In Andrew Huberman’s recent podcast with Peter Attia, Peter shares wisdom on:

• His framework for longevity

• The medications and supplements he personally takes

• Why he doesn’t take NAD, a molecule that’s gaining popularity in the longevity world

In this article, we summarize the key insights and actionable takeaways.

Peter Attia's framework for longevity

Peter Attia outlines three key categories for how people can impact their longevity:

1. Essential behaviors

   • Nutrition

   • Sleep

   • Movement

   • Emotional health

2. Exogenous molecules targeting disease processes

   • Today, living longer means delaying the onset of chronic disease (cardiovascular, cerebrovascular, cancer, neurodegenerative, and metabolic). This is a deviation from the previous century, where living longer meant surviving birth and avoiding infection or trauma.

   • This includes metformin, SGTL2 inhibitors, GLP-1 agonists, PCSK9 inhibitors, and statins.

3. Exogenous molecules that are geroprotective

   • There are 9-14 central markers that people would agree define an aging phenotype (e.g., more inflammation, abundance of senescent cells, reduced nutrient-sensing capacity of mTOR)

   • This includes rapamycin.

Attia's view places behavioral habits at the core of long-term health. These are foundational and non-negotiable if your goal is to extend both lifespan and healthspan. Advanced interventions are secondary.

He uses an analogy to emphasize the importance of prioritizing the right actions: NAD+, rapamycin, and other advanced interventions are like asking, “Did they serve lobster or steak on the Titanic?” On the other hand, nutrition, sleep, movement, and emotional wellbeing are like asking, “What direction was the Titanic going relative to the iceberg?” These basics determine the bigger picture.

The takeaway is clear: Before you dive into supplements or anti-aging treatments, you need to ensure you’re eating well, getting quality sleep, exercising regularly, and addressing your emotional health. These foundational practices are like steering the ship in the right direction, helping you avoid the "iceberg" of poor health and premature aging.

Nonetheless, Attia believes there is a lot of potential for certain molecules.

What Peter Attia takes to live better, longer

Peter Attia himself takes a carefully considered array of medications and supplements, targeting both disease prevention and aging itself.

• Disease-specific interventions

  • PCSK9 inhibitors: For lowering LDL cholesterol and preventing cardiovascular disease.

  • Bempedoic acid and SGLT2 inhibitors: Both aid in glucose management and metabolic health, with SGLT2 inhibitors also being broadly geroprotective

• Geroprotective interventions

  • Rapamycin (8 mg, once a week): Targets one of the key hallmarks of aging by inhibiting mTOR, which plays a role in nutrient sensing and cell growth.

    • Attia notes that this medication can cause canker sores, so he is usually on it for 2 months and off for 1 month.

    • Only around 10% of his patients take rapamycin.

    • Peter is cautiously optimistic about rapamycin given not only the molecular pathways (e.g., why does inhibition of mTOR stimulate autophagy, and why does that lead to fewer senescent cells), but mostly given the experiment data. This includes the ITP’s study in mice.

• Supplements:

  • EPA/DHA (Omega-3 fatty acids): For heart and brain health.

  • Curcumin (theracurmin): For cognitive function.

  • Vitamin D (5000 IU): For bone health and immune function.

  • Methylfolate and Methyl B12: For vascular health

  • Magnesium

    • Magnesium L-Threonate: For cognitive function and brain health. This form of magnesium can cross the blood-brain barrier more easily.

    • Magesium Chloride: For muscule relaxation and energy production. This slow-releasing form is highly bioavailable and supports general magnesium replenishment.

    • Magnesium Oxide: For digestion. Although less bioavailable, this is useful for addressing magnesium deficiencies quickly.

  • Ashwaganda: For sleep

  • Creatine monohydrate (5g/day): For muscle function and energy production

  • Probiotics: For gut health. Unlike other probiotics, Pendulum uses anaerobic bacteria, which Attia believes is critical.

  • Multivitamin: Attia mentions AG1. (Note: Attia is compensated by AG1 as a scientific advisor and is an investor).

  • Electrolytes: Attia mentions LMNT. (Note: Attia is an investor and advisor).

Why Peter Attia Doesn’t Take NAD

Importantly, Attia, unlikely many other longevity gurus, does not take NAD.

NAD (nicotinamide adenine dinucleotide) is a critical cofactor in many biological processes, including energy production, DNA repair, and cellular health. It acts as a shuttle for electrons, helping cells generate the energy they need to function. Because of its involvement in DNA repair and cellular metabolism, NAD has been linked to aging, with some suggesting that boosting NAD levels could slow down or reverse aspects of the aging process. However, Petter Attia doesn’t buy it.

NAD vs. NMN vs. NR

To start, let’s define some key terms.

Sirtuins: Sirtuins are a family of proteins that are involved in many biological processes, including metabolism, inflammation, and DNA repair. DNA repair is believed to be important for longevity. Sirtuins use NAD in the process of DNA repair.

NAD (nicotinamide adenine dinucleotide): NAD is primarily used in the body to shuttle electrons. NAD+ is the oxidized form of NAD, acting as an electron acceptor; when NAD+ accepts electrons, it becomes NADH.

NMN (nicotinamide mononucleotide): NMN is a precursor to NAD. NMN is directly converted into NAD+.

NR (nicotinamide riboside): NR is also a precursor to NAD. NR is converted to NMN inside cells, which is then converted into NAD+. NMN cannot cross the cell membrane because it has an extra phosphate group, so NR is slightly more bioavailable.

There’s been a lot of debate about whether directly taking NAD (often via infusion), NMN (often orally), or NR (often orally) is the best way to boost NAD levels. Peter Attia doesn’t think the differences matter much—the debate, Attia argues, is mostly commercial rather than scientific. The bioavailability of NR over NMN is irrelevant through dose adjustments. The key difference: NAD is significantly more expensive than NR, which is significantly more expensive than NMN.

The main question is whether boosting NAD levels actually translates into meaningful benefits for longevity—Attia believes the answer to be no.

Key studies on NAD

NAD has become a focal point in longevity research since the famous work in yeast where overexpression of sirtuins—proteins that rely on NAD—was linked to increased lifespan.

However, further studies produced mixed results. Most studies in flies, worms, and mammals have failed to show any increase in lifespan due to overexpression of sirtuins.

Only one mouse model showed an increase in lifespan for mice, and this increased was only observed by male mice. In fact, Interventions Testing Program (ITP)—the most rigorous approach to testing molecules for longevity—found that NAD (in the form of nicoatinamide riboside, or NR) had no impact on longevity.

Furthermore, the doses given to humans are significantly lower than the doses recommended by studies. The doses given to mice are on the order of 500-1,000 mg per kg, whereas people choosing to take NAD for its purported longevity effects take doses close to 1,500 mg total.

Bottom line: The lack of reliable, reproducible evidence makes Attia hesitant to believe that NAD is geroprotective.

What Peter thinks is most promising about NAD

Attia is cautious about NAD supplementation because of the mixed evidence. However, he finds some aspects of the research intriguing, particularly NAD’s potential role in reducing skin cancer risk. There are hints that NAD might protect against basal and squamous cell carcinoma, but the results need to be reproduced for Attia to trust it.

To sum it up

Peter Attia's approach to longevity is a blend of prioritizing foundational health behaviors—eating, sleeping, moving, and mental health—along with using targeted medications and supplements that address both specific diseases and the biology of aging. His cautious view of NAD supplementation reflects the current scientific uncertainty around its benefits, but his overall message remains clear: focus on what matters most for long-term health, particularly as you approach your 50s and beyond, and be skeptical of any medications or supplements that promise to be the fountain of youth.