Swimming for zone 2 and Max Aerobic Capacity
Dr. Attia, most longevity frameworks emphasize training across the four cardiovascular pillars—Zone 2 aerobic work, VO₂ max intervals, strength training, and stability. For athletes who primarily train through swimming, how can swim training be structured to effectively hit the aerobic and VO₂ max targets while still integrating the necessary strength and stability work on land to meet those longevity pillars without creating interference between adaptations?
PEMF
I am 80. I did a lot of running years ago ... maybe too much on hard surfaces. Active life until hip replacement 2 years ago. The other hip is complaining. A family member recently got a PEMF mat for her multitude of back problems and she reports it has helped a lot. Your thoughts and recommendaitons
VO2 Max
I'm a 72 y o 15-mile-per-week runner. I also do rucking and strength training. I have been diagnosed with paroxysmal AFib and have an AFib burden of 4%. I historically have not done much VO2 training, but I'm interested because of following your podcasts etc. Is it contraindicated given my afib? I scored around 12 mets recently on a stress test.
SGLT-2 Geroprotective?
I started taking Jardiance 10 months ago after suspected diastolic dysfunction. After a negative RHC, I am still taking it. I am a 72 y o runner and at the time Jardiance seen to noticeably improve my breathing while running. I'm curious if others have had similar experiences.
Post menopausal HRT
I am a 68 yr old woman. I had a hysterectomy at age 40. My ovaries were left intact, and no HRT was ever recommended. I may that time we were erroneously told that HRT caused cancer. Additionally, I was never a candidate for oral contraceptives in my younger years. Recently, I began working with a functional medicine Dr in conjunction with my concierge primary care physician. My functional med Dr prescribed subQ injections of estrogen and testosterone weekly and oral progesterone daily. I terminated that protocol after three weeks. The unpleasant side effects were breast/nipple swelling and sensitivity, swollen and sensitive exterior vaginal area, with an unpleasant vaginal discharge. After listening to your podcast with Lisa Mosconi I wondered what thoughts you had regarding why this occurred. I will add that my 66yr old sister experienced the same side effects. There was no medical reason for starting HRT other than lack of hormones. I’m wondering if I lack the estrogen receptors needed and thereby a balance of these three hormones could not be achieved.
Taking lipid lowering drugs even if normal cholesterol levels?
I’m referring to the very interesting article by Peter Attia on whether lowering cholesterol can harm the brain: https://peterattiamd.com/does-lowering-cholesterol-harm-the-brain/ In that context, it is stated (reg. neuro-protections): • HMGCR (statin target): OR = 0.24 (95% CI: 0.18–0.31) • NPC1L1 (ezetimibe target): OR = 0.18 (95% CI: 0.12–0.15) • CETP (obicetrapib target): OR = 0.30 (95% CI: 0.26–0.34) Based on this, I have a few questions: (a) Does it make sense to use lipid-lowering drugs even if cholesterol levels are already “normal”? Specifically, for cardio-protective benefits? (b) In the same situation, would it make sense to take such drugs for neuro-protective benefits? (c) If the answer to (a) and/or (b) is yes: • (c.1) How much lower should we aim for in terms of LDL or apoB? • (c.2) Which drugs to choose? The ORs for different targets vary — for example, PCSK9 inhibitors don’t appear to have a directly relevant OR in the above set. How should this influence choice? (d) For context: I currently lower my LDL/apoB primarily using a PCSK9 inhibitor plus 5 mg Rosuvastatin (due to 2 stents - no MI), and my LDL is very good around 0.9 mmol/L. Should I consider adding a low dose of ezetimibe or another agent? Thanks very much in advance for insights and thoughts! Best regards, Ruedi (also former McK… 🙂)
Apo B drug regime
Thanks to your influence, I have reduced my Apo B down to exellent levels. I am on a drug regime of 40 MG of rosavustatin and ezitimibe. I am a healthy 56 year old male with a slight high LP(a) and a family history of heart disease...(my father had a heart attack at 45 and a second fatal one at 50). I am in Canada and bempedoic is about to be approved for use. NILEMDO. Should I be altering my regime to add it and or a GLSK9 inhibitor. I have no noticeable side effects on the statin plus ezetimibe. I see lots of social media stuff about statins.
Pioglitazone & Fracture risk
After the discussion with Dr. DeFronzo, Dr. Attia mentions it became incorporated into his practice. However, given the data on increased fracture risk and decreased bone mineral density, how you are mitigating this risk, especially given the importance of fracture mitigation for "Healthspan"? Alternatively, how are you balancing these risks and benefits? I am imagining cycling it as needed to achieve relative diabetes remission so curious what you've been thinking.
Excercise
I mam88 years old Have participated in many events such as triathelons , swimming jogging etc Consider myself fairly fit still participate in 5 km runs( at a slowerPace now) since your audience for 80+ years is probably small and there is not much information available for my age group I like to know how streneous excercise I should perform at my age Since I have followed your for several years now I feel I know you personally I have lived in Toronto for many years and so have you I believe you went to Queens which I also did I am happy that I have connected to your information Wolfe ( still kicking)
Sleep deprivation APOE 4/4
Dr. Attia, I am a 40 year old firefighter. I discovered last year that I am a 4/4 ApoE. I currently work at a slower station and do get decent sleep most nights. 6-7 hours. At home I sleep really well 7-8 hours. I stopped drinking alcohol last year. I have always invested heavily in my health and fitness. I exercise a lot and mix it up regularly. My diet is also clean. I am on the list to promote to captain. If I do so I will be sent to a firehouse that is much busier. I could be in for sleepless nights. We work 48 hour shifts. Given my ApoE status will the 10 nights a month of decreased sleep quality be a significant hindrance to my long term brain health? Or can I offset a lot of it with my excellent habits on my days off? Thank you for any insight you can provide on this topic and thank you for all that you do.
Needed
There is certainly a cloud of uncertainty these days. It would be helpful to subscribers to see a simple breakdown of the big personality longevity snake oil salesmen, their claims, products, etc. also would be helpful to focus on some listeners who aren’t part of the 2% in terms of affordability for diet, supplementation, testing, etc.
Back damage comparison of rep ranges
In the podcast episode with Stewart McGill, he mentions that you are causing micro fractures when you hit personal bests. Usually people are doing personal bests with a 1 rep max. If I do the calculated equivalent of a personal best with a lower weight but more reps, is the same damage happening? Is it based how close I get to failure? Should I only do 6, 7 or 8 RPE (2, 3,4 RIR) How can I continue to get stronger at deadlift, squat etc to strengthen my back muscles without damaging the back?
Drinking
Hello Peter I’m a long time subscriber and listened to you since the first time you were on the Tim Ferris show. I would like to ask your advice on how to reduce drinking alcohol or stop altogether. I feel it’s become an unhealthy habit. I’m 47 years old and in good physical condition. I just had my first child. Baby girl Reese. She’s become my world and I’d like to become healthier for us both. However, I do really like drinking and can’t seem to wrap my brain around living a life without alcohol. But frankly I drink too much; 5-6 nights per week. 4-6 drinks per evening. I know that’s not healthy. Please advise.
Hip abducter/adducter
In your podcast with Adam Cohen the hip abducter/adducter muscles were likened to the rotator cuff of the hip. Very important to keep them strong. Do those abducter/adducter weight machines in gyms do a good job of that? Or do we all need to learn the DNS Star Plank. Or will doing squat variations and hip hinge variations take care of those muscles?
The Seemingly New Craze about TUDCA
Good Morning, I would like your knowledge and opinion on the use of TUDCA as a means of hepatocyte protection/regeneration in individuals with fatty liver and/or liver fibrosis. I have read countless scientific/medical studies, done on mice of course, that seem to point towards a "winner" for liver health. I cant seem to find any studies on humans though and I wasn't sure if you had the answer to this. I would appreciate any discussion on the mechanisms in which TUDCA works, at least in theory. Thank you Dr. Attia and research gang. ~ William
Sunscreen while indoors
I have heard that truckers have more skin cancer on the left side of their face due to UV getting in through the car window. How much should we be concerned about this when inside a building? For example, if I am not going to leave my apartment at all today, do I need to put on sunscreen to protect myself from potential UV coming in through the window? Or is that only necessary in a car or if I would otherwise be next to a window all day?
Need for Sunscreen by UV Index
I always put on sunscreen when I am going outside and the UV index is more than 0. Is this appropriate? In other words, for Fitzpatrick type 2 skin (for example), do I need sunscreen if the UV index is 1? Alternatively, might I need it even when the UV index is 0?
Sunscreen Timing Indoors
We are told to reapply sunscreen every two hours. But does that mean every two hours outdoors, or every two hours regardless (even if indoors)? In other words, is it the sun exposure that is degrading the sunscreen, or will its protective effects wear off regardless of UV exposure? The question can also be expressed in a practical way as follows: Imagine I put on sunscreen in the morning before walking 15 minutes outside to go to class, which lasts for four hours. Before I walk back home, do I need to reapply sunscreen? It's been 4.25 hours since I applied, but only 15 minutes of those were outside. Now, what about at the end of an 8-hour workday?
Lithium orotate for dementia delay or prevention
Hello! First off, I'm sorry for all the over-the-top, unhinged reactions you've been receiving lately. I hope you're able to continue with providing content soon. My question: I've been hearing chatter about supplementing with lithium orotate as a potential tool for delaying or preventing dementia. I'm not sure if there is any quality research behind this. Would you be able to help us evaluate the quality of any studies that address this? Thanks so much and I wish you the best.
Fiber type goals left out of zone two discussion??
“When we talk about longevity training, we often frame it as Hiit (2x per week), Zone 2 plus…..’some strength training.’ But muscle fiber distribution in strength training introduces a meaningful 2×2: Type I vs Type II fibers crossed with Power work, Hypertrophy work, high rep endurance work. Why do you think fiber type—and especially adaptations of Type II fibers at lower intensities—is often left out of the conversation, as if strength training were a single block rather than multiple distinct physiological quadrants? I count 4 or maybe 8 quadrants with two types of aerobic work and three types of barbell work (power, hypertrophy, endurance). this has big implications for sports specific training beyond just the pro athletes to 80% low intensity and 20% high intensity…. Not to mention neurological developments for movement specificity like you might get practicing a specific movement and adapting in that way. Thanks
starting and progressing z2 + older adults
I'm new to your full member podcasts and recently listened to episode #379 – AMA #79: A guide to cardiorespiratory training at any fitness level to improve healthspan, lifespan, and long-term independence. In the section on how to structure and execute a zone 2 workout [A: 59:45, V: 1:05:53], you suggested a practical starting point for people new to cardiorespiratory training: three 30-minute sessions per week. However, I didn't hear you discuss how to ease into this gradually—perhaps by building a base and limiting weekly increases to no more than 10% (or likely less for those already in their 60s or 70s). This concerns me because, as someone now in my mid-60s recovering from years of overtraining, it's taken considerable time to determine sensible weekly progressions (especially when combining aerobic and strength training), and to recognize when to increase volume versus when to hold back. I've read that the commonly cited 10% weekly increase may be optimistic for older adults, which suggests that starting at 90 minutes per week might not be appropriate for everyone. My questions are: 1. What actual starting point would you recommend for beginners—particularly older adults—when beginning zone 2 training? Should it be less than 3×30 minutes per week? 2. As we age, should weekly volume increases be more conservative—perhaps 5-8% rather than 10%? Acknowledging it’s not 1 size fits all. (I monitor myself via HRV, RHR, and lactate testing, so I'm managing my own progression. My concern is for listeners who may lack this guidance.)