Peter Attia TLDR

So I follow a lot of people…

And one of my primary interests over the past few years has become healthspan (how well you live) and lifespan (how long you live).

Some of my other favourites in the healthspan space are Ben Patrick (of ATG/@kneesovertoesguy), Oliver Burkeman (his work on philosophy and psychology of time management and happiness), Iñigo San-Millán, Ph.D. (his work on Zone 2 training), Andy Galpin, Ph.D. (his work on exercise & training), Matthew Walker, Ph.D. (his work on sleep), Alan Couzens (his work on exercise/training), Kelly Starrett (his work on mobility), Keegan Smith (his work on strength and athletic performance training), Andrew Huberman, Ph.D. (his podcast on science and science-based tools for everyday life), Layne Norton, Ph.D. (diet/nutrition/training) and Michael Easter, MA (his work on rucking & discomfort).

Peter Attia Background

But the one who I have taken most from is Peter Attia, MD and his research and content.

Attia has a medical practice that works to lengthen patients’ lifespan and simultaneously improving their healthspan. He publishes much of his research and strategies on his podcast, The Drive and after a long time, published his book, Outlive: The Science and Art of Longevity.

He’s got a very interesting past where he combines experiences and strategies from a range of areas. Got his medical degree from Stanford, trained for five years at the Johns Hopkins Hospital in general surgery, spent two years at the National Institutes of Health as a surgical oncology fellow at the National Cancer Institute, left medicine to work analysing credit risk at McKinsey & Co. & then came back to it. He has bachelor’s degree in both mechanical engineering and applied mathematics.

I think all of those go together in an interesting way (medicine, interest in fitness, data/analysis orientation from mathematics & engineering, focus risk/reward from his consulting days) to support his current Body of Work.

He is in a unique position with all of that experience and skills that most doctors don’t have at all.

I really like that his recommendations are based on good science & data. And that he changes beliefs as new data comes out. One of his principles is “strong convictions, loosely held.”

His practice is quite boutique, focusing on healthspan/lifespan. More of a consultant. He’s the doc for Tim Ferris, Rogan, Hugh Jackman, a bunch of San Fransisco tech founders you know the names of, various famous Hollywood folk and Wall Street muckity mucks.

I’ve heard his retainer is anywhere from 90-150K/year. And he’s not even their primary care doctor.

Healthspan/Lifespan Approach

The high level basics of his belief start with the strategy to delay the onset of the major diseases as long as we can through a variety of interventions.

Much of today’s medicine is focused on treating people after they develop disease.

His focus is on doing as much as possible to prevent the onset of those diseases.

And then he is also super focused on building our mental and physical capabilties up to super high levels (with respect to things like muscle mass/strength, bone health, cardiorespiratory fitness, metabolic flexibility) so that as the inevitable declines that comes with age eventuate, we are still left with a good degree of health and fitness.

The Four Horsemen of Death

80% of the deaths of people over 50 who do not smoke are caused by 4 diseases/syndromes.

They are:

1. Atherosclerosis (comprised of  cardiovascular disease & cerebrovascular disease)
2. Cancer
3. Metabolic Disease (everything from hyperinsulinemia to insulin resistance to fatty liver disease (NAFLD & NASH) to type 2 diabetes)
4. Neurodegenerative disease (Alzheimer’s disease being the most common)

Attia’s Five Interventions

His belief is that the best way to avoid/mitigate the Four Horsemen are through a series of interventions.

The categories he groups them into are:

1. Exercise – MOST CRITICAL intervention for many
   • Stability
   • Strength
   • Aerobic Fitness
   • Anaerobic Fitness
2. Sleep
   • Critical to get 8 hours or so of good sleep
3. Nutritional Biochemistry
   • Diet agnostic but needs to build metabolic health/flexibility
   • Very pro-keto for several years but has eschewed any specific diet religion
   • Some principles
     • Need to be on a caloric appropriate diet. For those needing calorie restriction
       • time – reduce your feeding window to achieve caloric restriction
       • dietary – eliminate certain foods/food groups from your diet to achieve caloric restriction (keto/low carb/vegan)
       • caloric – eat whatever but track your calories to ensure you’re in caloric restriction
     • Protein is critical to growing/maintaining muscle mass – necessary for metabolic health
     • Fiber is needed.
     • Micronutrients are needed.
4. Pharmacology – ALL of this would be individual to the person but some common mentions are…
   • Takes a series of regular supplements like creatine, magnesium, electrolytes, etc.
   • Aggressive in reducing ApoB for cardiovascular health which often results in statin use (or PSK9 inhibitors or other)
   • While he doesn’t recommend for all, takes rapamycin for longevity (doesn’t take metformin any longer)
5. Emotional Health – also completely individual

Exercise Efficacy

So although Attia caveats that all of the interventions are particular to a given person, assuming everything is in a degree of order, exercise is the most effective intervention to increase lifespan and healthspan.

“Exercise is by far the most potent longevity ‘drug,'” says Attia in his book Outlive. “The data are unambiguous: Exercise not only delays actual death but also prevents both cognitive and physical decline better than any other intervention. It is the single most potent tool we have in the health-span-enhancing toolkit—and that includes nutrition, sleep, and meds.”

As an example, it’s accepted that smoking or diabetes will double or triple a person’s risk of death.

Exercise can have double the positive impact that those do.

• High cardio respiratory fitness (having an elite VO2 max – in the top 2.5% of their age bracket) has a 5-fold reduction in all cause mortality.  That is the most highly correlated metric to a long life.
• And the second most highly correlated metric to length of life is composite metric of strength & muscle mass. High strength and muscle mass has a 3-fold reduction in all cause mortality.

There are no drugs that have anywhere near these levels of reduction in mortality.

Statistically speaking, smoking,  hypertension, type 2 diabetes, even the presence of cancer has less of impact on the shortness of a person’s life than excellent levels of VO2 max and strength.

Four Pillars of Exercise

1. Stability
   • Attia pursues a series of boutique exercises for stability that are a combination of Dynamic Neuromuscular Stabilisation (DNS) techniques and ones his personal trainer, Beth Lewis, has developed.
   • I personally am a big fan of Ben Patrick (of ATG/@kneesovertoesguy) for exercises that address stability, neuromuscular range and joint health.
2. Strength – Attia focuses on movements that develop
   • Grip strength
   • Concentric & eccentric loading
   • Pulling motions
   • Hip hinging
3. Aerobic efficiency
   • Zone 2 to widen VO2 max base – basically stead state training right a level where a person is still able to clear lactate (around 2 mmol/L)
   • Absent monitoring of lactate, RPE (rating of perceived exertion) can be useful to stay in this range. That rate of lactate clearance is about the level of activity where you can maintain a conversation but it’s not comfortable – basically if you were on the phone, the person would definitely know you were exercising.
   • This training helps develop mitochondrial function which improves energy production and the efficiency of fat-burning.
   • Prescription of a minimum of 3 hours per week (4x 45 min sessions or 3x 30 min sessions).
4. Anaerobic performance
   • Zone 5 to train VO2 max peak
   • Prescription of 1 set weekly of 5 sets of 4 minutes at the highest output you can sustain followed by 4 minutes of recovery.
   • Airbike, rower, stair master, treadmill are all good for this.

Sleep

Sleep is another area I’ve really focused on trying to improve. I make it a priority and try to get 8 hours every night.

I’ve also moderated some other behaviours so as not to impair sleep. Getting good sleep is really the primary reason I’ve minimised drinking alcohol.

Some of the Tips I Think Are Most Helpful

Have a bit more at https://chris.ly/sleep/.

• 1. Keep a regular sleep pattern
  • Your body’s circadian rhythm functions on a set loop. Establish a regular bedtime and wake time routine, even on weekends.
• 2. Start with and increase bright light exposure during the day
  • Sunlight helps your body manage your internal clack (your circadian rhythm). Get sunlight in your eyes first thing in the morning for at least 10 minutes if you can as it helps nighttime sleep quality and duration.
• 3. Exercise regularly (but not before bed)
  • Regular exercise also helps with sleep but don’t perform it too late in the day or too close to bedtime. Exercise increases alertness and hormones like epinephrine and adrenaline.
• 4. Reduce naps
  • Long or irregular naps during the day can negatively affect your sleep. Sleeping in the daytime can also confuse your internal clock.
• 5. Don’t consume caffeine late in the day
  • When consumed late in the day, caffeine stimulates your nervous system and may stop your body from naturally relaxing at night. Try to avoid caffeine up to 6 hours before bed.
• 6. Don’t drink alcohol
  • At this point, it’s been proven that no amount of alcohol has health benefits. And it absolutely does is impair sleep. Try to limit alcohol and not to drink within 3 hours of bed.
• 7. Don’t eat late in the evening
  • Eating too close to bedtime can also impair sleep. Avoid late dinners and minimise fatty or spicy foods.
• 8. Don’t drink liquids before bed
  • Try to get your hydration needs in early in the day. Drinking too close to bedtime can cause nocturia (medical term for excessive urination during the night). Try to not drink any fluids 1-2 hours before going to bed.
• 9. Reduce blue light exposure in the evening
  • Nighttime light affects your circadian rhythm, tricking your brain into thinking it’s still daytime. Avoid blue light from electronic devices like smartphones and computers. You can do a bunch of stuff like wearing glasses that block blue light, use an app like f.lux to block blue light on your laptop or computer but I think the best thing to do is avoid your phone and turn off any bright lights a couple hours before bed.
• 11. Optimize your bedroom environment
  • Make sure your bedroom is set up to facilitate sleep with regard to temperature, noise, lights. Get rid of light sources and keep your room really dark. Some folks have success with eye and ear masks/plugs.
• 12. Set a cool bedroom temperature
  • Ideal bedroom temp should be 65-68°F (18-20°C). Many people who are into longevity/healthspan use a cooling mattress or mattress cooling pad. At this point, most people in the space have moved to a mattress or pad from a company called Eight Sleep.
• 14. Take a hot bath or shower
  • In addition to relaxing oneself, it helps cool the body’s core temperature. It warms up the extremities, getting more blood supply into them. This draws blood away from your core and allows your core temperature to drop
• 15. Reserve Your Bed for Sleep and Sex Only
  • Don’t linger in your bed. If you do, you’re training your brain that your bed is not only for sleep. You want your brain to have a strong mental association between your bed and sleep.

Other stuff…

I’ll write more on his other stuff soon but those are the things of my current primary focus.

I’ve also improved and prioritised my sleep tremendously after abusing it terribly for years (working WAY too many late nights).

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