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Dr. Peter Attia: Exercise, Nutrition, Hormones for Vitality & Longevity | Huberman Lab Podcast #85

Andrew Huberman・152 minutes read

Dr. Attia discusses health span, longevity, and optimizing vitality through science-based tools, emphasizing blood testing, hormone health, strength training, and cognitive well-being. The podcast highlights the importance of personalized interventions, quality supplements, and regular exercise for overall health and longevity, with valuable insights on hormone replacement therapy and cholesterol management.

Insights

  • Dr. Peter Attia is a multifaceted expert in exercise physiology, sleep physiology, emotional and mental health, pharmacology, and various health interventions.
  • Evaluating health status, defining health trajectory, and optimizing vitality are central themes in the discussion between Dr. Attia and Andrew Huberman.
  • Dr. Attia's extensive background in mechanical engineering, applied mathematics, and medical training at Stanford and Johns Hopkins underpins his expertise in health interventions.
  • Blood work is emphasized as crucial for impacting lifespan and health span, focusing on when to start, frequency, and what to look for in blood tests.
  • The episode covers a wide range of topics including hormone health, drug therapies, supplementation, nutrition, exercise, and predictors of lifespan and health span.
  • Strength training is highlighted as key for improving bone density, longevity, and overall health, with specific recommendations for routine and intensity.
  • Hormone replacement therapy nuances, particularly for women in menopause, are discussed, emphasizing the importance of individualized approaches and bio-identical hormones for minimizing risks.

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Recent questions

  • What is the Huberman Lab Podcast about?

    The Huberman Lab Podcast discusses science and science-based tools for everyday life, hosted by Andrew Huberman, a neurobiology and ophthalmology professor at Stanford School of Medicine, with guest Dr. Peter Attia, a physician specializing in health span and lifespan interventions. The podcast delves into evaluating one's health status, defining health trajectory, and optimizing vitality while extending lifespan. Dr. Attia's expertise covers various health interventions, including exercise physiology, sleep physiology, emotional and mental health, pharmacology, and more.

  • Who is Dr. Peter Attia?

    Dr. Peter Attia is a physician specializing in health span and lifespan interventions, with expertise in exercise physiology, sleep physiology, emotional and mental health, pharmacology, and various health interventions. He holds a Bachelor of Science in mechanical engineering and applied mathematics, an MD from Stanford University School of Medicine, and has trained at Johns Hopkins Hospital in general surgery. Dr. Attia has also worked at the National Institute of Health focusing on immune-based therapies for melanoma and has trained with top experts in various fields related to health and longevity.

  • What topics are discussed in the Huberman Lab Podcast?

    The Huberman Lab Podcast covers a wide range of topics related to health and longevity, including hormone health, hormone therapies, drug therapies, supplementation, nutrition, exercise, predictors of lifespan and health span, and the importance of blood work. The podcast emphasizes the significance of cognitive, physical, and emotional domains for overall health, as well as the value of functional tests like DEXA, CPET, and VO2 max testing in providing valuable insights into one's health status.

  • What are some key insights on bone health discussed in the podcast?

    The podcast highlights the importance of strength training for improving bone mineral density at any age, with specific recommendations for heavy loads, low repetitions, and long rest periods 2-3 times weekly. It emphasizes that bones sense force applied through compression, activating osteoblasts to build bone, and that the critical bone development period until age 20-25 sets a lifelong trajectory, especially crucial for females. Additionally, the discussion covers how inhaled steroids and corticosteroids during development can impair bone building, and the importance of counteracting drug effects with nutrition, hormones, drugs, and training.

  • What are some recommendations for optimizing testosterone levels?

    The podcast discusses various aspects of testosterone therapy, emphasizing the importance of physiological dosing, careful monitoring of estradiol levels, and the use of injectable testosterone cypionate over pellets for better dosage control. It also mentions the significance of maintaining fertility with HCG while on testosterone therapy, the potential impact of testosterone on sperm count, and the importance of individualized treatment approaches based on total testosterone, free testosterone, and SHBG levels. Additionally, the podcast touches on the potential benefits and risks of testosterone therapy for men, highlighting the need for lifestyle factors like sleep, exercise, and nutrition before considering hormone replacement.

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Summary

00:00

"Optimizing Health and Longevity with Experts"

  • The Huberman Lab Podcast discusses science and science-based tools for everyday life, hosted by Andrew Huberman, a neurobiology and ophthalmology professor at Stanford School of Medicine, with guest Dr. Peter Attia, a physician specializing in health span and lifespan interventions.
  • Dr. Attia's expertise covers exercise physiology, sleep physiology, emotional and mental health, pharmacology, and various health interventions.
  • The discussion delves into evaluating one's health status, defining health trajectory, and optimizing vitality while extending lifespan.
  • Dr. Attia's background includes a Bachelor of Science in mechanical engineering and applied mathematics, an MD from Stanford University School of Medicine, and training at Johns Hopkins Hospital in general surgery.
  • He has also worked at the National Institute of Health focusing on immune-based therapies for melanoma.
  • Dr. Attia has trained with top lipidologists, endocrinologists, gynecologists, sleep physiologists, and longevity scientists in the US and Canada.
  • The episode covers the importance of blood work, including when to start, frequency, and what to look for in blood tests to impact lifespan and health span.
  • Topics discussed include hormone health, hormone therapies, drug therapies, supplementation, nutrition, exercise, and predictors of lifespan and health span.
  • The podcast is now partnered with Momentous supplements, emphasizing quality, single-ingredient supplements for optimized cost and effectiveness.
  • Additional sponsors include Thesis for custom nootropics, InsideTracker for personalized nutrition analysis, and Helix Sleep for customized mattresses and pillows.

11:36

"Genetic, Blood, and Functional Tests for Health"

  • Genes beyond APOE can influence risk stratification.
  • Blood testing of biomarkers offers insight into lifespan.
  • Cognitive, physical, and emotional domains are crucial for health span.
  • Cognitive testing aids in long-term risk assessment.
  • Functional tests like DEXA, CPET, and VO2 max testing provide valuable insights.
  • Emotional well-being is a vital aspect of overall health.
  • Screening for genetic drivers like Lp[a] is essential early in life.
  • Blood testing frequency should align with interventions and changes.
  • DEXA scans provide detailed information on bone mineral density and body composition.
  • Strength training is key for improving bone mineral density at any age.

23:35

Optimizing Bone Health Through Strength Training

  • Bones sense force applied through compression, activating osteoblasts to build bone.
  • Critical bone development period until age 20-25 sets lifelong trajectory, especially crucial for females.
  • Inhaled steroids, corticosteroids during development can impair bone building.
  • Counteracting drug effects with nutrition, hormones, drugs, and training is essential.
  • Steroid-based inhalants can impair bone mineral density, while beta-agonists are safe.
  • Topical corticosteroids' systemic effects depend on dose and absorption.
  • Strength training crucial for bone density and longevity, even in 30s-50s to prevent decline.
  • Strength training specifics: heavy loads, low repetitions, long rest periods, 2-3 times weekly.
  • Strength training benefits all ages, even older women with osteopenia or osteoporosis.
  • High bone mineral density crucial for preventing fractures, mortality, and improving quality of life in later years.

34:58

Effective Training for Aging and Longevity

  • Training for an athletic event requires knowledge of the specific event to prepare effectively.
  • Identifying one's marginal decade is crucial for effective training and preparation for aging.
  • The exercise of determining one's last decade and desired outcomes is beneficial for all individuals.
  • Back casting involves breaking down objectives into measurable metrics to plan for future health.
  • VO2 max of 30 milliliters of oxygen per minute per kilogram is a key metric for fitness.
  • Aging impacts oxygen uptake and strength, necessitating higher fitness levels than perceived.
  • Forecasting is suitable for short-term goals, while back casting is essential for long-term planning.
  • Smoking increases the risk of all-cause mortality by approximately 40%.
  • Low muscle mass and strength are associated with higher all-cause mortality rates.
  • Cardio respiratory fitness, measured by VO2 max, shows a significant impact on all-cause mortality, with elite levels reducing risk by 400%.

46:16

Attia's Rule: Exercise for Brain Health and Longevity

  • Refrain from discussing supplements and nutrition, known as Attia's rule.
  • Attia's rule is about aiming for a dead hang for a minute, with variations based on age and gender.
  • For cardiovascular health, aim to run a mile in a specific time or use online VO2 max estimators.
  • Deadlifting body weight is not included; instead, focus on farmer carries for a set duration based on gender.
  • Exercise is crucial for brain health, with studies showing its significant impact on Alzheimer's prevention.
  • Transitioning from sedentary to moderate exercise can reduce Alzheimer's risk by 50%.
  • Notable individuals in their 90s, including Nobel laureates, maintain cognitive sharpness through regular exercise.
  • One Nobel laureate uses nicotine for cognitive enhancement, with the method of intake varying.
  • Nicotine's potential benefits for cognitive enhancement are discussed, with personal experiences shared.
  • A company selling nicotine products is mentioned, with a personal anecdote about ordering from them.

57:25

"Nicotine, Hormones, and Focus Enhancement Risks"

  • Nicotine patches are considered concentration-enhancing substances, but can be addictive and require caution in dosing.
  • One cigarette contains about one milligram of nicotine, while some lozenges can deliver four to eight milligrams at once, posing a risk for those unfamiliar with nicotine.
  • The use of nicotine for focus enhancement has faced criticism, with concerns about encouraging its use, especially among college students.
  • Stimulants like Adderall and Vyvanse are not recommended for enhancing concentration, as they should be prescribed and monitored by healthcare professionals.
  • Modafinil and armodafinil are used off-label for focus enhancement, with potential benefits seen in sleep-deprived individuals.
  • Hormone therapies, particularly estrogen therapy for menopausal women, have been controversial due to past studies like the Women's Health Initiative.
  • Women's hormone levels fluctuate throughout their menstrual cycle, with estrogen dominating in absolute amounts over testosterone.
  • The menstrual cycle involves rising estrogen levels leading up to ovulation, followed by progesterone dominance in the luteal phase.
  • The shedding of the uterine lining during menstruation can cause PMS symptoms in susceptible women due to a rapid decrease in progesterone levels.
  • Hormone replacement therapy initiation timing during menopause can impact its effectiveness, with early initiation showing better outcomes than late initiation.

01:09:14

"Progesterone in HRT: Minimizing Risks and Benefits"

  • Stabilizing progesterone during the luteal phase can eliminate PMS symptoms.
  • The Allen Brain Institute provides data on progesterone receptors in the brain.
  • Menopausal symptoms include night sweats, hot flashes, and brain fog.
  • Estrogen replacement therapy was initially used for menopausal symptoms but led to uterine cancer risk.
  • Progesterone is necessary to counteract estrogen in hormone replacement therapy.
  • The Women's Health Initiative studied the effects of HRT on women without and with a uterus.
  • The WHI study had flaws like studying older, sicker women and using synthetic hormones.
  • Initial reports of increased breast cancer risk with HRT were misleading due to relative risk without absolute risk context.
  • Bio-identical hormones are now preferred in HRT to minimize risks.
  • Synthetic progesterone and oral estrogen may have contributed to negative outcomes in HRT studies.

01:21:47

Hormone Replacement Therapy Considerations for Men and Women

  • HELLP syndrome was discovered during the birth of the first daughter, prompting a detailed family history examination for clotting issues.
  • Topical estrogen therapies are discussed, with a preference for GYNs to provide hormone replacement therapy (HRT) and conduct annual endometrial ultrasounds and pap smears.
  • Not all women can tolerate progesterone, necessitating careful consideration of dosage and potential alternatives like progesterone-coated IUDs.
  • Oral contraception is used for symptomatic control in premenopausal women, with a preference for low synthetic estrogen and limited usage.
  • Testosterone therapy for women is approached cautiously, with consideration for physiological levels and potential benefits and risks.
  • Younger men seeking testosterone therapy for cosmetic effects are advised to prioritize lifestyle factors like sleep, exercise, and nutrition before considering hormone replacement.
  • Total testosterone levels are analyzed alongside free testosterone and SHBG levels to determine appropriate treatment approaches.
  • Factors influencing SHBG levels include estradiol, insulin, thyroxine, and aromatase activity, with potential interventions like aromatase inhibitors and thyroid management.
  • Supplements like Tongkat Ali and stinging nettle extract are discussed for their potential to reduce SHBG levels, with varying effects on testosterone and DHT levels.
  • Personal preferences regarding DHT levels and hair loss are highlighted, emphasizing the importance of individualized treatment approaches in hormone replacement therapy for men.

01:33:31

Optimizing Testosterone Levels for Prostate Health

  • DHT is valued for its positive effects when maintained within the appropriate range, impacting prostate size and health.
  • Medications like finasteride and Propecia can reduce DHT levels but may lead to adverse side effects.
  • SHBG levels are challenging to significantly lower through supplements.
  • Free testosterone and estradiol are key metrics to consider, with free testosterone being the primary focus.
  • Adjusting total testosterone levels is crucial to achieve the desired free testosterone levels.
  • Anavarax is not used due to complexities and potential patient errors.
  • Normalizing free testosterone can positively impact insulin resistance and glucose control.
  • Testosterone replacement therapy methods can be direct or indirect, with Clomid previously used but now avoided due to undesired effects on desmosterol levels.
  • Testosterone dosing frequency is crucial, with twice-weekly dosing recommended for optimal results.
  • Physiological dosing of testosterone can prevent side effects like acne and gynecomastia, with testicular atrophy being a potential concern.

01:44:41

Impact of Enzyme Inhibition on Cholesterol Levels

  • Inhibiting the enzyme delta-24 desaturates can lead to a rise in desmosterol, potentially impacting cholesterol levels.
  • The first drug approved for hypercholesterolemia in the 1960s targeted the same enzyme but was later withdrawn due to increased cardiovascular events.
  • Desmosterol may cause more damage and oxidative stress than cholesterol, suggesting high desmosterol levels could be harmful.
  • Clomid was replaced with HCG due to concerns about desmosterol, despite HCG being more challenging to handle.
  • HCG preserves testicular function and volume, commonly used in post-cycle therapy for bodybuilders.
  • Fadogia agrestis may increase luteinizing hormone levels but lacks long-term safety data, unlike established therapies like HCG.
  • Rapamycin shows promise in preserving ovarian health, with potential benefits for fertility.
  • Testosterone therapy involves low doses of testosterone cypionate, with careful monitoring of estradiol levels using Arimidex if needed.
  • Injectable testosterone cypionate is preferred over pellets for men due to better dosage control and ease of administration.
  • HCG is recommended for men seeking to maintain fertility while on testosterone therapy, as testosterone can reduce sperm count.

01:55:54

Optimizing Testosterone Therapy for Bodybuilders

  • Bodybuilders have shown the boundaries of physiological effects, including bloating, water retention, acne, hair loss, and growth.
  • A physiologic dose of testosterone replacement therapy (TRT) is around 100 milligrams per week, with rare cases requiring up to 70 milligrams twice a week.
  • The youngest patient put on TRT was around 40 years old, discouraging its use in younger individuals unless necessary.
  • HCG is recommended to preserve testicular function in younger TRT patients, with potential long-term effects on pituitary function.
  • TRT cycles can vary, with examples like eight weeks on testosterone followed by eight weeks on HCG to maintain testosterone levels.
  • Targeting SHBG directly could optimize free testosterone levels, potentially enhancing the effects of testosterone therapy.
  • Total testosterone levels do not always correlate with physical appearance, emphasizing the importance of free testosterone and estrogen levels.
  • Testosterone's primary role is to enhance recovery and muscle protein synthesis, requiring exercise and proper nutrition for optimal benefits.
  • Cholesterol is crucial for cell membranes and hormone production, with dietary cholesterol not significantly impacting blood cholesterol levels due to the body's recycling process.
  • The body's ability to digest food relies on cholesterol for bile salt production, highlighting its essential role beyond hormone synthesis.

02:07:51

"Cholesterol Regulation and Lipoprotein Transport Mechanisms"

  • Cholesterol enters the body through the Niemann-pick C1-like 1 transporter, which regulates its levels.
  • Body determines if there's enough cholesterol; if yes, it enters circulation, if not, it's excreted.
  • Esterified cholesterol from food can't pass through the transporter, but some dietary cholesterol does enter circulation.
  • Ancel Keys recognized in the 1960s that dietary cholesterol doesn't impact serum cholesterol.
  • Saturated fat raises cholesterol levels, but it's different from cholesterol.
  • Cholesterol is transported in lipoproteins due to its hydrophobic nature.
  • Different lipoproteins exist based on density, like HDL and VLDL.
  • LDL, VLDL, and HDL cholesterol levels contribute to total cholesterol concentration.
  • ApoB is crucial for atherosclerosis development, with levels established early in life.
  • Lowering carbohydrate intake reduces triglycerides and ApoB levels, while statins inhibit cholesterol synthesis to lower LDL levels.

02:20:18

"Novel Therapies for Cardiovascular Disease Management"

  • Patients with highly suppressed desmosterol levels should maintain desmosterol above a certain level to avoid over-suppressing synthesis.
  • A drug called ezetimibe blocks the absorption of cholesterol and is effective based on phytosterol levels.
  • Bempedoic acid is a liver-specific drug that blocks cholesterol synthesis with fewer side effects than statins.
  • PCSK9 inhibitors are potent drugs that target LDL receptors, discovered in individuals with familial hypercholesterolemia.
  • The most prevalent cause of death globally is cardiovascular disease, with heart disease affecting a significant number of individuals.
  • Medicine 2.0 focuses on treating based on 10-year risk, while Medicine 3.0 emphasizes treating the causative agent.
  • Age is a significant driver of risk for heart disease, with older individuals at higher risk regardless of other health factors.
  • Peptides, stem cells, and PRP are areas of interest for tissue rehabilitation, but lack controlled studies for efficacy.
  • Rapamycin is supported by extensive data for its effects, contrasting with the limited evidence for stem cells, peptides, and PRP.
  • Accepting the opportunity cost of unproven treatments is crucial, considering financial and time investments in experimental therapies.

02:32:34

Stem Cell Treatments: Efficacy and Ethical Concerns

  • The speaker had a long-standing injury from swimming the Catalina Channel in 2009, leading to the need for surgery.
  • Despite considering alternatives like stem cell infusions, multiple orthopedic surgeons advised against it for the speaker's complete labral tear.
  • Injecting stem cells may provide temporary relief but might not address the underlying issue.
  • Designing trials for stem cell treatments requires careful patient selection to avoid inconclusive results.
  • The speaker questions the motivation for legitimizing stem cell treatments due to financial incentives.
  • The speaker expresses a wish to fund clinical trials for overlooked research areas if they were a billionaire.
  • The speaker emphasizes the importance of dedicated prehab and rehab work post-surgery for effective recovery.
  • Trying BPC-157 with another doctor showed no noticeable effects for the speaker.
  • Metabolomics involves studying metabolites to understand physiological states and potential benefits like mimicking exercise.
  • GLP-1 agonists are discussed as potential blockbuster obesity drugs, with considerations for dosing and side effects like nausea.

02:44:26

Semaglutide: Long-term use and dietary considerations

  • Newer versions of semaglutide are being developed to prevent weight regain after stopping the drug, raising questions about its long-term use and potential resistance development.
  • The hope is that semaglutide could function similarly to testosterone and estrogen therapies, enabling individuals to focus on necessary behavioral changes for health and longevity.
  • It is noted that individuals can circumvent the benefits of semaglutide by consuming high-calorie beverages like alcohol, emphasizing the importance of dietary modifications for weight loss.
  • Dr. Peter Attia is commended for his thorough approach to clinical practice and dedication to staying updated on new research, making him a valuable resource in the health field.
  • Recommendations are made to explore Dr. Attia's podcast "The Drive," website, and newsletter for valuable health-related information, along with supporting the Huberman Lab Podcast through subscriptions and reviews on various platforms.
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