Peter Attia is a medical doctor who focuses on the science behind living a longer, healthier life.
In this post we’ll look at what Peter supplements, noting that’s what optimal for him isn’t necessarily optimal for you.
Table of Contents
- 1 Supplements
- 1.1 2011
- 1.2 2012, January
- 1.3 2015 – Tim Ferriss Podcast
- 1.4 2016 – Tools of Titans Chapter
- 1.5 2018 – AMA #2
- 1.6 2018 – AMA #3
- 2 Rapamycin
- 3 Final Words
- 4 Post Change Log
Peter doesn’t believe in a one-size-fits-all approach to supplementation. Thus Peter discusses the supplements he takes with hesitation, in case people copy it, thinking what works for him will work for them.
That being said, it’s still possible to gain insight from what Peter does, given his detailed explanations around what he does, doesn’t and why.
As part of research for this section, I’ve looked back at the different times Peter has discussed supplements. Start in 2011 and working to the present. It’s also encouraging to see how much Peter’s supplementation has changed over time – we’re all in the same boat with regards to research and understanding changing over time, and the need to constantly update our beliefs.
To save time, I’ve linked some of the main supplements he has discussed, so you can jump to those sections:
- Omega-3 Fish Oil (the main supplement, besides BCAAs, that Peter has discussed taking consistently since 2011)
- Vitamin D (levels you want to target)
- Lithium (why an ultra low dose may be of interest)
- Aspirin (and new scepticism on its usage for flights and CV risk)
- Berberine (what Peter likes it for)
- BCAAs – Branch Chain Amino Acids (which brands he trusts)
So lets begin (after the table of contents)…
In 2011, Peter listed his supplements as:
|Supplement?||How much and when?||Why? If reason given|
|Magnesium||400 mg per day||Adequate magnesium levels help preserve Potassium, which is necessary for cellular function, and prevents cramping|
|Potassium||200 mg per day||200mg is relatively minor, but he supplemented for the sake of avoiding muscle cramps|
|Fish Oil||2 teaspoons (10 mL) every evening with dinner, providing 1600mg EPA and 1,000mg DHA||He aimed to get his omega-3 to omega-6 ratio closer to 1:1, first by limiting sources of omega-6, and secondly by supplementing omega-3s.|
At this point his supplementation was fairly minimalistic.
Then in a video from 2012, Peter discusses taking:
|Supplement?||How much and when?||Why? If reason given|
|Multivitamin||Daily – no specifics on brand or composition||He actually says he thinks he probably shouldn’t be taking it, as it might be doing more harm than good. And says he will look into it more|
|Fish Oil||1 tablespoon/day of Carlson’s fish oil||Peter increased on his 2011 dosage, because recent a test showed him low in omega-3s|
|BCAAs (3 Amino Acids)||2-4grams with water, whilst in the weight room (resistance training)||Important for preserving muscle density and tissue integrity, under periods of great stress|
|Glutamine (Amino Acid)||Post hard workouts (bike, weights or swimming)||“Some evidence” glutamine helps your muscles rebuild after a difficult bout of training|
Whilst Peter’s supplements have varied widely between 2011 and 2019, one thing has stayed constant, which is the supplementation of omega-3 fish oil.
There seems to be a common understanding among experts that modern diets provide insufficient levels of omega-3 fatty acids. When I’ve looked at other thought leaders supplement habits; Joe Rogan (link) & Dr Rhonda Patrick’s (link), they also choose to take omega-3 fatty acids daily.
Peter mentions trusting two brands; Nordic Naturals and Carlson. On AMA #11 @ 17 mins he says he takes around 2 grams daily of EPA/DHA. With Carlson’s Fish Oil he prefers the non-encapsulated version.
If you find capsules more convenient (as I do), Carlson also do an encapsulated version; Elite Omega-3 Gems.
2015 – Tim Ferriss Podcast
|Supplement?||How much and when?||Why? If reason given|
|Vitamin D||Dose & timing not mentioned||Took in order to target a certain blood level|
|Baby Asprin||1x baby aspirin||Was taking to mitigate cardiovascular event risk|
|Methylfolate (B-9)||Approximately 2x per week||Peter has a MTHFR mutation which reduces folic acid processing efficiency, but taking the methylated form of of folic acid (folate), circumvents this absorption issue|
|B-12||Takes low dose, approximately 2x per week||To get B-12 to desired blood levels|
|Fish Oil||Dose & timing not mentioned||Same reasons as previously mentioned|
|Berberine||Dose & timing not mentioned||1) It activates AMP-Kinase, which suppresses hepatic glucose output, which maintains lower levels of insulin and therefore lower levels of IGF-1. The latter Peter says he values.
2) It inhibits PCSK9, which for over expressers of PCSK9 (he estimates ~10% of population) this can drop their LDL particle count.
|Probiotic||Taken periodically throughout the week||Not mentioned on this podcast|
Compared to 2012, Peter has dropped the multivitamin, and honed in on potential deficiencies he might have, such as B-vitamins and vitamin D. He also looks to be experimenting with probiotics, berberine and baby aspirin.
2016 – Tools of Titans Chapter
In Tim Ferriss’ 2016 book; Tools of Titans, each chapter is a list of tips from a different person. In the Peter Attia chapter, Peter shares a few nuggets on supplements.
Firstly, he discusses supplements he does not take:
- Multivitamin – Peter notes he is not an advocate of multivitamins (see more below).
- Vitamins A and E – Peter isn’t convinced he needs more than he absorbs through whole foods.
- Vitamin K – Peter believes that if you’re eating leafy green vegetables (big “if” for some people), you’ll be getting enough vitamin K. For vitamin K2, it may be a different story for some people, depending on their diet.
- Vitamin C – He posits that most people get enough in their diet. And whilst mega-doses may be interesting, in particular for combating viral illnesses, vitamin C isn’t bioavailable enough in oral form. These megadoses would require intravenous administration.
Then Peter touches on some of the supplements he is a proponent of:
Peter is a big proponent of magnesium supplementation. Magnesium is needed by every cell in the human body, and plays a crucial role in core functions such as energy production. In Tools of Titans he takes 600 to 800 mg per day, alternating between magnesium sulfate and magnesium oxide. He was also taking calcium carbonate 2 times per week.
Later, in 2018 (see tweet source above), Peter is taking a specific form of magnesium sulphate called Slow-Mag. Slow-Mag also has an enteric coating, which reduces the ability of the stomach acids to break down the outer capsule, meaning the capsule makes its way to the intestines before disintegrating and the contents being dispersed. This can help avoid stomach discomfort. Also, instead of just containing magnesium sulphite, Slow-Mag also contains calcium.
2018 – AMA #2
Then in Peter’s August 2018 AMA #2, he is taking the below supplements and now some prescription drugs (he may have been taking these prescription drugs for much longer, but this is the first time I see mention of them):
|Supplement?||How much and when?||Why? If reason given
|Vitamin D||Nightly, at bedtime||Not mentioned on this podcast|
|Methylfolate||Every morning||Not mentioned on this podcast|
|Methyl B12||Every morning||Not mentioned on this podcast|
|Lithium||Nightly, at bedtime||Not mentioned on this podcast|
|Fish Oil||Nightly, at bedtime||Presumably, same reason as prior|
|Selenium||Every morning||Not mentioned on this podcast|
|Baby Aspirin||Every morning||Not mentioned on this podcast|
|N-acetylcysteine (NAC)||Twice daily||Not mentioned on this podcast|
|Curcumin||Every morning||Not mentioned on this podcast|
|Magnesium Oxide||400mg nightly, at bedtime||Not mentioned on this podcast|
|Slo-Mag (Slow Release Magnesium||2 tablets, every morning||Not mentioned on this podcast|
|Prescription Drug||How much and when?||Why? If reason given|
|Metformin||1g – 2x daily||Not mentioned on this podcast.|
|Atorvastatin (Lipitor)||10 mg – Monday / Wednesday / Friday – Evenings||Not mentioned on this podcast. But Atorvastatin is a statin, intended to lower lipid levels and reduce cardiovascular disease risk.|
|Ezetimibe (Zetia)||10 mg – Tuesday / Thursday / Saturday – Mornings||Not mentioned on this podcast. But Ezetimibe is a drug to treat high cholesterol, and is generally taken alongside a statin.|
Just like with other vitamins, Peter doesn’t suggest indiscriminate usage. On his interview on Joe Rogan, he cites an optimal range of Vitamin as between 40-60ng/ml. To target optimal ranges, it requires at least 2 blood tests. One prior, to understand where you are currently, and then one after a period of time supplementing, to understand the effect of the supplementation.
It can be particularly valuable to check vitamin D levels during winter, if your sunlight exposure is limited.
First, a bit of background on lithium:
- Lithium is not essential for human life – at least not based on current understanding. There’s a big list of essential micronutrients that humans need to survive, and lithium is not one of them.
- That said, lithium is found abundantly in small quantities, in rocks and soil around the world, even making it into our drinking water. So humans are very used to getting it in small amounts.
- There’s a significant amount of research that associates higher levels of lithium in the drinking water, with lower levels of suicide1, and even reduced incidences of crimes and arrests due to drug addictions2. It appears to have mood improving and stabilizing effects3
- It’s used clinically in high doses to help treat conditions such as bipolar, schizophenia and major depressive disorder.
Peter has experimented with Lithium in 2 different ways:
- In AMA #3 he refers to an experiment, where he consulted with Psychiatrist Paul Conti, who specialises in lithium monotherapy for bipolar patients, and then started taking 600mg/day, which is about 1/2 of what a bipolar patient would take. This is a very high dose, and *should not* be done outside of the care of a specialist physician. Peter didn’t tell anyone about taking lithium, and waited to see if anyone noticed a change in his mood. After about 4 months his wife noticed his mood had improved, and he was being “less of an asshole”. Later, Peter decided to discontinue his mega-dose of lithium, experiencing some side effects such as nausea.
- As of AMA#3 (Oct 2018) he takes low dose lithium (10-20mg/daily). Noting he’s unclear if it has an effect, given that he has added things like meditation, which also make a big difference to his mood.
Peter hasn’t explicitly mentioned which Lithium supplement he takes, but given he favors Jarrow and Pure Encapsulations, and Jarrow don’t make a Lithium supplement, there’s a chance it’s something like Pure Encapsulations – Lithium orotate. It contains 5mg of lithium orotate, and 200mg of N-acetyl-l-cysteine (NAC), which is a precursor to glutathione, the major antioxidant in the brain, and is added to this formula, they say, for enhanced protection of brain cell membranes.
2018 – AMA #3
Then on Peter’s AMA #3 (October 2018) he updates a few details:
Peter’s stance on aspirin has changed as the data has changed. Prior to this podcast, he saw aspirin as valuable in 2 situations:
- If a patient’s AspirinWorks Test result was high, and they had one of the following; elevated LP-PLA2, or elevated Lp(a) (spoken out loud as “LP little a”), or if they had significant family history of heart disease. A combination of those two factors would make them a candidate from taking a daily baby aspirin.
- If you’re on a long flight, and you want to minimize your risk of getting a blood clot – especially if you have another risk factor such as Lp(a), which would increase your risk of blood clots.
So then in regard to (1) – Peter cites a recent study of twelve thousand people, that was randomized, double blinded, placebo controlled, with one group taking aspirin, and the other not. The results didn’t show any real benefit of taking aspirin – and thus Peter is now more hesitant to use aspirin as the benefits appear less clear.
In-flight Blood Clot Risk Reduction
With regards to (2), one of Peter’s researchers did a deep dive into the literature on using aspiring on flights to reduce thrombosis risk (blood clots). The research actually didn’t show benefits to taking aspirin on flights (in blinded trials). Which just leaves tools such low molecular weight heparin, which is an injectable, and thus a lot of hassle, or an over the counter supplement called Flite Tabs.
Peter elaborates more on Flite Tabs in his Kevin Rose interview [10m 53s], and explains how they contain FDA regarded “GRAS” substances (Generally Regarded As Safe) that are really good at thinning the blood under flight circumstances:
- Reduced oxygen concentration in the air
- Dehydration (almost inevitable on long flights)
- Physical seat confinement
When I was looking to buy FliteTabs they were out of stock on Amazon. Some searching around led me to Life Extension’s VenoFlow which is very similar to Flite Tabs. Both contain the same 2 ingredients; Pycnogenol, a pine bark extract, and nattokinase, a soy natto extract. Flite Tabs bottles are 4 servings of 300mg (2 caps), whereas Venoflow is 30 servings of 200mg (1 cap) per bottle.
Berberine is a plant derived supplement that Peter mentioned taking in the 2015 Tim Ferriss podcast. However in his next update (2016) he was no longer taking it. He occasionally uses it with patients, noting in AMA #3 [1:20:27] that Berberine has 2 key properties:
- It’s a weak activator of AMP Kinase, which is the “secret sauce” of metformin. Peter suggests that if you’re going after AMP Kinase activation, you’re best served through the use of metformin. In part at least, because metformin’s production is regulated as a pharamaceutical drug, and thus all the things you’d expect, like quality control, are scruitinized much more heavily. Whereas Berberine is sold as a supplement, and supplements are subject to comparatively little regulation.
- It’s a weak inhibitor of the enzyme PCSK9. Berberine acts to inhibit the PCSK9 enzyme, which then results in a reduction of total cholesterol and low-density lipoprotein cholesterol4. Thus in the small subset of the population that over-express PCSK9, Berberine can be effective. However Peter notes that when LDL-P is high, and the normal causes such as diet have been addressed, it is only around 5% of the time about PCSK9. There are literally thousands of other possibilities as to why it could be high.
Peter explains [1:53:10] that he is no longer taking either – presumably stopping at some point between AMA #2 and AMA #3.
He *was* taking them because he’s trying to live as long as he can, which means delaying the onset of atherosclerotic disease as long as possible. To achieve that, he’s taking an “all hands on deck approach” consisting of:
- Reducing the burden of lipoproteins (where statins can be used)
- Reducing inflammation
- Improving endothelial health
- Increasing insulin sensitivity
At the time Peter took them, these drugs helped Peter get his lipid scores below the 20th percentile in terms of risk. He’s now off those meds and trying a different approach, but intends to continue vacillating in and out of lipid lowering medications if needed.
In the discussion with Kevin around rapamycin, they meander onto the subject of branch chain amino acids. Peter explains that the bodybuilding community was wise to the idea that if you wanted to grow your muscles you want lots of these branch chain amino acids. Unfortunately, he says, most of the industry is a sham, and many of the products literally contain crushed bird feathers. There’s only two companies that he’s aware of that make a legitimate branch chain amino acid. Noting not to say that these are the *only* two, but these are the only two he can vouch for.
1) A company in Japan called Ajinomoto, the original creator a true pharma grade amino acid. They sell their BCAAs to other companies, who then put the Ajinomoto mark (branded as “Ajipure”) on their packaging.
2) The other is a company in Canada called Biosteel
If a patient comes to him and says, I want to be on Amino acids, Peter is putting them on Biosteel, because he thinks it’s the best option out there. And if they can’t stand the taste, because it’s a bit too sweet, then he says, lets look for something else, that at least has the Ajinomoto stamp on it – so that we know it’s coming in with the right stuff.
Supplement Companies Peter Uses
In AMA #3 [2:02:30]Peter was asked the question, “which brand of supplements have you found effective”. He notes that the supplement world is “kind of a shit show” because it’s so unregulated. He goes on to say that supplement companies he relies upon are:
- Pure Encapsulations
- Carlson (as mentioned above)
- Nordic Naturals
Noting there are a couple other companies he will use, depending on the product. For example with Berberine, they use the Thorne brand.
Peter announces on a 2018 podcast with Kevin Rose that he had started taking rapamycin(see approx. 52m 15s of the podcast). 3 years later, he’s still taking it.
Specifically mentions taking ~6 milligrams once per week. Each quarter he says he does 8 weeks on rapamycin, 5 weeks off. He mentions in AMA 11 that he does not take rapamycin whilst fasting.
In terms of unwanted side-effects, Peter notes that it gives him occasional aphthous ulcers. He also notes that his finger nails grow slower whilst taking it. Besides that, he doesn’t notice any other day-to-day differences from the drug.
Rapamycin is a prescription drug that is FDA approved for use as an immunosupressor. When taken daily, it stops the bodies of transplant patients from rejecting their new organ.
The use of rapamycin for healthspan/lifespan benefits is off-label, and does not have FDA backing (yet).
The reason for the interest in rapamycin for healthspan/lifespan benefits derives primarily from success in labs, where it has been able to extend the lifespan in animal models (fruit flies, worms and mice).
^ All 4 audio clips on Rapamycin come from this Tim Ferris interview
Despite this potential, there haven’t been any studies of its lifespan/healthspan benefits in humans yet. There are likely many reasons for this, but one of the main ones is:
- The FDA do not recognise ageing as a disease. This means that you can’t get a drug approved by them to help improve lifespan/healthspan. Instead you have to pick a very specific disease, such as a type of cancer, and get it approved for that. Thus, if you can’t get your drug FDA approved, then it’s hard for US companies to justify the high costs of the clinical trials needed to test if there are healthspan/lifespan benefits to rapamycin.
That said, in recent years, there has been substantial interest in the use of rapamycin to tackle ageing. Thus it’s likely studies in humans will take place in the coming years.
Should You Take Rapamycin? Probably not (yet)
As far as I understand, if someone was interested in taking rapamycin, they would first want to make sure they have everything dialed in with their current lifestyle, specifically; sleep, diet, exercise and stress. They would want to have significant numbers of blood markers tested over time, to ensure that their lifestyle was putting them in the optimal ranges. Those steps are by far the low hanging fruit of longevity.
Once that was all dialled in, they would then want to seek supervision of a doctor who is familiar with rapamycin usage for the purpose of improved healthspan/lifespan. On the podcast Peter mentions there is a doctor in New York (Alan Green) who provides off-label rapamycin treatment. Even under supervision, you’d still be stepping out onto the fringes of modern scientific understanding, and would in some ways be a guinea pig for scientific research.
Related to this, I was fortunate enough to catch a presentation by David Sabatini earlier in 2019. David is someone Peter talks about a lot, because David and his lab are at the forefront of research around mTOR, including first discovering mTOR complex 1 and 2. Anyway, after the presentation I asked David about his thoughts on taking mTOR, and he said he doesn’t personally take it. For now he simply eats a low carbohydrate diet and practices intermittent fasting. He thinks in the future there will better molecules than mTOR that capture the upsides, with less of the downside. I found that interesting, given he knows the subject area better than 99.9 (with lots more 9s proceeding) of the population. But, as Peter said, different people have different risk tolerances. And one things for sure, ageing is coming for us, whether we choose to try and delay it, or not.
Hopefully the above gives you a window into Peter’s supplement use (past & present). I’ve also written about Peter’s diet and exercise routines:
If you’ve got any questions or comments, please leave them below.
Lastly, this seems like a good opportunity to mention Peter’s subscription service – with which I have zero affiliation – but am enthusiastic about.
For an annual fee, it gives you access to his detailed show notes & “Qualys” series, which are short (<10 minute) highlights from the back catalog of podcasts.
This is a great way to support Peter’s continued time spent on the podcast, as well as make sure you’re getting all the latest and greatest info.
Post Change Log
For those curious, see this post for a log of the key changes to this article.
- Lithium levels in drinking water and risk of suicide – Hirochika et al. – 2018
- Lithium in drinking water and the incidences of crimes, suicides, and arrests related to drug addictions – Schrauzer et al. 1990
- Effects of nutritional lithium supplementation on mood. A placebo-controlled study with former drug users – Schrauzer et al. – 1994
- The Effects of Berberine on Blood Lipids: A Systemic Review and Meta-Analysis of Randomized Controlled Trials – Dong et al. (2013)