguably be more important than continuous glucose monitoring – “When the day comes that we can continuously assess one’s blood pressure, it will be an integral part of a persona’s health checkup.” – Dr. Peter Attia

“We don’t want to rely on feeling when it comes to atherosclerosis.” – the strikingly common presentation of heart attack is death – Dr. Peter Attia The best underlying predictor of a heart attack is…a heart attack

Prevention of atherosclerosis (the leading cause of death in the world: (1) maintain healthy blood pressure (120/80); (2) don’t smoke anything; (3) measure ApoB and lipoproteins starting in your 20s

We don’t have good data on the difference between smoking marijuana versus cigarettes versus vaping for heart disease but it’s best to avoid all smoking At a minimum, the chemical contents of vaping are undeniably carcinogenic

Cholesterol is a lipid the body synthesizes, essential for life – it’s necessary for the development and a vital component of cell membranes and precursor for critical hormones of the body Serum cholesterol levels rise during teenage years and in menopause for women What you measure in serum is a fraction of the entire body cholesterol

Not every cell can make as much cholesterol as it needs so it gets borrowed from other cells so it needs to be transported

Structure of cholesterol: cholesterol is also not water soluble so does not readily mix with plasma so is water soluble on the outside and fat-soluble on the inside – cholesterol is buried inside along with triglycerides and the outside is covered in protein (lipoprotein) Lipoproteins come in two families – ApoB (low-density lipoproteins derived from the liver) and ApoA (high-density lipoproteins) We worry about ApoBs because they’re atherogenic

ApoB refers to the single lipoprotein wrapped around an LDL particle LDLc (LDL cholesterol) takes the total number of particles, breaking them apart and measuring how much cholesterol is in them

Basically, you’re either going to die from heart disease or with it so you want your ApoB as low as possible – the longer you wait the more aggressively you need to treat

The problem is we’re approaching this backward: we don’t look at the full picture of risk factors and make inferences, we just look at numbers and treat or don’t treat

Fixing insulin resistance through nutrition will bring down triglycerides – most easily controlled with carbohydrate restriction Exercise plays a minimal role in improving lipids but will improve insulin sensitivity

Pharmacology approach to high cholesterol: take statins (minor side effects but may include muscle soreness, brain fog, insulin resistance) and/or ezetimibe (minimal side effects), PCSK9 inhibitors (improves the number of LDL receptors) Start with behavioral tools for blood pressure regulation first – exercise (low-intensity cardio 3-4 hrs per week), weight management, dial-in sleep

Interestingly, most species do not have ApoB so likely won’t get atherosclerosis As a note, the kidney is extremely sensitive to blood pressure – measure cystatin C (more accurate than creatinine)

When it comes to alcohol, “the frequency and the dose defines the poison” – Dr. Peter Attia 7 drinks in one day is different than 1 drink for 7 days

Sleep: don’t be overly anxious about what sleep trackers are telling you Focus on sleep hygiene: light, temperature, food, noise, alcohol There is a time and place for sleep trackers, for example – nothing will drive home just how much late-night food and alcohol are ruining your sleep – but it’s important not to obsess Consider not even taking a sleep tracker when traveling if you won’t sleep well

“Alcohol is not good for you in any dose – doesn’t mean we shouldn’t drink it at all but let’s not delude ourselves into thinking it’s actually healthy in any low dose, it’s not.” – Dr. Peter Attia

Peter’s personal guidelines for alcohol intake: Don’t drink anything that doesn’t taste good – it’s not worth it; You need a really good reason to have more than 2 drinks in a day; Don’t drink more than 3x per week (don’t exceed 7 drinks per week); Make sure drinking is a good 3 hours away from sleep

If you can not drink at all, you’re better off – if you will drink, really focus on keeping it to things that you genuinely enjoy at times that it makes sense (e.g., don’t drink crappy wine on a Tuesday – enjoy nice mezcal with friends over a good dinner)

Remember, alcohol is a carcinogen and we don’t know the exact dose that’s the tipping point

There’s about a 1 in 3 to 1 in 4 chance you will get cancer in your lifetime; the chance of dying from cancer is about half that

“Every man will die with prostate cancer, some will die from prostate cancer.” – Dr. Peter Attia No one should die from prostate cancer or colon cancer – they’re easy to screen for and treatment is effective Every colon cancer comes from a polyp and every polyp can be seen on a colonoscopy – start screening no later than 40

Any mutations in germline genes are inherited from parents but cancers from germline account for only about 5%

“The two clearest indications of drivers of somatic mutation are smoking and obesity. Obesity is now the second most prevalent environmental driver of cancer.” – Dr. Peter Attia But it’s likely that obesity is the symptom, not the cause – the things that come with obesity are insulin resistance and inflammation

A note about BMI: it works for the population level but not the individual; for individuals – look at the waist to height ratio which is more accurate, waist circumference shouldn’t be more than 50% of height

We don’t have control over cancer the way we do with other diseases – we can’t say if you exercise X hours per week, or follow X diet you’ll be clear

Early screening matters: there is no example of cancer that is more effectively treated late than early – in other words, treating cancer early has significantly better outcomes than treating cancer down the line, even with the same medications The first line of screening is visualization looking directly at the cancer Liquid biopsies look at cell-free DNA MRIs have lower radiation than other imaging methods (CT, PET, fluoroscopy) – ask how much radiation you’ll be exposed to when you get scans, they’re not all equal Set expectations: whole body MRIs will likely detect something that requires follow-up but isn’t cancer (sensitivity is high but not specificity) – if you’re interested checkout Prenuvo or Biograph

Alzheimer’s disease is the most prevalent form of dementia and the most prevalent neurodegenerative disease – that’s about 6 million people in the U.S. Age is the biggest risk factor but it’s not modifiable so not worth focusing on

The rate and growth of Parkinson’s disease are the highest now Exercise for neurological disease protection: diseases have some degree of prevention, even if not fully have some control – the benefit of exercise is the only thing that comes up repeatedly

Take all steps to maximize insulin sensitivity, muscle capacity, and reserve

Understanding ApoE There are three isoforms for the apoe gene – apoe1, apoe2, apoe3, apoe4 (we each have two copies) The normal isoform is a 3-3 combo The high-risk isoform is the 4 – but, it’s also a “devil you know” scenario – you know the impact on the body, role in cholesterol, ability to metabolize carbohydrates If you have someone with strong family history and 3-3, you don’t know the pathogenic mechanism The lowest risk isoform is the 2 E4 genes are not deterministic – but there are deterministic genes associated with Alzheimer’s (PS1, PS2, APP; these people are usually getting Alzheimer’s in their 50s)

People with Alzheimer’s die because of failure to thrive, aspiration, loss of appetite, infection

It’s unclear how important amyloid beta is because some people who die are full of amyloid beta but have no neurodegenerative disease – drugs targeting amyloid have also been unsuccessful There’s a bit of a crisis in the field because we’ve put so much into amyloid beta tracking

Unequivocal truths for brain health: sleep matters, lower LDL cholesterol, and ApoB is better, not having type 2 diabetes matters, exercise matters (low-intensity cardio, strength, interval training)

Major categories of accidental death: falls, automotive accidents, accidental overdose Accidental death is a fairly constant risk – car accident risk is a little more common under 60 than over but never goes away

“Fentanyl-related deaths have basically squashed all other deaths below 65 on the accidental front. It’s not even close.” – Dr. Peter Attia Fentanyl deaths come from counterfeit drugs, illicit drugs – it’s really making its way into a lot

Deaths of despair (suicide, alcohol-related, accidental overdose) rate is going up 20% per year since 2019 – this is almost entirely attributable to fentanyl poisoning Even more specifically from counterfeit pills laced with fentanyl that are used by youth

Fentanyl arrests the respiratory system Accidental death risks for the aging population are related to falls – once you hit 60-65 the risk of a fall that results immediately in death or death within 12 months is about 15-30%

Offsetting the probability of falls: the ability to jump and land safely The Hallmark of aging in muscle is the degradation of type 2 muscles (fast twitch) – we lose speed, then strength, then size Most people can’t slow themselves down – you have to be able to land safely and stick to the landing

As a note, most machines in the gym don’t lend themselves to joint stability – machines can be a good on-ramp for resistance training but you will need more

Components of emotional health: ability to maintain healthy relationships with others, sense of purpose, regulation of emotions, experiencing fulfillment and satisfaction, being present The degree of presence at that moment is a strong predictor of happiness of overall

Emotional health is potentially the most important factor in health – infinite lifespan, if you’re miserable, is worthless

People who spend more time contemplating their own mortality may be more at peace – to a degree, we don’t have great agency over the length of our lives but we do have agency over the quality of our lives

Are you living more for resumes or eulogy? Check out the Road To Character by David Brooks

Tips for emotional health: write & read affirmations, write in a journal, be mindful of times you damage relationships, and make amends You will set yourself up for failure if your goal is to be perfect, instead focus on being the best at repairing damage when you cause it

Tips for repairing relationships when you are the one who’s wronged: decide whether you’re optimizing for the relationship or the outcome (need-based or service-based relationship) – if your relationship matters, being right all the time doesn’t matter

Anger is usually superimposed on top of another emotion – understand what’s really bothering you

Having a hyper-analytical disposition can lead you to rationalize trauma in ways that you explain it away, which isn’t really a good thing – you don’t have to be a slave to adaptations you made to get through an experience

Peter has struggled with rage his whole life and hit rock bottom a few times which led him to enter in-patient rehab Being aware of self-talk and emotions is critical to health within yourself and healthy relationships with others Redirecting self-talk: stop yourself and pretend like it is someone else who made the mistake and audibly talk to that ‘person’ – for example, if you want to be mad at yourself for overcooking something, step back and pretend like it was your friend who overcooked and speak how you would talk to them at that moment Communicating lovingly with yourself is critical for your ability to not beat up those around you as well