Published March 2023 on YouTube

Dr. Peter Attia: Improve Vitality, Emotional & Physical Health & Lifespan | Huberman Lab Podcast

1. Dr. Peter Attia

Dr. Peter Attia shares actionable tools for extending health span and longevity, including behavioral, nutritional, and prescription drug-based approaches. He also emphasizes the importance of emotional health in achieving longevity and vitality. The discussion includes insights from his newly released book, "Outlive: The Science and Art of Longevity."

2. Sleep and Performance

Andrew discusses the importance of regulating body temperature for optimal sleep and introduces Eight Sleep, a smart mattress cover that can help regulate temperature. He also talks about the critical role of electrolytes and hydration for mental and physical performance, and recommends Element as a solution. Finally, Andrew introduces HVMN Ketone IQ, a supplement that can increase blood ketones for better focus and energy levels during cognitive work and exercise.

3. Lifespan vs. Healthspan

Peter Attia and Andrew Huberman discuss the importance of defining longevity and healthspan. While lifespan is binary, healthspan is squishier and involves physical, cognitive, and emotional health. They emphasize the need to address all three dimensions for healthy aging.

4. “4 Horseman of Death”, Diseases of Atherosclerosis

Andrew and Peter discuss the four main causes of death and how atherosclerosis is the most common, with cardiovascular disease being the lion's share of that. They also touch on cerebrovascular disease and the importance of blood flow to the brain.

5. Blood Pressure and Stroke

Blood Pressure and Hemorrhagic Stroke:Peter and Andrew discuss the leading driver of hemorrhagic stroke phenomenon, which is hypertension. They delve into the importance of managing blood pressure to be within the 120 over 80 range, and how measuring blood pressure can be often misleading.
Blood Pressure Accuracy:Peter Attia emphasizes the importance of measuring blood pressure accurately, discussing the differences between manual and automated cuffs. He recommends using a manual cuff and stethoscope for more accurate readings and suggests that individuals can learn to measure their own blood pressure with the right equipment and resources.
Blood Pressure Monitoring:Andrew and Peter discuss the importance of monitoring blood pressure and the limitations of current devices. They suggest using automated cuffs for two weeks and discuss the potential for continuous monitoring through wearable devices.

6. Arterial Health Tips

Preventing Arterial Atherosclerosis:Andrew and Peter discuss the top three ways to prevent arterial atherosclerosis, which include maintaining healthy blood pressure, avoiding smoking, and reducing exposure to ApoB bearing lipoproteins. Smoking and high blood pressure can both cause damage to the endothelium, making it more susceptible to damage from lipoproteins. They also touch on the effects of vaping and cannabis on arterial health.
Cannabis and Vaping Risks:Peter Attia discusses the risks of smoking cannabis and vaping. While there is no evidence to suggest that smoking cannabis is better than smoking cigarettes, the dose seems to be significantly lower. Similarly, vaping is not a good idea, but it is less harmful than smoking.
Risks of Smoking and Vaping:Peter and Andrew discuss the risks of smoking and vaping, particularly in relation to nicotine and cannabis. They highlight the dangers of inhaling chemical constituents and particulate matter, emphasizing the importance of being mindful of what we expose our lungs to. They suggest alternative delivery methods for these substances, such as tinctures and patches.

7. Sponsor: AG-1 (Athletic Greens)

Andrew explains the importance of gut health and how athletic greens can provide the optimal probiotics for microbiotic health. He shares how he has been taking athletic greens since 2012 and how it contains adaptogens, vitamins, and minerals to meet all of his foundational nutritional needs.

8. Cholesterol, ApoB

Cholesterol and Cell Membranes:Andrew Huberman and Peter Attia discuss the importance of cholesterol in the body, particularly in the structure of cell membranes. They explain how cholesterol is synthesized and its role in the body's survival.
Cholesterol's Importance:Peter explains how cholesterol is not only a precursor to important hormones in our body but also how it's demand can cause cells to borrow or take cholesterol from other cells in the body. Additionally, he discusses the issue of transporting cholesterol due to it not being water-soluble.
Understanding Lipoproteins:Peter and Andrew discuss the science behind lipoproteins and how they transport cholesterol throughout the body. They explain the different types of lipoproteins and their relative concentrations of protein and lipids, with a focus on the atherogenic apob family.

9. Cholesterol and Brain Development

LDL and APOB:Peter Attia explains that while LDL and APOB can perform functional roles in the body, they are not necessary as all functions can be done by HDL. Most species do not even have APOB and are chemically incapable of atherosclerosis. There is no evidence to suggest that a higher level of LDL reflects a healthy metabolic need.
Cholesterol and Brain Development:Peter explains how cholesterol is a critical component of the synaptogenesis process and the formation of connections between neurons in the developing brain. He also discusses the relationship between serum cholesterol levels and CNS nutrition in infants and children.

10. Preventing Heart Disease

Heart Disease Prevention:Andrew and Peter discuss the importance of preventing heart disease by monitoring apob levels and cholesterol intake. They explain that the earlier you start taking preventative measures, the less aggressively you need to do so in the future.
Causality and Smoking:Peter and Andrew discuss the importance of understanding causality in medicine, specifically in relation to smoking and lung cancer. They debate whether it would be better to use a model to predict when someone's risk of lung cancer is high enough to stop smoking or to simply acknowledge that cigarettes are causally related to lung cancer and encourage cessation.
Causality and Risk Calculation:Peter discusses how Mendelian randomizations and clinical trial literature prove that LDL cholesterol or apob is causally related to atherosclerosis. He also highlights the backwardness of the current risk calculation method in medicine, which predicts the ten year risk of major adverse cardiac events.
Managing Cardiac Risk:Peter discusses the importance of managing cardiac risk factors, regardless of the calculated risk percentage. He emphasizes the need to modify causal and modifiable risks, such as LDL and Apob, and the importance of early intervention. The discussion highlights the need to consider individual risk factors and the importance of causality in making judgments about cardiac risk.

11. Lowering Cholesterol Levels

Lowering Apob Levels:Andrew and Peter discuss how to reduce Apob levels through nutrition and medication. They mention that fixing insulin resistance in an insulin resistant person will bring down the levels. They also discuss how carbohydrate restriction can lower triglycerides, which are an integral of carbohydrate consumption.
Cholesterol Drugs:Peter Attia explains how statins and Ezetimibe work to lower cholesterol levels in the body. Statins target an enzyme that reduces the body's pool of cholesterol while Ezetimibe blocks a transporter in the gut that absorbs cholesterol. While statins have some side effects, Ezetimibe has virtually none.
Statin Side Effects:Peter and Andrew discuss the potential side effects of statins, including elevated transaminases, muscle soreness, brain fog, and insulin resistance. They explain that while these side effects are not common, there are many statin options available with low side effect profiles, and periodic CGM tracking can help monitor for insulin resistance.
Cholesterol Medications:Peter discusses the side effects of Crestor and the discovery of PCSK Nine inhibitors, which are used to treat familial hypercholesterolemia. He explains how the drug works and his personal experience with taking it.

12. Monitoring ApoB

Genetics and Atherosclerosis:Andrew and Peter discuss the underlying biology of genetics and atherosclerosis. They emphasize the importance of intervening in high Apob levels, even if the person feels fine, as the most common presentation of a heart attack is death.
Health Insights:Peter Attia and Andrew Huberman discuss the importance of good sleep and measuring Apob numbers for heart health. Peter shares his personal experience of getting his Apob numbers measured and how it changed the direction of his life. They also emphasize the importance of early measurement, especially if there is a family history of heart disease.

13. Sponsor: InsideTracker

Andrew discusses the importance of getting regular blood work done and how Inside Tracker can help individuals understand their body better by analyzing data from their blood and DNA. He explains how the personalized dashboard can help address nutrition-based behavioral measures and supplement-based approaches to move values into ranges that are optimal for an individual's vitality and longevity.

14. Lowering Blood Pressure

Peter and Andrew discuss ways to lower blood pressure, including exercise, weight management, and medication. They emphasize the importance of trying non-pharmacological methods first, such as low-intensity cardio and getting enough sleep, before turning to medication.

15. High Blood Pressure & Kidneys

Peter emphasizes the importance of kidney health for longevity and how it is often overlooked in modern medicine. He explains how the kidney is a sensitive organ that is susceptible to elevated blood pressure and how measuring kidney function correctly is crucial for a healthy aging process.

16. Alcohol, Sleep & Disease Risk

Cancer Prevention:Andrew and Peter discuss the risk factors for cancer and the impact of alcohol consumption. Research shows that there is no healthy dose of ethanol and that the French Paradox is not a reliable indicator of cardiovascular health.
Alcohol Consumption:Peter and Andrew discuss the risks associated with alcohol consumption. While there may be no measurable harm for most people who consume one drink a day, the risk climbs steeply after that. Andrew suggests that if you can avoid drinking altogether, that is the best option.
Alcohol and Health:Peter Attia discusses the impact of alcohol on health, particularly on sleep and the risk of neurodegenerative diseases. While he enjoys certain alcoholic beverages, he acknowledges the trade-offs and emphasizes the importance of quality of life in healthy aging. Matt Walker's contributions to raising awareness about the critical role of sleep are also highlighted.

17. Cancer Risks and Drivers

Cancer Risk:Andrew and Peter discuss the probability of getting cancer and dying from it, as well as the importance of early screening and treatment for certain types of cancer. They also touch on the complexity of different types of cancer and how they require different approaches to treatment.
Cancer Drivers:Peter Attia discusses the role of genetics in cancer and how germline mutations account for less than 5% of cancers. He also explains how somatic mutations, specifically those caused by smoking and obesity, are the main drivers of cancer.
Cancer Risks:Peter Attia discusses the limitations of using BMI as a measure of obesity and suggests that waist to height ratio is a better metric. He argues that insulin resistance and inflammation, rather than obesity, are the driving factors behind cancer risks. While certain environmental toxins and alcohol can also increase the risk, there is no proven cancer diet or exercise routine.

18. Cancer Screening & Survival

Importance of Cancer Screening:Andrew and Peter discuss the importance of cancer screening and how MRI technology can be used to detect tumors in the brain. They argue that early detection is crucial in treating cancer and that there is no example of a cancer that is more effectively treated when the burden of cancer cells in the body is higher than when it is lower.
Cancer Screening:Peter Attia discusses the importance of catching cancer as early as possible and the different methods of screening for cancer, including imaging and liquid biopsies. He also highlights the potential risks of relying on certain imaging modalities, such as CT scans, due to the high levels of radiation exposure.

19. Radiation Risks, CT & PET Scans

Radiation Exposure:Andrew discusses the trivial amounts of radiation exposure from airport scanners, flying, and microwaves. He also highlights the major sources of radiation, including medical procedures like CT and PET scans. While these procedures are not harmful in moderation, frequent exposure can increase cancer risk.
Radiation Awareness:Peter Attia emphasizes the importance of being aware of the amount of radiation exposure from CT scans and imaging studies. He advises asking about the amount of radiation before getting any scans and recommends going to a reputable place with better software and engineering for faster and more accurate scans. He also suggests opting for MRI scans which do not involve any radiation.

20. Environmental Carcinogens

Andrew and Peter discuss the potential cancer risks associated with everyday exposure to pesticides and solvents found in common household items. They acknowledge the difficulty in calculating such risks but suggest focusing on what can be controlled to reduce overall risk.

21. Cancer Screening Insights

Genetic Screening:Peter Attia discusses genetic screening and its role in cancer prevention. He emphasizes the importance of being proactive in screening for cancer and the benefits of knowing one's genetic predispositions. Attia also touches on the challenges of aggressive screening and the need to balance risks and benefits.
Whole Body MRI:Peter and Andrew discuss the benefits and limitations of whole body MRI for cancer screening. Peter explains the low specificity of MRI and the need for further investigation for non-cancerous findings. They also touch upon the cost of whole body MRI and mention a company called Prinuvo.

22. Preventing Neurodegenerative Diseases

Preventing Neurodegenerative Diseases:Andrew and Peter discuss the prevalence of Alzheimer's disease and other neurodegenerative diseases, as well as the controversy surrounding their underlying causes. They explore the role of age as a risk factor and offer insights on how to offset cognitive decline and prevent these diseases.
Alzheimer's Risk:Peter Attia discusses the Apob gene and its isoforms, which offer varying levels of protection against neurodegenerative diseases like Alzheimer's. He explains how the E4 isoform historically offered protection against infections, but today there is a clear stratification of risk for Alzheimer's based on the isoforms.
Alzheimer's Genetics:Peter Attia explains the prevalence of Alzheimer's genetics and how they are not deterministic. He also discusses the devastating consequences of deterministic genes and how Alzheimer's patients usually die due to failure to thrive or aspiration.

23. Alzheimer’s Disease & Amyloid

Alzheimer's Disease Controversy:Peter discusses the controversy surrounding Alzheimer's disease and the overemphasis on amyloid beta. He explains that while amyloid is responsible for the changes seen in the brain, it's not clear how important it is. Additionally, people who have died with no cognitive impairment have been found to have lots of amyloid, which raises questions about the link between amyloid and Alzheimer's.
Alzheimer's Research Scandal:Andrew and Peter discuss a scandal in Alzheimer's research where a falsified paper on an amyloid variant set the field back a decade. They question the disciplinary action taken and the efficacy of amyloid therapies and biomarkers. The field is in a crisis due to the lack of precision medicine in Alzheimer's disease.

24. Brain Health Basics

Brain Health Basics:Peter and Andrew discuss the four things that are unequivocally true for brain health: sleep, lower LDL cholesterol, being insulin sensitive, and exercise. They recommend doing 1 hour of low-intensity cardio, 1 hour of strength training, and 1 hour of interval training if you can only exercise 3 hours a week. Andrew also mentions the importance of avoiding head hits.
Head Injuries:Andrew and Peter discuss the prevalence of head injuries in various settings and the emerging use of hyperbaric oxygen as a treatment for traumatic brain injury. While Peter is skeptical of the claims made about hyperbaric oxygen, he acknowledges the need for further rigorous study in this area.
Brain Health Interventions:Andrew and Peter discuss the efficacy of hyperbaric oxygen and various brain supplements. While hyperbaric oxygen may be useful for wound healing and TBI, it is time-consuming and expensive for other purposes. They also touch on the unimpressive evidence for many brain supplements, emphasizing that exercise, sleep, insulin sensitivity, and lipid management are the most crucial interventions for brain health.

25. Deadly Fentanyl Crisis

Avoiding Accidental Death:Andrew and Peter discuss accidental deaths and how fentanyl has become the leading cause of accidental deaths in America, surpassing car accidents and falls. They also touch on the increase in deaths of despair due to alcohol-related deaths, suicides, and accidental overdoses.
Fentanyl Crisis:Peter and Andrew discuss the rise of fentanyl-related deaths, particularly among cocaine users. They question why people are still using cocaine despite the known risks and how fentanyl is being obtained and distributed. The episode highlights the need for more awareness and education on the dangers of fentanyl.
Deadly Counterfeit Pills:Peter and Andrew discuss the dangers of counterfeit pills laced with fentanyl, which are causing accidental poisonings and deaths among both adults and children. They urge listeners to be cautious and not trust pills from unknown sources, even if they seem harmless.

26. Fall Risk & Stability, 4 Pillars of Strength Training

Aging and Muscle:Andrew and Andy discuss how the ability to jump and land correlates with the probability of falls, and how muscle atrophy of fast twitch fibers is the hallmark of aging. To age well, one must train to strengthen and delay the hypertrophy of type two fibers.
Strength Training Fundamentals:Peter Attia discusses the importance of strength training and the four pillars of strength training, including eccentric strength. He emphasizes the significance of explosive movements and the ability to control landings to prevent falls, especially in older individuals.
Four Pillars:Peter and Andrew discuss the four pillars of longevity through physical exercise and the importance of maintaining strength, stability, aerobic efficiency, and aerobic peak output for a better quality of life.
Stability Matters:Peter and Andrew discuss the importance of stability in aging well and how typical commercial gym machines don't really tap into it. They also highlight the multifaceted nature of stability and how it involves doing a lot of things, including resistance training.

27. Emotional Health

Emotional Health:Peter Attia shares his personal experience and insights on emotional health, which he believes is the most important aspect of quality of life. Despite initial resistance from others involved in the book, he includes a long chapter on emotional health based on his patient experience and knowledge acquisition.
Longevity's Greatest Struggle:Peter Attia discusses the importance of emotional health in longevity and how it ranks as the top factor on his personal longevity dashboard. Without emotional well-being, even infinite lifespan would be miserable.
Emotional Health:Peter and Peter discuss the importance of emotional health and how it can be difficult to define. They touch on the components that make up emotional health, such as the ability to maintain healthy relationships and attachments to others, having a sense of purpose, and being able to regulate emotions.
Being Present:Andrew and Peter discuss the importance of being present in the moment and how it can lead to greater happiness. They reference a study that found presence to be a stronger predictor of happiness than enjoyment of the activity itself. Despite this, many people struggle to be present in today's fast-paced world.
Time Perception:Andrew and Peter discuss the human brain's ability to contract and dilate our perception of time, and how it can be both a blessing and a curse. They also touch on the importance of being present in the moment and savoring the finite number of moments we have in life.

28. Living with Mortality

Living with Mortality:Andrew and Peter discuss the impact of contemplating mortality on being present in life. They explore the idea that accepting mortality can lead to a more peaceful life and how quality of relationships is a key factor in living a fulfilling life. Peter also shares his insights on how he plans to extend his life by 10-15 years.
Emotional Well-Being:Peter Attia shares his daily practices for emotional well-being and healthy aging, emphasizing the importance of being mindful of damaging relationships and acting on it quickly. He also discusses the challenge of balancing work and expectations and the need for self-care, which varies from person to person.
Repairing Damage:Peter Attia discusses the dangers of perfectionism and the importance of repairing relationships when damage is done. He shares personal examples of being too harsh with his son and how he quickly rectifies the situation by apologizing and repairing the damage.

29. Repairing Relationships

Repairing Relationships:Peter and Andrew discuss the process of repairing relationships when one feels wronged or screwed up. They explore the importance of optimizing around the relationship or the outcome in different situations, and how this affects the process of repairing a relationship fracture.
Understanding Emotions:Peter and Andrew discuss the importance of understanding oneself and the nature of relationships when dealing with interpersonal conflicts. Peter emphasizes the need to deconstruct emotions and understand their underlying causes, while Andrew highlights the coarseness of language when it comes to expressing emotions. They both agree that self-awareness is key to navigating difficult situations and optimizing outcomes while maintaining healthy relationships.

30. Emotional Healing Insights

Healing Retreats:Peter Attia shares his experience of going on two retreats to understand himself better. Despite being emotionally challenging, he learned that being overly analytical can lead to rationalizing problems away. He also discovered the importance of emotional processing and how it affects relationships.
Emotional Trauma:Peter and Andrew discuss the emotional processing of trauma and how the brain repurposes circuitry used as children in adulthood. Peter shares his experience of accepting his emotional trauma and how it allowed him to let go of the adaptations that came from it. They also discuss the difficulty of emotionally revisiting childhood trauma and the importance of practicing skills learned from the experience.

31. Inner Rage

Overcoming Inner Rage:Peter shares his personal experience with anger and how it affected his inner monologue. He talks about how boxing helped him release his rage and how he eventually became aware of his violent self-talk.
Overcoming Self-Criticism:Peter shares how he overcame his self-criticism by pretending to talk to a friend instead of himself every time he made a mistake. He was able to record kinder self-talk and send it to his therapist, which helped him shed this trait.
Overcoming Negative Self-Talk:Peter shares his journey of overcoming negative self-talk and how it has helped him communicate better with himself and others. He also discusses how it only took him four months to get rid of his inner critic and how he has been able to bring it back in a loving way.
Emotional Health:Andrew and Peter discuss the importance of emotional health and self-talk in maintaining overall well-being. Peter's book provides actionable items related to health, span, and lifespan, and the section on emotional health was particularly profound for Andrew. They also discuss the vulnerability required to share personal experiences and the importance of internalizing the gifts we give to others.

32. Longevity Tips

Andrew and Peter discuss tips for living longer, including the benefits of supplements and Momentous Supplements' partnership with the podcast. They also mention Dr. Attia's upcoming book on longevity.