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cover of episode #276 ‒ Special episode: Peter answers questions on longevity, supplements, protein, fasting, apoB, statins, and more

#276 ‒ Special episode: Peter answers questions on longevity, supplements, protein, fasting, apoB, statins, and more

2023/10/23
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The Peter Attia Drive
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Peter Attia：我不相信通过生物黑客就能活到120岁甚至更久。我们缺乏应对衰老生物学底层机制的工具。虽然我们可以减缓衰老速度，但目前没有证据表明可以显著逆转衰老过程。关于长寿科技的媒体宣传与实际科学进展之间存在巨大差距。即使长寿科技有进展，也可能无法惠及现阶段的人们，因此应该重视现有的疾病预防和健康管理方法。针对心血管疾病、癌症和神经退行性疾病，目前只有心血管疾病有相对清晰的延缓发病的途径。预防心血管疾病的关键在于尽早采取极端措施，例如保持ApoB水平低于30或40毫克/分升，并始终保持代谢健康。我们对延缓癌症、神经退行性疾病和痴呆症等疾病缺乏确定性。采取积极的健康措施可以延长寿命，但延长幅度可能有限，重点应放在压缩晚年患病期。mTOR抑制剂在延长寿命方面具有潜力，尤其是在动物模型中表现出色。缺乏衰老生物标志物，使得评估抗衰老药物和补充剂的效果变得困难。许多干预措施缺乏明确的生物标志物来评估其有效性。由于缺乏衰老生物标志物，难以评估抗衰老干预措施的有效性和剂量。评估干预措施时，应考虑风险和收益，并根据风险大小选择合适的干预措施。不应盲目模仿他人的补充剂方案，而应根据自身情况和科学依据选择。我服用EPA和DHA补充剂，并通过血液检测来监控剂量。我服用维生素D，认为其风险极低。我服用甲基叶酸和甲钴胺，并通过检测同型半胱氨酸水平来监控剂量。我减少了B6的摄入量，因为过量摄入可能导致神经病变。我每天服用阿司匹林，但认为其益处和风险需要重新评估。我的补充剂方案会随着时间推移和新研究结果而调整。降低ApoB最有效的方法是药物干预，其次是营养干预。通过减少碳水化合物和饱和脂肪的摄入可以降低ApoB，但效果可能有限。为了将ApoB降至理想水平，需要药物干预。我反对使用大剂量他汀类药物，因为其疗效增益有限，而副作用却会增加。他汀类药物存在肌肉酸痛、转氨酶升高和胰岛素抵抗等副作用。我看好一种针对Lp(a)的新药，但该药的广泛应用取决于其价格和临床试验结果。没有“好胆固醇”和“坏胆固醇”之分，应准确使用术语。营养研究的复杂性在于人体自身的复杂性和饮食干预的复杂性。维持能量平衡是决定代谢健康最重要的因素，而不同饮食方案的关键在于长期可持续性。不能简单地将长寿人群的长寿归因于他们的饮食，因为还有其他许多因素会影响寿命。我不再进行长时间禁食，原因是缺乏明确的益处和生活方式的改变。对于50岁以下人群，是否需要减少蛋白质摄入取决于其肌肉质量和能量平衡。我每天摄入150-180克蛋白质，主要通过鹿肉干和蛋白质奶昔摄取。我目前最喜欢的可穿戴设备是Morpheus，用于监测心率、呼吸率和心率变异性，以评估训练准备度。我经常使用CGM来监测患者的葡萄糖水平，以优化治疗方案。CGM对于非糖尿病患者也具有价值，可以提供有用的血糖信息。使用CGM时，应关注平均血糖、标准差和血糖峰值。我认为连续血压监测设备即将问世。我希望能够在运动过程中持续监测乳酸水平。 Nick: 对长寿、补充剂和健康老龄化相关问题的提问和讨论。

Deep Dive

Chapters
Peter discusses the challenges of significantly extending lifespan beyond current limits, emphasizing the limitations of current tools in addressing the underlying processes of aging. He highlights the importance of focusing on healthspan and using available tools for disease prevention, rather than relying on unrealistic longevity claims.
  • Current tools are insufficient to significantly reverse aging.
  • Focus should be on healthspan and disease prevention.
  • Significant technological breakthroughs are needed for substantial lifespan extension.

Shownotes Transcript

View the Show Notes Page for This Episode)

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In this special episode of The Drive, Peter discusses a variety of topics, breaking away from the typical deep-dive format to explore a wide range of common questions submitted by listeners. Peter tackles subjects like the viability of living to 120 and beyond, addressing some of the optimistic theories regarding achievement of this remarkable feat. Peter then shares his drug and supplement regimen while emphasizing how individualized these protocols need to be. The conversation also touches on lowering apoB, the long-term use of statins, the myth of good vs. bad cholesterol, the complexities of nutrition research, the quest for the ideal diet, and Peter's strategies for hitting daily protein goals. Peter finishes with a discussion about his favorite health-tracking wearables, the role of CGM in non-diabetics, and more.

We discuss:

  • Overview of topics and previous episodes of a similar format [2:45];
  • The viability of living to 120 and beyond: some optimistic theories [4:45];
  • The potential of mTOR inhibition as a mid-life intervention, and longevity potential for the next generation [13:30];
  • A framework for thinking about geroprotective drugs and supplements in the context of a lack of aging biomarkers [17:00];
  • Supplements Peter takes and how his regimen has changed in the last year [26:15];
  • Pharmacologic strategies to lower ASCVD risk, the limitations of statins, nutritional interventions, and more [36:15];
  • Misnomers about cholesterol [48:00];
  • Why nutritional research is so challenging, some general principles of nutrition, and why Peter stopped doing prolonged fasts [50:45];
  • Optimizing protein intake [59:45];
  • Wearables for sleep and exercise, continuous glucose monitors (CGM), and a continuous blood pressure monitor on the horizon [1:04:45]; and
  • More.

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