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Last Updated: 12.06.23

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

Huberman hosts Dr. Peter Attia, an expert in healthspan, performance, and longevity. They explore health evaluation, exercise, nutrition, hormone therapy, and strategies for vitality and disease prevention, including cholesterol management.

Key Takeaways

High level takeaways from the episode.

Blood work can help address:

  • Atherosclerotic disease: good predictor of risk if you know what to look for
  • Cancer: less helpful, but can provide some insight
  • Neurodegenerative disease: limited in predicting risk
  • Metabolic disease: can provide useful information on risk factors

Generally, start getting blood work in your 20s or 30s

  • Frequency can vary from every 6 months to every 2 years, depending on the individual and their needs

Blood work can provide some insight into factors affecting vitality

  • However, blood work has blind spots and may not provide a complete picture

ApoB: single most important lipoprotein

DEXA (Dual-​​energy X‑ray Absorptiometry) scan: gold standard for measuring body fat, lean mass, and bone mineral density

  • Provides information on body fat, bone mineral density, visceral fat, and appendicular lean mass index and fat-​​free mass index

Bone mineral density important for understanding risk of osteoporosis and osteopenia, especially in women going through menopause

Bone health is crucial for overall health and longevity

  • Over the age of 65, a fall and broken hip can result in a 30–40% chance of death within a year

Bone mineral density (BMD) is measured using a Z score

  • A Z score of 0 means you’re at the 50th percentile for your age and sex
  • A Z score of +1 means you’re one standard deviation above, ‑1 means below

Strength training is essential for maintaining and improving bone mineral density

  • Critical window for bone development is up to age 20–25
  • Strength training is especially important for females during this time

Powerlifting (heavy loads, low repetitions) is most effective for bone health

  • Strength training should be a lifelong practice to prevent decline in bone health

Inhaled steroids for asthma and other conditions can impair bone mineral density

  • Particularly concerning if used during the critical window of development

Strength training has both local and systemic effects on bone health

Marginal decade refers to the last decade of a person’s life

  • Exercise involves detailing what one wants their marginal decade to look like
  • Helps design a program to achieve those goals

Smoking increases all-​​cause mortality risk by 40%

High blood pressure increases all-​​cause mortality risk by 20–25%

End-​​stage kidney disease increases all-​​cause mortality risk by 175% (hazard ratio of 2.75)

  • Low muscle mass people have about a 3x hazard ratio (200% increase) in all-​​cause mortality
  • Low strength could be 3.5x as a hazard ratio (250% greater risk) vs high strength

Cardiorespiratory fitness

  • 2x difference in risk of all-​​cause mortality between bottom 25% and top 25% for age and sex in terms of VO2 max
  • 5x difference (400% difference) in all-​​cause mortality between bottom 25% and top 2.5% (elite) for age and sex in terms of VO2 max

Strength and Fitness Metrics

  • Dead hang: 1.5 minutes for a 40-​​year-​​old woman, 2 minutes for a 40-​​year-​​old man
  • Air squat at 90 degrees: 2 minutes for both men and women at 40
  • Farmer carry: body weight for 2 minutes for men, 75% of body weight for women
  • VO2 max: online estimators available to determine approximate VO2 max based on activity

Exercise has been shown to be the single best thing for Alzheimer’s prevention

  • Affects various aspects of the brain, including BDNF, vascular endothelium, glucose disposal, and insulin signaling

Going from sedentary to 15 met hours per week can lead to a 50% reduction in risk

  • Met: metabolic equivalent; 1 met = sitting quietly, 5 mets = brisk walking

Women’s Health Initiative (WHI) study on hormone replacement therapy (HRT) in the 1990s had limitations and flaws

  • Older, sicker women; not started when HRT would normally be initiated
  • No symptomatic patients included in the study
  • Use of conjugated equine estrogen and synthetic progesterone (MPA)
  • Results led to medical field turning away from HRT for women

Bioidentical hormones (estradiol and progesterone) used today

Topical estrogen (patches) preferred over oral estrogen

  • Oral estrogen increases blood clotting risk

Annual endometrial ultrasound recommended for women on HRT

Progesterone tolerance varies among women

  • Progesterone-​​coated IUDs used for local protection in the uterus

Long-​​term effects of oral contraception is not well-known

Factors affecting SHBG (Sex Hormone Binding Globulin) levels:

  • Estradiol: higher levels increase SHBG
  • Insulin: lower levels increase SHBG
  • Thyroxine: imbalances can interfere with SHBG

Supplements and medications that can affect SHBG:

  • Anavar (Oxandrolone): can lower SHBG in small doses
  • Stinging nettle extract: claimed to reduce SHBG, but not proven
  • Tongkat Ali: may increase free testosterone, but mechanism unclear

DHT (Dihydrotestosterone) levels:

  • Important for overall well-​​being, but can cause prostate issues
  • Finasteride (Propecia) can reduce DHT, but may have side effects
  • No known supplements that can profoundly drop DHT levels

Little correlation between absolute testosterone levels and physical appearance

Factors like free testosterone, estrogen, training, and nutrition play a role

Testosterone alone won’t improve appearance; it helps with recovery and muscle protein synthesis, but requires effort and exercise

Cholesterol is a crucial component of cell membranes and hormone production

  • Dietary cholesterol does not significantly impact serum cholesterol levels
  • Cholesterol in food is esterified and cannot pass through the body’s regulatory checkpoint
  • Only a small fraction of dietary cholesterol makes its way into circulation

American Heart Association now acknowledges that dietary cholesterol has no bearing on serum cholesterol levels

Saturated fat consumption can raise LDL cholesterol in many people

ApoB (apolipoprotein B) is a protein that wraps around LDL and VLDL particles and is a causative agent of atherosclerosis

Atherosclerosis is a lifelong disease that begins developing at a young age

  • Autopsies of young people who died in wars show that cardiovascular disease is already taking hold in people as young as 18–20 years old
  • ApoB is necessary, but not sufficient, to develop atherosclerosis

Nutritionally, reducing carbohydrate intake can lower triglycerides, which can help reduce ApoB levels

Lowering saturated fat intake can also help reduce ApoB levels

Pharmacological interventions, such as statins, can help lower cholesterol and ApoB levels

  • Other drugs, such as ezetimibe (which blocks cholesterol reabsorption) and bempedoic acid (which blocks cholesterol synthesis in the liver), can also help lower cholesterol and ApoB levels

Stem cells, BPC-​​157, and PRP have anecdotal evidence, but lack substantial data

  • Unclear if they work or not
  • Opportunity cost in terms of time, effort, and finances when considering these treatments

Incentive for legitimizing stem cell procedures is lacking

  • People making money from unproven procedures
  • Need for a pharma angle or billionaire funding clinical trials

Metabolomics: study of metabolites (e.g., glucose, acetyl COA, lactate)

  • Metabolomics can provide insights into disease states and potential treatments


We recommend using this distillation as a supplemental resource to the source material.

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

    Huberman Lab #85

    Huberman hosts Dr. Peter Attia, discussing health, longevity, performance, exercise, nutrition, hormones, disease prevention, and optimizing cognitive and physical health.

Full Notes

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