#661: Dr. Peter Attia — The Science and Art of Longevity, Optimizing Protein, Alcohol Rules, Lessons from Glucose Monitoring with CGMs, Boosting Your VO2 Max, Preventing Alzheimer's Disease, Early Cancer Detection, How to Use DEXA Scans, Nature's Longevity Drug, and More

Get periodic DEXA scans (a couple times a year) and track metrics beyond body fat, including ALMI and FFMI, to monitor muscle and bone.

Target an ALMI above the 75th percentile, ideally above the 90th or 97th percentile, as people with higher ALMI live longer, better lives.

Consume about 1 gram of protein per pound of body weight per day to support muscle mass.

Prefer animal-sourced protein over plant-sourced for greater bioavailability and higher leucine, lysine, and methionine content.

Track leucine intake — aim for roughly 6–8 grams per day — as a key amino acid for hypertrophy and mTOR stimulation.

Track lysine intake, aiming for an amount comparable to leucine, as a key amino acid for hypertrophy.

Track methionine intake, aiming for at least 2 grams per day. Eggs are a high source.

Attia uses the Carbon app to track macronutrients and see where his protein and amino acids come from.

During workouts Attia consumes only an electrolyte drink rather than amino acids.

Use high-quality whey protein post-workout in place of in-workout amino acids.

Attia recommends his 'Studying Studies' five-part blog series as a foundational primer on epidemiology and study types.

Attia mentions Layne Norton's REPS course as a scientific literacy course in reading exercise and nutrition studies.

Tim Ferriss suggests reading Ben Goldacre's Bad Science to build scientific literacy basics.

Use the Bradford Hill criteria to scrutinize observational/epidemiologic data for likely causation.

Tim Ferriss strongly recommends Peter Attia's book Outlive: The Science and Art of Longevity.

Tim Ferriss recommends Darrell Huff's How to Lie with Statistics as a fast read to recognize sensationalist statistical claims.

Carbohydrate restriction is a particularly effective approach for managing type 2 diabetes, working through improved glucose regulation and as a gateway to caloric restriction.

Attia uses CGMs in non-diabetics as a behavioral and learning tool to understand individual glucose responses to food, sleep, and exercise.

Train both concentric (acceleration) and eccentric (deceleration) phases — eccentric weakness is a common cause of falls and injury, especially with age.

Use the standing broad jump as a benchmark — aim to jump further than your height lying down.

Nordic hamstring falls train pure eccentric hamstring strength; beginners should use assistance.

Use single-leg step-ups as a key strength exercise — no axial loading, exposes asymmetries, and trains eccentric strength on the way down.

Attia rucks for an hour with 55–60 pounds, focusing on hilly terrain to combine cardio uphill and eccentric loading downhill.

Train to carry half your body weight in each hand for one minute as a strength benchmark.

Train to maximize VO2 max with 3-8 minute intervals at high intensity (zone 5) once a week, alongside zone 2 base building (~80% of training time).

Train and track grip strength — repeatedly shown to be a strong proxy for longevity and lower dementia risk.

Attia plugs GoRuck packs and bolt-on waistbands for rucking — designed to bear weight on the hips.

Attia highly recommends Michael Easter's The Comfort Crisis.

Use a point-of-care finger-prick lactate device to identify zone 2 (lactate ~1.7–2 mmol/L).

Build aerobic base with zone 2 training — pace at which you can talk but don't want to — for ~3 hours/week, typically 3x60 or 4x45 minute sessions.

Exercise is the most important modifiable behavior for reducing risk of Alzheimer's, Parkinson's, and Lewy body dementia.

Know your APOE genotype to understand Alzheimer's risk and motivate preventive measures.

Measure ApoB to assess all atherogenic particle concentration — a more important cardiovascular marker than LDL-C or HDL-C.

Test Lp(a) at least once — it's a genetically-determined high-risk lipoprotein that informs how aggressively to optimize ApoB.

Attia includes uric acid in his core biomarker panel.

Attia includes homocysteine in his core biomarker panel.

Attia tracks insulin as a core biomarker for metabolic health.

Use cystatin C instead of creatinine to assess kidney function — far more accurate, unaffected by muscle mass.

Grail's cell-free DNA test can be a useful early cancer screening tool, especially sensitive for aggressive cancers like triple-negative breast cancer.

Attia advocates aggressive colon cancer screening with colonoscopy; he's had three by age 50.

Write personal affirmations and read them aloud in a mirror twice daily — Attia did this with 47 affirmations for six months as part of his emotional health recovery.