Episode 85: Dr. Peter Attia – Exercise, Nutrition, Hormones For Vitality & Longevity | Huberman Lab (Preview)

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Key Takeaways

  • Only by clearly defining what you want in your last decade of life can you work backward and put in place a plan to get there
  • 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.)
  • ApoB is the single most important biomarker to measure – be proactive in obtaining this as early as possible! It’s uncommon in the U.S. though used in Europe & other places as part of regular health check
  • You should monitor weight but an annual DEXA scan is more valuable than tracking BMI
  • “There’s not one thing I’ll tell patients that is more important than exercising.” – Peter Attia
  • “Strength training is an essential part of our existence. It’s never too late to start but you should never stop.” – Peter Attia
  • Try the backcasting thought experiment: In detail, what do you want the last 10 years of life to look like? Then you can plan and live accordingly. Until you do, everything is abstract.
  • 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
  • Philosophical differences in prevention – Medicine 2.0: we’ll treat you if it seems like disease is imminent in the next 5-10 years; Medicine 3.0: treat the causative agent now

Introduction

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)

Ins & Outs Of Biomarkers

  • 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)

Fitness For Longevity & Importance Of Bone Density

  • “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

Back Casting & The Marginal Decade

  • 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:

Levers For Longevity & All-Cause Mortality

Use Of Nicotine

  • 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):

The Failure & Nuances Of Hormone Replacement Therapy Women

  • 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 …

Hormone Replacement Therapy For Men

A Dive Into Cholesterol

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Notes By Maryann

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