Peter Attia, MD On Becoming a Centenarian Decathlete, Metabolic Health & All Things Zone 2

David [Sinclair] and Charles [Brenner] basically go back and forth about two different molecules, NR and NMN, as precursors for NAD. And again, I would say say no disrespect to them, but that's like rearranging the deck chairs on the Titanic compared to exercise.

The data for the efficacy of NR and NMN as a tool to boost longevity is nonexistent at this point in time ... The interventions testing program at the NIH... unequivocally showed that NR did not work. So, if there are benefits to NR and NMN, we haven't seen them yet. And I would argue that if they do exist, they're not going to be that big. They're certainly not going to be on the order of what we see with exercise.

I was kind of joking about this with Andrew Huberman the other day, which was I wish they would just create a rule that says, you're not even allowed to argue on Twitter about a molecule until you're exercising 10 hours a week.

Exercise is the single biggest elixir for brain health. And it's amazing how much more powerful it appears to be than nutrition, even sleep. And those things are very important, but exercise is in a league of its own.

The difference in risk between a person whose VO2 max is in the top 2.5% for their age and someone who's in the bottom 25%... It's a 5-fold difference in accruing risk of all-cause mortality.

It's true that if you're doing no exercise, just getting you to do 3 hours a week has an unbelievable impact on your life—probably more than anything else you could tell that person to do ... If you could do 10 hours a week, and it's really well-structured, the sky's the limit for what you could achieve.

If you're training for a specific sport, you're going to have to understand what zone you need to be in and spend the appropriate time there. But if you're talking about health, I think you're talking 90% zone 2, 90-95; 5-10% is zone 5—that's about it. So, I do 1 VO2 max workout a week. That's it.

If you're 65, and you fall and break your hip, your 12-month mortality—meaning, the probability you'll be dead within the next 12 months—depending on the study, is 30-40%.

Even more so than cancer and certainly cardiovascular disease, we really don't have options for patients once they have dementia. This has been an area of extensive study that has yielded effectively nothing. If we're going to be brutally honest, it has yielded effectively nothing.

I took metformin for probably 8 years ... But once I got really nerdy on my zone 2 training and was really tracking lactate levels and doing all sorts of stuff, I just couldn't help but wonder, was metformin potentially poisoning my mitochondria just a little bit?

Of the three metrics that we care about—average glucose, variability of glucose, and just the number or frequency of spikes—I would say that the frequency of spikes is probably the least important.

Athletes are the best cheaters. The more you're a grinder, the better you are at cheating your way around bad movement patterns.

Lifespan and healthspan are sort of the two vectors of longevity ... The good news is they're not independent vectors; they are actually not orthogonal vectors ... If you take all of the steps to live a better life, they're just, invariably, going to also lead to a longer life.

There are 9 hallmarks of aging, and 1 of them is mitochondrial dysfunction. We just know that, as we get older, our mitochondria get less and less effective. And what you really want are mitochondria that can access fat stores at basically higher and higher levels of work output.

There's a prescription drug called trazodone that really helps people who are dysregulated in their sleep because of rumination. It's a non-habit-forming, amazing drug that, more importantly, preserves sleep architecture. Most sleep drugs don't really preserve sleep architecture that well.

Hypercortisolemia is completely destructive to your metabolic health in excess ... This chronic elevation of cortisol is incredibly destructive for insulin resistance and all sorts of other things.

Zone 2 is the one that is basically defined as the maximal level of aerobic output that you can generate while keeping lactate below 2 mmol.