In a medical landscape crowded with conflicting advice and questionable interventions, Dr. Peter Attia stands out for his evidence-based approach to extending not just lifespan, but “healthspan”—the period of life spent in good health. The Stanford and Johns Hopkins-trained physician has devoted his career to understanding what truly works in longevity medicine, differentiating scientific reality from wishful thinking.
Attia’s framework for longevity centers on four pillars that he believes deliver approximately 80% of potential longevity benefits: exercise, nutrition, sleep, and emotional health. “Those three things probably have the biggest impact on your physical health. It’s hard to say that somebody who’s achieving 80% of their potential on each of those three isn’t also achieving 80% of their longevity potential,” Attia explains in his approach to preventative medicine.
Unlike many in the field, Attia emphasizes that there is no one-size-fits-all solution for nutrition. Having personally experimented with various diets including ketogenic, vegan, and intermittent fasting approaches, he now advocates for personalized nutrition based on metabolic health, individual goals, and sustainability. His own regimen focuses on maintaining muscle mass with adequate protein intake—approximately 40-50 grams four times daily—while carefully monitoring glucose levels and insulin production.
For exercise, which Attia calls “the most potent ‘drug’ we have for extending quality and perhaps quantity of life,” he recommends a comprehensive approach built on four elements: stability (the foundation), strength training, aerobic/zone 2 cardio, and anaerobic/zone 5 training. Physical metrics like VO2 max, muscle mass, and grip strength serve as more reliable longevity indicators than many newer biological age tests.
When it comes to emerging biotech interventions, Attia maintains a cautious perspective, categorizing interventions as “proven, promising, fuzzy, noise, or nonsense.” Among these, he views rapamycin as “promising” due to its consistent life-extending effects across various species in laboratory settings, while considering metformin and fasting as “fuzzy” based on mixed evidence, and dismissing resveratrol as “nonsense.”
Rapamycin, which works by inhibiting a protein called mTOR involved in cellular growth, has shown remarkable potential in animal studies. “A lot of people, myself included, believe rapamycin is probably the most interesting drug we have in our toolkit for longevity,” Attia has noted. However, he emphasizes that human data remains limited, and questions about optimal dosing, timing, and long-term effects need resolution before widespread recommendation.
The NAD+ pathway, which has garnered significant attention in longevity circles, represents another area of interest but limited clinical evidence. While declining NAD+ levels correlate with aging, and precursors like NMN (nicotinamide mononucleotide) and NR (nicotinamide riboside) theoretically boost cellular energy production, Attia discusses these supplements with scientific caution, acknowledging their biochemical rationale while noting the gap between theory and proven human benefit.
For those seeking to optimize longevity now, Attia advocates focusing first on the fundamentals—what he calls “Medicine 3.0″—an approach centered on anticipating and preventing diseases decades before they manifest rather than simply responding to them. This preventative strategy targets the “Four Horsemen” of health decline: vascular disease, diabetes, cancer, and neurodegenerative conditions.
Against the backdrop of an industry often prone to hype, Attia’s evidence-based methodology provides a refreshing perspective. His work suggests that while exciting biotech interventions may eventually transform longevity medicine, the most reliable path to a longer, healthier life remains rooted in optimizing the fundamentals of physical activity, nutrition, sleep, and emotional wellbeing—interventions accessible to almost everyone without prescriptions or cutting-edge technology.
As the field evolves, Attia continues monitoring emerging research while reminding us that the science of longevity requires both patience and skepticism. The most valuable approach may be one that combines diligent attention to established health fundamentals while maintaining informed curiosity about promising developments on the horizon.