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December 27, 2023 • 3hr 59min
#085 Dr. Peter Attia on Mastering Longevity – Insights on Cancer Prevention, Heart Disease, and Aging
FoundMyFitness
In this episode, Dr. Peter Attia, a renowned expert in preventive medicine and longevity, discusses a wide range of topics related to optimizing health and extending lifespan. As the author of the bestselling book "Outlive" and host of "The Drive" podcast, Dr. Attia brings deep expertise in applying cutting-edge science to clinical practice.
The conversation covers cardiovascular disease prevention, cancer screening, hormone replacement therapy, exercise, and many other aspects of proactive healthcare. Dr. Attia emphasizes the importance of personalized, data-driven approaches to identify and mitigate health risks early.
#085 Dr. Peter Attia on Mastering Longevity – Insights on Cancer Prevention, Heart Disease, and Aging
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Key Takeaways
- ApoB is a superior predictor of cardiovascular disease risk compared to LDL particle number or LDL cholesterol levels. It encompasses the total atherogenic burden from LDL, IDL, and VLDL particles.
- Optimal ApoB levels are likely below 60 mg/dL for most people. Levels below 30 mg/dL may make atherosclerosis development impossible, but are difficult to achieve without medication.
- Major factors that elevate ApoB include: insulin resistance, excessive saturated fat intake, genetics, and impaired LDL clearance.
- Statins are effective but have side effects like muscle aches (7% of users) and increased insulin resistance (0.4% develop diabetes). Alternatives like PCSK9 inhibitors may be preferable for some patients.
- Aggressive cancer screening is recommended, especially for breast, colon, and prostate cancers. Catching cancer early dramatically improves outcomes.
- Hormone replacement therapy for menopausal women likely reduces risks of cardiovascular disease, osteoporosis, and possibly dementia when started early in menopause. Risks were likely overstated by flawed studies.
- Testosterone replacement for men can be beneficial for symptoms of low T, but should be carefully considered and monitored. Injections twice weekly are preferred over gels.
- Blood pressure target should be 120/80 or lower. Exercise, weight loss, and stress reduction are key lifestyle interventions. Medications may be needed for some.
- VO2 max is one of the best predictors of longevity. An 80/20 mix of zone 2 cardio and VO2 max training is recommended to optimize cardiovascular fitness.
Introduction
In this episode, Dr. Peter Attia, a renowned expert in preventive medicine and longevity, discusses a wide range of topics related to optimizing health and extending lifespan. As the author of the bestselling book "Outlive" and host of "The Drive" podcast, Dr. Attia brings deep expertise in applying cutting-edge science to clinical practice.
The conversation covers cardiovascular disease prevention, cancer screening, hormone replacement therapy, exercise, and many other aspects of proactive healthcare. Dr. Attia emphasizes the importance of personalized, data-driven approaches to identify and mitigate health risks early.
Topics Discussed
Cardiovascular Disease Prevention (07:36)
Dr. Attia explains that atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death globally. Key points include:
- ASCVD involves plaque buildup in coronary arteries, leading to reduced blood flow and potential heart attacks
- Nearly 50% of first presentations of ASCVD are sudden death
- ApoB is the best predictor of ASCVD risk, superior to LDL-C or LDL particle number
- ApoB below 60 mg/dL is likely optimal for most people
- Major factors elevating ApoB: insulin resistance, saturated fat intake, genetics, impaired LDL clearance
"If you had an ApoB level below about 30 milligrams per deciliter, 20 to 30 milligrams per deciliter, it wouldn't be possible to develop atherosclerosis," states Dr. Attia, referencing work by Dr. Peter Libby.
Lipid-Lowering Medications (56:19)
Dr. Attia discusses various pharmacological approaches to lowering lipids:
- Statins are effective but have side effects in some patients
- PCSK9 inhibitors are highly effective with minimal side effects, but expensive
- Ezetimibe blocks cholesterol absorption, less potent than statins
- Bempedoic acid lowers cholesterol synthesis only in the liver, avoiding muscle side effects
He emphasizes personalized approaches: "We handle each of those on a case by case basis...We're not very comfortable initiating HRT in women who are ten years out [from menopause]. But at the same time, we realize there are a lot of women who are 60 today who went through menopause at the height of the stupidity around the WHI."
Exercise for Metabolic Health (1:11:09)
Dr. Attia recommends an 80/20 mix of zone 2 cardio and VO2 max training:
- Zone 2 training improves metabolic flexibility and mitochondrial function
- VO2 max training (3-8 minute intervals) optimizes cardiovascular fitness
- Strength training is also crucial for overall health and longevity
"We basically do with our patients is we start from a standpoint of time. How much time are you willing to exercise a week?...Of the cardio, it's 80/20. 80% of that will be zone 2, 20% of that will be VO2 max."
Cancer Screening (2:15:03)
Aggressive cancer screening is recommended, especially for:
- Breast cancer: mammogram + ultrasound or MRI
- Colon cancer: colonoscopy starting at 40-45, every 3 years
- Prostate cancer: PSA testing with follow-up as needed
- Liquid biopsies like Grail test for multi-cancer early detection
"If you catch this in a stage one, it's a non-fatal disease. A stage four disease is a uniformly fatal disease," Dr. Attia notes regarding breast cancer.
Hormone Replacement Therapy (2:45:13)
Dr. Attia discusses hormone replacement therapy (HRT) for menopausal women:
- HRT likely reduces risks of cardiovascular disease, osteoporosis, and possibly dementia when started early in menopause
- Risks were likely overstated by flawed Women's Health Initiative study
- Bioidentical hormones and transdermal delivery preferred over oral synthetic hormones
- Testosterone replacement may benefit some women for sexual function
"I think there has been no greater disservice brought by the medical community onto anyone, but in particular in this case women, than the abject failure of the interpretation of the Women's Health Initiative in 2001, 2002," Dr. Attia states emphatically.
Testosterone Replacement for Men (3:23:05)
Key points on testosterone replacement therapy (TRT) for men:
- Consider TRT for low testosterone symptoms + low lab values
- Injections twice weekly preferred over gels for consistent levels
- Monitor for side effects like acne, hair loss, prostate enlargement
- May slightly increase cardiovascular risk in first year of treatment
"We're very biased towards injections. I think they're far more consistent," Dr. Attia explains regarding TRT administration.
Blood Pressure Management (3:32:33)
Dr. Attia emphasizes the importance of blood pressure control:
- Target should be 120/80 or lower based on SPRINT trial data
- Lifestyle interventions like exercise, weight loss, and stress reduction are key
- Proper measurement technique is crucial - sit quietly for 5 minutes before checking
- Home monitoring over 2 weeks provides the most accurate assessment
"We're very aggressive, right. I mean, if you look at the SPRINT trial, I think it's very clear that 120 over 80 or better is the place to be," states Dr. Attia.
Dr. Attia's Personal Health Practices (3:45:30)
Dr. Attia shares his own health optimization routines:
- Sleep: 8 hours nightly, 10pm-6am, using cooling mattress cover
- Diet: Balanced omnivore diet focused on protein intake and avoiding junk food
- Exercise: Daily workouts including zone 2 cardio, VO2 max training, and strength training
- Alcohol: 0-8 drinks/week, never more than 2/day, consumed early in evening
- Mental health: Weekly therapy, journaling, dialectical behavioral therapy
"I'm sure that everything I'm about to say is going to make me sound really rigid. And people are going to be like, that guy's a psycho. So I'm always a little hesitant when in talking about what I do," Dr. Attia prefaces before sharing his routines.
Conclusion
This wide-ranging conversation with Dr. Peter Attia covers numerous aspects of proactive, preventive healthcare aimed at extending both lifespan and healthspan. Key themes include the importance of early detection and intervention for cardiovascular disease and cancer, the benefits of hormone optimization when indicated, and the crucial role of exercise and lifestyle factors in health outcomes.
Dr. Attia emphasizes personalized, data-driven approaches to identify and mitigate health risks early. He advocates for a shift from reactive "medicine 2.0" to proactive "medicine 3.0" focused on prevention. While some of his recommendations may seem aggressive compared to standard medical practice, they are based on a careful analysis of available evidence with the goal of optimizing long-term health outcomes.
Listeners are encouraged to take an active role in their health, work closely with knowledgeable physicians, and consider how they might implement some of these strategies in their own lives. As always, any significant changes to one's health regimen should be discussed with a qualified healthcare provider.
