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Improve Vitality, Emotional & Physical Health & Lifespan | Dr. Peter Attia

Episode 116 Mar 20, 2023 3h 25m 22 insights
In this episode, my guest is Peter Attia, M.D. He completed his medical and advanced training at Stanford University School of Medicine, Johns Hopkins School of Medicine and the National Institutes of Health (NIH). Dr. Attia is host of the health and medicine podcast, The Drive, and the author of a new book, “Outlive: The Science & Art of Longevity,” which examines disease prevention and healthy aging, including emotional health. He explains the leading causes of death worldwide and how to measure one’s risk of death and mitigate each risk factor. Dr. Attia shares how, in addition to blood-based markers of lipids and hormones, there are behavioral measures and interventions, and key aspects of emotional health (i.e., relationships, emotional stability, purpose, etc.) that fundamentally impact our physical health and longevity, and how to assess and adjust our emotional health. This episode is rich with actionable information related to disease screening and biomarker testing, nutritional, exercise, behavior and prescription-based tools that area useful to all people regardless of age, male or female, and that can significantly improve vitality, health and lifespan. For the full show notes, visit hubermanlab.com.
Actionable Insights

1. Prioritize Emotional Health

Recognize emotional health as potentially the most important aspect of longevity and quality of life, as infinite lifespan without it would be a curse. Focus on ’eulogy virtues’ (character, relationships) over ‘resume virtues’ (achievements) to find meaning and satisfaction.

2. Cultivate Presence

Deliberately practice being present in the moment, as it is a strong predictor of happiness and overall well-being. Actively redirect thoughts from future planning or past rumination to savor current experiences, especially with loved ones, as this is not a default state for many.

3. Rapid Relationship Repair

Accept that you will inevitably damage relationships, but the goal is to quickly repair damage when it occurs, not to be perfect. Aim to make amends within minutes or hours, rather than letting conflicts fester, to maintain strong connections and improve relationship quality.

4. Deconstruct Emotions for Conflict

When experiencing interpersonal conflict or feeling slighted, first assess if the relationship matters. Then, deconstruct your true feelings (e.g., anger might mask hurt, fear, shame, loss, or abandonment) to understand and articulate them before approaching the other person, as this self-awareness is crucial for effective communication.

5. Rewire Negative Self-Talk

To overcome chronic negative self-talk or rage, immediately stop the internal monologue when it occurs. Instead, imagine a close friend made the same mistake, and audibly speak kindly to that ‘friend,’ recording the interaction for accountability (e.g., sending to a therapist), a practice that can rewire self-talk patterns in a matter of months.

6. Manage Blood Pressure Aggressively

Aim to keep blood pressure at or below 120/80 mmHg to significantly reduce the risk of heart attacks and strokes. Hypertension is hands down the leading driver of hemorrhagic stroke phenomenon and a major contributor to atherosclerosis.

7. Accurately Measure Blood Pressure

Do not rely solely on doctor’s office readings, which are often misleading. Sit still for five minutes before measurement, and consider using a manual cuff and stethoscope for accuracy, or an automated cuff while being aware it may run high. Record readings twice daily for two weeks annually to scrutinize numbers further.

8. Optimize ApoB Levels

Get your ApoB (apolipoprotein B) levels measured via a blood test, ideally starting in your 20s or 30s, especially with a family history of heart disease. Aim for ApoB levels around 60 mg/dL (5th percentile) if healthy, or 30-40 mg/dL (1st percentile) if starting later or with existing disease/risk factors, as ApoB is causally linked to atherosclerosis.

9. Address Insulin Resistance for Lipids

If ApoB levels are high, prioritize fixing insulin resistance, which often lowers triglycerides. Aim for triglycerides below 100 mg/dL, ideally at or below HDL cholesterol, and no more than two times HDL, with carbohydrate restriction being particularly effective.

10. Avoid Smoking and Vaping

Completely avoid smoking (cigarettes, cannabis) and vaping (nicotine, cannabis) due to their chemical and mechanical irritation to the endothelium and the presence of carcinogens. If seeking nicotine or cannabis, use alternative delivery methods like lozenges, gum, patches, tinctures, or edibles to reduce harm.

11. Prioritize Sleep for Brain Health

Ensure adequate, quality sleep consistently, as it is unequivocally critical for overall brain health and significantly impacts cardiovascular and cerebrovascular disease risk. Alcohol, even in moderate amounts, can profoundly disrupt sleep.

12. Maintain Insulin Sensitivity

Strive for good insulin sensitivity and avoid type 2 diabetes, as this is unequivocally beneficial for brain health and a key factor in reducing cancer risk. Being insulin sensitive helps prevent the tonic growth stimulus that can drive cancer.

13. Engage in Diverse Exercise

Exercise regularly for brain health, cardiovascular health, and to offset falls. If limited to three hours per week, allocate one hour to low-intensity cardio (Zone 2), one hour to strength training, and one hour to interval training, but recognize that more exercise is always better for brain health.

14. Strengthen Type 2 Muscle Fibers

To offset age-related falls and maintain mobility, incorporate training that specifically stresses Type 2 (fast-twitch) muscle fibers, which atrophy with age. This includes strength training, reactivity training, explosive movements, and jumping and landing exercises, along with practicing eccentric strength (e.g., slow step-downs) to improve braking ability.

15. Avoid Head Injuries

Minimize the risk of head injuries from sports, accidents (e.g., car, bike), or occupational hazards. If a head injury occurs, it is crucial to avoid subsequent ones, as the best thing to do is not get another.

16. Reduce Cancer Risk Factors

Focus on modifiable risk factors for cancer: avoid smoking and address obesity (defined by waist circumference more than 50% of height, which correlates with insulin resistance and inflammation). Recognize that no dose of ethanol is healthy, and consider abstinence or strict moderation to reduce cancer risk, as alcohol is a carcinogen.

17. Aggressive Cancer Screening

Prioritize early cancer detection through screening, as no cancer is more effectively treated when the burden of cancer cells is higher. Get ApoE gene tested for Alzheimer’s risk, and for colon cancer, get screened no later than age 40, as it is 100% preventable if polyps are removed.

18. Question Medical Radiation Exposure

Before undergoing any CT scan or imaging study, ask your medical professional for the exact millisieverts of radiation exposure. If they cannot provide this, seek clarification or consider alternatives, as CT and PET scanners are major sources of radiation, and a single scan can exceed a significant portion of annual limits.

19. Monitor Kidney Function

Pay close attention to kidney function, as high blood pressure severely impacts this vital organ. Request cystatin C testing (more accurate than creatinine) and do not tolerate kidney function that is too low for your age, as compromised kidney function carries a higher all-cause mortality risk than heart disease or cancer.

20. Beware of Fentanyl Poisoning

Exercise extreme caution regarding illicit or counterfeit pills, as fentanyl is increasingly contaminating them (e.g., fake oxy, Valium, Adderall, sleeping pills). Do not trust any pills obtained outside of legitimate medical channels, as even tiny, unpredictable doses of fentanyl can be lethal due to respiratory inhibition.

21. Consider Whole Body MRI for Cancer Screening

For comprehensive cancer screening, consider a whole-body MRI (e.g., Pronuvo, around $2500), which uses no radiation. Be prepared for a ~25% chance of finding non-cancerous anomalies that may require further investigation due to MRI’s high sensitivity but lower specificity.

22. Optimize Aerobic Capacity

Build a strong aerobic base (Zone 2 cardio, 180-250 minutes/week) and a high aerobic peak (VO2 max, through interval training). Visualize this as a pyramid with a wide base and a tall peak, essential for overall physical longevity and vitality, as the best pyramid has both.