@desertshores where’s your Tongat Ali? Already off the list?
I have always been surprised by how short Attia’s supplement list has been. For a long time I figured he wasnt telling us everything he took but now I don’t know. My list grows shorter with great effort. If I ever relax I find my pre-order list has doubled (and then I have to kill it again).
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It’s on my list as fadogia agrestis it’s actually fadogia agrestis/Tongkat Ai.
This is the combo mentioned in Peter Attia’s podcast/YouTube video.
I corrected it on my list.
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This video talks about GG. Apparently good for testosterone, vitamin k and coq10.
I am using it with good success in relieving statin muscle aches after lifting.
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I make my own decision, not the doctor/physician I hire{yes, that is what occurs you hire a doctor/physician - who is the boss?]
The doctor/physician may not agree, but I make the finial decision.
As I have posted numerous times;
“If you wait until you are ready, it is almost certainly too late.” ~ Seth Godin
I am not the waiting type nor do I allow others to make decisions that effect me.
“When writing the story of your life, do not let anyone else hold the pen.” ~Jack Kerouac
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In the United States patients have to consent to all recommended treatments, with a rare exception of patients that verbalized intent to harm themselves or others, that could be committed involuntarily for short period of time. So, Yes Joseph, EVERY patient with rare exceptions makes the final decision.
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Now, having said that, great majority follow doctor’s advice. So for doctors to recommend any experimental treatments especially when there are proven alternatives available would be pure malpractice.
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Over 99% of agents discussed on this thread (except for rapamycin of course) are available WITHOUT prescription… and I highly doubt that most were recommended by a physician. I sometimes recommend few supplements in certain cases where there is a very clear benefit to risk ratio.
11g of glycine. Do you take collagen as well? (At ~30% of the amino acids in collagen)
I take 6g of glycine but then 30g of collagen (powder) so this should be roughly another 9g of glycine.
I’m trying to offset methionine in my heavily animal protein diet. I understand glycine may absorb methionine for glutathione production.
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I have been following Attia for ten years or so. I initially found him when I got interested in Keto back when it was the thing to do. His thinking has evolved over the years.
If I had to put a value on HIS emphasis on of “pillars of health”, I would estimate 55 % is exercise as described above, 25% is sleep, 10% is diet (don’t eat SAD), 7% is practice to maintain mental health (other than 3 mentioned, social, coping mechanism, meditation, etc.) and 3% are supplements. My personal breakdown is similar but with bigger emphasis on the diet
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In the UK court proceedings can be used to dispense with patients consent (strictly to appoint someone else to make decisions on their behalf).
However, the key here is the strength of evidence that is required before an intervention is started. That can be exercise, a prescription molecule, a non prescription molecule or something else.
This forum is chocabloc with people who self experiment. It is a good idea particularly when starting this to get some medical advice. However, when I look at a new substance as I have been doing recently with Molybdenum I read the papers on it and look at dosing and the complexities of its interrelationship with other interventions (eg copper supplementation).
When I start with a new intervention I try to identify some objective test to identify an impact from it. This, of course, risks the placebo type psychosomatic effect. However, I am in the broader sense happy with my approach.
To get good results in improving health does IMO require multiple interventions. I think testing complex protocols in the form of RCTs will be difficult. To do things properly needs decisions to be taken as a result of the outcomes in a single individual.
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Sleep is something I find interesting. IMO part of aging is mitochondrial heteroplasmy. I think pineal melatonin at night reinforces general mitochondrial melatonin. There is an argument that the prepuberty higher levels of melatonin acts to prevent puberty. I wonder myself it an increase in heteroplasmy and associated ROS is part of the cause of puberty.
One thing I do differently to many people is large doses of exogenous melatonin. This does reduce ROS. I think it also acts to hold back mitochondrial heteroplasmy although reducing heteroplasmy will require mitophagy (or at least fusion and fission).
Hence I wonder if a substantial part of the importance of sleep is generating more pineal melatonin. There are also benefits for the brain that go beyond this.
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His focus on eg
- Methylated b vitamins to nail homocysteine with measurements
- EPA and DHA for brain health and using the Omega Index for measurement
- PCSK9i, Bempedoic acid, Eze and until recently statins (and multiple measurements begin Apo B)
- SGLT2i (and in the past Acarbose)
- Baby aspirin
- 3-4 types of magnesium per day
- Theracumin and other supplements for people at increased risks of dementia
- Measurement of Vitamin D and optimization
- Creatine
- Glycine
- Ashwaganda
- Pendulum probiotics
- And of course, Rapamycin, Rapamycin, Rapamycin
does makes it feel like he has an “and” approach
I agree that he says that exercise, diet and sleep are the fundamental pillars. But he clearly also pends a lot of time and energy on how the addition of quite a few molecules/supplements can further help himself, his patients and his followers. And when he talks about any supplement, be it EPA/DHA, methylation support via B vitamins, to magnesium, to probiotics to rapamycin he does in a very deep and well researched way.
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Other than Rapamycin what percentage of his book “Outlived” dedicated to these supplements ?
more or less than 3% ?
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Many of the things in my list of molecules are clearly included in very and many valuable ways throughout the book in the context where they are relevant (cardiovascular health, brain health/dementia, sleep, etc, etc, etc).
Let’s just agree to disagree if you have a different view of the book and Dr Attia overall as it pertains to the value of molecules as one part of a longevity playbook / quiver. Not sure anyone is getting any value from our continued back and forth. Feel free to have the last word if you want, this is likely my last post on this sub-topic.
For context, the reason for my first comment is that Dr Attia and his big team and resources have been one of the best sources around prescription and not prescription based supplements for me personally and I felt it would be a shame if anyone new to the field or not familiar with Dr Attia think that they only could learn about exercise and sleep from him.
His advice on molecules specifically has been a main driver and reason for that
- my Apo B is now massively lower
- my homocysteine had come down a lot
- my Omega 3 Index is in better shape
- my sleep is better
- my gut is more optimized, and
- that I’m trying out an SGLT inhibitor this month, then trialing acarbose.
If anyone else can be helped by his insight, his teams research and his recommendations re molecules even to a small fraction of how it has helped me, I hope they are not discouraged to see his wealth of resources also on molecules (as well as on exercise and other topics)
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Neo, you always give very nuanced answers. I hope some day to be able to give answers like you.
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Approach to Supplementation
I enjoyed reading this discussion thread and seeing the many different perspectives, all of them well reasoned. Without going into detail, my approach is more one of broad base than minimalist, with one important difference.
Model
With the exception of rapamycin (which I’m putting on hold for the moment) and metformin, my model is to take low doses of substances at levels that are generally higher that might be obtained from a diet but lower than is generally recommended as a healthspan enhancer. I take these supplements indefinitely until a consensus research trend suggests otherwise.
As an example, I supplement my intake of most of the well researched polyphenols (all types) at doses close to what I might get from my diet but only with great diligence and not for all of them combined. I used to take megadoses of some supplements but have backed off in recent years. I used to take 2,000 mg./day vitamin-C, sometimes more for example, but now take 1,000 mg. or ess per day.
The one exception to my general decision-rule is supplementing where I believe or know I have an outsize risk. I take a specialized prostate supplement for BPH, and DIM for E2 balance.
Evidence
Having taken supplements diligently for more than 50 years, I have no way of being sure that they are helping me. An article of faith is involved beyond the research. I have two observations that support inferring that they are beneficial in an outsize way. On a few occasions, I have not taken supplements for more than the day or two break I have always taken one or twice a month. On those occasions, my overall energy and sense of well being drops significantly. However, the explanation could be more one of habituation than long term benefit. Placebo is a possibility as well but much less likely over these decades. Also, I am a low placebo reactor. The second reason for inferring benefit might be stronger. The men in my family line from grandfather, to father, to uncles, to cousins (maybe 10 in all), have a remarkably consistent profile of health, fitness, energy and wellness. So far, my profile is at least a standard deviation and maybe two above the others. Everyone in the family has observed this exception.
Sources
My go-to sources for guidance are the NIH and other research stacks, Life Extension researchers, Kamal at Examine.com, and ConsumerLab.com. Increasingly, I’m finding the three AI LLMs I use to be a useful time saver. It is fairly easy to work around their shortcomings once you get the hang of it. More than once, an LLM has dug out an inference I missed due to its strength of considering all available sources more-or-less simultaneously.
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FWIW: I recently switched from berberine to dihydroberberine because it has higher bioavailability than berberine and a longer half-time.
“Results from this study demonstrate that dihydroberberine, irrespective of what dose is delivered, achieves greater area under the curve as well as peak berberine concentrations when compared to oral ingestion of berberine or placebo”
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I saw some stuff that said much of what berberine does comes from the microbiome, so is it possible you’re better off if it’s not absorbed?
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I searched for more information on this and couldn’t come up with a good answer (specifically if this conversion process is what benefits the gut microbiome). What I found out is that berberine is converted to dihydroberberine by a healthy gut microbiome (but not if you take an antibiotic) and that this form is much more absorbable to cross the intestinal tissue where it is then converted back to berberine to enter the blood. This process depends on oxidation and will be terminated by the presence of Vitamin C, so don’t take them together (true for both forms of berberine).
" Vitamin C, a strong antioxidant, was then added to the reaction solution. As shown in [Fig. 4c], the dhBBR-to-BBR reversion was almost completely terminated by vitamin C, suggesting that the oxidization reaction is crucial for the dhBBR-to-BBR reversion in intestinal tissues."
“Human studies have clearly shown that individual gut microbiome differences predictably determine differences in the metabolism and absorption of berberine.”
Berberine Modulates Gut Microbiota
Research in rats fed a high-fat diet (HFD) shows that the prevention of obesity and insulin resistance driven by berberine supplementation is partly mediated by structural modification of the gut microbiota, which helps to alleviate inflammation by reducing exogenous antigen load in the host and elevates short-chain fatty acid levels in the intestine.9 Berberine increased Akkermansia spp. abundance in HFD-fed ApoE-knockout mice, decreased HFD-induced metabolic endotoxemia, lowered arterial and intestinal expression of proinflammatory cytokines and chemokines, increased thickness of the colonic mucus layer, and increased intestinal expression of tight junction proteins (related to restoring the gut barrier integrity).10 Additionally, in these HFD-fed ApoE-knockout mice, berberine treatment significantly reduced atherosclerosis.
As many now know, metformin has similar modulating effects on the microbiome, also increasing the abundance of beneficial commensal organisms Akkermansia spp.11 In fact, berberine and metformin have been shown to similarly shift the gut microbiota in animal models.12 Interestingly, in HFD-fed rats supplemented with berberine or metformin, the diversity of the gut microbiota was significantly decreased by both metformin and berberine treatment; while both increased SCFA-producing bacteria (berberine increasing the SCFA-producing bacteria to a greater extent than metformin). Berberine treatment has been shown to promote the production of butyrate in the gut microbiota, which may account for its effect on blood lipids and glucose. Importantly, pretreatment of animals with antibiotics abolished the effect of berberine on butyrate production.13
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Yes, but I don’t thinks it’s in the 5% of the science here that you consider factual.
…And I’m truly shocked that you made a post that didn’t mention AboB or LDL. That must have been hard…
Edit: I had a dream that I gave your ear a yank and all 3 of your eyeballs spun around and finally came to rest showing 3 "ApoB"s, Then you opened your mouth and a whole cascade of statins came pouring out.
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