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Dr. Peter Attia: Training, Eating & Optimizing To Live Longer And Healthier In 2025

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This content is a discussion about optimizing healthspan, focusing on practical approaches to exercise, nutrition, and emerging longevity interventions, while critically evaluating their current utility and scientific backing.

well thanks Peter for uh taking the time

to sit down I know we just did a thre

hour marathon with Rich Miller and Steve

aad which will be coming out on the

drive I'm sure sometime soon that was

fun um hope you enjoyed it as much as I

did sure did so I uh have just really

about seven or eight questions and then

I thought we'd do a lightning round and

some of them will overlap with the

conversation with uh step rich but um I

want to get your thoughts specifically

on on some of these things so let's

start with a kind of a broad concept

which we did touch on with steveen Rich

which is this idea of Health span and

how do you define health

span I Define it pretty Loosely and

Squishy as some combination of um

physical function and

performance um and you can get you know

you you can start to Define these things

right you can talk about measurements of

strength and

power um and explosiveness and

reactivity and balance and flexibility

and Freedom From Pain although that

might not be thought of as performance

but a bunch of things that are both

subjective and objective around physical

performance and then a comparable set of

things around cognitive performance

which again you know we can Define and

measure many of these things right

what's you know how how is short-term

memory how is long-term memory how is executive

executive

function um how is Vis visual spatial

recall all of those things are

measurable and definable and they do

predictably decline with age but the

longer we can preserve those things and

then the the hardest I think to Define

is is maybe a group of things around

emotional health which are far more

subjective um but but I think anybody

would argue just as important um and

they Center probably around um sense of purpose

purpose

relationships uh Joy satisfaction you

know things that could could could be

rolled up into the idea of happiness but

but again I think the broader term is

less important than its components and

do you do you spend time trying to

measure it or put a number on it or do

you look at each of those components

individually as you're trying to

evaluate and just the last group or the

whole the whole thing yeah we try to

measure these as best we can and um do

do whatever is is is possible to to

delay their Decline and in some cases

improve them and and what do you think

about this again this is a concept we

touched on um earlier but this idea of

um separation of healthspan and lifespan

is that something that you spend a lot

of time worrying

about you mean the notion that in

2025 the gap between lifespan and health

span is widening right no I think that's

a that's an interesting and important

population-based um observation and we

discussed some of the reasons for for

why I think that's happening I think at

the individual level what I tell people

is if you focus more of your energy on

improving Health span you are going to

get a lot of lifespan benefits along the

way um there are certain things you do

for lifespan that have no immediate

healthspan benefit they will down the

line right so why should you manage your

cholesterol and your blood pressure um

you're not going to feel better from

either of those right neither of those

things produce any symptom and fixing

them doesn't amate any symptom but

there's a big difference between having

you know a heart attack at 75 and maybe

never having a heart attack and so if

you're 50 and you're thinking about it

then it definitely would impact Health

span um although we tend to think of

that more as a lifespan intervention

whereas you know frankly when we're

doing a lot of

exercise even though there were clear

lifespan benefits we mostly frame it in

terms of health span which is you're

training yourself now to be able to do

things as you get older and body and

motion stays in motion and um we know

that that training more than exercise is

what matters right training is

specificity of of movement not just sort

of kinetic movement which is valuable

right you'll get a lot of lifespan

benefits from that but you don't really

get the the the specific training

benefits right you in other words if I

just told you like just get on a

treadmill and run really hard every day

You' be good at running on a treadmill

every and you would get a lot of health

benefits from it wouldn't necessarily

benefit you in old age when movement is

much more multimodal and that you know

you're only training to do one thing

whereas life is a much more complicated

sport right so so I think it let me let

me rephrase what you said and make sure

that I get it right so there's benefit

to exercise period And it almost doesn't

matter what the kind of exercise is but

if you're looking to optimize Health as

you get older it matters the kind of

exercise you do and making sure that you

maintain functionality in all of the

important um things that you need to be

able to do as you get older and that

could be somewhat individual as well

right because it's going to be matter

what it is you want to able to do yeah

but I do think you know mistake number

one is not exercising that's the most

common mistake mistake number two is

exercising without a purpose because

then you're you're doing the hard part

in a sense you're you're setting aside

the time and you're expending

the energy you're burning the candles

but you're not recouping all of the

benefit you're only recouping part of

the benefits right so that person who's

just out there mindlessly running and I

don't say that to pick on running but

like they're they're doing you know

they're they're they're they're doing

80% of the work and they're going to

recoup 20% of the value what they're

missing is if I was more deliberate and

thoughtful and considered myself an

athlete and trained in a way that was

more specific and directed towards all

of the activities that are going to

matter to me in the last decade of My

Life um if I treated life more like a

sport and treat and acted more like a

competitive athlete um in my Approach

not necessarily my intensity uh I would

not have to spend more time doing this

or necessarily hurt more yeah uh or be

inconvenienced more but I'd get a much

better outcome on the health span side

even though not necessarily on the

lifespan side right what do you say to

people who say well but I just really

love to and I hate lifting weights and

and you know I think there is some truth

to the idea that whatever whatever

strategy you adopt needs to be something

that you're going to maintain over the

long term so what do you say to people

who take that sort of a a mindset coming

in yeah or the reverse right the person

who loves lifting weights but they just

don't love to do any sort of cardio

training I think you you sort of say

look it's great what you're doing but it

is important to understand that it will

not lead to the optimal result it will

be a far better result than if you did nothing

nothing

but here is the consequence of that so

if you love to run but you don't want to

lift anything um we can show you you

probably have not great muscle mass you

probably don't even have great bone

density by the way although it's

certainly better than if you were

sedentary or if you were just a swimmer

cyclist um and you're probably quite

weak and at some point I think just a

person needs to just as you you know you

have to convince a person that not

smoking is probably in their best

interest doesn't mean it's easy right um

so I think I I I tend to operate from a

place of showing people what's possible

right so it's like if you devoted either

less time to running and more time to

resistance training or kept running what

you were doing but added more time in

your week to resistance training this is

what you could have and this is what

it's going to look like in your marginal

decade that it won't look like now right

that makes sense um okay so that's

exercise let's talk briefly about

nutrition and again we could obviously

spend hours going in deep on nutrition

but I I guess what I want to ask you is

you know when you think about the

different um ways to approach nutrition

from the context either of healthspan or

lifespan how do you put how do you rank

if you had to rank what you eat when you

eat and how much you

eat how would you rank those in terms of

importance for Health and Longevity well

that's tough um because obviously any

extreme is a fail like you you know if

if you ate you only ate the most like

you know

farmtable organic perfect remarkable

regenerative food but you literally

consume 2x the amount that you needed to

be an energy balance that's bad um if

you always ate a caloric slight caloric

deficit you know you were 5% below and

you maintained you know a very very lean

body weight you were almost always in a

state of some Hunger without being

malnourished um and you did it on

Twinkies that's bad mhm um and if you

compressed all of your eating to a

three-hour window and you know blew it

on other metrics that's bad so I I think

it's maybe not the easiest way to frame

that question I'm not going to Rich

Miller you on that but you can imagine

what Rich would say what if I said you

have to you have to rank them but you

can rank how close they are to each

other no I mean think or maybe you maybe

you don't think it's worth trying to do

well I think that the data would suggest

an answer which I think is probably the

best place to start the data would

suggest that how much you eat probably

is the most important thing in other

words uh energy balance probably trumps

everything else um but the reason again

I think the question is a bit misleading

is it's much easier to be in energy

balance when you are

eating um a diet that is they're inter

related yeah yeah it's it would be

really even though theoretically we

could talk about what it would be like

to eat just 2500 calories perfectly

measured of junk food a day the truth of it

is whether it's based on you know um you

know Stephen Simpsons hypothesis around

protein searching like you're probably

going to end up overeating if you're

gorging on junk food right um we've seen

that yeah yeah yeah so so so so um I

tend to focus on how much protein am I

getting and how many calories am I

getting and I don't think about much

else okay yeah I mean the way I sort of

think about it is I have how much at the

top but what is pretty close and then I

put when pretty far down the list so I'd

like to yeah I would agree with that I

don't I don't pay any I mean just by the

nature of how my day is structured I I I

don't eat my first thing till typically

about 11:00 a.m. and is that intentional

because you believe that shrinking the

window or it's just that's works for you

yeah it does it's not there's not I'm

not out there trying to eek out four

hours of autophagy in the morning yeah

okay um so it's that hey it just so

happens that I eat between 11: and 7

yeah um I think there's nothing magical

about that fact and by the way if at 7

o'clock in the morning my kids don't

finish their French toast like they

didn't you I'll eat it like I don't care

yeah right okay that that's that's uh

that's helpful and and I think I tend I

mean it sounds like we pretty well on

that I've been pretty unconvinced about

the Tim restricted eating for Tim

restricted eating's purposes independent

of calories exactly I think it is and I

I think the data on this are pretty

clear unless somebody's got data in

humans that I'm unaware of that suggest

that there's something magical about the

window I I think it's one of the uh good

tools to restrict calories yeah for a

lot of people it helps restrict calories

for sure yeah okay um what about

processed foods and where do you land on

this I mean I think again yes of

course eating a diet only of processed

foods not great right but you know

there's also I think a lot of attention

moving towards the idea that that we

should take all processed foods out of

our diet and and where do you land on

that and how important is it to

differentiate between what we mean by

processed foods yeah I do struggle a

little bit with with the idea that there

should be no such thing as processed

foods because it's true that on average processed

processed

foods the term serves as a heuristic for

things that are on average not as good

as Whole Foods it's sort of like

saying imagine like some really evil

emperor came along and said man I just

want to get rid of all the unhealthy

people anyone whose BMI is over 25 I'm

going to send to another

planet well okay I guess on average

you're going to send lots of unhealthy

people BMI over 25 to another planet but

there are lots of people with a BMI over

25 who are really freaking healthy and

by the way there are lots of people with

a BMI below 25 that are really unhealthy

so maybe on average that intervention

would would accomplish the goals of the

evil uh Emperor um but at the individual

level not not even close yeah right and

so similarly that's my take on processed

foods right is that on average if we

eliminated processed foods people would

be heavy uh healthier um but there are

plenty of processed foods that I think

are completely reasonable and you have

to also ask the question like what's the

problem we're trying to solve like if

people had infinite time to you know buy

Fresh Foods every single day and cook

them that's great but a lot of people

don't and I have means and I don't yeah

like I don't have the with I mean I was

telling you before we started this

podcast like what did I have for

breakfast today David bar three Maui Nei

venison sticks shameful plug for two

companies that you know I I I also have

an interest in um but but I mean that's

what I'm eating for breakfast most days

and you feel like that and those are

both processed the framework of a diet

that you consider healthy for you yeah I

mean look I also happen to have the

benefit of knowing everything about

those companies so I know exactly how

the products are made and I I wouldn't

necessarily just say I would eat any

protein bar and any sort of you know

jerky stick but you know I happen to

know what goes into these things I

happen to know that um you know I am

maximizing protein and minimizing

calories that's what I'm trying to do in

that meal um it's always after I've

worked out right so my I'm trying to

provide substrate for muscle protein

synthesis I want um actually prefer to

eat it in a whole food um it's more

satiating to me than drinking a shake so

so like I have my reasons for doing it

but the bottom line is it's processed

now on a week

yeah maybe like if I've got the time I'd

rather make an omelette and you know

some avocado toast right um but I don't

have that time during the week like you

you've seen my schedule like I I don't

stop yeah yeah I mean I think that

Nuance is super important that first of

all not all processed foods are the same

and and you know there are multiple sort

of competing aspects in your daily life

that um contribute to the way that you

approach your your nutrition um but I

also think what you said about know the

composition of those products is

important and probably pretty

challenging for the average person right

so that because the macros don't always

tell you the whole story you have to

kind of understand a whole bunch of

other factors and yeah so as a rule of

thumb avoiding highly processed foods as

much as you can reasonably is a good

idea and when you can't as best you can

know the macros for sure and the quality

of the ingredients as much as you can

yeah what about alcohol where do you

land on that because it seems to me that

there has been or there is a ongoing you

know uh I don't know if it's truly a

shift but greater emphasis on the idea

that alcohol is a toxin and all alcohol

is bad and yet there is evidence out

there that moderate consumption of

alcohol is associated with at least

reduced all cause mortality where what's

your has your thinking changed on that

and where are you at now on that that

sort of question I think this is a

nuanced question and we we could go as

deep as you want to go on it um but I

would I would sort

of maybe start with like Tylenol and

acetaminophen is an example right so um

acetam menen is hepatotoxic it's toxic

to the

liver um but Tylenol is readily sold

over the counter and uh it's an amazing

drug like it really really works

interestingly we don't know how by the

way it's one of those drugs we have no

idea what the mechanism of action is

yeah another one of those examples like

no idea how this thing works um but it

sure does work right if you have a fever

it's going to bring it down if your

body's aching it's going to help you

stop if you're if you're in pain I mean

it's a it's a in some ways I think it's

an underutilized drug in the hospital

for patients postsurgically um it's it's

a great way that we could reduce

dependence on on opioids um but let's be

clear your your hepatocytes get taxed

every single time you take it now most

of the time it doesn't matter because

you're taking it at a low enough dose

that and the liver is has the greatest

capacity to regenerate of any organ in

the body so most of the time we're

taking um acetaminophen it's like you

know our liver takes a little hit comes

back takes a little

hit to be clear at no dose of acetam

Menin is it benefiting the liver right

it's benefiting the organism other uses

yeah yeah it's benefiting us as a person

but the actual hepy never experiences a

benefit a

Rejuvenation so it's not good for the liver

liver

um but it creates a blunting of certain

symptoms now of course at some point

probably around 4 G in a single dose boy

you start to take a big hit you'd

probably actually measure a bump in the

transaminases and at not much more than

that like literally in the ballpark of

20 to 40 grams you could irreversibly

injure the liver and that's an

individual that will be dead in 72 hours

absent a liver transplant um that's kind

of Staggering

so what's the analogy with with alcohol

I think the analogy with alcohol is if

you believe the mandelian randomizations

there is no dose of ethanol that is

beneficial um but beneficial for what

outcome ACM all cause mortality okay now

again you know I don't know how much we

want to go down the rabbit hole of um of

how mandelian randomization works and

what its limitations are but of course

it does have its limitations let let me

let me ask

you where what do you believe do you are

are you 95% sure there's no benefit for

all cause mortality at any dose are you

50% sure or you know where would you put

the sort of prob let me finish what I

was going to say because I think the

it's less about what do I believe and

more about what's the magnitude of the

okay sure it's really it's a dose

question it's a dose makes the poison

question so even if I believe the Mr

Data are correct and that there is no

dose that ACM goes down let's say I

believe that okay but that's based on a

certain type of analysis again I think

the literature at best is mixed on this

question right way I I mean the

epidemiology though by itself is the

least convincing of this because the

confounders are horrible right the

amount of never drinkers former drinkers

why people don't drink I think does

conflate the slight bump in uh survival

that we see in low drinkers um but my

point is who cares the the magnitude is

so small that if drinking a glass of

wine a day actually brings you Joy and

there's some pro-social benefit that

comes from it do it who cares like when

I hear people argue about this I I

actually think they need a life like

you're you've missed the point right the

point here is not whether one drink a

day is is toxic the point here is is it

good to be drinking four drinks a day is

it good to be drinking three drinks a

day and I think there the data are

pretty clear that the answer is no it is

not you know and it's

probably 30 to 45 grams per day that it

is pretty clear that this is lousy

furthermore what I don't think these

Studies have the granularity to to

provide input on is timing matters it's

a big difference between having a glass

of wine right before you go to bed and

your sleep is indeed Jack M there's no I

mean there's no denying this today right

that your sleep is disrupted by alcohol

and proximity to sleep that's a totally

different equation than I had a I had a

I had a cocktail before dinner at 6 o'

and by the time I went to bed I'd

completely metabolize that alcohol and

my sleep was unaffected the data don't

capture that Nuance but but this is kind

of like realworld example of of a

difference so I don't know my view is um

I know the Surgeon General recently

issued uh a warning that that alcohol is

a cursin ask you about that yeah yeah I

I don't know I mean I have to be honest

with you

I I don't know that I care much for for

public policy on this stuff I think

public policy has a really bad track

record of declaring things carcinogenic

I mean the who apparently considers

sleep deprivation a

carcinogen well I think sleep is very

important I have yet to see any evidence

to tell me that poor sleep actually

causes cancer maybe it does but that it

would that we could say so with such a

high degree of confidence that the World

Health Organization would decree it I

think that's irresponsible I think that

erodes people's trust in health advocacy

groups so I mean I think the one thing

you could point to where public policy

did have an impact is tobacco right and

obviously there were lots of other

things that that went into that but um

it did it did seem to move the needle in

that case uh so I guess one question

again would be is is it comparable right

yeah no it's not even it's not even

within the same zip code yeah if indeed

alcohol at a certain dose is

cogenic and I could yeah I there's

biological plausibility that at high

enough doses it could be yeah yeah yeah

um it's probably still a far less

convincing story than it is with tobacco

and by the way with

tobacco I don't know did they ever

really parse out the dose effect like do

you think one cigarette a day increases

your risk of cancer like I'm not

advocating that one does it because one

cig could easily lead to two and could

lead to four and at some point it's

clearly an issue but remember when we

talk to patients about smoking and when

we risk stratify them we do it by pack

years in other words we calculate the

integral of what they've smoked right

you could make the same argument about

alcohol right one drink leads to two

drinks and and we know people probably

much like tobacco back in the day lie

about how much they drink so it's a

complicated question I think we probably

shouldn't get into that side of it um

but it it is it is further Complicated

by the fact that many people do struggle

to stick with a dose that may have

minimal negative effects and may have

some benefits so I

gu this is the thing I don't buy that

there are any benefits of alcohol

physiologically that's the part I want

to say I I really do not buy that what

about lower blood glucose yeah I don't I

don't find those data convinc I mean if

it is lower it's not clinically significant

significant

right so um I don't buy the antioxidant

argument particularly um I really do

think that in the sort of Mediterranean

data where we see the benefits of

drinking you know wine I think it's more

a part of the dietary pattern in other

words I think it is the diet the wine

the engagement the sense of community

right and I think that you know again

this is like this is the kind of thing

that Rich Miller would pull his hair out

over right is how do you tease out which

of those things is contributing which

factor I don't know and that's why I say

to people like by all means like if it's

if it is such it's a wonderful and

pro-social thing for you to have a drink

like by all means do it but at some

point like acknowledge that this isn't

good for you it's just maybe at low dos

is not bad for you yeah what if I told

you that there's data that low dose

ethanol increases lifespan in SE allans

and in mice would that change it

wouldn't it wouldn't necessarily change

my change my point of view I'd be

interested in why what what dose I don't

know oh oh you're hyp I mean there is no

there is actually data in celegans I

don't remember the dose and there is

data in mice I haven't seen it but I

know people who have done those studies

and trust them I'm not I'm not trying to

use this as a like alcohol's good um I

think there are some some uh potential

clearly you can come up with handwavy

mechanisms for how the ethanol molecule

itself or effects on blood glucose or

other things that ethanol may do in

terms of circulatory function um could

have a benefit for longevity but I don't

think anybody has any clue as to what

the actual

mechanism would be could be and it's not

it's not rock solid it's not at the

level of Romy I guess well I want to

understand the dose right because there

could be like some hormetic dose of of

ethanol that's beneficial but it doesn't

really replicate the way ethanol is

consumed in a human dietary

pattern I don't know unless one drink a

day at lunch is harm headache like maybe

yeah I don't know it's it's I we're not

going to get to any sort of answer but I

guess I would say I'm I I think I align

with you on the pragmatic side I'm not

100% convinced that there is no benefit

to lowd dose ethanol but I think for

many people the risks would out outweigh

I just think it's a rounding error

either way so it's like it just a

population level sure or even for me

like I probably drink four to six drinks

a week I'm I certainly am not doing that

thinking it's got a pro longevity

benefit it's I'm not drinking it like

cough syrup and fish oil H just taking

my medicine um and at the same time I'm

losing no sleep over the fact that

that's shortening my life there are lots

of things in my life that are clearly

shortening my life my four to six drinks

a week not it by the way I love

non-alcoholic beer um and uh I I I wish

there was a non-alcoholic wine that

tasted good I've never found a

non-alcoholic anything sounds like a

business opportunity as long as you keep

the Resveratrol in there right you have

to I mean god without that okay so we uh

we talked about alcohol we talked about

food talked about exercise let's move on

to something that I think we both have

pretty strong opinions about but I'm

interested to hear where you land on

sort of this idea of biological aging

clocks in general and epigenetic clocks

specifically we can talk about the

science all you want obviously I love to

get in the Weeds on that stuff but I'm

also interested in sort of the clinical

utility use of these things how they're

being used and do you use them in in

your practice we do not use them at all

um and the reason for it is we do not

find them to be reproducible we don't

find them to be um actionable and we

find the data to be too noisy and is

that are you referring primarily to the

EP clocks the direct consumer on consum

over the counter tests yeah do you do

any formal or informal assessments of

biological age in your in your practice

we do countless assessments of of of

biologic parameters and biologic

functions that all change with age and

therefore we Encompass kind of

performance on those 40 to 50 metrics as

as things that we track what we don't

attempt to do is that aggregate that

into a number put it into a number and

say you're 54 years old biologically

exactly like I think that that's I think

that's a Fool's errand but you do use

percentiles right you say here's where

you are for a given met for a given

metric sure we would say your V2 Max is

at this percentile your visceral fat is

at this percentile relative to your age

and sex your apob is at this

percentile um your testosterone is at

this percentile your strength is at this

percentile for this particular movement

right there are lots of different way

lots of different strength metrics you

would test right yeah um and what do you

do when some when one of your clients

asks for one of these tests you how do

you how do you convince them they're not

useful um I mean look I've written a lot

of stuff on this and I usually just

point them to that and say look go read

this if you want to order it knock

yourself out like I don't I don't I

don't have I don't have some super

strong conviction about it but but I

have yet to have a patient who has read

through kind of my Spiel listen to my

Spiel and then come back and said no I

still really want to do this they're

usually like oh I can see this isn't

really going to this is not going to

change our Behavior this is not going to

modify what we do this does not impact

things that we are doing um because I

don't think I mean at least today with

today's test we just don't know what to

do with these numbers right when a

55-year-old person gets a test that says

50 versus 60 how should we behave in the

presence of that information yeah what

do you think about the idea and I mean

at least one of the directed consumer

companies is now offering this in their

test so we can kind of leave aside

whether it works or not yet but the idea

that you can get epigenetic signatures

of organ or tissue aging so that in one

person for example you take this test we

get your results back and it says your

brain heart liver muscle all look great

your kidney looks like you might be bu

biologically older than you should be

would that be something that would be

potentially more useful in your view I

think the question is is that going to

be more accurate than my estimated

glomular filtration rate from cateny

from creatine and from urinary protein

levels all of which I'm already checking

yeah and if it is like I'm all ears but

that someone's going to have to prove to

me that that's the case by the way

there's nothing I'm going to do with

that information that I'm not already

doing in other words let's just let's

take that case so let's pretend I've got

a patient who's got a perfect egfr by

creatin and a perfect egfr by cattin C

they're not spilling any protein in your

urine so as far as we know they have

perfect kidney function um they also by

the way have normal blood glucose and

they're normotensive because if they

were hypertensive I would still be

treating their hypertension I don't wait

until your kidneys start showing the

effects of hypertension to treat you we

treat hypertension regardless because

it's causal treat causal risk ma factors

before a problem shows up now I do this

test and it says oh oh Matt there

kidneys Matt's 50 but boy his kidneys

are 60 okay what do I do

yeah by the way I can't get a

nephrologist in the United States to

give a about a patient whose egfr

is 60 when it should be 80 and if

there're a nephologist listening and you

care please contact us okay CU we cannot

find one nefrologist who gives a rat's

ass about a patient whose GFR is 60 when

based on age it should be 80 in other

words their view is what are you talking

about he's fine and I'm like no no he's

not fine he's 20 points lower than he

should be at this age they're basically

like call me when he needs

dialysis right that's what I was going

to ask is why is that is because it's

not yet to this sort of arbitrary

threshold to be considered a disease or

I I'm I'm I'm I'm I'm really frustated

with the field of neur nephology because

I don't see people even asking the

question hey should these people be on

sglt2 Inhibitors even if they're not

diabetic because there might be some

nephr protection there like I I don't

know it's it's it's actually quite

frustrating for me is it is it because

there is not yet an appreciation that

those people who are below age Norms are

going to move on to disease or death

because I mean blood pressure you could

have made the same argument but we treat

blood pressure right yeah I mean again

again I I we don't know is the short

answer right so we don't know if that

person at 60 was completely normal and

then took a hit and then they've reset

but their rate of Decay is slowed like

or are we catching them in a Decay so so

we just don't have the DAT yeah we we

just don't know okay interesting well

good Public Service Announcement there

yeah hopefully there's a nephologist out

there who says no no no Peter I care

about this we have an entire practice

that is dedicated to preventive

nefrology I if if you tell us who we are

we we would to send our patients to you

cool um and I I want to come back to the

point you were making before that though

which which I agree with which is that

if the the biological age test no matter

what it is whether it's one of these

epigenetic tests or whatever the next

generation is if that doesn't line up

with the markers or functional metrics

that are at least mechanistically

Associated if not directly what you're interested

interested

in they're they're useless like it

doesn't you you you should not modify

your behavior or uh intervention or

treatment plan based on an epigenetic

test that doesn't match everything else

here's the only place I could ever

imagine using one if I was 100% sure it

worked I would love to use it with Rapa

and with and with off Lael use of

metformin and kaga flows and and all of

these geroprotective things that we

think might be gero protective but we

don't know that's the only use case

because as it stands today if we were to

use any of those agents we have no idea

if it's working because it's not showing

those are the things that do not show up

anywhere in the metrics that matter

right rapy does not show up in your V2

Max test your strength test your apob

your insulin sensitivity it's just not

showing up so if it's doing something

it's doing something at such a

foundational level of Aging that over

the period of short time that we're

measuring 3 months 6 months 9 months a

year two years don't know what it's

doing yeah and that would be the case

but I don't think these tests are even

remotely qualified to answer that

question so then they're trying to

answer a question for which I already

have something better in other words

these tests to me are like someone

showing me how to rub sticks together to

make a fire while I have a freaking

Zippo lighter like I'm like I I don't

need your dumb inaccurate useless test

that only works once in a while but I

don't know which times it's going to

work when I've got this predictable

perfect way to assess how to do things

and yet people are using these tests you

know influencers who will remain unnamed

are out there you know telling people

they should take them and modify their

lifestyle or off Lael use of medications

based on it companies are making lots of

money it's it's a real challenging time

I think for that part of the field

because there's no guard rails and I

agree with you I think you know we're

starting to get some ideas of precision

and accuracy and it's not looking good

for these things things I mean did you

share with your audience your test we

have an episode on on my self experiment

that people can go check out if you

haven't seen it yet but but I mean I

think the the the tldr is that um the

variance is enormous yeah and so we

really have no way of knowing how

accurate these are and it varies a lot

also across different companies we have

no idea if any of them whose test is is

working so yeah it's really challenging

um but it sounds like we're sort of in

the the same place I think I guess one I

mean maybe this isn't even worth

spending too much time on but I think

one of the things that I've noticed is

there are a growing number of doctors

now recommending that their patients use

these tests and I'm wondering if you

have any insights into like what would

they use that information for I don't

know okay maybe if your doc recommends

you use these tests you should ask them

because it's not hopefully people will

leave comments on in the video and say

hey my doctor does and this is what we

do with the information yeah okay yeah

okay okay let's talk just briefly about

apoe and I guess the question is I mean

I get why we want to know we want to

measure it um and we can measure it you know

know

genetically does it change your approach

to a patient knowing their apoe status

and if so how it does in the sense that

um and it depends on the patient right

there are some patients

who you know they don't that information

doesn't change anything because they're

already going to kind of do everything

that is at their disposal to reduce

their risk of uh either no Deen of

disease or

dementia uh there are other patients

though for whom I think it does serve as

uh additional motivation to take certain

steps sure um and so that's one fundamental

fundamental

difference and and maybe benefit to

knowing your apoe4 status so can I

paraphrase just to make sure that I get

it right there's nothing that you would

tell somebody uh that they should do

differently from what people should

already be doing based on apoe status

but it can motivate some people to be

more Vigilant in a person who's young

and healthy yes right so so this I I

think there are differences when we get

into disease state but if we're talking

about the type of people I take care of

who are really in the early stages of

prevention right you know they might be

at much higher risk for developing they

might be higher risk these are not

patients that necessarily have MCI mild

cognitive impairment um but yes the

Playbook is largely the same now you you

start to learn that there are subtle

differences so people with

apoe4 tend to respond a little less

favorably to a high fat diet right so

carbohydrate restriction with highs

saturated fat in apoe4 patients tends to

anecdotally at least uh produce a

suboptimal phenotype um you also kind of

have certain patterns that you can

expect to see and look for if you're

doing cognitive testing um again I'm not

a huge advocate of this I think the

purpose of cognitive testing is to

largely help you rule out biomarkers

that start moving in the wrong direction

so again the you know the biomarkers

that you can start to look at in

high-risk individuals at a certain age

are you know the presence of of ab40 and

ab42 and and Pau um and if those

biomarkers are present especially the

ab40 and

ab42 you know it's not necessarily

caused for alarm right um so sometimes a

cognitive test there can be a very

powerful tool to help you decide if you

can ignore this finding or not and

knowing an apoe4 status uh can also help

you interpret the findings because

you're going to see different patterns

of of of early cognitive impairment

um but I also don't think it's like

imperative and I also think that

somebody who's APO

e33 should be just as concerned about

this and should be taking just as many

steps to to protect their brain I I I

can't really think of anything I would

be I'm a 33 I don't know that I'd be

doing anything different if I were a 34

or a 44 right um at least not at this

time which is frustrating right I mean I

guess one question would be uh do you do

you think it's reasonable for people who

are 44

to take

Rapa based on that and I and and I asked

because that is that was one of the um

reasons why a lot of people started

taking Rapa M off label I would love to

see this studied we we do this

anecdotally is is APO status something

that informs your calculation for rap no

it's more the presence of of of ab40 and

ab42 that we use to track it so we use

that as a biomarker for Raa in patients

who have ab40 and ab42 interesting yeah

does rrap a m and move the needle there

yeah but again you know we're talking

about a pretty small n but yeah it

drives it down wow that's cool but again

that that that should be studied

absolutely there's just a laundry list

of things that need to be studied yeah

we we should have a rant sometimes about

all the stuff that's not being done that

should be done um so how do you you

handle and I'm sure you get them a lot

how do you handle requests for let's

just say experimental therapies which

can mean a lot of different stuff right

but there's a lot of there's a lot of

gray area in the sort of longevity space

right now and so people I'm sure you get

this a lot people are asking for stem

cell therapies

peptides Gene therapies on secret

Islands you know off the

Honduras to the extent that you want to

get specific I'd love to hear your

specific thoughts but in general you

know how do you how do you navigate that

because some of this stuff might work

and I think a lot of it we don't know

how do you think about that well you

know I always kind of ask somebody what

is it you're trying to accomplish right

like what is your

objective um and it's actually kind of

amazing how most people even at the

first and simplest question don't have an

answer oh hey my friend I was at a party

yesterday and my friend told me about

this peptide they take I really think I

should take it what are they taking it

for usually it's like they don't even

have an answer to that question right

so um I think that's just an important

place to start what is what is the

objective of this um is this something

you are taking for uh Health span to to

improve quality of life is this

something you are taking for lifespan to

um lengthen life if you're taking it for

lifespan do you believe it's broadly

geroprotective and impacts you know sort

of foundational aspects of Aging or do

you think it's sort of disease specific

like you get two questions into this and

people have no idea yeah so so then I I

sort of say well man if we have no idea

why we're doing this like that makes me

a little uncomfortable um at least if

we're talking about something like rap a

mice and we could answer all of the you

know my eight questions on that list I

have and then I asked the question well

what's the alternative and and do we

have more information about an

alternative right so um you know pick

your favorite example right if someone

says oh I you know I want to I want to

go down to the middle of nowhere to get

fallatin gene therapy because I want to

make more fallatin to inhibit my

myostatin so my muscles get bigger and

it's like okay we know other ways to

make your muscles biger are there

alternative ways to do this either

unenhanced where you know you just go

and like actually eat right and lift a

bunch of Weights uh or even enhanced

where we use exogenous testosterone

which is you know clearly an anabolic

agent is going to help and and and and

and so how do you how do you you know

how do how does one think about risk I

think it kind of comes down to their own

appetite for risk um I think I have a

high normal appetite for risk um but I

also kind of appreciate things that are

asymmetric and I just think that for a

lot of these things that are touted the

upside is not that huge and the downside

is unknown right we don't really know

like what I especially with like gene

therapy right that's a clear case where

there's just no long-term data no idea

so it's like the it just doesn't make

any sense to me now I've also talked to patients

patients

who you know whose parents are in the

final stages of Alzheimer's disease and

they're looking for a Hail Mary well you

know what my risk appetite changes a lot

right and they found some guy in Costa

Rica who's got this stem cell therapy

and they don't care about how much it's

going to cost they don't care that this

guy's going to charge them

$60,000 um because honestly like their

dad is so demented at this point that

you and I sort of say look I want to

prepare you for the fact that I think

this will have no

effect but if you will have a greater

regret when your father is dead that you had

had

$60,000 that you didn't give a hail Mar

to then you should probably do it but

but those are very different questions

and very sort of extreme that's an

extreme case right I mean I it is but I

get that believe I get I get a lot of

that as well yeah I think stem cells are

a place particularly where I I struggle

a little bit even to know where I land

because I think the the preclinical and

to some extent clinical data that's

available I think clearly there are use

cases where stem cells really really

beneficial right and may even if done

properly slow the aging process um and

yet there are a bunch of these clinics

out there operating where I have no clue

like what are they actually doing and

yeah this is a bit of a regulatory um

disaster yeah um and I suspect the

reason is that the FDA can't or doesn't

want to open up the Pandora's Box

because it would not be difficult to

identify a particular indication for

stem cells y but if stem cells receive

an approval for indication X the way the

FDA works is now you can use it for

anything and everything and so I believe

that's why the FDA is not approving stem

cells for even the narrowest indication

where you could at the very least do the

experiment like it would really be

interesting to know if you have a torn

rotator cuff if an injection of stem

cells into that torn rotator cuff would

produce a better response than letting

it heal on its own and or doing surgery

that's quite testable the most

challenging thing is understanding the

protocol y because that's the problem

with all cell-based therapies is the the

how do you make it is part of the drug

um but again I think that their view is

oh well if we open the door to that I

mean it's forget about it it's

interesting I I i' never thought about

it from that angle before so that's an

interesting hypothesis as to why I think

it's the same with the whole peptide

space as well yeah right so the FDA has

put the kibos on peptides the FDA has

put the how are peptides any different

from any other small molecule right in

the sense that you know specifically

what the peptide is you can do

manufacturing I think I think their view

is just that like

um well it's an interesting question

right do they think that like let's take

the two ones that people get that talk

about the most right people talk about

bpc 157 and and and um CJC 1296 those

are the two that I I I certainly get

asked about the most um I think

decent not it's not implausible that

those things have efficacy in certain

situations uh have you used either one

of them no um but I've had patience use

them both sure um I prior to the FDA

sort of banning them um when you could

actually buy them in the US from

credible sources like when you could go

to a really good compounding pharmacy

they could give you a COA yeah is it

actually banned yeah they cannot be sold

outside of research purposes oh

interesting so what that means is at

least this was true in 20 in September

2023 this was the ruling I assume it's

check it out yeah interesting so

basically you you can't you can sell

them for research purposes and you can

buy them for research purposes so

there's a lot of wink wink going on like

sites are selling them and you can buy

them but you have to you know you're

buying them for research they're selling

them for research the problem is like

nobody's checking what they are um so

there's a purity which you know I think

the same thing could be true for stem

cells because there's a lack of quality

control yeah uh so that that's my point

it's like I just I just wish that that

that I I would prefer to do this stuff

in bright light yeah no to shade yeah i'

never thought about the FDA uh Pandora's

Box sort of idea before but I think the

fact that they

haven't played any real significant role

especially with stem cells has led to a

situation where people are doing this

and people are you know there's a small

number who come back with miraculous

stories we don't know how many people

didn't have miraculous outcomes um and

we don't have any information on like

what was actually done what was injected

there's no data that we can actually

look at to use to answer the question

you asked which is is this therapy

actually beneficial for a given

indication that's totally knowable we

should know that by now but but I think

the fact that the FDA hasn't played any

role here in in

regulating um has led to the lack of

data actually coming to light I I would

be highly doubtful that systemic stem

cells would do much of anything um so in

other words this idea of just getting an

IV infusion of stem cells I'm calling

that placebo effect coupled with some

local transient you know effect of

whatever is being infused but I just

have a real hard time believing that

those stem cells are not getting

sequestered in the lung and you know

being chomped up by macroasia or

whatever like I have I have a hard time

believeing that where I think and what I

would want to see tested is is kind of

the local use of stem cells so you know

stem cells at you know facet joints or

discs or you know torn muscles things

like that um I think that's I think that

would be interesting yeah and and

knowable like the these

could be done right okay now I've got a

lightning round for you so um I know you

see my thick stack of note cards here

but uh it won't we'd have to go through

all of them but it shouldn't take too

long but the idea here is I know how

much you hate because I think you and I

are very much alike in this with these

sort of tier list or rankings yet and

yet you pulled one out of your hat a

couple hours ago

so um uh because I think it's always so

hard we just want to be absolutely

precise and like what is the question

and what are we ranking on and I'm going

to say just drop that that okay we're

going to do one to five one is yes I

like this it probably works I feel

confident five is don't waste your time

and you can use any rationale you want

to get there you can explain it if you

want to but you don't need to okay and

also recognizing I know you and I both

uh are agree on this that this is like

opinion as of what we know today it

might change tomorrow with new data okay

so we'll start with easy ones to kind of

set the scale I think they're easy very

generic healthy diet 1 to five one yes

five don't bother and I'll tell you what

I what I did after you tell me what you

did we'll see what we dis Health sorry

this is just gonna healthy diet very

health diet don't overthink it I know

you I know you have to I'm gonna go with

a two really okay I have it as a one I'm

interested why you well again because I

well you know if that means like you

can't have any processed foods and

whatever you think a healthy diet your

version of a healthy all right man uh

Resveratrol six I have a five all right

RPA two yep that's what I had two bat

and gene therapy five yep I have a five Alf

Alf

ketoglutarate uh four okay I had a three

we're pretty close three for me is just

like I don't I don't have enough

information to know at this point probiotic

probiotic

supplements uh totally depends on the

brand but call it a the best one out

there best one out there I'd say three

okay that's what I've got chronic

caloric restriction in humans we're

talking about humans now not mice

chronic yeah meaning you're trying to

replicate what's been done in mice for

the idea that it will increase your

longevity three because you might

actually live a bit longer but boy it is

not going to be worth it so three to

four I have it as a five actually and I

have it as a five because I think it

would be a miserable existence and I

actually think there's a better chance

because of mice are so different from

people that there would be harmful

things y that would counteract the

benefits okay spermine supplements oh I

this is something I've become quite

interested in um as of today I'm GNA go

with like two to three interesting I've

got a three so um and you're interested

because some of the data I've seen recently

recently

looks compelling enough that I want to

see I want my my appetite for more

research here is growing I agree

completely yeah it's it's one of the

more promising supplement products that

are out there to talk to Rich about that

yeah that's right yeah uh close

friendships oh I mean I think in terms

of quality of life one okay yeah me too

sleep tracking the utility of sleep

tracking um I think it's pulsatile right

I don't think it's something you need to

be doing all the time um but it can

create a great sense of awareness on

certain habits right so it's frankly the

way a lot of people learn that eating

too close to bedtime and drinking

alcohol before bedtime is not helpful um

but you can also get really paralyzed

and anxious around it so I'm just going

to call it a three yep that's what I had

too I actually given the way you

described it would probably mve to a two

but yeah I I would agree

SAA I'm going to go with a two okay I

have a three there why do you go with a

two even though it's mostly

epidemiologic data I think the the

consistency of the findings the

magnitude of the F you know if you sort

of Bradford Hill it a little bit I think

there's a signal there I also think it's

just a great pro-social thing so you

know I think for many people they're not

just going in the sauna by themselves

they're going in with friends or spouse

for me and my wife certainly it's it's

20 to 30 minutes four or five times a

week uh when we don't hear our kids

talking right so independent of the sort

of physiological effects that may be

there there's the social aspect as well

okay cool vitamin D I would say no study

has been done correctly in my mind to

actually answer this question right

because if you want to do the study

correctly you need to measure changes in

vitamin D levels and in other words you

need to titrate the amount of vitamin a

person takes you need to take a bunch of

people who are walking around at

30 and keep them at 30 and then you need

to give a bunch of other people whatever

amount you need to to get them to 60 or

70 or whatever and for some people that

might be 2,000 for some people be 5,000

for some might be 10,000 IU and you need

to do that study for long enough and

measure the right stuff and until that's

been done we have no earthly clue so I'm

going to call it a three okay I gave it

a one and I just want to clarify what

you said uh make sure that that I

understand it and clarify it for the the

listeners and viewers is the studies

that have been done where they report

either a benefit from vitamin D

supplementation or probably more often

no null finding yeah no

effect will take a population of people

who've been taking a vitamin D

supplement and compare it to a

population of people who haven't but

they don't actually show that the people

taking the I discount studies because

they're kind of useless I think the rcts

which are the ones that usually come up

null are problematic cuz they're like

hey we'll take a bunch of people that

have low vitamin D and will'll give one

group 2,000 IU and another group a

placebo and they don't monitor

compliance and they don't check what the

vitamin D goes to and as far as I'm

concerned it could be a placebo versus

placebo trial like it's sort of a dumb

trial yeah and a lot of people need you

pulled out 2,000 but that's probably

pretty reasonable for some of these St

need more than that to move the vitamin

D so it's I take 5,000 and that in the

winter gets me to somewhere in the 40s

like I'm not even you know getting to

these super high levels so you take

vitamin D even though you rate it as a

three and it's more of like an insurance

policy well I mean my view is to be I

think that to be between 30 and 60 is a

no-brainer um so if if the question is

should you take supplemental vitamin D

if you are below 30 I think the answer

is one measure it first and then take it

if you needed okay the answer is one

we're on the same page but what I don't

know is is is 70 better than 40 like I

have no idea because that study hasn't

been done although I'd like it to be

done I agree yeah okay NAD boosters five

I TBD TB I me no it's total opinion as

of today like I don't take it not in my

portfolio yeah I don't take it either I

gave it a three why are you so

optimistic um I think there's there's a

lot of smoke right and so there's enough

smoke that I think there's a reasonable

chance what's the smokiest thing you see

in humans well there have been a there

have been a few small clinical trials

for so Parkinson's disease looks

interesting um there's been at least one

function yeah so again none of them are

great they're all shortterm um there's

there's it seems clear that you can

boost NAD levels in people with at least

some of these things and that for some

indications so this this gets to the

idea that is NAD going to be going to

benefit most people for aging no idea is

NAD by the way that's sort of where my

five is yeah no that's that's my this is

why we don't need to overthink it too

much but I think we're both of the

opinion that there's potential but right

now no great evidence for benefits for

the average person and then teaser if

you want to get more into this topic we

got a little bit more into this with

Rich and Steve about the different types

of NAD precursors and all of that stuff

but generally speaking still unclear

whether NAD generally declines with age

and boosting is going to be beneficial

maybe you're life the name we we did a

deep dive on this a little while ago and

came up with a big five really yeah oh

interesting okay I had it as a three and

I would say B that's probably about the

same that that I would I would say same

confidence as I have for NAD at this

point um again based on some of the

preclinical work in worms and mice

although there's not a lot in mice yet

and some of the the not very great human

studies short-term stuff but potentially

promising I'm always happy to find a

study that that overturns the studies

I've looked at but we didn't we did not

find a compelling so you're not so where

would you rank and where would if you

had to say which is more likely to turn

out to be beneficial NAD boosters versus

euroian a NAD boosters I would give a

little more confidence to cool um we

sort of already talked about stem cell

therapy but where would you put that

well it's so broad right because it's

like again you've heard what my point of

view is if it's IV systemic like five if

it's intramuscular partic you know maybe

a two okay I gave it a three not

breaking it down that way and it was

just kind of like I don't know I think

there's a there there potentially but we

don't have enough okay veg diet again it

always compares to what right you take a

person who's on a standard American diet

who's just killing themselves eating you

just can't help yourself I can't I mean

how can you answer these questions

otherwise like compared to what right

what's the number I don't know a three I

mean okay has has a lot of benefits but

also has a lot of costs yeah right like

you're going to have to work really hard

on getting enough protein and making

sure you're you know you don't you know

you you you miss out on the three best

sources of protein right you're missing

eggs dairy and beef yeah um so you've you've you've got to work really hard to

you've you've got to work really hard to get enough protein in um and it's also

get enough protein in um and it's also really easy to eat a junky vegan diet

really easy to eat a junky vegan diet like lot of people know college vegan

like lot of people know college vegan diet is also so I just hate the label

diet is also so I just hate the label truthfully again this gets back to what

truthfully again this gets back to what you eat in addition to how much you eat

you eat in addition to how much you eat and when you eat all being important and

and when you eat all being important and their flavors of vegan diet yeah yeah

their flavors of vegan diet yeah yeah yeah again I I just put all diets in the

yeah again I I just put all diets in the waste bin as far as is like that's fair

waste bin as far as is like that's fair anybody who feels so compelled as I once

anybody who feels so compelled as I once did 15 years ago to make such a big deal

did 15 years ago to make such a big deal about their identity and their diet yeah

about their identity and their diet yeah I I just I don't no patience I have no

I I just I don't no patience I have no patience for you I don't care do what

patience for you I don't care do what you want just stop talking okay I gave

you want just stop talking okay I gave it a four and I and I gave it a four

it a four and I and I gave it a four mostly because I feel like a hardcore

mostly because I feel like a hardcore vegan diet the risks outweigh I think

vegan diet the risks outweigh I think there's a lot of good stuff about a

there's a lot of good stuff about a vegan diet but going that extreme has

vegan diet but going that extreme has some real risks associated with I think

some real risks associated with I think carnivore diet that'll be the last diet

carnivore diet that'll be the last diet I promise yeah I mean I again compared

I promise yeah I mean I again compared to what like I've seen a lot of people

to what like I've seen a lot of people who are struggling like hell to lose

who are struggling like hell to lose weight and to gain control of their

weight and to gain control of their health and they go on a carnivore diet

health and they go on a carnivore diet and things get a hell of a lot better

and things get a hell of a lot better I've seen enough people to believe that

I've seen enough people to believe that there is a signal there why that happens

there is a signal there why that happens I'm not entirely you think it's long

I'm not entirely you think it's long term I don't know and I don't know how

term I don't know and I don't know how sustainable it is long term and I don't

sustainable it is long term and I don't know what the long-term consequences are

know what the long-term consequences are of eating just meat right um so so I

of eating just meat right um so so I would sort of put this in the same C

would sort of put this in the same C give it a three as well which is to say

give it a three as well which is to say um interesting tool but what happens

um interesting tool but what happens when you go off it and can you stay on

when you go off it and can you stay on it indefinitely yeah I think the idea

it indefinitely yeah I think the idea that it's a tool kind of like Tim

that it's a tool kind of like Tim restricted eating that works really well

restricted eating that works really well for some people at least in the short

for some people at least in the short term makes sense I have the same sort of

term makes sense I have the same sort of concerns with that that I do with the

concerns with that that I do with the vegan diet that these extremes are very

vegan diet that these extremes are very rarely going to turn out to be

rarely going to turn out to be beneficial and pretty good reason to

beneficial and pretty good reason to believe they might cause harm so for and

believe they might cause harm so for and the question is you know we always want

the question is you know we always want to differentiate between an optimal diet

to differentiate between an optimal diet to treat something that is already

to treat something that is already broken versus an optimal diet to

broken versus an optimal diet to maintain Health those we don't they

maintain Health those we don't they don't have to be the same diet

don't have to be the same diet absolutely no agree completely uh

absolutely no agree completely uh hyperbaric

hyperbaric oxygen uh again depends on the

oxygen uh again depends on the indication so if we're talking about

indication so if we're talking about wound healing it's a one um if you if if

wound healing it's a one um if you if if you asked me what do I think its

you asked me what do I think its benefits might be for head trauma

benefits might be for head trauma concussion

concussion TBI maybe a two to three what about

TBI maybe a two to three what about longevity yeah I I don't buy any of

longevity yeah I I don't buy any of those data I think it's all crap data

those data I think it's all crap data I'm going with a five okay I gave it a

I'm going with a five okay I gave it a three again because I just don't know I

three again because I just don't know I don't know where to put it I I don't

don't know where to put it I I don't find the data compelling I think that

find the data compelling I think that whole Israeli study from a few years ago

whole Israeli study from a few years ago is super uncompelling I think tiir

is super uncompelling I think tiir length means nothing AG so so when when

length means nothing AG so so when when when someone shows me an hbot study that

when someone shows me an hbot study that ties the tiir lengthening I'm like yeah

ties the tiir lengthening I'm like yeah great like what did their eye color

great like what did their eye color change too like who

change too like who cares uh hormone therapy and here I'm

cares uh hormone therapy and here I'm talking about hormone therapy HRT for

talking about hormone therapy HRT for women men men or women you can you can

women men men or women you can you can you can give them different numbers if

you can give them different numbers if you want to but I'm not talking about

you want to but I'm not talking about taking hormones if you don't need to

taking hormones if you don't need to take hormones um I think for women I I

take hormones um I think for women I I put HRT at the one level I think it's so

put HRT at the one level I think it's so beneficial and I think all the fear

beneficial and I think all the fear mongering around breast cancer has been

mongering around breast cancer has been so dramatically overblown that even if

so dramatically overblown that even if you take the Whi at face value and

you take the Whi at face value and there's a lot of reason not to but let's

there's a lot of reason not to but let's just take it at face value zero increase

just take it at face value zero increase in the death due to breast cancer and 0

in the death due to breast cancer and 0 . 1% increase in the risk of breast

. 1% increase in the risk of breast cancer right if that's the worst case

cancer right if that's the worst case scenario from the worst study ever done

scenario from the worst study ever done on this and you look at all of the other

on this and you look at all of the other benefits that's a one plus when it comes

benefits that's a one plus when it comes to testosterone replacement therapy in

to testosterone replacement therapy in men um I would still frankly give it a

men um I would still frankly give it a one maybe a two because again I think

one maybe a two because again I think the data are really clear now that um

the data are really clear now that um it's it's it so first of all the data

it's it's it so first of all the data are I think less there's less benefit on

are I think less there's less benefit on the disease front side um for men and I

the disease front side um for men and I think there's also probably um less

think there's also probably um less benefit than there is for women on the

benefit than there is for women on the quality of life front because the change

quality of life front because the change is so de the the precipitous decline of

is so de the the precipitous decline of estrogen progesterone women is so

estrogen progesterone women is so significant um so so in other words I

significant um so so in other words I just think the magnitude of effect the

just think the magnitude of effect the magnitude of the benefit is a little

magnitude of the benefit is a little lower in men but could that be because

lower in men but could that be because men are going to be more stratified like

men are going to be more stratified like all women go through menopause right

all women go through menopause right clearly there are differences and and

clearly there are differences and and different women will respond differently

different women will respond differently to hormone therapy but men are I think

to hormone therapy but men are I think much more variable both in onset and

much more variable both in onset and degree of change in in testosterone yeah

degree of change in in testosterone yeah I also think men's's suffering when tea

I also think men's's suffering when tea is low is not as severe as women's

is low is not as severe as women's suffering off hormon symptomology

suffering off hormon symptomology symptom wise yeah yeah yeah yeah but

symptom wise yeah yeah yeah yeah but anyway look I think I think HRT for both

anyway look I think I think HRT for both men and women is is is really safe and

men and women is is is really safe and if it's done correctly and by the way

if it's done correctly and by the way there's lots of docs out there that I

there's lots of docs out there that I think are not doing it correctly and and

think are not doing it correctly and and and so so I'm assuming in my answer here

and so so I'm assuming in my answer here is you have a person who is not a

is you have a person who is not a coconut who is treating you who really

coconut who is treating you who really understands how to manage these things

understands how to manage these things but if that's the case I think they're

but if that's the case I think they're ones yeah that's what I had too all

ones yeah that's what I had too all right metformin for

right metformin for non-diabetics yeah we talked a lot about

non-diabetics yeah we talked a lot about this on the podcast

um again I struggle with the fact that it doesn't get into the muscle um and

it doesn't get into the muscle um and that it's potentially just getting into

that it's potentially just getting into the gut and the liver which has its

the gut and the liver which has its benefits on glucose as we know but

benefits on glucose as we know but no I my intuition is that it's a three

no I my intuition is that it's a three to a four I gave it a four but I could

to a four I gave it a four but I could be convinced to move to a three with a

be convinced to move to a three with a little bit more data but I'm just not

little bit more data but I'm just not not convinced at this point sglt2

not convinced at this point sglt2 inhibitors for

inhibitors for non-diabetics uh I'm going to go one to

non-diabetics uh I'm going to go one to two on that actually I'm pretty bullish

two on that actually I'm pretty bullish on the sglt2 Inhibitors are you more

on the sglt2 Inhibitors are you more bullish than

bullish than Rapa no but I'm more willing to use it

Rapa no but I'm more willing to use it than rap ay cuz there's so benign okay

than rap ay cuz there's so benign okay yep I gave it a two as well which is

yep I gave it a two as well which is what I gave rapid M uh growth hormone in

what I gave rapid M uh growth hormone in elderly super interesting question um

elderly super interesting question um and probably the thing I get asked about

and probably the thing I get asked about more than anything else in the practice

more than anything else in the practice by patience hey Peter what what do you

by patience hey Peter what what do you think about little GH um and I'll tell

think about little GH um and I'll tell you what I tell all my patients can we

you what I tell all my patients can we wait a little bit longer you know you're

wait a little bit longer you know you're only 50 let's save this bullet for later

only 50 let's save this bullet for later I'm I'm all for I'm all for having this

I'm I'm all for I'm all for having this bullet in the gun when we really need it

bullet in the gun when we really need it but I don't know that I want to use it

but I don't know that I want to use it right now and I'd love a little bit more

right now and I'd love a little bit more data yeah I would agree I gave it a

data yeah I would agree I gave it a three but I also don't know that I have

three but I also don't know that I have enough data and that I'm familiar enough

enough data and that I'm familiar enough with all the data that's out there to be

with all the data that's out there to be confident in well I can save you a bit

confident in well I can save you a bit of trouble because we've already done

of trouble because we've already done this there are no great data out there

this there are no great data out there at all right you're going to look at

at all right you're going to look at really short-term use cases and burn

really short-term use cases and burn patients and AIDS patients and things

patients and AIDS patients and things like that but there's really nothing to

like that but there's really nothing to look at outside of reading all the

look at outside of reading all the bodybuilding forums which are actually

bodybuilding forums which are actually quite interesting if often ahead of the

quite interesting if often ahead of the ahead of the medical if you really want

ahead of the medical if you really want to kind of understand what's happening

to kind of understand what's happening in the community for people taking

in the community for people taking long-term use of this drug the problem

long-term use of this drug the problem with those um with those data is it's

with those um with those data is it's confounded by Mega does of other

confounded by Mega does of other anabolic agents so it's very difficult

anabolic agents so it's very difficult but I will say this I've never spoken to

but I will say this I've never spoken to a person on GH

a person on GH who on a modest low dose of GH who who

who on a modest low dose of GH who who really complained of much um and I've

really complained of much um and I've also not found I don't think it's

also not found I don't think it's anagenic right I don't think it I don't

anagenic right I don't think it I don't think it's sure yeah but but but but you

think it's sure yeah but but but but you know there's still a part of me that

know there's still a part of me that feels like it wouldn't be responsible to

feels like it wouldn't be responsible to just give this to somebody without

just give this to somebody without absolutely being sure they didn't have

absolutely being sure they didn't have cancer right um what are your thoughts

cancer right um what are your thoughts or are you familiar with the trim

or are you familiar with the trim protocol this it's growth hormone DHE

protocol this it's growth hormone DHE and uh met foran yeah what are your

and uh met foran yeah what are your thoughts on that I'm I'm asking cuz I've

thoughts on that I'm I'm asking cuz I've sort of been playing around the idea of

sort of been playing around the idea of trying it myself just to see if there's

trying it myself just to see if there's any any detectable change in biomarkers

any any detectable change in biomarkers yeah that was the study the fam study

yeah that was the study the fam study that fah yeah feah was it yeah yeah and

that fah yeah feah was it yeah yeah and they looked at thymic regeneration there

they looked at thymic regeneration there been a couple now yeah both all all from

been a couple now yeah both all all from fahe so you know yeah I don't know I

fahe so you know yeah I don't know I have they looked at actual immune cell

have they looked at actual immune cell function I think a little bit but

function I think a little bit but certainly nothing none of the trials

certainly nothing none of the trials have been large or comprehensive I I

have been large or comprehensive I I it's been so long I don't actually even

it's been so long I don't actually even remember why they use DHEA

remember why they use DHEA and why they used metformin although I

and why they used metformin although I remember at the time reading it and

remember at the time reading it and thinking it didn't even make sense then

thinking it didn't even make sense then so the metformin was was to offset any

so the metformin was was to offset any metabolic consequences of GH but what

metabolic consequences of GH but what was the d i I mean I heard bee once say

was the d i I mean I heard bee once say in an interview that DHEA declines with

in an interview that DHEA declines with age and so we put it in the mix I'm

age and so we put it in the mix I'm assuming there's more to it than that

assuming there's more to it than that but regardless I find DHEA to be the

but regardless I find DHEA to be the most useless hormone in men completely

most useless hormone in men completely full stop does nothing uh in women it

full stop does nothing uh in women it can boost testosterone a little bit but

can boost testosterone a little bit but yeah okay anyways that's a little bit of

yeah okay anyways that's a little bit of a of a tangent but I'm intrigued by that

a of a tangent but I'm intrigued by that possibility of thymic regeneration and

possibility of thymic regeneration and yeah so I would give the the that

yeah so I would give the the that protocol like a four okay um continuous

protocol like a four okay um continuous glucose

glucose monitoring I put this in like I put this

monitoring I put this in like I put this in the same whatever I gave sleep

in the same whatever I gave sleep tracking I would give this which is

tracking I would give this which is really great everybody should do it once

really great everybody should do it once amazing to understand how nutrition

amazing to understand how nutrition exercise sleep and stress your

exercise sleep and stress your glucose and for some people to to have

glucose and for some people to to have that around that information at your

that around that information at your disposal all the time is an amazing way

disposal all the time is an amazing way to modify behavior and that's great if

to modify behavior and that's great if it improves the behavior without

it improves the behavior without increasing distress for other people

increasing distress for other people that produces distress don't do it so

that produces distress don't do it so let's call it a three okay I I gave it a

let's call it a three okay I I gave it a I think I gave it a one but for the

I think I gave it a one but for the exactly the same reasons I think we

exactly the same reasons I think we completely agree on everything you said

completely agree on everything you said bpc 157 well I sure love to see it

bpc 157 well I sure love to see it studied again it's a VF analog so I

studied again it's a VF analog so I could absolutely make the case if

could absolutely make the case if somebody you know tears an Achilles or

somebody you know tears an Achilles or has some other injury where we really

has some other injury where we really want to in increase vascular

want to in increase vascular endothelium like I'd love to see it

endothelium like I'd love to see it being used so again I bet that there's

being used so again I bet that there's something there but I don't know how to

something there but I don't know how to make sense of it today and I don't know

make sense of it today and I don't know how to assure quality yeah and I you

how to assure quality yeah and I you know this is one of those things I wish

know this is one of those things I wish the FDA would uh would let it be studied

the FDA would uh would let it be studied but again how are you know you could

but again how are you know you could make the argument well who's going to

make the argument well who's going to study who's going to pay to study it uh

study who's going to pay to study it uh yeah I mean very much like any uh drug

yeah I mean very much like any uh drug that's off patent right yeah same same

that's off patent right yeah same same problem it's a solvable question that

problem it's a solvable question that there's no incent profit incentive for

there's no incent profit incentive for people to study yeah so I think in its

people to study yeah so I think in its pure form a two but in its practical

pure form a two but in its practical form maybe a four okay because how do

form maybe a four okay because how do you ensure Purity how do you know how to

you ensure Purity how do you know how to dose it right so you're convinced Enough

dose it right so you're convinced Enough by the data though that if you knew it

by the data though that if you knew it was good quality that there's enough

was good quality that there's enough reason to think it could haveit no I'm

reason to think it could haveit no I'm not because I haven't seen enough data

not because I haven't seen enough data I'm just convinced by the this is purely

I'm just convinced by the this is purely mechanistic because it's an analog of

mechanistic because it's an analog of VF I could certainly make the case that

VF I could certainly make the case that if I'm trying to heal tissue VF would

if I'm trying to heal tissue VF would matter now I've seen people selling oral

matter now I've seen people selling oral bpc157 if you're watching this and

bpc157 if you're watching this and you're buying oral peptides please stop

you're buying oral peptides please stop yeah they literally get destroyed in

yeah they literally get destroyed in your stomach yeah uh so so please make

your stomach yeah uh so so please make sure you're not buying much like you

sure you're not buying much like you shouldn't put the rra ofon powder on

shouldn't put the rra ofon powder on your and eat it because it will also get

your and eat it because it will also get destroyed in your stomach yeah what

destroyed in your stomach yeah what about gp1 Agonist for so I gave that a

about gp1 Agonist for so I gave that a three as what about gp1 Agonist for

three as what about gp1 Agonist for nonobese people yeah I'm going to go

nonobese people yeah I'm going to go with um too soon to tell um well sorry

with um too soon to tell um well sorry non-diabetics or non- obese sorry non

non-diabetics or non- obese sorry non obes okay yeah um I don't know man it's

obes okay yeah um I don't know man it's really intriguing I agree maybe a two to

really intriguing I agree maybe a two to three okay I gave it a three but again

three okay I gave it a three but again it's mostly from lack of data not

it's mostly from lack of data not because I don't believe there's anything

because I don't believe there's anything there I think there probably is um t R

there I think there probably is um t R activators five yeah me

activators five yeah me too uh Young Blood therapeutic plasma

too uh Young Blood therapeutic plasma exchange boy oh boy um love to see the

exchange boy oh boy um love to see the experiments done

experiments done um I guess I give it a three for now

um I guess I give it a three for now until proven otherwise yep I'm in the

until proven otherwise yep I'm in the same boat okay do you know this uh fatty

same boat okay do you know this uh fatty 15 has this come across your radar yeah

15 has this come across your radar yeah where do you put that um I I remain

where do you put that um I I remain completely unconvinced by this so I'm

completely unconvinced by this so I'm going to give it a four yeah that's what

going to give it a four yeah that's what I gave it to um it's a little bit

I gave it to um it's a little bit frustrating to me to see this sort of

frustrating to me to see this sort of traction happening but um it is what it

traction happening but um it is what it is uh okay I think I know where you're

is uh okay I think I know where you're gonna land here epigenetic age tests

gonna land here epigenetic age tests direct to Consumer yeah I'm gonna go

direct to Consumer yeah I'm gonna go with a five right now y me too

with a five right now y me too nmn five I put that in the same bucket

nmn five I put that in the same bucket as NR and NAD me too all right uh okay

as NR and NAD me too all right uh okay that's it for the speed round I have two

that's it for the speed round I have two hopefully fun questions one of them will

hopefully fun questions one of them will definitely be fun um the first one is do

definitely be fun um the first one is do you want to play the Hallmark game no

you want to play the Hallmark game no okay we won't do that well how many do

okay we won't do that well how many do you think you can rattle off no I was

you think you can rattle off no I was thinking we would go back and forth we

thinking we would go back and forth we each name one until we get to some I

each name one until we get to some I don't know actually I could probably I

don't know actually I could probably I can definitely do seven or eight I don't

can definitely do seven or eight I don't know I get up I can do more I think I

know I get up I can do more I think I can do better than that okay go uh

can do better than that okay go uh epigenetic changes uh mitochondrial

epigenetic changes uh mitochondrial dysfunction well that was my favorite

dysfunction well that was my favorite that was my answer uh genome

that was my answer uh genome instability uh epigenetic deterioration

instability uh epigenetic deterioration I already said that that was my did that

I already said that that was my did that was your first one so we've blown my

was your first one so we've blown my memory out the door uh uh nutrient

memory out the door uh uh nutrient sensing deficiency yep uh uh okay let's

sensing deficiency yep uh uh okay let's say uh disbiosis

say uh disbiosis patrici okay sent cells inflammation oh

patrici okay sent cells inflammation oh that was my next one uh macro autophagy

that was my next one uh macro autophagy disregulation

disregulation um now it's gonna get tough genomic

um now it's gonna get tough genomic instability I said that one already did

instability I said that one already did yeah was the second one was that your

yeah was the second one was that your third one okay it was the second second

third one okay it was the second second one

one yeah now we're GNA be we're going to go

yeah now we're GNA be we're going to go back and people like you didn't actually

back and people like you didn't actually say that

say that oh I know I got one okay don't say it no

oh I know I got one okay don't say it no proteostasis decline in proteostasis so

proteostasis decline in proteostasis so I think we're missing two that's no

I think we're missing two that's no we're only at eight I was up to five on

we're only at eight I was up to five on my hand right well regardless folks you

my hand right well regardless folks you can see

can see how yeah okay what's your favorite

how yeah okay what's your favorite Hallmark what what do you like best not

Hallmark what what do you like best not most important like what what do you

most important like what what do you like best these days I do I think a lot

like best these days I do I think a lot about epigenetic change okay I still

about epigenetic change okay I still have mitochondrial dysfunction is my

have mitochondrial dysfunction is my favorite um I love mitochondria what's

favorite um I love mitochondria what's your least favorite go disbiosis oh

your least favorite go disbiosis oh really okay last time it was tiir

really okay last time it was tiir shortening oh yeah yeah yeah of I would

shortening oh yeah yeah yeah of I would still say that I still I would still say

still say that I still I would still say that why gut disbiosis because you don't

that why gut disbiosis because you don't think it's important or you don't think

think it's important or you don't think we understand it well I think it's I

we understand it well I think it's I think it's so hard to figure out yeah I

think it's so hard to figure out yeah I think that's a pretty weak one to be put

think that's a pretty weak one to be put in the Hallmarks of Aging well it wasn't

in the Hallmarks of Aging well it wasn't in the original Hallmarks it was it was

in the original Hallmarks it was it was it was sort of in the expansion League

it was sort of in the expansion League yeah

yeah exactly uh what do you think is the most

exactly uh what do you think is the most important for human health span of the

important for human health span of the Hallmarks if you could fix fix one I I

Hallmarks if you could fix fix one I I think maybe mitochondrial dysfunction hm

think maybe mitochondrial dysfunction hm okay I would that that I'd put up there

okay I would that that I'd put up there I'd probably do inflammation just

I'd probably do inflammation just because I feel like that leads to so

because I feel like that leads to so it's associated with so many of the

it's associated with so many of the diseases and symptoms that go wrong with

diseases and symptoms that go wrong with aging that if you could fix that you're

aging that if you could fix that you're still going to it's not going to fix the

still going to it's not going to fix the problem but it I think it will it and

problem but it I think it will it and maybe I'd lean that way because maybe

maybe I'd lean that way because maybe that's the one that therapeutically I

that's the one that therapeutically I think we have the the the the shortest

think we have the the the the shortest path but interesting um okay so now for

path but interesting um okay so now for the last game uh I understand you're a

the last game uh I understand you're a metall fan mhm what is the best

metall fan mhm what is the best Metallica

Metallica album um what was the what was the

album um what was the what was the 1991 uh it came out in October 91 was

1991 uh it came out in October 91 was that black yeah yeah I think so okay I

that black yeah yeah I think so okay I and by the way speaking of Metallica

and by the way speaking of Metallica have you I talked about this on a

have you I talked about this on a previous podcast with Nick Stenson um

previous podcast with Nick Stenson um have you seen that video of them playing

have you seen that video of them playing in Russia in 91 I don't think so it's so

in Russia in 91 I don't think so it's so it's actually a pretty cool there's a

it's actually a pretty cool there's a video out there on YouTube of the 10

video out there on YouTube of the 10 largest concerts ever and uh this was

largest concerts ever and uh this was one of them wow and I can't remember the

one of them wow and I can't remember the size of the audience but it was more

size of the audience but it was more than a million so you got a picture like

than a million so you got a picture like Russia just after the fall of the Soviet

Russia just after the fall of the Soviet Union right like these guys have barely

Union right like these guys have barely had a few months to get blue jeans and

had a few months to get blue jeans and you've got Metallica rocking out to like

you've got Metallica rocking out to like I don't remember the 1.8 million people

I don't remember the 1.8 million people like I think they're like I think the

like I think they're like I think the video shows them playing Enter Sandman I

video shows them playing Enter Sandman I mean it is incredible is that the album

mean it is incredible is that the album you were thinking of as that has Sandman

you were thinking of as that has Sandman on it that's the Black Album yeah okay

on it that's the Black Album yeah okay uh so my favorite is Ride the Lightning

uh so my favorite is Ride the Lightning but I struggled between kill them all

but I struggled between kill them all and Ride the Lightning um so anyways I

and Ride the Lightning um so anyways I have you seen metallic in concert no I

have you seen metallic in concert no I have not seen nor have I seen Nickelback

have not seen nor have I seen Nickelback like how I've not seen Nickelback or

like how I've not seen Nickelback or Metalica I don't know I saw him once in

Metalica I don't know I saw him once in my my misspent youth and then once maybe

my my misspent youth and then once maybe four years ago I think it was just

four years ago I think it was just pre-co we went with the whole family

pre-co we went with the whole family which was pretty fun there are tons of

which was pretty fun there are tons of bands that I really regret not seeing

bands that I really regret not seeing and the other I would say I would put

and the other I would say I would put really high on the list is Rush yeah

really high on the list is Rush yeah like how I never saw Rush yeah that's

like how I never saw Rush yeah that's and I had a chance to and I was just too

and I had a chance to and I was just too freaking lazy one day but don't wait

freaking lazy one day but don't wait folks these guys aren't getting any

folks these guys aren't getting any younger and uh you know maybe maybe we

younger and uh you know maybe maybe we can give them some some

can give them some some tips all right cool thanks Peter that

tips all right cool thanks Peter that was fun uh I hope you enjoyed it I

was fun uh I hope you enjoyed it I really appreciate you sitting down and

really appreciate you sitting down and uh doing this and um I'm looking forward

uh doing this and um I'm looking forward to uh next time we get a chance to get

to uh next time we get a chance to get together and uh Easter Island is still

together and uh Easter Island is still on my bucket list so hopefully we get a

on my bucket list so hopefully we get a chance to do that I think we should plan

chance to do that I think we should plan that for 2026 cool well thank you all

that for 2026 cool well thank you all right

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YouTube Transcript:Dr. Peter Attia: Training, Eating & Optimizing To Live Longer And Healthier In 2025