Exercise, nutrition, hormones for vitality and longevity with Dr. Peter Attia | Huberman Lab Podcast #85
--
This episode of the Huberman Lab Podcast features a discussion with Dr. Peter Attia, a physician focused on promoting health span and lifespan using various interventions. Professor Huberman and Dr. Attia discuss topics such as evaluating one’s health status and trajectory, optimizing vitality while extending lifespan, hormone and drug therapies, and nutrition and exercise.
🚀 I’ve got some news to share! 📣
Hello, Knowledge Enthusiasts!
The feedback I’ve received from my articles summarising Huberman Lab Podcast episodes encouraged me to dream bigger. I am taking the first steps towards building Mind Guide!
Curious? Join our list for exclusive updates and be a part of the knowledge evolution with Mind Guide.
Stay curious,
Connor Pelby and the Mind Guide team
Blood work is useful for assessing lifespan and health span. Blood testing for cancer biomarkers is not particularly helpful, but biomarkers can be useful in understanding dementia, particularly Alzheimer’s disease. Genetic testing can help stratify risk, and in aggregate, blood testing of biomarkers provides good insight into lifespan.
Health span is divided into cognitive, physical, and emotional domains. Biomarkers are less helpful in assessing functional testing for health span. Cognitive testing is useful for long-term risk assessment for good cognitive health. Physical functional tests such as DEXA, CPET, VO2 max testing, and fat oxidation are more helpful than biomarkers. Emotional well-being is an important component of health span, and without it, other aspects may not matter.
Individuals should be screened early in life to identify genetic drivers of health issues. Lp(a) is a genetic driver of atherosclerosis, affecting up to 20% of the population. Blood tests should be taken if there is a need for a better understanding of a particular level. Doctors might check blood two to four times a year, alongside other interventions to track progress. Blood tests are useful for identifying changes and measuring the success of interventions.
DEXA scans are an annual alternative to tracking weight and BMI for a better estimate of body fat. The four pieces of information that come from a DEXA include body fat, bone mineral density, visceral fat, and appendicular lean mass index and fat-free mass index. Bone mineral density is important because bone loss puts people at risk for osteoporosis and osteopenia, especially for women going through menopause. It’s recommended to track bone mineral density Z-scores and aim to prevent further decay or increase it slightly each year to avoid becoming at risk for osteoporosis or osteopenia.
Strength training is essential for bone health throughout life, particularly for women going through menopause. Heavy loads that are hard to move, with low repetition ranges and long rest periods, are ideal for strength training. It is never too late to start strength training, and it is an essential part of maintaining healthy bones. Strength training has been shown to improve bone health in older women who have never lifted weights before.
Exercise prompt patients to plan for their marginal decade, or the last ten years of their life. The importance of knowing what one wants to achieve in their last decade in order to train towards it. Back casting is a method of planning and breaking down goals into measurable metrics appropriate for long-term goals. Gravity of aging is more vicious than realized and requires starting to plan for the marginal decade early on. Back casting approach puts blood work and individualized goals in context and is highly useful.
Part of living longer involves improving one’s smoking habits, blood pressure, muscle mass, strength, and cardiorespiratory fitness. Exercise-related neurogenesis in mice may offer insights into the benefits of cardiovascular exercise. Moving is the best way to prevent brain atrophy in animal models. Enriching the environment and movement leads to bigger neurons and more connections in animal models. Exercise is the single greatest efficacy for Alzheimer’s prevention in humans, according to clinical trial data.
The use of nicotine for cognitive enhancement and potential prevention of Parkinson’s and Alzheimer’s disease is discussed. Nicotine can augment acetylcholine receptors, leading to improved focus and neural enhancement. However, smoking or vaping nicotine is not recommended due to its addictive properties and negative health effects.
Robert Sapolsky discussed the importance of timing when it comes to estrogen therapy for menopause. Starting estrogen therapy during the middle to tail end of menopause can have bad outcomes, while initiating it as women enter menopause or before can have good outcomes. Dr. Attia believes hormone replacement therapy for menopause was the biggest screw up of the medical field in the last 25 years. Progesterone plays an important role in the emotional symptoms of PMS, and stabilizing it during the luteal phase of a woman’s cycle can eliminate those symptoms.
Menopause symptoms include vasomotor symptoms such as hot flashes and night sweats, as well as long-term complications such as vaginal dryness and osteoporosis. Hormone replacement therapy (HRT) with estrogen and progesterone was a common treatment for menopause symptoms, but it was later discovered to increase the risk of uterine cancer. Bioidentical hormones are now used for HRT, and topical application of estrogen has been found to lower the risk of heart disease in women. Testing for clotting disorders such as Factor V is typically done based on a detailed family history rather than a routine test.
Gynecologists prefer to provide HRT to women and work in partnership with endometrial ultrasounds. Not all women can tolerate progesterone, and women with PMS react differently to it. IUDs can be used for local progesterone protection. Testosterone therapy for women is approached with caution, and testosterone replacement for women is done at physiologically normal levels.
Younger men are injecting testosterone or taking Anavar for cosmetic effects without knowledge of potential side effects. It is important to get adequate sleep, exercise, and nutrition before hormone replacement therapy. SHBG is often elevated in men with low free testosterone, and there are three hormones that regulate it: estradiol, insulin, and thyroxine. The focus should be on free testosterone levels rather than total testosterone levels. Testosterone replacement therapy can improve glycemic control and insulin signaling. There are multiple methods for testosterone replacement therapy, including indirect methods such as Clomid and direct methods. The decision for testosterone replacement therapy should be based on symptoms and biomarkers.
Taking anastrozole to lower estrogen levels can cause issues like joint pain, memory issues, and drops in libido. Low estrogen can also cause fat accumulation. A study found that higher testosterone levels and estradiol levels between 30–50 resulted in better outcomes. Clomid is a fertility drug that stimulates FSH and LH production, leading to increased testosterone in response. Clomid can increase desmosterol levels, which may be damaging to cardiovascular health. HCG preserves testicular volume and function without requiring aromatase inhibitors, but can decrease endogenous testosterone production. Testosterone doses should be taken more frequently than every two weeks for better results. Testosterone clinics often use ineffective dosing and aromatase inhibitors, and may prioritize profit over patient care.
FSH and LH decrease on high doses, but lower doses of Fadogia agrestis supplement appear to increase luteinizing hormone and have an effect on testicular size and volume; however, long-term safety and efficacy are unknown. The supplement market is unregulated compared to FDA-approved treatments like HCG and testosterone. Supplements like Tongkat and Fadogia provide an intermediate option before hormone therapy, but sourcing and dosages must be worked out individually. Rapamycin has shown promise in preserving ovarian life in mouse models and may have benefits for female fertility in clinical trials. Some people are trying various methods, including red light therapy and collagen supplements, to promote longevity, fertility, and overall health.
TRT involves using testosterone cypionate in injectable form; pellets are not preferred. Aromatase blockers are used to control estrogen levels. HCG is optional for fertility purposes. Low doses of TRT generally have no adverse side effects. SHBG is difficult to target with a molecule.
Testosterone levels don’t always match appearance. Free testosterone and estrogen play a role in appearance. Testosterone is important for muscle recovery and protein synthesis, not just appearance. Psychologically, testosterone can make you feel good and enjoy effort. Excess testosterone without exercise and proper nutrition is a waste. Overtraining can decrease testosterone levels. Adjusting activity in the amygdala is the main reason testosterone makes effort feel good.
There is debate about the direct relationship between dietary and serum cholesterol. Eating saturated fat can increase LDL and decrease HDL levels, but this is not related to dietary cholesterol. Cholesterol is important for hormone production and cell membrane fluidity. Dietary cholesterol does not significantly contribute to serum cholesterol levels. ApoB is the causative agent of atherosclerosis and its levels should be kept below 30mg/dL for longevity and better health. Cardiovascular disease starts developing in people as young as 18–20 years old. ApoB is necessary but not sufficient to develop atherosclerosis.
Two ways to target ApoB are through nutrition and medication. ApoB is related to LDL and VLDL particles, which carry cholesterol and triglycerides. Carbohydrates drive up triglycerides, but too much fat intake can still raise ApoB. Statins are effective in lowering LDL by inhibiting cholesterol synthesis, but there are other drugs now available. PCSK9 inhibitors are the most potent drugs to lower LDL levels. A vast majority of patients over 45 are prescribed statins or other compounds to address ApoB levels. Cardiovascular disease is the leading cause of death globally, and ApoB is a significant factor that needs to be addressed.
Medicine 2.0 treats ASCVD by modifying 10-year risk, while Medicine 3.0 treats the causative agent. The US is stubborn on implementing ApoB guidelines to treat the causative agent. Age is the biggest driver of risk for ASCVD, making the 10-year risk model flawed. The paradigm shift in prevention is a philosophical difference. The focus of preventing ASCVD is on the individual, not society. The decision to treat is based on the person’s ability to justify the cost of treatment.
Peptides, stem cells, and PRP are being used for tissue rehabilitation but there are few controlled studies on their effectiveness. There is a high level of uncertainty and potential risks associated with these treatments. It’s important to consider opportunity costs, both in terms of finances and time, when considering their use. There needs to be more incentives and investment in clinical trials for these treatments. It’s important to not rely solely on these treatments and instead focus on the hard work of rehabilitation. A study on BPC-157 did not show any noticeable effects.
Metabolomics is the study of metabolites, which are a finite number of molecules in the body that are involved in physiological processes. Metabolomics can help us understand how exercise affects the body and potentially uncover new treatments for diseases. Exercise produces a distinct signal in the metabolomic profile and finding small molecules that can replicate the protective benefits of exercise could be valuable for treating other diseases. In the field of pharmacology, GLP-1 is a hot topic.
GLP-1 agonists mimic or increase glucagon-like peptide and have more efficacy and safety than previous obesity drugs like fen-phen. Despite some drawbacks like nausea and muscle loss, they are effective in suppressing appetite and causing weight loss. Newer versions are more long-lasting and may preserve weight loss even off the drug. However, cheating on the drug and drinking alcohol or consuming high-calorie drinks may decrease its benefits.
If you enjoyed this article, be sure to check out the other ones. Scroll down to see the links. For future articles, make sure you follow me and subscribe. Links, also, below. Thank you!
Link to podcast: https://www.youtube.com/watch?v=DTCmprPCDqc&t=2s
These notes are my take on the podcast and not word-for-word. I did my best to get it right, but mistakes happen. So, take them with a grain of salt, use them as a map, double-check the details by listening to the podcast yourself and take responsibility for your actions. Hope you find them helpful!
