peter attia stem-talk

Peter Attia Gives an Update on His Views Regarding Longevity and Healthspan on STEM-Talk

Check out the STEM-Talk Episode Page & Show Notes

Key Takeaways

  • The five drivers of longevity:
    • Nutritional biochemistry
    • Exercise physiology
    • Sleep physiology
    • Everything that goes into improving emotional health (techniques for increasing distress tolerance, enhancing mindfulness, etc.)
    • Exogenous molecules
  • The best longevity-based lab tests (and data):
    • Continuous glucose monitor (CGM) data
    • Long-term average glucose & its standard deviation (the latter gives insight into insulin secretion)
    • ApoB or LDL-P (LDL particle number)
    • Lactate levels at a specific level of exertion
    • Overall inflammation levels 
    • Any tests related to liver function (particularly one’s uric acid levels)
  • In regards to lab tests, what constitutes “normal” is based on an unhealthy general population
  • There’s a strong association between lower insulin and lower glucose and improved metabolic health, and therefore risk reduction of atherosclerotic disease, neurodegenerative disease, and cancer” – Peter Attia
  • There’s no longevity “magic bullet”—focusing on exercise, nutrition and sleep will give 95%+ of the benefits

Products Mentioned

  • Peter wears an Oura Ring to track his sleep 

Intro

Peter’s New Book?!?!

  • “The book’s coming along. I definitely see the finish line … It’s far too long right now—it’s almost 200,000 words … There’s a lot of trimming and re-writing left to do.” – Peter Attia
  • Fun fact: Peter does his best writing on airplanes
  • The subtitle of Peter’s new book (no hints on the title), which he aims to release in the winter of 2020 or spring of 2021 is “The Science and Art of Longevity”

Longevity Consists of Optimizing for Lifespan and Healthspan

  • Lifespan is how long you live, healthspan is how well you live—cognitively, emotionally, and physically

Focus on the Strategy, Not Tactics

  • Tactics are the specifics—how often you exercise, how you exercise, what you eat, when you eat, what supplements you take, etc.
  • “The strategy is what matters—that’s the scaffolding upon which you can always evaluate new tactics” Peter Attia
    • For instance, Peter stopped taking metformin (a tactic) (and this is discussed more below) using his strategy of continually evaluating the evolving scientific literature 
  • Peter, in his new book, tends to focus more on longevity strategies, rather than specific tactics

Peter’s Evolving Longevity Framework

  • Back in 2016, Peter said there were eight drivers of longevity:
    • Optimal nutrition
    • Exercise
    • Sleep habits
    • Hormone optimization
    • Stress management
    • A sense of purpose
    • Social connection
    • Avoidance of harmful behavior
  • Now in 2020, Peter lumps these drivers into five buckets:
    • Nutritional biochemistry
    • Exercise physiology
    • Sleep physiology
    • Everything that goes into improving emotional health (techniques for increasing distress tolerance, enhancing mindfulness, etc.)
    • Exogenous molecules

🎧 The Best Longevity-Based Lab Tests (and Data)

  • Continuous glucose monitor (CGM) data
  • Long-term average glucose & its standard deviation (the latter gives insight into insulin secretion)
    • Specifically, Peter would want to know how often glucose rises above a certain threshold
  • ApoB or LDL-P (LDL particle number)
  • Lactate levels at a specific level of exertion
  • Overall inflammation levels 
  • Any tests related to liver function (particularly one’s uric acid levels)

How does Peter determine optimal blood test reference ranges?

  • After all, what constitutes “normal” is based on an unhealthy general population—only ~20% of American adults have good metabolic health; why would we derive what’s “normal” from this?
  • It depends on the patient
  • Some specifics:
    • Most labs consider a normal uric acid level <6.9, but Peter likes to see it <5
      • “There’s a significant improvement in blood pressure and endothelial health when uric acid is below 5, which is far below the level you need to prevent gout—the thing most people think about uric acid for” – Peter Attia
    • The upper limit of “normal” for a man in regards to ALT is 42, but Peter likes to see his patients <20

There’s No Magic Bullet; Focus on Sleep, Nutrition, and Exercise

  • “They’re just such potent stimuli that not enough people appreciate” – Peter Attia
  • Nutrition is broader than you think—it involves what you eat, when you eat, and how much you eat
    • “There isn’t a drug that can rival what you can do when you have complete command on how to manipulate those variables”Peter Attia
  • “With exercise, from a metabolic standpoint alone, it’s one of the most potent drugs in our toolkit” – Peter Attia
    • In regards to dementia prevention: “According to the currently available literature, exercise is probably the most potent tool that we have, hands-down”

Utilize All the Longevity Tools

  • “There’s no harder problem in biology than longevity, full-stop … If you’re going into an arena to face the toughest opponent in the history of civilization, why would you not want to be armed with every possible tool?” – Peter Attia

Is longevity optimization only for the rich?

  • NO
  • “If you could never afford to buy a single medication, supplement, or drug, you could achieve 80% of the benefits of longevity through correct information, and knowing how to navigate the information minefield” – Peter Attia

Let’s Get Technical

  • A primary inhibitor of brain-derive neurotrophic factor (BDNF) is histone deacetylases (HDAC), and beta-hydroxybutyrate (BHB, a ketone) inhibits HDAC
    • What you need to know: Exercise increases BDNF by inhibiting HDAC through the elevation of BHB

The Lower Your Insulin Area Under the Curve (AUC), the Longer Your Lifespan

  • Although not easily measured, this is one of Peter’s favorite longevity markers (to gauge insulin AUC, one has to collect their urine for an entire day and measure levels of C-peptide)
  • 🎧 “I very much have a strong thesis that if you can minimize the AUC of insulin, it’s directly correlated to lifespan. There’s a powerful association between lower insulin and lower glucose and improved metabolic health, and therefore risk reduction of atherosclerotic disease, neurodegenerative disease, and cancer.”Peter Attia

Peter’s Wearables of Choice

  • Peter wears an Oura Ring to track his sleep, as well as a continuous glucose monitor (CGM) 
    • On the latter: “It’s a behavioral tool. When I’m not wearing it, I’m more likely to eat things that increase my glucose.” – Peter Attia
    • The same serves true for the Oura Ring—Peter’s come to learn that blue light exposure before bed, how late he eats his last meal, and alcohol intake all adversely impact sleep quality
  • (Note: Peter’s an advisor and investor in Oura)

Peter Loves Him Some Rapamycin

  • Peter has said in the past: “For me, personally, nothing is more interesting than rapamycin”
  • Rapamycin is the only drug proven to extend lifespan in EVERY model organism, ranging from yeast to animals (although not yet in humans)
  • Peter takes ~6 mg of rapamycin once per week, although he’s only ever prescribed it to one patient; why this dose and frequency?
    • Based on data, Peter suspects this regimen inhibits mTOR complex 1 (mTORC1) without inhibiting mTORC 2 (Woah! We just got technical. To dig deeper, check out these Podcast Notes)
      • For a little more background, by suppressing mTORC1, you increase autophagy, the self-destructive process by which damaged cells are killed off

When will we be able to measure autophagy?

  • “We’re definitely not as close as I’d like to be” – Peter Attia
  • Why the need to measure autophagy in the first place?
    • Measurements would indicate the optimal fasting protocol (i.e., 3 days, 1x a month vs. 7 days, 1x a quarter, etc.)  
      • As of now, we can only guess—we have no clue what the optimal fasting regimen is! (although one thing Peter has a pretty good idea of is that it takes 3 days of fasting for autophagy to begin)

Muscle Loss and Fasting

  • During Peter’s long-term fasts, he lifts weights daily to stimulate muscle mTOR (so muscle doesn’t waste away)
  • During a fast, our leucine (an amino acid) levels stay relatively elevated (and leucine is a potent stimulator of mTOR)

The Debate Around Protein Consumption

  • Dr. Valter Longo recently stated: “Consuming a high protein diet is nearly as bad as smoking for one’s health”
    • Ken doesn’t necessarily agree, but one thing’s for sure—there’s a wide variation in protein recommendations among health experts
  • Things get more complicated: If, by chance, limiting protein intake increases lifespan, what about the increased risk of a fall later in life due to a lack of muscle?
    • Fact: The most common cause of accidental death in the elderly is falling
  • “I find the discussion around protein to be as religious as the discussion around animal-based products. I don’t enjoy politics, I don’t enjoy religion, and I don’t enjoy nutrition. They’re all basically the same—they’re all tribal discussions that aren’t grounded in reality.”Peter Attia
    • It’s quite ironic: The more certainty, passion, and anger with which people hold nutrition positions, the more of an error bar there is around that specific position

Optimal IGF-1 Levels

  • Peter talked about IGF-1 extensively in his interview with Dr. Rhonda Patrick; check out the Podcast Notes
  • For background: IGF-1 is increased with frequent protein consumption. When you fast, your IGF-1 levels drop significantly. 
  • As usual, it’s complicated:
    • Data indicates low IGF-1 levels are associated with greater mortality (but that doesn’t necessarily mean low IGF-1 plays a causal role)
    • Extremely high levels of IGF-1 are also associated with increased mortality (specifically, cancer-related mortality)
    • “If there’s one disease that seems to have a lower and lower association with rising IGF, it’s Alzheimer’s disease” – Peter Attia
      • Think about it: IGF is a growth hormone, and anything growth-related in the brain tends to be positive
  • Peter’s approach: The best thing to do is cycle high and low IGF-1 levels with periodic long-term fasts

Is red meat unhealthy?

  • The Annals of Internal Medicine recently published a study claiming that eating red meat poses minimal health risks
  • Again, it depends: What kind of red meat are we talking about—a grass-fed steak, a hot dog, or a Slim Jim?
    • “To even suggest that the health effects of eating each of those three different things is comparable—it’s impossible; it can’t be” – Peter Attia
      • “Until the nutrition community wants to stop averaging out different elements of nutrition, they’ll never get meaningful answers

Dry vs. Infrared Saunas

  • Peter, personally, prefers using a dry sauna
    • Many claim dry saunas provide more significant health benefits, but undoubtedly, infrared saunas are cheaper/easier to access
  • Peter’s advice: Go with what you have better access to

How long can humans live?

  • The number one factor that influences your lifespan: genetics (and 99.99% of people lack “centenarian genes”)
  • “My reading of the literature indicates there’s probably a 10-15 year life extension that can come from a significant effort towards delaying chronic disease” – Peter Attia
    • (And most centenarians aren’t immune from chronic disease—it’s arrival is just delayed)
  • 🎧 “I have no delusion that I’m going to live to be 105 or something like that—my genes are very mediocre. But what I don’t want to do is die at 75 or 80 and have spent the last decade of my life in decline. I’d prefer to be in my 90s, and know I’m as robust as someone in their 60s. To me, that’s a very practical, achievable goal that comes with enormous upside.”Peter Attia

Why Peter and Ken Stopped Taking Metformin, A Drug Used to Lower Hepatic Glucose Output in Diabetics

  • Recent data suggests metformin inhibits the mitochondrial benefits from exercise in older adults
  • Other data suggests it blunts muscle growth in response to resistance training, again in older adults
  • That said: “I still believe the benefits of metformin are worth it for people who are metabolically ill … But for someone like myself, it doesn’t make sense.” – Peter Attia

A Valuable Lesson from Peter’s Interview with Katherine Eban

  • “My interview with Katherine is one of my favorite interviews; it may go on to be one of the most important interviews I ever do from a public health standpoint” – Peter Attia
  • The lesson: Listen to the interview (the gist: most of the time, avoid generic drugs)

What’s the most critical question Peter doesn’t yet know the answer to?

  • What’s the optimal fasting frequency?
  • Think about it this way:
    • The fasting function: F (x,y,z) (AKA fasting is a function of x, y, and z)
      • x = the amount you restrict calories (100% = full calorie restriction)
      • y = the duration of the fast
      • z = the frequency at which the fast is repeated
    • As of now, we have no clue as to the most optimal values for x, y, and z!

Is there anything Peter’s changed his mind about over the last few years?

  • How vital exercise is for longevity
    • Three years ago: “I don’t think I appreciated how powerful a tool it was for improving the function of the mitochondria and increasing brain levels of BDNF”Peter Attia

Additional Notes

  • When recording this interview, Peter was 6 days into a 7-day fast
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