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Journal Club With Dr. Peter Attia | Metformin for Longevity & the Power of Belief Effects

Episode 141 Sep 11, 2023 2h 18m 20 insights
In this journal club episode, my guest is Stanford and Johns Hopkins-trained physician, Dr. Peter Attia, M.D., who is also the host of The Drive podcast and the author of the bestselling book "Outlive: The Science & Art of Longevity." We each present a scientific paper and discuss the findings' strengths, weaknesses and actionable takeaways. First, we discuss an article that addresses whether taking the drug metformin can enhance longevity. Then, we discuss an article on belief effects (similar to placebo effects), showing how the effects of a drug on the brain and cognition depend on one's belief about the dose of the drug taken, not the actual dose. Our conversation also highlights how to read, interpret and critique scientific studies. This episode ought to be of interest to those curious about health and longevity, medicine and psychology and for anyone seeking to better understand how to read and digest scientific findings. For show notes, including referenced articles and additional resources, please visit hubermanlab.com. Use Ask Huberman Lab, our new AI-powered platform, for a summary, clips, and insights from this episode.
Actionable Insights

1. Exercise to Prevent Insulin Resistance

Engage in regular physical exercise, as it is one of the most important actions to prevent insulin resistance, a fundamental problem in type 2 diabetes.

2. Prioritize Adequate Sleep

Ensure sufficient sleep, as sleep deprivation (e.g., 4 hours for a week) can profoundly reduce glucose disposal by about half and induce profound insulin resistance.

3. Manage Energy Balance

Maintain a healthy energy balance to prevent excess fat accumulation in muscles, liver, and pancreas, as this exacerbates insulin resistance.

4. Ensure Proper Hydration & Electrolytes

Prioritize adequate hydration and electrolyte intake (sodium, magnesium, potassium) in correct ratios for optimal brain and body function; dissolve one packet of Element in 16-32 ounces of water upon waking and during physical exercise.

5. Optimize Male Estrogen Levels

Males should aim to keep their estrogen levels as high as possible without negative symptoms, as estrogen is crucial for libido, brain function, tissue, and bone health, and unnecessary estrogen suppression should be avoided.

6. Monitor Resting Lactate Levels

Consider monitoring resting fasted lactate levels, aiming for below 1 millimole (ideally 0.3-0.6 millimole), as elevated levels can indicate compromised mitochondrial function.

7. Eat Unprocessed Foods

Focus on consuming mostly unprocessed or minimally processed foods to obtain nutrients, as this can allow for greater satiety and enjoyment of eating.

8. Leverage Belief in Drug Efficacy

Be aware that your beliefs about a drug’s dose and expected effects can significantly influence how your brain and physiology respond to it, potentially altering brain activation.

9. Reframe Drug Side Effects

Consider reframing the perception of drug side effects as evidence that the medication is working, which can lead to a more positive experience and greater reported relief from primary symptoms.

10. Cultivate Intellectual Humility

Adopt a mindset of intellectual humility, acknowledging the limits of current scientific knowledge and being open to new evidence that may change understanding.

11. Critically Analyze Scientific Papers

Develop the skill of dissecting scientific papers to understand their nuances, limitations, and true conclusions, fostering a scientific and clinical mindset.

12. Structured Scientific Paper Analysis

When reading a scientific paper, ask four key questions: 1) What is the general and specific question? 2) What was the approach/methods (and look up unfamiliar methods)? 3) What did they find (check figure headers)? 4) Are the conclusions truly substantiated by the findings?

13. Strategic Paper Reading Order

When reading scientific papers, start with the title and abstract, then review the figures to grasp the main findings visually, and only then read the full text for details.

14. Know Study Design Limitations

Be aware of the inherent biases and limitations of epidemiological studies (e.g., inability to control all confounders) and the strengths of randomized prospective experiments, understanding the ‘blind spots’ of each.

15. Beware Confounding Lifestyle Factors

When interpreting studies, especially observational ones, consider that lifestyle choices and underlying health convictions can introduce confounders that are difficult to measure and may influence outcomes.

16. Understand Statistical Power

When evaluating research, consider the statistical power of the study to determine if a non-significant result truly means no effect, or if the study was simply underpowered to detect a difference.

17. Review Supplemental Paper Information

Always check the supplemental information of scientific papers, as important details and data often reside there due to journal length constraints.

18. Practice Yoga Nidra/NSDR

Engage in meditation, yoga nidra, or non-sleep deep rest (NSDR), even for short 10-minute sessions, to greatly restore levels of cognitive and physical energy.

19. Utilize Show Notes for Papers

Refer to the podcast show notes for access to the scientific papers and figures discussed to deepen understanding of the topics.

20. Advocate for Aging Biomarker Research

Recognize the critical need for more research dollars into better biomarkers of aging to accurately assess the effectiveness of longevity interventions.