Dr. Peter Attia on Longevity Drugs, Alzheimer's Disease, and the 3 Most Important Levers to Pull (#517)

“Caloric restriction, dietary restriction, time restriction. You’ve probably heard me go on and on about my framework, the three levers. Always pull one, sometimes pull two, occasionally pull three, never pull none.”
— Peter Attia

Dr. Peter Attia (PeterAttiaMD.com) is a former ultra-endurance athlete (e.g., swimming races of 25 miles), a compulsive self-experimenter, and one of the most fascinating human beings I know. He is one of my go-to doctors for anything performance or longevity related.

But here is his official bio to do him justice:

Peter is a physician focusing on the applied science of longevity. His practice deals extensively with nutritional interventions, exercise physiology, sleep physiology, emotional and mental health, and pharmacology to increase lifespan (how long you live), while simultaneously improving healthspan (how well you live).

Peter trained for five years at the Johns Hopkins Hospital in general surgery, where he was the recipient of several prestigious awards, including Resident of the Year, and the author of a comprehensive review of general surgery. He also spent two years at NIH as a surgical oncology fellow at the National Cancer Institute, where his research focused on immune-based therapies for melanoma. He has since been mentored by some of the most experienced and innovative lipidologists, endocrinologists, gynecologists, sleep physiologists, and longevity scientists in the United States and Canada.

Peter earned his M.D. from Stanford University and holds a B.Sc. in mechanical engineering and applied mathematics.

Peter also hosts The Drive, a weekly, deep-dive podcast focusing on maximizing longevity and all that goes into that, from physical to cognitive to emotional health. It features topics including fasting, ketosis, Alzheimer’s disease, cancer, mental health, and much more. Subscribe on Apple Podcasts, Spotify, Overcast, or wherever you listen to podcasts.

Please enjoy!

Listen to the episode on Apple Podcasts, Spotify, Ov ercast, Stitcher, Castbox, Google Podcasts, or on your favorite podcast platform. You can also watch the interview on YouTube.

Brought to you by Athletic Greens all-in-one nutritional supplement, Oura smart ring wearable for personalized sleep and health insights, and Eight Sleep’s Pod Pro Cover sleeping solution for dynamic cooling and heating. More on all three below.

You can find the transcript of this episode here. Transcripts of all episodes can be found here.

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#517: Dr. Peter Attia on Longevity Drugs, Alzheimer's Disease, and the 3 Most Important Levers to Pull

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What was your favorite quote or lesson from this episode? Please let me know in the comments.

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Want to hear Peter’s last time on the show? Listen to this conversation in which we discuss Centenarian Olympics, goblet squats, dynamic neuromuscular stabilization, intra-abdominal pressure, egg boxing, tearing phone books in half, archery hunting, non-fixed personality traits, podcasting pointers, and much more.

#398: Peter Attia, M.D. — Fasting, Metformin, Athletic Performance, and More

SELECTED LINKS FROM THE EPISODE

Connect with Peter Attia:

Website | Twitter | Facebook | Instagram | YouTube

SHOW NOTES

What is a liquid biopsy, and why is Peter excited about this recent innovation? How does it work, what is it good at detecting, and why does Peter consider the bureaucratic red tape snagging its rollout a “tragedy?” [07:22]
The four pillars of exercise someone seeking to improve their metabolic health should understand. [19:38]
A few of the major causes for modern posture problems, and methods for remedying them. [22:06]
If Peter were Czar for a day, here’s how he’d train children to grow up into a more habitually active adulthood. [27:23]
What is zone two training, and what is it designed to do? [30:35]
Why a ketogenic diet won’t necessarily make you lose weight (nor will an all-Doritos or all-Twizzlers diet, for that matter). [32:43]
What Peter has learned about fasting since the last time we talked. [35:01]
The pros and cons of front-loading one’s meals when observing time-restricted feeding (aka intermittent fasting). [39:08]
The three levers of Peter’s nutritional framework: caloric restriction, dietary restriction, time restriction. “Always pull one, sometimes pull two, occasionally pull three, never pull none.” [43:16]
Does Peter recommend using branched-chain amino acids to mitigate muscle loss during a fast? [47:52]
Thoughts on a recent New England Journal paper comparing the effects of Lexapro to psilocybin in patients with depression, and how you can (and why you should) increase your scientific literacy to best understand the results of such papers. [49:47]
Why the research around MDMA as a treatment for patients with PTSD comes to clearer conclusions than the study comparing Lexapro and psilocybin. [1:10:30]
How is Peter’s thinking evolving around apoB and its relationship to cholesterol control in the body? [1:12:24]
Are there any benefits to low apoB outside of lowering cardiovascular risk? [1:24:27]
What is Mendelian randomization, how does it allow us to infer cause when an experiment is not done, and how was it used recently to understand the correlation between lower apoB and improved all-cause mortality? [1:26:05]
Is Peter more bearish or bullish on rapamycin since the last time we discussed it? As someone who’s not receiving an organ transplant, why has he been taking it for the past three years? [1:29:03]
Beyond potentially increasing lifespan, do we know if rapamycin can reverse aging-related impairments to our healthspan, such as hearing loss? [1:40:19]
What are some of the other pharmacological candidates for extending lifespan or healthspan that Peter currently finds interesting? How does someone bring potential candidates to the attention of the ITP? [1:44:42]
How the Age of COVID may have finally driven Peter (and his poor family with whom he’s been locked down) bananas. [1:53:16]
Why Peter has become bullish on the efficacy of saunas no matter how vigorously the Finns try to sway him otherwise. [1:55:24]
Peter’s preferred method of zone two training. [1:59:57]
Peter’s thoughts on semaglutide, the new drug treatment for chronic weight management that was just approved by the FDA. [2:00:39]
Peter’s resources and recommendations for people who want to further step up their scientific literacy, improve their ability to separate fact from fiction, and discern hype from reality. [2:09:17]
On the botanical origins of certain Central American spirits, and the only thing about Texas that Peter doesn’t like (so far). [2:11:38]
Decaffeinated brands, Tommy Want Wingy, and other parting thoughts. [2:14:20]
As promised, here’s the segment detailing everything you ever wanted to know about zone two training: aerobic efficiency, what happens on a chemical level, current research, minimum effective dose, and long-term adaptations and benefits. [2:16:50]

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The Tim Ferriss Show is one of the most popular podcasts in the world with more than one billion downloads. It has been selected for "Best of Apple Podcasts" three times, it is often the #1 interview podcast across all of Apple Podcasts, and it's been ranked #1 out of 400,000+ podcasts on many occasions. To listen to any of the past episodes for free, check out this page.

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Lars Kluegel

2 years ago

This tipped me to buy the Oura ring, however looks like $399 on the site, vs. $299 in the notes…is there something special to use to get the $299 price?

Awesome episode. Thank you.

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Team Tim Ferriss

Reply to Lars Kluegel

Hi, Lars –

Thanks for your question. The link takes you to a page where you can choose your color. The default is gold, which is $399. If you scroll to the other colors and click on silver, you’ll go to the page for the silver model, which is $299 [https://ouraring.com/product/heritage-silver/step1].

Thanks for checking out Tim’s sponsor!

Best,

Christopher abalos

The importance of exercise

Matt Lasensky

Tim, great episode! PLEASE look into interviewing a woman named Dr. Audrey Evans. I’ll save you the time but she has one of the most incredible stories and she’s in her 90’s so an interview would be a great documentation of history. Here’s a wiki bio if you’re interested.

https://en.wikipedia.org/wiki/Audrey_Evans

Karolina Skibicka

Thank you for a great episode! One quick comment – when GLP-1 is discussed, glucagon production by the liver was mentioned, but not the source of GLP-1. GLP-1 is made primarily in the intestine and the hindbrain, it is a completely different hormone from glucagon in terms of function. Also the appetite reduction by GLP-1 (and the now approved semaglutide) is not linked to its glucoregulatory/incretin role, and insulin release. It is solely mediated by brain GLP-1 receptors, so if one would inject the drug in the brain only it will not increase insulin but it will potently reduce food intake.

Jay Martel

It’s time to take a stand Tim. Your readers (our citizens of planet earth) are being sold a bill of goods). We are being led down a very dark path of medical tyranny. We know you know it because you are an intuit.
We know that the folks you rub elbows with are aware of the path, and how great the changes on the horizon will be. We ask you not to be complicit. We ask you to sound the alarm. You are an innately critical thinker. It’s time to be brave. You don’t need the money anymore. You need to make a difference! Please speak up for the sake of the lives of your audience. You’ve got to “let it rip”!

Teri

Loved this episode, powered me through a long run!

Jonathan

Great podcast as always, love having Peter as a guest and listen to the drive quite often as well (although don’t know if Peter has mentioned what I’m about to talk about before in another episode)

With that being said I dislike how you casually dropped the bombshell that intermittent fasters/time restricted feeders are gaining significant bodyfat without elaborating further other than “they have to continue strength training while fasting”? (paraphrasing).

This is a huge topic that I’ve never heard of before now (at least from people from Tim’s circle) and warrants a much deeper discussion since Tim and Peter, at least from my perspective, have both been huge proponents of the fasting or time restricted feeding lifestyle either directly through their own books/podcasts about fasting or TRF or indirectly hosting many podcasts with Dr Rhonda Patrick who has a lot of research specifically about time restricted feeding.

What are the exact regimens being discussed here?
Are you saying someone who used to eat in a 15hr window (7am to 10pm) who shrinks their window to a 12 or 10hr window (10am to 8pm) with the same calories and exercise is now losing muscle and gaining bodyfat?
Is this about people who shrink their eating windows significantly to less than 6hrs or are doing 1 meal a day?
What would be the ideal eating window everyday to avoid this unfavourable change in body composiiton? Or should we be varying whether the hours regularly. (this and many more questions).

Would love some clarification on this and I imagine i’m not alone. The probability of practicing some version of IF given you are a listener of Tim Ferriss/Peter Attia is probably pretty high.

Thanks,

y orn

Reply to Jonathan

Ditto! Fully agree!

Mark

This was a great episode! But to be honest I probably understood 10% of what Peter was talking about. But I found that 10% really interesting!

charles604

Reply to Mark

This went over my head too. But that’s ok. 🙂

Would be great to get a final short synopsis with the most important points.

Steven M. Geary

Awesome Podcast! Who is Kaiser Sosa?? Love IT!
Thanks Tim!!

Zoe

Reply to Steven M. Geary

From The Usual Suspects https://en.m.wikipedia.org/wiki/Keyser_S%C3%B6ze

Aniket

That interesting blog. Enjoyed reading it. Keep writing on such topics

Tim Bachmann

It was strange to observe a guest so well educated about health express such a strong interest in pharmaceutically derived solutions. The inevitable array of side effects so detracts from this space. I don’t get the fascination. I find topics such as regenerative agriculture – and the associated health benefits to our planet and health – to be far more interesting. Naturopathy. Functional medicine. Lifestyle. Yes. I got some good tips about diet, which was worth the time. Deep dives into lab derived ‘molecules’ – not so much.

Alex Rossi

As usual complex, rich and insightful. Thanks as usual for sharing such a great episode.

Dan

Hi Tim, I saw your recent request for a recommendation on a wood-fired sauna design which relates to this podcast episode. I would be happy to assist with your project. I work for a sauna company that my Dad started where we custom manufacturer outdoor and indoor saunas. I can help discuss various options that we have and help design a sauna that fits exactly what you have in mind. We appreciate all the great discussions you have had over the years regarding the fantastic health benefits of sauna use and owe you a debt of gratitude for helping grow awareness of saunas in North America. I loved Dr Attia’s quote of “I am way, way, way more bullish on saunas now than I have ever been before.”

sree

Is there a resource to find doctors in my area (Maryland) who are recommended by Dr. Attia or Dr. Mager who share a similar focus on cutting edge labs, biomarkers, and testing?

Dr. Peter Attia on Longevity Drugs, Alzheimer’s Disease, and the 3 Most Important Levers to Pull (#517)

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