Peter Attia, MD
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Dr. Peter Attia's Longevity Protocol (2025)

Peter Attia, MD

Peter Attia, MD

Physician (MD, Johns Hopkins/Stanford), host of The Drive podcast, author of Outlive

peterattiamd.com

Dr. Peter Attia is a physician who trained at Johns Hopkins and Stanford. His podcast The Drive and book Outlive have made him the most influential voice in preventive longevity medicine. His framework, Medicine 3.0, advocates for proactive health optimisation decades before disease onset — the opposite of conventional medicine's reactive model. Attia has publicly updated his protocol significantly: he dropped metformin after concluding it blunts exercise adaptation, doubled down on rapamycin, and increasingly emphasises exercise above all supplements.

Core Philosophy

  • Exercise is the single most potent longevity intervention — VO2 max and muscle mass are the strongest predictors of lifespan
  • The four horsemen: cardiovascular disease, cancer, neurodegeneration, metabolic dysfunction — address all proactively before symptoms
  • "Outlive" thinking: optimise not just for lifespan but for healthspan — functioning at 85 like most 65-year-olds
  • Dropped metformin: publicly concluded exercise benefits outweigh metformin benefits for non-diabetics
  • Bloodwork every 6 months minimum, targets ApoB under 60 mg/dL — the most aggressive lipid target in clinical practice
  • Emotional health is the sixth pillar of longevity — often the most neglected and most impactful

Exercise: The Primary Drug

Attia considers exercise his most important longevity intervention — more impactful than any supplement or drug. He targets specific performance benchmarks for his age.

Zone 2 Cardio

Mitochondrial biogenesis, metabolic flexibility, cardiovascular efficiency. Attia targets lactate under 2 mmol/L — true Zone 2.

4+ hours per week
Distributed across week, never back-to-back daysAttia uses a Wahoo trainer with lactate meter to confirm true Zone 2. He considers this the foundation of all other training.

VO2 Max Intervals

VO2 max is the single strongest predictor of longevity. Each 1 MET improvement reduces all-cause mortality ~13%.

2 sessions per week, 4x4 Norwegian protocol
Separate from Zone 2 daysAttia targets top 2% VO2 max for his age — approximately 55+ ml/kg/min at 50. He considers moving from low to above-average VO2 max more impactful than quitting smoking.

Strength Training

Anti-sarcopenic intervention. Muscle mass is independently predictive of longevity. Attia targets 1g protein per lb bodyweight daily.

3 sessions per week
Non-consecutive daysFocuses on dead hangs, farmer carries, and functional movements that preserve independence into old age.

Stability and Mobility

Injury prevention, fall prevention — falls are a leading cause of death in the elderly. Attia works with ATC (Attia Training Company) protocols.

Daily, 15–30 min
Morning or pre-workoutAttia integrates DNS (Dynamic Neuromuscular Stabilisation) and specific stability work around every training session.

Foundation Supplements

Supplements Attia takes daily regardless of biomarker status — his nutritional insurance policy.

Omega-3 (EPA/DHA)

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Cardiovascular risk reduction, anti-inflammatory, cognitive protection. Attia considers this one of his highest-confidence supplements.

2–4g EPA+DHA
With meals

Vitamin D3 + K2

Immune function, bone health, cardiovascular. Tests 25-OH-D quarterly, targets 40–60 ng/mL.

5,000 IU D3 + 180mcg MK-7 K2
Morning with fat

Magnesium L-Threonate

Sleep quality, cognitive function, cardiovascular. L-Threonate crosses the blood-brain barrier more effectively than other forms.

2g (144mg elemental Mg)
Evening

Creatine Monohydrate

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Muscle, cognitive neuroprotection. Attia calls it one of his highest-confidence supplements alongside omega-3.

5g/day
Anytime — consistency over timing

Zinc

Immune function, testosterone support, protein synthesis. Higher end during training blocks.

25–45mg
With dinnerAttia tests zinc status — supplementation only if borderline deficient.

Glycine

Sleep quality, core body temperature reduction, collagen synthesis, anti-aging via methylation support

3g
Before bedLow safety risk, modest evidence for sleep quality improvement. Attia considers it a reasonable add-on.

Metabolic & Longevity Interventions

Attia's most discussed longevity pharmacology — including his public decisions to drop metformin and add rapamycin.

Rapamycin

mTOR inhibition — the most evidence-backed longevity drug in animal models. Extends lifespan in every species tested.

8mg/week (takes breaks for mouth sores)
Once weeklyRx only. Attia considers this the most compelling pharmacological longevity intervention. Takes breaks when mouth sores (common side effect) occur. Not for everyone — requires physician monitoring.

Berberine

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AMPK activator — replaced metformin for training days. Improves insulin sensitivity without blunting exercise adaptation.

500mg 2x/day with meals
With mealsAttia publicly dropped metformin after the MILES trial showed blunted muscle adaptation with exercise. Berberine provides similar AMPK activation without this effect.

PCSK9 Inhibitor or Statin

Attia targets ApoB under 60 mg/dL — one of the most aggressive cardiovascular prevention stances in mainstream medicine

Individualised to Rx
As prescribedRx only. Attia is explicit: he considers ApoB the most important modifiable longevity biomarker. Most people need pharmacological support to reach under 60 mg/dL.

Sleep Optimisation

Attia calls sleep "the single most powerful anti-aging tool we have that does not require a prescription."

Sleep Tracking

HRV, sleep staging, respiratory rate — data to guide recovery decisions. Attia tracks sleep data alongside bloodwork to understand cumulative load.

WHOOP or Oura nightly
ContinuousAttia is explicit that sleep quality is more important than most supplements combined. He targets 7–9 hours consistently.

Ashwagandha KSM-66

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Cortisol reduction, sleep quality support during high-stress periods

600mg
Evening during high-stress periods

Trazodone (situational)

Sleep continuity during travel or high-stress periods

50–100mg
As neededRx only. Attia uses this sparingly — sleep hygiene and behavioural interventions are the foundation. Medication is a last resort.

Important Disclaimer

Attia's protocol is personalised to his specific bloodwork, genetics, and health history. Rapamycin, statins/PCSK9 inhibitors, and trazodone require physician prescriptions. His public position on many interventions has evolved — always check his current podcast for updates.

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At a Glance

Supplements12
Est. monthly cost$150–300/month (excluding Rx)
ComplexityAdvanced
ApproachMedicine 3.0
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