Dr. Peter Attia on Longevity Drugs, Alzheimer’s Disease, and the 3 Most Important Levers to Pull (#517)

Artist's rendering of Peter Attia

“Caloric restriction, dietary restriction, time restriction. You’ve probably heard me go on and on about my framework, the three levers. Always pull one, sometimes pull two, occasionally pull three, never pull none.”

— Peter Attia

Dr. Peter Attia (PeterAttiaMD.com) is a former ultra-endurance athlete (e.g., swimming races of 25 miles), a compulsive self-experimenter, and one of the most fascinating human beings I know. He is one of my go-to doctors for anything performance or longevity related.

But here is his official bio to do him justice:

Peter is a physician focusing on the applied science of longevity. His practice deals extensively with nutritional interventions, exercise physiology, sleep physiology, emotional and mental health, and pharmacology to increase lifespan (how long you live), while simultaneously improving healthspan (how well you live).

Peter trained for five years at the Johns Hopkins Hospital in general surgery, where he was the recipient of several prestigious awards, including Resident of the Year, and the author of a comprehensive review of general surgery. He also spent two years at NIH as a surgical oncology fellow at the National Cancer Institute, where his research focused on immune-based therapies for melanoma. He has since been mentored by some of the most experienced and innovative lipidologists, endocrinologists, gynecologists, sleep physiologists, and longevity scientists in the United States and Canada.

Peter earned his M.D. from Stanford University and holds a B.Sc. in mechanical engineering and applied mathematics.

Peter also hosts The Drive, a weekly, deep-dive podcast focusing on maximizing longevity and all that goes into that, from physical to cognitive to emotional health. It features topics including fasting, ketosis, Alzheimer’s disease, cancer, mental health, and much more. Subscribe on Apple Podcasts, Spotify, Overcast, or wherever you listen to podcasts.

Please enjoy!

Listen to the episode on Apple Podcasts, Spotify, Overcast, Stitcher, Castbox, Google Podcasts, or on your favorite podcast platform. You can also watch the interview on YouTube.

Brought to you by Athletic Greens all-in-one nutritional supplement, Oura smart ring wearable for personalized sleep and health insights, and Eight Sleep’s Pod Pro Cover sleeping solution for dynamic cooling and heating. More on all three below.

You can find the transcript of this episode here. Transcripts of all episodes can be found here.

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This episode is brought to you by Oura! Oura is the company behind the smart ring that delivers personalized sleep and health insights to help you optimize just about everything. I’ve been using it religiously for at least six months, and I was introduced to it by Dr. Peter Attia. It is the only wearable that I wear on a daily basis.

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What was your favorite quote or lesson from this episode? Please let me know in the comments.


Want to hear Peter’s last time on the show? Listen to this conversation in which we discuss Centenarian Olympics, goblet squats, dynamic neuromuscular stabilization, intra-abdominal pressure, egg boxing, tearing phone books in half, archery hunting, non-fixed personality traits, podcasting pointers, and much more.


  • Connect with Peter Attia:

Website | Twitter | Facebook | Instagram | YouTube


  • What is a liquid biopsy, and why is Peter excited about this recent innovation? How does it work, what is it good at detecting, and why does Peter consider the bureaucratic red tape snagging its rollout a “tragedy?” [07:22]
  • The four pillars of exercise someone seeking to improve their metabolic health should understand. [19:38]
  • A few of the major causes for modern posture problems, and methods for remedying them. [22:06]
  • If Peter were Czar for a day, here’s how he’d train children to grow up into a more habitually active adulthood. [27:23]
  • What is zone two training, and what is it designed to do? [30:35]
  • Why a ketogenic diet won’t necessarily make you lose weight (nor will an all-Doritos or all-Twizzlers diet, for that matter). [32:43]
  • What Peter has learned about fasting since the last time we talked. [35:01]
  • The pros and cons of front-loading one’s meals when observing time-restricted feeding (aka intermittent fasting). [39:08]
  • The three levers of Peter’s nutritional framework: caloric restriction, dietary restriction, time restriction. “Always pull one, sometimes pull two, occasionally pull three, never pull none.” [43:16]
  • Does Peter recommend using branched-chain amino acids to mitigate muscle loss during a fast? [47:52]
  • Thoughts on a recent New England Journal paper comparing the effects of Lexapro to psilocybin in patients with depression, and how you can (and why you should) increase your scientific literacy to best understand the results of such papers. [49:47]
  • Why the research around MDMA as a treatment for patients with PTSD comes to clearer conclusions than the study comparing Lexapro and psilocybin. [1:10:30]
  • How is Peter’s thinking evolving around apoB and its relationship to cholesterol control in the body? [1:12:24]
  • Are there any benefits to low apoB outside of lowering cardiovascular risk? [1:24:27]
  • What is Mendelian randomization, how does it allow us to infer cause when an experiment is not done, and how was it used recently to understand the correlation between lower apoB and improved all-cause mortality? [1:26:05]
  • Is Peter more bearish or bullish on rapamycin since the last time we discussed it? As someone who’s not receiving an organ transplant, why has he been taking it for the past three years? [1:29:03]
  • Beyond potentially increasing lifespan, do we know if rapamycin can reverse aging-related impairments to our healthspan, such as hearing loss? [1:40:19]
  • What are some of the other pharmacological candidates for extending lifespan or healthspan that Peter currently finds interesting? How does someone bring potential candidates to the attention of the ITP? [1:44:42]
  • How the Age of COVID may have finally driven Peter (and his poor family with whom he’s been locked down) bananas. [1:53:16]
  • Why Peter has become bullish on the efficacy of saunas no matter how vigorously the Finns try to sway him otherwise. [1:55:24]
  • Peter’s preferred method of zone two training. [1:59:57]
  • Peter’s thoughts on semaglutide, the new drug treatment for chronic weight management that was just approved by the FDA. [2:00:39]
  • Peter’s resources and recommendations for people who want to further step up their scientific literacy, improve their ability to separate fact from fiction, and discern hype from reality. [2:09:17]
  • On the botanical origins of certain Central American spirits, and the only thing about Texas that Peter doesn’t like (so far). [2:11:38]
  • Decaffeinated brands, Tommy Want Wingy, and other parting thoughts. [2:14:20]
  • As promised, here’s the segment detailing everything you ever wanted to know about zone two training: aerobic efficiency, what happens on a chemical level, current research, minimum effective dose, and long-term adaptations and benefits. [2:16:50]


The Tim Ferriss Show is one of the most popular podcasts in the world with more than 600 million downloads. It has been selected for “Best of Apple Podcasts” three times, it is often the #1 interview podcast across all of Apple Podcasts, and it’s been ranked #1 out of 400,000+ podcasts on many occasions. To listen to any of the past episodes for free, check out this page.