Dr. Peter Attia

Sponsors: Eight Sleep, LMNT, HVMN, Momentous

Lifespan vs. Healthspan

“4 Horseman of Death”, Diseases of Atherosclerosis

Tool: Hypertension & Stroke, Blood Pressure Testing

Preventing Atherosclerosis, Smoking & Vaping, Pollution

Sponsor: AG-1 (Athletic Greens)

Cholesterol, ApoB

Cholesterol Levels, LDL & ApoB Testing

ApoB Levels & Atherosclerosis, Causality

ApoB Reduction, Insulin Resistance, Statins, Ezetimibe, PCSK9 Inhibitors

Monitoring ApoB

Sponsor: InsideTracker

Reducing Blood Pressure, Exercise & Sleep

High Blood Pressure & Kidneys

Alcohol, Sleep & Disease Risk

Cancer & Cancer Risks: Genetics, Smoking & Obesity

Cancer Screening & Survival

Radiation Risks, CT & PET Scans

Environmental Carcinogens

Genetic & Whole-Body MRI Screening, Colonoscopy

Neurodegenerative Diseases, Alzheimer’s Disease, ApoE

Alzheimer’s Disease & Amyloid

Interventions for Brain Health, Traumatic Brain Injury (TBI)

Accidental Death, “Deaths of Despair”, Fentanyl Crisis

Fall Risk & Stability, 4 Pillars of Strength Training

Emotional Health

Mortality & Preserving Relationship Quality

Relationships vs. Outcomes, Deconstructing Emotions

Treatment Centers, Emotional Processing & Recovery

Tool: Inner Monologue & Anger, Redirecting Self-Talk

Zero-Cost Support, YouTube Feedback, Spotify & Apple Reviews, Sponsors, Momentous, Social Media, Neural Network Newsletter

The Huberman Lab Podcast features Dr. Peter Atiyah, an expert in healthspan, vitality, and longevity. He discusses major causes of death and ways to prevent them through various approaches, including the importance of emotional health. Dr. Atiyah has a newly released book called "Outlive: The Science and Art of Longevity." The podcast aims to bring science-related information to the general public for free and is sponsored by several companies. Blood pressure, smoking, and ApoB levels are the three major risk factors for health, but lifestyle changes can help adjust ApoB levels and lower blood pressure without medication. Low kidney function can lead to dialysis and increase the risk of death. Cancer is the second leading cause of death globally, and no dose of ethanol is healthy for the body. Ethanol consumption can impact sleep and increase the risk of neurodegenerative diseases. Screening is important for detecting cancer early. Alzheimer's disease is the most prevalent form of dementia, and age is the biggest risk factor. Emotional health is the most vital component of overall health and includes connectivity, purpose, regulating emotions, fulfillment, and being present. Repairing relationships involves understanding emotions and the nature of the interaction.

- The Huberman Lab Podcast discusses science and science-based tools for everyday life.
- Dr. Peter Atiyah is a medical doctor and world expert in healthspan, vitality, and longevity.
- In the podcast episode, Dr. Atiyah discusses the major causes of death worldwide and ways to prevent them through behavioral, nutritional, supplementation-based, and prescription drug-based approaches.
- Emotional health is also important for physical health and longevity, and Dr. Atiyah shares his personal experiences and tools to improve emotional health.
- Dr. Atiyah has a newly released book called "Outlive: The Science and Art of Longevity," which is a comprehensive health guide that includes information on emotional health and is available for pre-order.

- The podcast is separate from the speaker's teaching and research roles at Stanford.
- The podcast aims to bring zero cost science-related information to the general public.
- The podcast is sponsored by Eight Sleep, Element, HVMN Ketone IQ, and Momentus Supplements.
- Eight Sleep makes smart mattress covers that regulate temperature for better sleep.
- Element is an electrolyte drink that helps with hydration and mental and physical performance.
- HVMN Ketone IQ is a supplement that increases blood ketones for better focus and energy.
- Momentus Supplements can be found at livemomentus.com/huberman.
- The podcast features a discussion with Dr. Peter Atiyah.

- To reduce high cholesterol levels, nutrition and carbohydrate restriction should be the first approach before considering medication.
- Elevated triglycerides are a hallmark of insulin resistance and can be lowered through carbohydrate restriction.
- Exercise can improve insulin sensitivity and lipids, but has a minimal role in reducing cholesterol levels.
- Statins and ezetimibe are common prescription medications for high cholesterol, but can have side effects such as muscle soreness, brain fog, and insulin resistance.
- PCSK9 inhibitors are a newer class of drugs that block a protein that degrades LDL receptors, leading to lower LDL cholesterol levels.

- Short-term benefits are not expected when taking drugs to reduce ApoB levels.
- Atherosclerosis can be asymptomatic and the most common presentation of a heart attack is death.
- Improving sleep, exercise, and nutrition can lead to feeling better, but improving ApoB levels may not have an immediate effect on how one feels.
- It is recommended to measure ApoB levels starting in one's 20s, especially if there is a family history of concern.

- InsideTracker is a personalized nutrition platform that analyzes data from blood and DNA to help understand the body and reach health goals.
- Blood work is important to monitor hormone markers, lipids, and metabolic factors that impact immediate and long-term health.
- InsideTracker provides a personalized dashboard to address nutrition, behavior, and supplement-based approaches to move values into optimal ranges.
- InsideTracker now includes a measurement of apolipoprotein B (ApoB), a key marker of cardiovascular health.
- Use the code "Huberman" to get 20% off any of InsideTracker's plans.

- The three major risk factors for health are blood pressure, smoking, and ApoB levels.
- Exercise, nutrition, and weight management can help adjust ApoB levels and lower blood pressure without medication.
- Medication is an option if lifestyle changes do not work, but it should be a last resort.
- Getting enough sleep is also important for overall health.

- High blood pressure can have a significant impact on the kidney and brain.
- The kidney is a vital organ that needs attention for longevity.
- Measuring kidney function accurately is important, and relying on creatinine alone may not be sufficient.
- Low kidney function can lead to the need for dialysis and increase the risk of death.
- The kidney is sensitive to blood pressure and needs to be taken care of.

- Cancer is the second leading cause of death.
- There is no dose of ethanol that is healthy for the body.
- The risk of harm from alcohol consumption increases non-linearly after one drink per day.
- The impact of ethanol on sleep is underappreciated and can have indirect effects on cardiovascular and cerebrovascular disease.
- Ethanol consumption can also impact neurodegenerative diseases, especially dementia.
- One should make trade-offs between pleasure and healthspan when it comes to consuming alcohol.

- Globally, there are about 11-12 million deaths per year due to cancer.
- Between one in three and one in four people will get cancer in their lifetime, but only half of them will die from it.
- Germline mutations account for less than 5% of cancer cases, while somatic mutations are the main drivers of cancer, with smoking and obesity being the two clearest indications.
- Obesity is the second most prevalent environmental driver of cancer, but it is likely due to insulin resistance and inflammation rather than just excess fat.
- There is no proven anti-cancer diet or exercise regimen, and screening is currently the best way to detect cancer.

- Screening for cancer is important because it is more effectively treated when caught early.
- Imaging is the first line of screening for cancers inside the body.
- MRI scanners are a good option for screening because they do not use radiation.
- Liquid biopsies are a new method of screening that look for cell-free DNA in the blood to detect cancer.
- The problem with relying on one screening modality is optimizing sensitivity and specificity.

- Trivial amounts of radiation are emitted from body scanners at airports and DEXA scans.
- Pilots who fly frequently may receive up to 10 millisieverts of radiation per year, which is still within the recommended limit of 50 millisieverts per year.
- CT and PET scanners used in medical procedures are the biggest source of radiation, with some off-the-shelf scanners emitting up to 20 millisieverts of radiation.
- Patients should ask about the amount of radiation they will be exposed to before undergoing any imaging studies, and should choose a facility with better equipment and software to minimize radiation exposure. 
- MRI scanners are preferred over CT and PET scanners because they do not emit radiation.

- The author worked with mutagens and radioactive materials as a graduate student, but acknowledges that most people are exposed to carcinogens through everyday household items like pesticides and paint thinners.
- The author is unsure of the real cancer risk posed by these ubiquitous items, as it is difficult to calculate.
- Asbestos and lead warnings are common in buildings, but the author does not worry about them unless they are being agitated.
- The author believes it is more productive to focus on controlling what they can, rather than worrying about uncontrollable risks.

- The discussion will cover important topics related to vitality and longevity.
- Longevity involves both lifespan and healthspan.
- Healthspan is the period of time free from disability and disease, but also includes physical, cognitive, and emotional health.
- Longevity must address all of these dimensions to be effective.
- Emotional health is the most complicated and difficult to measure.

- The speaker cannot control their genes but can control the timing and frequency of cancer screening.
- They recommend genetic screening for certain genes, such as ApoE for neurodegenerative disease.
- Colon cancer screening is important and can be done through colonoscopy, but there are risks involved.
- Whole body MRI has a high sensitivity but low specificity, and may lead to false positives.
- The cost of a whole body MRI can vary, but one company mentioned is Prenuvo.

- Alzheimer's disease is the most prevalent form of dementia and neurodegenerative disease, affecting roughly 6 million people in the US.
- Age is the biggest risk factor for developing Alzheimer's disease, as well as other neurodegenerative diseases such as Lewy body dementia and Parkinson's disease.
- The ApoE4 gene is highly associated with the risk of Alzheimer's disease, but it is not deterministic. There are other deterministic genes that make up about 1% of cases.
- Alzheimer's disease can lead to failure to thrive, aspiration, and vulnerability to infections due to loss of bodily control and awareness.

- The index case for Alzheimer's disease had an APP mutation, which led to an overemphasis on amyloid beta.
- Removing amyloid is important, but it's not crystal clear what it does.
- There have been unsuccessful drugs that target amyloid.
- The field of Alzheimer's research is in crisis due to the lack of efficacy in anti-amyloid therapies and biomarkers.

The following are the four things that are unequivocally true for brain health: 
1. Sleep matters
2. Lower LDL cholesterol and ApoB is better than higher
3. Not having type two diabetes matters
4. Exercise matters, specifically one hour of low intensity cardio, one hour of strength, and one hour of interval training per week. 

Other potential interventions for brain health include hyperbaric oxygen therapy and supplements such as theracumin, magnesium with L3N8, methylated vitamins, and EPA and DHA. However, the evidence for these interventions is unimpressive compared to the big four. Additionally, avoiding head injuries is important for brain health.

- Accidental deaths are a significant cause of death, with automotive accidents, falls, and overdoses being the primary causes.
- Fentanyl-related deaths have surpassed all other accidental deaths below the age of 65, with the majority of deaths coming from counterfeit pills laced with fentanyl.
- The risk of falls leading to death or mortality within 12 months is high for those over 65, with a 15-30% probability of death after breaking a femur or hip. 
- The speaker advises caution when taking pills from unknown sources, as they may be laced with fentanyl.

- Ability to jump and land is highly correlated with the ability to avoid falls and control them to minimize injury.
- Atrophy of type two muscle fibers is the hallmark of aging on the muscle, leading to loss of explosive power and speed.
- To age well, training must stress and strengthen type two fibers, including strength, reactivity, and explosive training, as well as jumping and landing exercises.
- Four pillars of longevity through physical exercise include strength, stability, aerobic efficiency, and aerobic peak output. Stability is often overlooked but crucial for aging well.
- Stability training involves multifaceted exercises, including slow step-ups and step-downs, to build concentric strength and avoid cheating.

- The emotional health chapter in the book is different from the others as it is based on experiential knowledge rather than expertise.
- Emotional health is an important component of quality of life and is difficult to define, but includes connectivity with others, having a sense of purpose, regulating emotions, experiencing fulfillment and satisfaction, and being present.
- Being present is a challenge for many people, including the author, and requires deliberate attention.
- The ability to contract and dilate our time perception is remarkable but can also take us out of what's meaningful in the moment.

- The author wonders if our difficulty in being present is due to a subconscious refusal of our own mortality.
- The literature suggests that contemplating one's mortality can actually bring peace.
- The author believes they have more agency over the quality of their life than the length of it, particularly in terms of relationships.
- The author has incorporated various practices and behaviors into their daily routine to maintain emotional well-being and health, including being mindful of and quickly repairing any damage caused in relationships.
- The author believes that striving for perfection in relationships is unrealistic, but repairing damage when it occurs is crucial.

- The text discusses how to repair a relationship fracture when feeling wronged by a loved one or coworker.
- The first step is to determine if the relationship is worth repairing.
- It is important to understand one's own emotions and deconstruct them to approach the situation effectively.
- The nature of the interaction should be considered, whether it is transactional or if the relationship matters.
- The coarseness of language limits our ability to understand and express our emotions accurately.

- The author went to treatment centers in 2017 and 2020 due to rock-bottom moments in their life.
- The experiences were emotionally difficult but taught the author about their overly analytical nature and the importance of dropping rationalizations.
- The author learned to accept emotional traumas and surrender to the adaptations that came from them.
- The author does not revisit their childhood experiences often but continues to use dialectical behavioral therapy and practice skills learned from their experiences.

- There are four major causes of death: diseases of atherosclerosis, cancer, cerebrovascular disease, and hemorrhagic events.
- Atherosclerotic cardiovascular disease is the leading cause of death globally, with 18-19 million deaths per year.
- Cerebrovascular disease can occur through embolic events, which interrupt blood flow to the brain and can be caused by clots or plaque buildup.
- Hypertension is a risk factor for both heart and brain-related diseases.
- The majority of strokes result from an embolic phenomenon.

- The speaker has had a lifelong issue with anger and rage.
- They had a violent and critical inner monologue that spilled over into their interactions with others.
- They worked with a therapist who gave them an exercise to speak to themselves as if they were a close friend whenever they had negative self-talk.
- This exercise helped them get rid of their inner critic in just four months.
- The speaker believes that emotional health is the most vital component of overall health.

- Dr. Peter Atiyah has a new book coming out on March 28th, 2023 called "Outlive, the Science and Art of Longevity"
- The podcast can be supported by subscribing to their YouTube channel and leaving a five-star review on Apple and Spotify
- The podcast has partnered with Momentus Supplements and their products can be found at LiveMomentus.com/huberman
- The Huberman Lab podcast covers science and science-based tools on social media platforms such as Instagram, Twitter, Facebook, and LinkedIn
- The Huberman Lab podcast neural network newsletter is a monthly newsletter that includes free toolkits and can be found at HubermanLab.com

1. Blood pressure is the leading driver of hemorrhagic stroke phenomenon.
2. The more aggressively blood pressure is managed to be within the 120 over 80 range, the better.
3. Blood pressure readings in the doctor's office can be often misleading, and manual blood pressure is better than automated.
4. People can check their own blood pressure with a cuff and a bulb, and it is not rocket science.
5. A typical range of costs for a quality blood pressure cuff is around $40, and a good stethoscope is a couple of hundred dollars.
6. Continuous blood pressure monitoring would be an integral part of a person's health checkup once a year.

- Arteriosclerosis is the number one killer and can be prevented through three major ways: maintaining good blood pressure, not smoking, and avoiding ApoB bearing lipoproteins.
- Smoking is harmful to the endothelium, the innermost part of the arterial wall, and can cause chemical irritation, while high blood pressure can cause mechanical irritation.
- The risks of smoking cannabis and vaping are not fully understood, but they are still harmful to the body and should be avoided if possible.
- Inhaling any substance can be harmful to the body, as the lungs have a large surface area for absorption.
- Air pollution, particularly from particulate matter, is a major health concern and can be more deadly than greenhouse gas emissions.

- Athletic Greens is a vitamin mineral probiotic drink that covers all foundational nutritional needs.
- It contains probiotics that are optimal and vital for microbiotic health.
- It also contains adaptogens, vitamins, and minerals to meet all foundational nutritional needs.
- The speaker has been taking Athletic Greens since 2012 and recommends it.
- Listeners can try Athletic Greens and get five free travel packs by going to athleticgreens.com/huberman.

- Athleticgreens.com/Huberman offers five free travel packs and a year's supply of vitamin D3K2.
- Maintaining blood pressure at 120 over 80 or better and avoiding smoking and vaping can help prevent health issues.
- Cholesterol is a vital molecule that the body synthesizes and is essential for cell membranes and hormone production.
- Lipoproteins, such as ApoB, transport cholesterol around the body, but those with ApoB are atherogenic and can contribute to atherosclerosis. 
- Understanding the role of lipoproteins and cholesterol in the body is important for preventing health issues.

- LDL and ApoB perform functional roles in the body, but their levels can also be bad for health.
- HDL can perform all the functions of LDL and ApoB.
- Most species do not have ApoB and are incapable of atherosclerosis.
- Cholesterol is important for brain development, but infants and children have low levels of serum cholesterol.
- ApoB is a better predictor of risk than LDL-cholesterol.

- The speaker's ApoB levels are above the high end and will be discussed over dinner.
- Dietary cholesterol has no direct link to ApoB and LDL, but dietary saturated fat does.
- The ideal ApoB level depends on individual objectives and factors such as family history and age.
- ApoB is causally related to atherosclerosis and should be modified regardless of risk tail in duration.
- The earlier treatment starts, the less aggressive it needs to be. The ideal ApoB level may be around 60 milligrams per deciliter, but may be lowered to 30-40 milligrams per deciliter for those with other risk factors. High ApoB levels are a red flag and require investigation.

Dr. Peter Attia: Improve Vitality, Emotional & Physical Health & Lifespan | Huberman Lab Podcast