Notes from Invest Like the Best LiveStream: Peter Attia M.D.


About Peter

Maximizing lifespan and more importantly healthspan including recommendation
  • Insight about lifespan 
If you are >40, if you don’t smoke and don’t commit suicide there’s an 80% chance you will die from:
1. Heart disease and stroke
2. Cancer
3. Neuro-degenerative disease Alzheimer’s)
4. Accidental death
    • 50% of fatal car accidents happen on freeways; his hack to maintain concentration: imagine there is a random driver on the road whose sole intent is to kill you
    • 40% of fatal accidents occur at intersections with an oncoming driver approaching from the left, usually running a red light
  • Defining Healthspan 
1. Cognition
    • Executive function
    • Processing Speed
    • Short Term Memory
2. Physical
    • Maintenance of muscle mass
    • Functional movement
    • Freedom from pain
3. A sense of Purpose and Social Support
4. Distress Tolerance
  • Medicine regimes and their associated breakthroughs which increased longevity
    • Medicine 1.0
      • Up to last century; not scientifically rigorous; breakthrough’s in this era for increasing longevity was an understanding that microscopic germs caused sickness and then antibiotics and the advent of sewers/sanitation
    • Medicine 2.0
      • Randomized Control Trial which provided a means to test; this allowed us to more accurately map the proper to treatments to a diagnosis (HIV, heart disease, life support)
      • A common feature of advances in this era is that its methods were best suited to treat conditions which afflict patients quickly (heart at
      • tacks, infections, HIV)
    • Medicine 3.0 is concerned with increasing healthspan
      • While the earlier regimes made sharp jumps in improving lifespans, the challenge of studying techniques to increase healthspan is the impossibility of truly randomized, controlled, longitudinal, humane studies.
      • This regime is more of an empirically driven strategy that we must embed while tolerating a need for certainty that will not be satisfied. It relies on inference from studies and logic to make bets on the healthspan maximizing courses of action. These bets can and will be re-calibrated if the weight of evidence warrants unseating prior knowledge. The parallels to investing include being highly critical, curious, probabilistic in thought, and a servant to both a degree of randomness as well as the cumulative sum of compounded decisions. Recognizing every treatment has an opportunity cost or even an outright side-effect is health’s version of TAANSTAFL. Every habit or remedy has risk and reward. In some cases (ie antibiotic for a UTI), the trade is an easy choice. In some cases, it may be a difficult choice (extend a cancer patient’s life for X months with a brutal treatment) and in some cases, the choice may not present its pros and cons so plainly (“do these vitamins even work?”).


  • Our active role in medicine 3.0
There are 7 macro levers we can pull which can provide us with our own experiments and each lever has an infinite number of combinations within the lever and between the levers.
    1. Diet
    2. Exercise
    3. Sleep
    4. Modulation of stress
    5. Drugs
    6. Hormones
    7. Supplements
Without a sound abstracted strategy we will hopelessly flail between levers, so before diving into the latest fad we must take inventory about what we might know about these levers, how much confidence to have in this knowledge, and have a model for how to evaluate what new information makes sense to incorporate into our canon.
The strategy (imperfect as it must be) is to triangulate on possible answers using the 3 sources of knowledge we have which are capable of informing longevity.
    • Data on centenarians (about 1 in 250 people);
      • pro(s): they are humans
      • con(s): no experimental evidence, purely observational. No insight into causality
      • These studies suggest a large genetic component to longevity. While they smoke at 2x the rate as everyone else they are far more likely to carry genes which code for certain growth hormone receptors, APO-C3, APO-E2 etc
    • Studies on animals
      • pro(s): we can have controlled experiments
      • con(s): they are not humans so we are always making a leap by generalizing
    • Molecular biology
      • Discovery of senescent cells and studies of mTOR protein; these are cellular agents of biological aging
      • Studies of parabiosis (blood transfers); shows promise but we don’t understand the mechanism
      • Understanding of autophagy (body ‘rebalances its portfolio’)
  • Using evolution as a guide
    • Agriculture period coincides with .10% of our genetic history.
      • Ramifications
        1. We now live in an era of caloric abundance
          • Our ancestors thrived despite regular periods of fasting
          • We should at least be critical of ‘food in a box’
          • Preference for nutrient-dense organ meat or dark green veggies
        2. We do not need to exercise the way our ancestors did
          • Effect of sitting (our ancestors had no chairs)
          • Look how pre-school age children move perfectly
    • Sleep
      • Reasoning to why sleep must be important
        • Our ancestors’ purpose was to eat and procreate; in a dangerous world sleeping 8 hours per day (which is what the record shows our ancestors did in fact do) would appear to be a vulnerable activity to be selected against.
        • It is easy to imagine how adaptive it would appear to not require sleep and the advantage it would have conferred to those individuals. However, the odds of carrying the gene which lowers your need for sleep is less than 1 in 1000!
        • In modern times with electricity and reasons to be awake longer, it is conceivable that such an adaptation will be selected for but such changes occur over thousand of generations.
        • Summary of Matthew Walker’s “Why We Sleep”
    • Evolution can be an irrelevant guide
      • He did not find evolution to be a relevant lens for evaluating mindfulness (he expected that our ancestors were far more ‘present’) nor pharmacology (the intensity and depth of drugs being absent in ancient times)
      • In the last 200k years, our APO genes have expanded from a single type to three different types. The newer types have made our brains more resistant to brain parasites and less resistant to alzheimers.
      • Paleo people argue that meat was the way of our ancestors while vegans argue that our ancestors had no need to worry about heart disease or health in old age. Ancestral considerations will have more difficulty bearing on the sources of food.
  • Studying the sources of knowledge which represent the pillars of his strategy there will be many tactics within each of the 7 levers to employ. Some of the tactics he has incorporated as the longest standing habits in deference for the overwhelming evidence of their benefits:


    • Lifts weights and sprint/similar (strength and bone density as insurance against accidental/falling injuries in older age)
    • Sleep 7-9 hours per night
    • Time-restricted feeding
    • Don’t spike insulin; eat fewer carbs
    • Movement matters; be strong in the positions your ancestors would have been in
    • Meditation
    • Gamified feedback (wearing a glucose meter or aura ring) to nudge desired behavior. Note how the 7 levers do not offer immediate feedback making them difficult to learn from.

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