July 29, 2024 • 2hr 30min

Dr. Peter Attia: Supplements for Longevity & Their Efficacy

Huberman Lab

In this episode, Dr. Andrew Huberman interviews Dr. Peter Attia, a longevity expert and physician, about NAD and supplements purported to extend lifespan. They discuss the current evidence around NAD precursors like NR and NMN, as well as other popular longevity interventions. Dr. Attia provides a skeptical perspective on many supplements, emphasizing the primacy of sleep, exercise, nutrition and mental health for longevity.

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Key Takeaways

NAD is a ubiquitous molecule in cells involved in energy production and DNA repair. Levels decline with age, leading to interest in supplementation.
There is currently no convincing evidence that NAD precursor supplements like NR or NMN extend lifespan in humans. Most benefits seen in studies are statistically but not clinically significant.
The most promising potential benefit of NAD precursors may be reducing risk of basal and squamous cell skin cancers, though more research is needed.
Rapamycin is one of the most promising compounds for extending lifespan based on animal studies, but has side effects and unknown long-term impacts in humans.
The most important factors for health and longevity are sleep, exercise, nutrition, and emotional wellbeing. Supplements should be viewed as minor additions, not replacements for healthy behaviors.
There is little evidence that "biological age" tests provide meaningful information beyond chronological age for predicting lifespan.
Radiation exposure from air travel and airport scanners is likely not a significant health concern for most people.
The 50s-70s may be a critical window for building physiological reserve through exercise and healthy habits to support health in later decades.

Introduction

In this episode, Dr. Andrew Huberman interviews Dr. Peter Attia, a longevity expert and physician, about NAD and supplements purported to extend lifespan. They discuss the current evidence around NAD precursors like NR and NMN, as well as other popular longevity interventions. Dr. Attia provides a skeptical perspective on many supplements, emphasizing the primacy of sleep, exercise, nutrition and mental health for longevity.

Topics Discussed

NAD Pathway and Sirtuins (25:01)

NAD is involved in hundreds of cellular pathways as a cofactor for energy production. A small portion is used as a substrate by sirtuins for DNA repair. Early research on sirtuins in yeast suggested a link to caloric restriction and longevity, but this connection has not held up in mammals.

NAD levels decline with age in most tissues, especially skin
Sirtuins use NAD as a substrate for DNA repair
Early sirtuin research in yeast suggested links to longevity, but this hasn't translated to mammals

NAD Precursor Supplements (1:02:17)

NR and NMN are precursors that can raise NAD levels when taken as supplements. However, there is little evidence this provides meaningful benefits for longevity in humans.

NR can cross cell membranes directly, while NMN requires conversion
Both can raise blood NAD levels, but impact on tissues is unclear
Mouse studies use extremely high doses not practical in humans
NR failed to extend lifespan in rigorous mouse studies

Research on NAD Precursor Benefits (1:17:43)

Dr. Attia reviews key studies on NR and NMN, finding most benefits are statistically but not clinically significant.

Study on fatty liver disease found minor benefits only in subset analysis
Study on glucose disposal showed very modest improvements
Most promising finding is potential reduction in basal/squamous cell skin cancers
"If you have to resort to really interesting statistical machinations to see something, there probably isn't something very interesting there." - Dr. Peter Attia

Rapamycin for Longevity (17:22)

Dr. Attia discusses his use of rapamycin and the evidence for its effects on longevity.

Takes 8mg once per week, with breaks due to side effects
Only intervention besides caloric restriction to extend lifespan across species
Awaiting results of dog aging study for more evidence in mammals
May improve immune function when dosed intermittently

Biological Age Tests (1:44:37)

Dr. Attia is skeptical of the value of biological age tests:

Unclear if they predict lifespan better than chronological age
Many inputs are noisy biological markers
Precision of results likely overstated
"Who cares? Truthfully, like, is that a good thing? Yes, probably. But is it tangibly, measurably meaningful, like, to have a biologic age of 35 versus 40 versus 30 if you're 60?" - Dr. Peter Attia

Radiation Exposure (1:55:24)

Dr. Attia explains why radiation from air travel and airport scanners is likely not a major health concern:

Annual radiation limits are much higher than typical exposures
Even pilots and nuclear plant workers don't show increased cancer risk
Radiation from a cross-country flight is very low

Maintaining Health in 50s-70s (1:58:12)

Dr. Attia emphasizes the importance of building physiological reserve in middle age:

50s-70s may be a critical window for maintaining muscle mass and strength
Harder to build muscle and recover from setbacks at older ages
Focus on consistent exercise, sleep, and nutrition habits

Exercise Timing and Energy Levels (2:07:12)

Dr. Huberman shares his experience with exercise timing affecting energy levels:

Exercising before 9am leads to more energy throughout the day
Mid-morning workouts can be depleting for the afternoon
May relate to body temperature changes throughout the day
Suggests people experiment with timing to optimize energy

Supplement Regimens (2:11:22)

Dr. Attia and Dr. Huberman share their personal supplement regimens:

Dr. Attia's supplements:

EPA/DHA fish oil
Theracurmin
Vitamin D
Methylfolate and methyl B12
Magnesium (3 forms)
Creatine monohydrate
Pendulum probiotics

Dr. Huberman's supplements:

AG1 multivitamin
Fish oil
Vitamin D
Methyl B12
Tongkat Ali
Green tea extract
NMN/NR (intermittently)
Creatine monohydrate
Magnesium threonate
Apigenin
Theanine
Inositol

Supplements vs Critical Behaviors (2:24:34)

Both doctors emphasize that supplements are far less important than core health behaviors:

Sleep, exercise, nutrition, and emotional health are the most critical factors for longevity
Supplements should be viewed as minor additions, not replacements for healthy behaviors
"Exercise, sleep, nutrition, emotional health is the question of what was the heading of the Titanic? Okay, so I just want people to understand the magnitude of what we're talking about. How you eat, how you sleep, how you train and how you take care of your mental health is the equivalent of what direction was the Titanic going with respect to the iceberg. All this supplement bullshit that we just talked about is equivalent to were they serving lobster or were they serving steak?" - Dr. Peter Attia

Conclusion

Dr. Attia concludes that there is currently insufficient evidence to recommend NAD precursor supplements like NR or NMN for longevity purposes. While they may raise NAD levels, the clinical significance of this is unclear. Both doctors emphasize that core health behaviors like sleep, exercise, nutrition and emotional wellbeing are far more important for health and longevity than any supplement regimen. They encourage maintaining an open mind as new evidence emerges, but for now view most longevity supplements with skepticism.