Quotations by Peter Attia

Assuming that you're not someone who engages in ultrarisky behaviors like BASE jumping, motorcycle racing, or texting and driving, the odds are overwhelming that you'll die as a result of one of the chronic diseases of aging that I call the Four Horsemen: heart disease, cancer, neurodegenerative disease, or type 2 diabetes and related metabolic dysfunction. To achieve longevity-to live longer and liver better for longer-we must understand and confront these causes of slow death. [2023] - Peter Attia

Rapamycin has been demonstrated to do something that no other drug has ever done before: extend maximum lifespan in a mammal. Even though rapamycin is already approved for use in humans for multiple indications, there are formidable obstacles to launching a clinical trail to look at its possible impact on human aging-mainly, its potential side effects in healthy people, most notably the risk of immunosuppression. [2023] - Peter Attia

Caloric restriction (CR)'s usefulness remains doubtful outside of the lab. Very lean animals may be more susceptible to death from infection or cold temperatures. And long-term severe caloric restriction is difficult if not impossible for most humans to sustain. Furthermore, there is no evidence that extreme CR would truly maximize the longevity function in an organism as complex as we humans. [2023] - Peter Attia

With a few exceptions, such as glioblastoma or other aggressive brain tumors, as well as certain lung and liver cancers, solid organ tumors typically kill you only when they spread to other organs. Breast cancer kills only when it becomes metastatic. Prostate cancer kills only when it becomes metastatic. You could live without either of those organs. So when you hear the sad story of someone dying from breast or prostate cancer, or even pancreatic or colon cancer, they died because the cancer spread to other, more critical organs such as the brain, the lungs, the liver, and bones. When cancer reaches those places, survival rates drop precipitously. [2023] - Peter Attia

I'm cautiously optimistic about the emergence of so-called "liquid biopsies" that seek to detect the presence of cancers via a blood test. These are used in two settings: to detect recurrences of cancer in patients following treatment and to screen for cancers in otherwise healthy patients, a fast-moving and exciting field called multicancer early detection. [2023] - Peter Attia

The Galleri test looks at methylation patterns of the cell-free DNA, which are basically chemical changes to the DNA molecules that suggest the presence of cancer. In a study, the Galleri test proved to have a very high specificity, about 99.5%, meaning only 0.5% of tests yielded a false positive. If the test says you have cancer, somewhere in your body, then it's likely that you do. The trade-off is that the resulting sensitivity can be low, depending on the stage. (That is, even if the test says you don't have cancer, you're not necessarily in the clear.) Keep in mind this test still has much higher resolution than radiographic tests such as MRI or mammogram. Those imaging-based tests require "seeing" the tumor, which can happen only when the tumor reaches a certain size. With Galleri, the test is looking at cell-free DNA, which can come from any size tumor-even ones that remain invisible to imaging tests. [2023] - Peter Attia

In Medicine 3.0, we have 5 tactical domains that we can address in order to alter someone's health. The first is exercise. I break it down into its components of aerobic efficiency, maximum aerobic output (VO₂ max), strength, and stability. Next is diet or nutrition-or as I prefer to call it, nutritional biochemistry. The third domain is sleep, which has gone underappreciated by Medicine 3.0 until relatively recently. The fourth domain encompasses a set of tools and techniques to manage and improve emotional health. Our fifth and final domain consists of the various drugs, supplements, and hormones that doctors lean about in medical school and beyond. [2023] - Peter Attia

I used to recommend long periods of water-only fasting for some of my patients-and practiced it myself. But I no longer do so, because I've become convinced that the drawbacks (mostly having to do with muscle loss and undernourishment) outweigh its metabolic benefits in all but my most overnourished patients. [2023] - Peter Attia

Peak aerobic cardiorespiratory fitness, measured in terms of VO₂ max (via a treadmill test), is perhaps the single most powerful marker for longevity. VO₂ max represents the maximum rate at which a person can utilize oxygen. This is measured, naturally, while a person is exercising at essentially their upper limit of efforts. (If you've ever had this test done, you'll know just how unpleasant it is.) The more oxygen your body is able to use, the higher your VO₂ max. [2023] - Peter Attia

Zone 2 is one of five levels of intensity used by coaches and trainers in endurance sports. Some models have five zones, but others have six or seven. Typically, zone 1 is a walk in the park and zone 5 (or 6, or 7) is an all-out sprint. Zone 2 is more or less the same in all training models: going at a speed slow enough that one can still maintain a conversation but fast enough that the conversation might be a little strained. Zone 2 is a powerful mediator of metabolic health and glucose homeostasis. For some people, a brisk walk might get them into zone 2; for those in better condition, zone 2 means walking uphill. [2023] - Peter Attia

Where HIIT intervals are very short, typically measured in seconds, VO₂ max intervals are a bit longer, ranging from 3 to 8 minutes-and a notch less intense. I do these workouts on my road bike, mounted to a stationary trainer, or on a rowing machine, but running on a treadmill (or a track) could also work. The tried-and true formula for these intervals is to go 4 minutes at the maximum pace you can sustain for this amount of time-not an all-out sprint, but still a very hard effort. Then ride or jog 4 minutes easy, which should be enough time for your heart rate to come back down to below about 100 beats per minute. Repeat this 4-6 times and cool down. [2023] - Peter Attia

It takes much less time to lose muscle mass and strength than to gain it, particularly if we're sedentary. Even if someone has been training diligently, a short period of inactivity can erase many of those gains. [2023] - Peter Attia

You should at least check your bone density (technically, bone mineral density or BMD) every few years. When we detect low or rapidly declining BMD in a middle-aged person, we use the following four strategies: 1. Optimize nutrition, focusing on protein and total energy needs. 2. Heavy loading-bearing activity. Strength training, especially with heavy weights, stimulates the growth of bones-more than impact sports such as running (though running is better than swimming/cycling). 3. HRT, if indicated. 4. Drugs to increase BMD, if indicated. Ideally, we can solve the problem with the first two, but are not afraid to use the second two methods where appropriate. [2023] - Peter Attia

Fundamentally I structure my training around exercises that improve the following: 1. Grip strength, how hard you can grip with your hands, which involves everything from your hands to your lats. 2. Attention to both concentric and eccentric loading for all movements, meaning when our muscles are shortening (concentric) and when they're lengthening (eccentric). In other words, we need to be able to lift the weight up and put it back down, slowly and with control. Rucking down hills is a great way to work on eccentric strength, because it forces you to put on the "brakes." 3. Pulling motions, at all angles from overhead to in front of you, which also requires grip strength (e.g., pull-ups and rows). 4. Hip-hinging movements, such as the deadlift and squat, but also step-ups, hip thrusters, and countless single-leg variants of exercises that strengthen the legs, glutes, and lower back. [2023] - Peter Attia

One key test in our movement assessment is to have our patients stand with one foot in front of the other and try to balance. Now close your eyes and see how long you can hold the position. 10 seconds is a respectable time; in fact, the ability to balance on one leg at ages 50 and older has been correlated with future longevity, just like grip strength. [2023] - Peter Attia

I'm no longer a dogmatic advocate of any particular way of eating, such as a ketogenic diet or any form of fasting. It took me a long time to figure this out, but the fundamental assumption underlying the diet wars, and most nutrition research-that there is one perfect diet that works for every single person-is absolutely incorrect. [2023] - Peter Attia

The results of the large Spanish study known as PREDIMED were so dramatic. The group receiving the olive oil had about a one-third lower incidence (31%) of stroke, heart attack, and death than the low-fat group, and the mixed-nuts group showed a similar reduced risk (28%). By the numbers, the nuts-or-olive-oil "Mediterranean" diet appeared to be as powerful as statins, in terms of number needed to treat (NNT), for primary prevention of heart disease-meaning a population that had not yet experienced an "event" or a clinical diagnosis. [2023] - Peter Attia

TR or time restriction-also known as intermittent fasting-is the latest trend in ways to cut calories. But this can still backfire if you overeat. I have, much to my amusement, watched patients gain weight on a one-meal-a-day approach by turning their meal into a contest to see who could eat the most pizza and ice cream. But the more significant downside of this approach is that most people who try it end up very protein deficient. One not uncommon scenario that we see with TR is that a person loses weight on the scale, but their body composition alters for the worse: they lose lean mass (muscle) while their body fat stays the same or even increases. [2023] - Peter Attia

Avoiding diabetes and related metabolic dysfunction-especially by eliminating or reducing junk food-is very important to longevity. There appears to be a strong link between calories and cancer, the leading cause of death. The quality of the food you eat should be as important as the quantity. If you're eating the SAD (Standard American Diet), then you should eat much less of it. Conversely, if your diet is high quality to begin with, and you are metabolically healthy,, then only a slight degree of caloric restriction-or simply not eating to excess-can still be beneficial. [2023] - Peter Attia

A significant issue with Dietary Restriction (DR) is that everyone's metabolism is different. Some people will lose tremendous amounts of weight and improve their metabolic markers on a low-carbohydrate or ketogenic diet, while others will actually gain weight and see their lipid markers go haywire-on the exact same diet. Conversely, some people might lose weight on a low-fat diet, while others will gain weight. Any form of DR that restricts protein is probably a bad idea for most people, because it likely also impairs the maintenance or growth of muscle. Similarly, replacing carbohydrates with lots of saturated fats can backfire if it sends your apoB concentration (and thus your cardiovascular disease risk) sky-high. [2023] - Peter Attia