Chasing Longevity

Until a few years ago, I’d never heard of the blood molecule lipoprotein (a), or Lp(a). Then I started listening to The Drive, a podcast hosted by Peter Attia, who trained as a surgeon, then became a McKinsey consultant, and now runs a concierge medical practice focused on “healthspan”—a term he’s helped to popularize. Unlike lifespan, which is how long you live, healthspan refers to how long you’ll enjoy an active, disease-free lifestyle, and on his podcast, Attia interviews experts about the best ways to do that. He talks frequently about Lp(a), which is rarely included in routine bloodwork but can indicate your inherited risk for heart disease. So after bingeing The Drive, I asked my doctor to measure mine: 307 nanomoles per liter, compared to a normal value of under 75. Yikes. I now see a cardiologist regularly. There is nothing new about humans seeking to optimize their health and extend their lives. Hippocrates espoused cold baths; Benjamin Franklin preached vegetarianism; John Kellogg advocated corn flakes, enemas, and sexual abstinence. If they were alive today, they’d probably be competing over their podcast rankings and book deals. Attia’s work—and that of his competitors—is especially popular among the executive class, partly because it is framed in terms of optimization, performance, and tech advances but also because the high-touch medical care often prescribed requires significant income. At their best, these podcasters deliver evidence-based clinical insight, offer advice on what patients should ask their doctors, and serve as aspirational role models. (Most of them are jacked gym rats.) At their worst, however, they dish out questionable advice and lead people to go to extremes in pursuit of immortality. Among the podcasters, Andrew Huberman sits atop the rankings. A Stanford neuroscientist, he launched his show, Huberman Lab, in 2021, and today it’s regularly among the world’s top 10. He also has a forthcoming book, Protocols, which is supposed to be out this fall, although review copies weren’t available at press time. Huberman is a research scientist and a teacher, not a clinical physician, and while he covers a growing range of topics (recent episodes focus on grief, productivity, creativity, diet, hearing, and balance), the long episodes (often running more than two hours) sometimes involve dense talk about neurotransmitters and wonky studies. Huberman has also been criticized for promoting unproven supplements, some sold by his advertisers. Though I’d prefer shorter, more accessible episodes, I still listen frequently—and I recognize that Huberman’s focus on living better, instead of fixating on avoiding looming decrepitude, makes his work slightly more upbeat than other longevity pros. If you lean toward techno-futurism, Eric Topol, a cardiologist and a professor of molecular medicine, may be more your speed. His podcast, Ground Truths, is a snooze, but he’s been a lively guest on other shows, like Armchair Expert. In interviews and in his latest book, Super Agers, Topol focuses on emerging technologies and discoveries that may improve our health. He describes how genetic testing is allowing doctors to better understand individual patients’ disease risks, how AI will transform our understanding of what causes illnesses, and why GLP-1 drugs won’t just help us lose weight—they may also have the potential to reduce the frequency of Alzheimer’s, Parkinson’s, and cancer. Comparatively, Topol is focused less on diet and exercise and more on how things happening inside research labs may someday improve our health. Attia remains my favorite of these gurus. Compared with Huberman, his ad-free podcast focuses more directly on treating patients, and his book, Outlive, which has spent 104 weeks on bestseller lists, is packed with useful advice. In it, Attia goes deep on the “four horsemen” that limit healthspan (heart disease, cancer, neurodegenerative disease, and metabolic disease), criticizes current medical guidelines for waiting too long to treat them, and urges people to embrace what he calls Medicine 3.0—a more aggressive and proactive approach to testing and treatment. Like all these experts, Attia can get into the scientific weeds. Critics say he advocates for too much testing and off-label pharmaceutical use, and that only affluent people can implement some of his ideas. Despite that, his book is highly readable (hat tip to cowriter Bill Gifford), and his focus on exercise as the foundation of any age-defying routine makes sense. One of his novel concepts: Instead of just hitting the gym, think about the activities you hope to do in your “marginal decade”—that is, your 80s or beyond. He calls these pursuits the “centenarian decathlon,” and Attia’s own list includes opening a jar, climbing four flights of stairs, having sex, and putting a 20-pound suitcase into an overhead compartment (among others). To optimize your workouts, reverse engineer from your own list and build strength now, knowing it will decline over time. Can you take this stuff too far? Absolutely. For evidence of that, consider tech-mogul-turned-longevity-freak Bryan Johnson, subject of the Netflix documentary Don’t Die. Johnson earned a fortune in fintech in the 2010s and now spends a reported $2 million a year on a health regimen he calls Blueprint. It involves dozens of daily supplements (sold on his website), a hyperspecialized diet (his final meal of the day is at 11 AM ), frequent bloodwork and scans, injections of blood plasma from his teenage son, and social media posts detailing the strength of his nocturnal erections (a marker of cardiac health). His daily bedtime: 8:30 PM . Although he’s 47 (at the time of this writing), he claims tests show he’s putting just 0.48 years on his biologic odometer every 12 months. “My birthday now happens every two years,” he writes. I recognize that Johnson will probably outlive me. (Bloodwork aside, he’s seven years younger.) And though I don’t find his all-in lifestyle appealing, some of his far-out techniques may catch on: A small research study suggests plasma exchanges may have improved biomarkers among 42 subjects (with an average age of 65) who tried the vampirish procedure. I wouldn’t be surprised if wealthy executives begin to follow his lead, realizing that money might indeed be able to buy a healthier, longer life, if not necessarily a happier one. For now, though, my plan is to stick to more-traditional medicine—and to use these gurus as inspiration to eat fewer desserts and get away from my computer and into the gym more often.

Chasing Longevity

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