What are the 'four horsemen' diseases Peter Attia is most concerned about?

The 'four horsemen' are arteriosclerotic cardiovascular disease (ASCVD), cancer, neurodegeneration, and dementia. Attia believes ASCVD is the most amenable to significant delay through aggressive early prevention, while the others lack the same degree of certainty for indefinite postponement.

What is Peter Attia's target ApoB level?

Peter Attia's target ApoB level is between 30 and 40 mg/dL. He considers his a baseline of 90-100 mg/dL to be too high, necessitating pharmacological intervention to effectively remove ASCVD as a cause of death.

What are the main strategies to lower ApoB?

The most potent way to lower ApoB is through pharmacology. Nutrition can help by dramatically reducing carbohydrates (lowering triglycerides) and cutting saturated fat (reducing cholesterol synthesis and increasing LDL receptor expression). Exercise has minimal impact on ApoB directly.

Why is nutrition research so difficult and unreliable?

Human nutrition research is complex due to the complexity of the human organism and the intervention (eating). Controlled studies are hard to conduct long-term outside a research setting, leading to reliance on less precise epidemiological data with many confounders.

What are the key principles of Peter Attia's nutritional advice?

The most important parameter is energy balance; excess calories lead to poor metabolic health regardless of diet type. For individuals with insulin resistance, carbohydrate restriction is often more effective than general caloric restriction. Sustainability and adherence are paramount over short-term perfection.

Does Peter Attia still practice intermittent or prolonged fasting?

No, Peter Attia no longer practices prolonged fasting. He finds it logistically difficult now that he doesn't travel and lacks clear biomarkers to confirm its benefits, considering the cost to muscle mass potentially too high without evidence of significant positive rewrites.

What is Peter Attia's stance on protein intake for individuals under 50?

Attia believes high protein intake is generally safe and beneficial for those under 50, especially if they are under-muscled and need to build muscle. He finds data linking high protein to increased mortality in this age group unconvincing, often attributing it to caloric excess or other confounders.

What wearable devices does Peter Attia currently find useful?

Peter Attia uses the Morpheus device for readiness scores and training zones during Zone 2 and VO2 max workouts. He also finds Continuous Glucose Monitors (CGMs) invaluable for assessing metabolic health in both diabetic and non-diabetic patients.

What are the most important metrics when using a CGM?

The most important metric is average blood glucose, as lower levels correlate with lower all-cause mortality. Standard deviation (glucose variability) is also crucial. The size of glucose spikes becomes less critical if the average and standard deviation are within healthy ranges.

Are continuous blood pressure monitors available or close to market?

A device called Actia, a bracelet that optically measures blood pressure, is available in Europe and awaiting FDA approval in the US. It provides 12 readings per day after calibration, aiming to replace cumbersome ambulatory cuffs.

What future wearable technology is Peter Attia excited about?

Attia is excited about continuous lactate monitoring during exercise, which would provide more accurate physiological data than heart rate or RPE. He also anticipates advancements in continuous blood pressure monitoring and would welcome more accessible options for tracking.

276 ‒ Special episode: Peter on longevity, supplements, protein, fasting, apoB, statins, & more

Peter Attia MD

Science & Technology4 min read85 min video

Oct 23, 2023|425,654 views|7,243|559

Peter Attia MD Dr. Peter Attia Early Medical The Drive Podcast The Drive Longevity Zone 2

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Key Moments

TL;DR

Peter Attia discusses longevity, supplements, and health strategies, emphasizing practical application over extreme lifespan extension.

Key Insights

Realistic lifespan extension focuses on compressing morbidity, not just adding years.

Biomarkers are crucial for evaluating interventions, especially in longevity.

Supplement choices are individualized and based on a risk-reward framework.

Pharmacology is key for significant ASCVD risk reduction (e.g., lowering apoB).

Nutrition research is complex; sustainable, individualized approaches are best.

Wearable technology, like CGMs and future blood pressure monitors, aids personalized health insights.

REALISTIC LONGEVITY ASPIRATIONS

Peter Attia expresses skepticism about achieving extreme lifespans (120-200 years) due to the lack of scientific tools to reverse fundamental aging processes. He emphasizes that while incremental improvements in lifespan and healthspan are possible, the focus should be on "ultra-primary prevention" to delay diseases like cardiovascular disease, cancer, and neurodegeneration. The primary goal is not necessarily living to an extreme age, but rather compressing the period of morbidity, ensuring robust physical and cognitive function in later life, often referred to as the 'marginal decade'.

THE CRUCIAL ROLE OF BIOMARKERS

A significant challenge in longevity research and intervention is the lack of reliable biomarkers for aging itself. Unlike interventions for specific diseases (e.g., blood pressure for hypertension), aging interventions lack clear metrics for success. Peter highlights that without these biomarkers, it's difficult to determine if a supplement or drug is working, if the dosage is correct, or if adverse effects are occurring. This uncertainty underscores the need for robust diagnostic tools to validate the efficacy of zero-protective strategies.

A PERSONAL SUPPLEMENT STRATEGY

Peter outlines his personal supplement regimen, emphasizing that these choices are individualized and based on a risk-reward framework. Key supplements include high-dose EPA/DHA (fish oil) titrated to red blood cell membrane concentration, Vitamin D (5000 IU), slow-release magnesium, methylfolate and methyl B12 (to manage homocysteine), and occasionally baby aspirin. He notes changes in his regimen, such as reduced B6 dosage, reflecting ongoing evaluation based on new data and personal experience. Brands are mentioned for transparency, with no affiliations.

PHARMACOLOGY FOR ASCVD RISK REDUCTION

Addressing cardiovascular disease (ASCVD) is a primary focus due to the clear paths for significant risk reduction. Peter advocates for aggressive lowering of apoB levels, targeting 30-40 mg/dL, which he believes necessitates pharmacologic intervention. He uses a combination of a PCSK9 inhibitor (Repatha) and a dual-acting drug (Nexlizet: bempedoic acid and ezetimibe). While exercise impacts overall health, it plays a minimal role in directly lowering apoB, unlike nutrition and potent fármacos.

NUANCES OF NUTRITION AND DIET

Nutrition research is inherently complex and often yields conflicting results due to the difficulty in controlling variables in human studies. Peter emphasizes that sustainable, individualized dietary approaches are more effective than rigid, short-term adherence to perceived 'best' diets. Energy balance is paramount; excess calorie intake, regardless of diet type, leads to poor metabolic health. While carbohydrate restriction can be beneficial for insulin resistance, the key is finding a manageable and long-term sustainable eating pattern.

LEVERAGING WEARABLE TECHNOLOGY

Wearable devices offer valuable insights for personalized health management. Peter discusses using Morpheus for readiness scores and training zones, finding it tracks well with Zone 2 and VO2 max workouts. Continuous Glucose Monitors (CGMs) remain a key tool, valuable even for non-diabetics, to assess average blood glucose, glucose variability, and metabolic response to food. The development of continuous blood pressure monitors is anticipated with excitement, potentially revolutionizing cardiovascular monitoring due to their ease of use and compliance.

PROTEIN INTAKE ACROSS THE LIFESPAN

The role of protein intake, particularly in relation to aging, is a topic of discussion. Peter believes that for individuals under 50, especially those who are under-muscled, maintaining high protein intake is crucial for building and preserving muscle mass, which is vital for maintaining robustness later in life. He disputes the convincingness of data suggesting increased mortality from high protein intake in younger individuals, attributing such associations more likely to caloric excess or other confounders. For those over 50, preserving existing muscle mass becomes the priority.

PERSPECTIVES ON LONG FASTING AND WEARABLES

Peter is no longer engaging in long fasts (e.g., 7-10 days) primarily due to logistical challenges (lack of travel) and a lack of clear biomarkers demonstrating their benefit. He reserves the right to change his mind if compelling evidence emerges. Regarding future wearables, he expresses strong interest in continuous lactate monitoring during exercise, which would provide more precise data than heart rate or RPE for optimizing training intensity and metabolic response.

Mentioned in This Episode

●Supplements

●Products

●Tools

●Companies

●Organizations

●Books

●Studies Cited

●Concepts

●People Referenced

Dr. Peter Attia's Health & Longevity Framework

Practical takeaways from this episode

Do This

Act seriously about primary and secondary prevention of disease to optimize lifespan and healthspan.

Focus on compressing the period of morbidity late in life, aiming for physical and cognitive robustness in your 'marginal decade'.

If necessary, use pharmacology aggressively to achieve ApoB levels of 30-40 mg/dL for ASCVD prevention.

Prioritize energy balance and metabolic health, finding a sustainable diet that works long-term.

Maintain high protein intake, especially if under-muscled, to preserve muscle mass entering middle age.

Utilize wearables like CGMs and continuous blood pressure monitors for objective health data.

Consider new pharmaceutical interventions for cardiovascular health as they become available and are proven.

Stay informed about potential health breakthroughs but temper expectations regarding radical life extension.

Avoid This

Do not rely on unproven 'biohacking' methods for radical life extension (120+ years).

Do not ignore the importance of preventing the 'four horsemen' diseases (ASCVD, cancer, neurodegeneration, dementia).

Do not assume nutrition research is simple or definitive; focus on general principles like energy balance and satiety.

Do not use 'good cholesterol' and 'bad cholesterol' terminology; use accurate nomenclature for LDL and HDL cholesterol.

Do not take supplements without considering the risk-reward matrix and available biomarkers.

Do not neglect muscle mass, especially as you approach and enter middle age.

Do not expect current technology to reverse the fundamental aging processes in a meaningful way.

Do not exclusively attribute longevity in populations to diet; consider activity, sleep, stress, and social connections.

Common Questions

Peter Attia believes current technology cannot address the fundamental biological processes of aging. While we can slow down aging, there's no evidence we can reverse it meaningfully. Significant technological breakthroughs in halting or reversing aging would be required for such extreme longevity.

Topics

ASCVD Prevention CGM Blood Pressure Monitoring

Mentioned in this video

conceptArthritis

An age-related condition that matters but is not as prominent as the 'four horsemen'.

productMorpheus

A device with chest and forearm straps that measures heart rate, respiratory rate, and heart rate variability to provide a daily readiness score and training zones.

conceptBiological terrorism

Considered a potentially great threat to the human species due to low barriers to entry and proliferation.

drugNexlizet

A combo drug containing bempedoic acid and ezetimibe, used to lower ApoB levels.

conceptZone 2 workout

A type of aerobic exercise where heart rate and RPE are compared against Morpheus predictions, and potentially lactate levels.

personKyler Brown

Mentioned as a friend who would note Peter's mood.

conceptMitochondrial function

A biological process that deteriorates with age, for which current technology cannot effectively reverse.

companyKarlan 79

A vegan restaurant in New York City that Peter Attia visited, which caused a significant spike in his blood glucose.

productActia

A continuous blood pressure monitor in the form of a bracelet, currently approved in Europe, which optically measures blood pressure and calibrates against an automated cuff.

personEthan Weiss

Mentioned in the context of discussing the importance of blood pressure monitoring devices.

personMatt Cable

Mentioned in relation to a previous podcast episode discussing aging mechanisms.

conceptDNA breaking and repair

A biological process that deteriorates with age, for which current technology cannot effectively reverse.

conceptNuclear war

A potential existential threat to the human species, considered alongside biological terrorism and climate change.

conceptPostprandial glucose AUC

Area under the curve for glucose response after a meal challenge, reduced by 30% with the Pendulum probiotic, indicating improved insulin sensitivity.

drugRosuvastatin

A statin where maximum efficacy is achieved at a low dose (e.g., 5mg), with higher doses primarily increasing side effects.

productContinuous blood pressure monitors

Devices that can optically measure blood pressure, providing regular readings throughout the day, with Actia being a notable example available in Europe.

conceptNutrient sensing pathways

Biological pathways that degrade with age and cannot currently be reversed meaningfully.

conceptEpigenome modulation

Selective and high-fidelity modulation of the epigenome is a key area of interest for potential technological breakthroughs in aging.

studyMinnesota Coronary Study

A seven-year study conducted in a nursing home, controlling patient diets, which yielded unexpected results regarding its hypothesis.

companyMag-Team

The brand associated with Magnesium L-Threonate, ensuring the proprietary combination is present.

companyPendulum

The company that produces the glucose control probiotic.

drugFatavastatin

A statin recommended as a potential option with fewer side effects.

companyMaui Nui

A company selling venison jerky sticks, which Peter Attia consumes for protein.

conceptASCVVD

Arteriosclerotic cardiovascular disease, one of the 'four horsemen' of aging, which can potentially be significantly delayed with aggressive early intervention.

companyCarlson's

A brand of EPA and DHA fish oil that Peter Attia uses.

supplementSlow Mag

A brand of magnesium supplement, taken in doses of two to three per day to reach approximately one gram of elemental magnesium daily.

companySolgar

The brand of Ashwagandha Peter Attia currently uses.

conceptLp(a)

Lipoprotein(a), a marker for cardiovascular risk for which a new drug is in phase three trials to potentially obliterate it.

supplementMethyl B12

Taken with Methylfolate to monitor and maintain homocysteine levels below nine.

companyGero

A brand used for Methylfolate and Methyl B12 supplements.

supplementVitamin B6

Dosage reduced to 50mg three times a week due to potential neuropathy risks with excessive intake, influencing homocysteine levels.

productGlucose Control

A probiotic taken in the morning with AG1, aiming to improve average blood glucose markers.

conceptLactate monitoring

Continuous monitoring of lactate levels during exercise, especially cardio training, is desired for more accurate physiological understanding.

conceptAntisense oligonucleotide

A type of drug being developed to disrupt the synthesis of Apo(a), the protein that forms Lp(a).

conceptVO2 max training

High-intensity training sessions where continuous lactate monitoring would be beneficial for tracking metabolic breakdown.

productRepatha

supplementezetimibe

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