August 15, 2022 • 2hr 47min

Dr. Peter Attia: Exercise, Nutrition, Hormones for Vitality & Longevity

Huberman Lab

In this episode, Dr. Peter Attia discusses strategies for assessing and optimizing health status, longevity, and vitality. As a physician focused on the science of longevity, Dr. Attia brings deep expertise on topics ranging from biomarkers and imaging to exercise, nutrition, hormones and beyond. The conversation covers how to evaluate current health, set appropriate goals, and implement evidence-based interventions to extend both lifespan and healthspan.

0:00

-0:00

Key Takeaways

Assessing health status should focus on both lifespan (avoiding major diseases) and healthspan (cognitive, physical, and emotional functioning)
Blood testing can provide insight into lifespan risks like atherosclerosis, but has limitations for assessing healthspan
DEXA scans provide valuable data on bone mineral density, body composition, and risk of conditions like osteoporosis
"Backcasting" from your desired health in your final decade of life can help determine what metrics and interventions are needed now
Exercise, particularly strength training and cardiorespiratory fitness, has an enormous positive impact on all-cause mortality risk
Hormone replacement therapy for both men and women can be beneficial when done appropriately, but requires careful consideration
Apolipoprotein B (ApoB) is the key marker for assessing cardiovascular disease risk, more important than standard cholesterol panels
Diet, statins, and other interventions can help lower ApoB and reduce heart disease risk
GLP-1 agonist drugs show promise for weight loss but have some downsides like muscle loss
Focusing on exercise, strength, and cardiovascular fitness should take priority over debating supplements or specific diets

Introduction

In this episode, Dr. Peter Attia discusses strategies for assessing and optimizing health status, longevity, and vitality. As a physician focused on the science of longevity, Dr. Attia brings deep expertise on topics ranging from biomarkers and imaging to exercise, nutrition, hormones and beyond. The conversation covers how to evaluate current health, set appropriate goals, and implement evidence-based interventions to extend both lifespan and healthspan.

Topics Discussed

Assessing Health Status & Biomarkers (0:07:29)

Dr. Attia explains that assessing health status should consider both lifespan (avoiding major diseases) and healthspan (cognitive, physical, and emotional functioning). For lifespan, key factors include:

Atherosclerotic disease
Cancer
Neurodegenerative disease
Metabolic disease

Blood testing can provide insight into some of these risks, particularly atherosclerosis. However, Dr. Attia notes that blood work has limitations for assessing healthspan factors like cognitive and physical function.

"Blood testing of biomarkers provides pretty good insight into lifespan. When you get into healthspan, the biomarkers are far less helpful, and here we kind of rely more on functional testing."

He recommends getting blood work 2-4 times per year for most patients, but emphasizes that frequency should be based on individual factors and interventions being used.

DEXA Scans for Body Composition (0:16:01)

Dr. Attia discusses the value of DEXA scans for assessing:

Bone mineral density - Critical for evaluating osteoporosis risk
Body fat percentage
Lean mass
Visceral fat - Fat around organs, linked to metabolic issues

He notes that bone mineral density is particularly important to track, especially for women approaching or past menopause due to increased osteoporosis risk. Strength training is emphasized as a key intervention for maintaining bone density.

The "Marginal Decade" and Backcasting (0:32:16)

Dr. Attia introduces the concept of the "marginal decade" - the final decade of one's life. He recommends patients envision in detail what they want to be able to do physically and cognitively in that decade. This vision then allows for "backcasting" - working backwards to determine what metrics and interventions are needed now to achieve those goals.

"Until a person can tell you what it is that they want to be doing in that last decade, you can't design a program to get them there."

This approach helps contextualize health metrics and interventions in terms of long-term functional goals rather than arbitrary targets.

Exercise and All-Cause Mortality (0:38:31)

Dr. Attia emphasizes the profound impact of exercise, particularly strength and cardiorespiratory fitness, on all-cause mortality risk:

Strength: Low vs high muscle mass associated with ~3x difference in mortality risk
Cardiorespiratory fitness: Bottom 25% vs top 2.5% of VO2 max associated with ~5x difference in mortality risk

He argues these factors are more impactful than many popular interventions:

"I just can't get enough of the machinating and arguing about this supplement versus that supplement...You shouldn't be arguing about those things until you have your exercise house in order."

Hormone Replacement Therapy (1:03:12)

Dr. Attia discusses hormone replacement therapy (HRT) for both women and men:

For women:

Bioidentical estrogen and progesterone can help manage menopausal symptoms and health risks
Previous concerns about breast cancer risk were likely overstated
Topical estrogen preferred over oral to reduce clotting risk

For men:

Focus on free testosterone levels rather than total testosterone
Typical doses much lower than bodybuilding amounts (e.g. 100mg/week vs 500-1000mg)
Consider fertility impacts - may use HCG instead for younger men

He emphasizes individualizing treatment and carefully monitoring effects.

Cholesterol, ApoB, and Cardiovascular Risk (2:02:51)

Dr. Attia explains that Apolipoprotein B (ApoB) is the key marker for assessing cardiovascular disease risk, more important than standard cholesterol panels:

ApoB represents the total number of atherogenic particles
Optimal levels depend on individual risk factors and goals
For maximum longevity, may target ApoB below 30 mg/dL

He discusses dietary and pharmacological interventions to lower ApoB:

Reducing saturated fat and refined carbohydrates
Statins
PCSK9 inhibitors
Ezetimibe
Bempedoic acid

Dr. Attia argues that aggressively lowering ApoB, often with medications, is critical for reducing cardiovascular disease risk and extending lifespan.

GLP-1 Agonists for Weight Loss (2:40:44)

Dr. Attia discusses GLP-1 agonist drugs like semaglutide for weight loss:

Show significant efficacy for weight loss
Act primarily through central (brain) mechanisms
Downsides include muscle loss along with fat loss
Nausea is a common side effect
Long-term effects still being studied

He is cautiously optimistic about their potential but notes more research is needed on long-term use and cycling protocols.

Conclusion

This wide-ranging conversation with Dr. Peter Attia provides a wealth of insights on science-based approaches to extending lifespan and healthspan. Key themes include:

The importance of setting clear long-term health goals and working backwards to inform current interventions
Prioritizing exercise, particularly strength training and cardiorespiratory fitness, as foundational for longevity
Using appropriate biomarkers and imaging to assess health status and disease risk
Carefully considering hormone replacement therapy when indicated
Aggressively managing cardiovascular risk through ApoB reduction
Staying informed on emerging interventions while maintaining a critical eye on the evidence

Dr. Attia's approach emphasizes personalization, rigorous analysis of scientific evidence, and focusing on the interventions likely to have the greatest impact on long-term health outcomes. His insights provide a valuable framework for anyone looking to optimize their vitality and longevity.