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 healthspan. Peter is also the host of the popular podcast, The Drive.
In this episode, Andrew Huberman & Peter Attia dive into all things related to evaluating and extending healthspan. They break down how best to measure your health status using routine blood work, body scans, and regular tests of physical strength and endurance; delve into hormone modulation for men and women; parse the complexity of cholesterol and cardiovascular health, provide actionable daily tools, and so much more.
Host: Andrew Huberman (@hubermanlab)
Be specific with what you want to optimize – performance, longevity, healthspan, etc.
Two vectors of longevity: (1) lifespan: literally whether you are alive and breathing; (2) healthspan: how many healthy years you live – biomarkers matter less, and physical & performance tests matter more (DEXA scan, VO2, fat oxidation, emotional state, etc.)
Lifespan is impacted by the “four horsemen of disease”: (1) cancer; (2) atherosclerotic disease; (3) neurodegenerative disease; (4) metabolic disease (won’t kill you but will lead to the other diseases)
Atherosclerotic disease: ApoB is the most important biomarker
There’s a blind spot when it comes to cancer: blood testing & biomarker testing for cancer aren’t usually the most helpful unless/until blood biopsies are more prevalent
Biomarkers can be helpful for dementia but not most other neurodegenerative diseases – “The same things that drive the risk of heart disease are driving the risk of dementia.” – Peter Attia
How frequently should you get bloodwork done? Early in life and regular but it’s a snapshot so you want to have action plans based on the outcomes
Lipoprotein(a): you are born with this; it’s the single most prevalent genetic driver of atherosclerosis (but unfortunately most physicians don’t know what it is)
“You shouldn’t be arguing about the nuance of [supplements and nutrition] until you can deadlift your bodyweight for ten reps…until your VO2 max is at 75th percentile and you can dead hang for a minute and wall sit for two minutes.” – Peter Attia
An annual DEXA scan is a more comprehensive measurement than BMI – but you certainly want to monitor weight  
DEXA scan: basically an x-ray that measures body fat percentage, bone mineral density, visceral fat, appendicular & lean mass metrics; visually, the definition of your abs is not a bad way to assess your fat visually
Bone density is critical (especially for peri-menopausal women): “If you are 65 or older and fall and break your hip, there’s a 30-40% chance you’re dead in a year.” – Peter Attia
The diagnosis of osteopenia and osteoporosis is based on three locations: the left hip, the right hip, the lumbar spine
Strength train/weight lift (not cardio or running) to improve the bone mineral density …
Marginal decade: last decade of your life (barring accidental death)
Until you explicitly define what you want your marginal decade to look like, everything is abstract
Understand cognitively, physically, and emotionally what you want life to look like in old age (whatever that number is for you) and work backward from there
Backcasting: think about what you want to do at 70, 80, 90, etc., and work backward from there, measuring relevant biomarkers & setting yourself up for that life
Pillars of backcasting:
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Augmenting acetylcholine through nicotine (not by smoking!) for brain health: it is effective for enhancing concentration and focus
Tip: the lozenges and gums have a densely high nicotine content and can be addictive so use with caution
Peter Attia cycles on and off nicotine lozenges
Think of nicotine, really as a substitute for stimulants
As always, behavioral tools and configuring the right environment are better strategies than jumping into supplements
Alpha-GPC (Huberman uses sometimes): …
A woman’s testosterone is less potent than a man’s, but women have more testosterone than estrogen in their body – yes, you read that right – phenotypically, estrogen dominates but women have more testosterone by the amount
Menstruation & hormone cycle:
  • Day 0: Start of the period (day 0) estrogen and progesterone are low, almost immeasurable
  • Day 5: good day to measure follicle-stimulating hormone (FHS), luteinizing hormone (LH), estrogen, and progesterone
  • Around days 14-16: estrogen and progesterone rise in response to FSH in preparation for ovulation
  • If not pregnant: LH comes online, progesterone rises and dominates the second half of the cycle – eventually leading to uterus lining shedding and menses
  • The last 7 days of the cycle are when PMS takes place, likely due to the rapid reduction of high volumes of progesterone
During menopause estrogen declines leading to symptoms like night sweats, and hot flashes – before entering long-term side effects like osteopenia/osteoporosis, vaginal dryness, brain fog
The concern with estrogen (without progesterone for balance) was an increase in uterine cancer  
The story of the Women’s Health Initiative:
  • A study was done by NIH in the early 1990s to test the impact of hormone replacement therapy on women
  • Arm: (1) women without uterus – placebo arm and estrogen arm; (2) women with a uterus – placebo arm and progesterone arm
  • Problems with the study: women were beyond menopause when hormone replacement therapy would normally be done, enrolled disproportionately unwell women, did not enroll symptomatic women, synthetic progesterone was used
  • Headline on synthetic progesterone: because some women in the synthetic progesterone group developed breast cancer, the data was taken extremely out of context and falsely reported as a 25% increase in breast cancer
  • Negative findings: small increase in the risk of heart disease, a small increase in the risk of breast cancer
Peter Attia on the Women’s Health Initiative that deterred the medical community from hormone replacement therapy for women: “It’s hands down the biggest screw up of the entire medical field in the last 25 years.” – Peter Attia
Ideally, hormone replacement therapy should …
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