I agree in part. Certainly having low vo2max is an indicator of poor health (though not necessarily an indicator of illness, yet). On the other hand, having a very high vo2max requires a large investment in time and stress. What must be given up to make this investment in type 1 muscle fibers and the means to move a lot of O2 around the body. What about type 2 muscle or everything muscle related for muscles not needed for the vo2max test? What about balance or reaction speed or hand eye coordination? I think a well rounded physical fitness routine (or sport) is a better healthspan bet than optimizing on vo2max (edit: I see we are in agreement with the conclusion)
4 Likes
Is it just me or both Peter Attia and Matt both looked OLDER since they started taking GLP-1
Dr. Matt Ranks Longevity Supplements: The Winners and Total Scams
3 Likes
It’s been my observation with friends and family that anyone over the age of 40 who loses a significant amount of weight often looks older at first. As we age, our skin loses elasticity, so when the fat is gone, it takes a long time for the skin to shrink back down. It’s just like wearing clothes that are too big for you. Younger people’s skin can catch up pretty quickly, but the older you get, the longer it takes. Sometimes, being healthier doesn’t immediately equal looking younger."
9 Likes
Yes, @Jonas, what @desertshores said… this is universally true.
Funny thing is this morning I thought, hmmm, my face looks better, so I knew to go get on the scale… I gained 2 pounds… yep, predicable.
Btw, back to Epstein… in the event anyone is interested, I’m watching an Ezra Klein interview with Anand Giridharadas and it’s probably the best piece I’ve seen on Epstein.
2 Likes
“Ozempic face” refers to a, hollowed, saggy, or aged facial appearance resulting from rapid fat loss, commonly associated with GLP-1 agonists like Ozempic or Wegovy ??
1 Like
I wasn’t aware that either of them were taking an incretin mimetic (aka “GLP” med). Matt is taking empagliflozin (an SGLT2i). Is that what you meant?
3 Likes
I’m not aware of Attia saying he was taking glp1s, but he was against them for a long time (in being cautious). Then, one day he said, well if these were safe I’d like to take them to lose 10 pounds. Then, not too long afterwards, he said he was no longer worried about them… then poof, next time I saw him, he was aprox 10 pounds thinner
1 Like
So Attia hasn’t said he’s taking one, and we know Matt K isn’t taking one because he just recently went through his complete drug/supplement stack.
5 Likes
If memory serves me (grain of salt), I THINK I recall him recently saying he tried one short term just to see what the effects were. IF I remembered this correctly, it was definitely my impression it was a very short term experiment. I doubt he was on it long enough to lose any noticeable weight. He has been slim in my eyes for quite a long time.
EDIT:
PS, I just started watching Matt’s podcast and I think he looks great!
Peter Attia appears to be staying at CBS News despite Epstein communications https://www.theguardian.com/media/2026/feb/14/cbs-peter-attia-jeffrey-epstein
2 Likes
Has anyone see the new attacks of Attia based on his apparent misrepresentation of VO2max from a chart and repeated claims that it is the most highly predictive of longevity of any single metric? I will have some time later to post a little on it but perhaps someone else has already run down that path, not because of caring much about Attia but to get clear on what modifiable metrics we should be managing. My take on Attia’s strong and repeated claim to that effect is that the truth is more complex. It is not a bad metric to manage to if you consider it as your personal VO2peak and not VO2max and are aware that the heritability coefficient is somewhere in the neighborhood of 60% or more. There are large datasets that support Attia’s claim but if you dig into them, you see retrospective analyses with many flaws. Interesting topic, anyway, and some researchers seem to think he force fit the data, although I do not know how that would benefit him.
2 Likes
Google Gemini says:
Recent criticisms of Dr. Peter Attia regarding VO2 max focus on the interpretation of studies linking it to longevity, arguing that he overstates the causal relationship between a high VO2 max and extended lifespan, while potentially ignoring confounding factors. Critics suggest that while VO2 max is a strong marker of cardiovascular fitness, it is not necessarily the primary driver of increased longevity. [1, 2, 3, 4]
Key points in the recent debates and “attacks” on this topic include:
- Correlation vs. Causation (Reverse Causation): Critics argue that high VO2 max might be a result of being healthy (and therefore able to train intensely) rather than the cause of longevity. People with higher VO2 max are likely to have fewer chronic diseases, making it unclear if the VO2 max itself is providing the protection, or if it is simply a reflection of an already healthy, non-diseased state.
- Misinterpretation of Studies: Arguments have been made that the data Attia often cites relates more to overall aerobic performance (such as metabolic equivalents or METs) rather than a direct, causal link to a high VO2 max number.
- The “Elite” Focus Misalignment: Some critics contend that focusing on reaching “elite” VO2 max levels for one’s age might be misplaced, arguing that the greatest health benefits are achieved by moving from a low to an average, or average to high, level, rather than solely focusing on elite, top-percentage levels.
- Alternative Explanations for Decline: While Attia emphasizes VO2 max as a key, modifiable metric, some critics argue that the age-related decline in VO2 max is more heavily influenced by motor unit loss (a direct consequence of aging and muscle loss) rather than purely cardiovascular limitations.
- Efficiency vs. Output: There is a long-standing debate that in elite athletes, a very high VO2 max might actually be associated with slightly lower, or worse, efficiency (economy), challenging the assumption that “higher is always better” for overall health. [1, 3, 5, 6, 7, 8, 9]
These criticisms suggest that while improving VO2 max is a valid fitness goal, the intensity of focus Attia places on it as a “panacea” for longevity may be oversimplified or misrepresented in the broader scientific context. [2, 4]
AI responses may include mistakes.
[2] https://www.reddit.com/r/PeterAttia/comments/1mtnm3f/peter_is_obsessed_with_vo2_max/
[3] https://www.reddit.com/r/PeterAttia/comments/1fzinzh/vo2max_is_overrated_myths_and_realities_for/
[4] https://www.youtube.com/watch?v=insEmxHXQSw
[9] The difference between maximum aerobic capacity and efficiency - Peter Attia
3 Likes
Good Gemini report. It hits on most of the salient points. Others have to do with the heritability component and how much it can be modified, a lack of subclassification in the large datasets that imply a causal arrow, and (touched upon by Gemini) the fact that few people typically or even ever reach VO2max, even in lab tests they stop for other reasons before O2 plateau, and ‘max’ in inferred. In my case as a former distance runner old guy who enjoys climbing steep hills for aerobic CV/aerobic exercise, my large muscles are the limiting factor well before I reach maximum HR much less VO2max. Then there is hard empirical data pointing to a broader picture. Falls account for a significant number of deaths in the elderly from which it follows that balance and not peak O2 exchange is a factor. And so on. To be fair to Attia, he does emphasize flexibility and balance in the podcasts I have heard. I think the evidence is pretty strong for most (not all) of us, that CV fitness (not necessarily the highest VO2max – in fact, it would not surprise me to see a slight downturn of the curve at its very peak) is one of several causal forces in longevity and especially health span.
1 Like
I do appreciate Attia for the indirect help he has given me and my family in the past. His book convinced my father to aggressively lower his lipids. This probably saved his life.
10 Likes
Honestly Outlive changed my life. I am now training for the Centenarian Decathlon. Only 25 years to go😀
8 Likes
To be fair I was a little dismissive of them initially but now I’m on board. My only remaining concern is the heart rate increase they cause (specifically Retatrutide)
1 Like
Oh, I thought glp1s were nuts for anyone less than morbidly obese for a very long time. My concern was based on hearing anesthesia can be dangerous for anyone on them. I remember telling friends, but what if you need emergency surgery!!!
I’m still nervous about it, but I never hear this mentioned anymore, so it’s sort of out of mind. My hope is my dose is low enough that I won’t die on the table 
My heart rate is higher than I’d like and I do wonder about the same thing.
I was on retatrutide while getting anesthesia for a shoulder operation back in June and had no issues. Here is a recent study showing you should stay on GLP1s during surgery since they can improve outcomes and healing.
2 Likes
It is what anesthesia says not so much what Ortho says. The fact is the most devastating outcome of any surgery is aspiration and the risk is higher on GLP-1s. The article was short on timing in my skimming of it. I don’t think they were arguing to counter anesthesia rules.
Most guidelines want you off for a week despite delayed gastric emptying for about 30 days after last dose. It was a compromise and felt to be safe enough. The ASA offers some options including liquid diet for 24 hours before and a nuanced approach based on dosage, time on drug etc. To my read, I see why stopping for 7 days is typical.
As an aside. The ASA differentiates daily and weekly but that doesn’t make sense for rybelsus which is daily but half life is same as weekly injection.
For emergency surgery, you are always treated as having a full stomach with different protocols. That being said, take 2 people in the same exact emergency setting and the GLP1 patient will have a higher risk of aspiration than a non-GLP1 patient.
Aspiration is so awful because otherwise healthy people can die. It is rare but not so rare that I haven’t seen it several times.
While GLP1s are lumped together for now, that probably will change at some point.
I’ve personally seen food in the stomach that shouldn’t be there several times before the rules went into effect - 3 years ago.
3 Likes
I have not commented here mostly because I have no idea what is going on with Epstein. Talk is about the abuse of children and women which I really don’t even understand. Also it’s probably wrong to judge people based on imperfect information. I’ll just briefly mention Harvey Weinstein who had Fornier’s gangrene and his testicles were surgically implanted in his inner thighs. Several of the female witnesses claimed (imagined) he was normal. So they had no sex with him despite their testimony. They convicted him on the logic that since some of them got it right he must be guilty.
So justice isn’t perfect. We don’t know what’s going on. So Josh Mittledorf just did a great job illuminatiing the possibilities here:
Ha ha ha such a brilliant man and such a polished writer and he doesn’t know any more than I do.
2 Likes