The guest
Peter Attia: Physician and longevity expert, author of the bestselling book Outlive and host of The Drive podcast. He focuses on healthspan, lifespan, and metabolic health.
What this episode covers
In their first joint Journal Club, Andrew Huberman and Dr. Peter Attia walk listeners through how scientists critically read research papers. Attia presents a large Danish-registry study (Keyes et al.) that reassesses the famous 2014 Bannister metformin paper, concluding metformin offers no longevity advantage that erases the harms of type 2 diabetes. Huberman then covers a bioRxiv preprint showing that simply believing you took a low, medium, or high dose of nicotine produces a dose-dependent change in real brain activation, not just subjective feelings. Along the way they explain insulin resistance, epidemiology methods, Kaplan-Meier curves, hazard ratios, statistical power, fMRI, and belief versus placebo effects.
Recommended on this episode
BookRecommendedISBN verified
The 4-Hour Body
Tim Ferriss
“I still am a big fan of Tim ferriss's slow carbohydrate diet”
“I still am a big fan of Tim ferriss's uh slow carbohydrate diet because I like to eat meat and vegetables and starches”— Andrew Huberman
The guest's own work
BookBy the guestISBN verified
Outlive
Peter Attia
“he is the author of a best-selling book entitled outlive which is a phenomenal resource on all things Health span and lifespan”— Andrew Huberman
Also referenced (named, not recommended)
ProductReferenced
Metformin (Glucophage)
Bristol-Myers Squibb
“this is a drug that's been around forever trade name glucophage or brand name and uh but but again it's you know it's a generic drug today”— Peter Attia
ProductReferenced
Berberine
“if I took berberine and I don't recall the milligram count and then I ate you know 12 donuts I felt fine it was as if I had eaten one donut”— Andrew Huberman
ProductReferenced
Rapamycin
“rapamycin has been studied several times it's always worked another one we should talk about at a subsequent time is 17 Alpha estradiol”— Peter Attia
ProductReferenced
Acarbose
“a carbos is another one of those drugs that actually found a survival benefit in the ITP and it was a very interesting finding”— Peter Attia
ProductReferenced
Canagliflozin (SGLT2 inhibitor)
Janssen
“canaga flows in an sglt2 inhibitor also very successful in the ITP but again interestingly rapid metformin not”— Peter Attia
ProductReferenced
Ozempic
Novo Nordisk
“glp-1 agonists are another drug they increase insulin sensitivity initially causing you to also make more insulin um so that's ozempic yes”— Peter Attia
ProductReferenced
Adderall
“ADHD drugs so things like Adderall Vyvanse methamphetamine for that matter um Ritalin yeah why it's counter-intuitive that a stimulant would be a treatment”— Andrew Huberman
ProductReferenced
Vyvanse
“ADHD drugs so things like Adderall Vyvanse methamphetamine for that matter um Ritalin yeah why it's counter-intuitive that a stimulant would be a treatment”— Andrew Huberman
ProductReferenced
Ritalin
“ADHD drugs so things like Adderall Vyvanse methamphetamine for that matter um Ritalin yeah why it's counter-intuitive that a stimulant would be a treatment”— Andrew Huberman
ProductReferenced
Nicorette gum
Nicorette
“which must be miserable for those people you can't have Nicorette gum or anything no nothing they must be dying”— Andrew Huberman
ProductReferenced
Zyn
Swedish Match
“we know that nicotine Vaped smoked dipped or snuffed or these little Zin pouches or taken in capsule form does improve cognitive performance”— Andrew Huberman
ProductReferenced
Eight Sleep
Eight Sleep
“when you take a sleep supplement you can look at your eight sleep and go oh my sleep is getting better like there's a biomarker”— Peter Attia
Big reveals from this episode
- Attia notes the 2014 Bannister paper claimed metformin gave diabetics a 15% reduction in all-cause mortality versus non-diabetics, the result that drove the metformin-longevity craze.
- The newer Keyes study finds metformin did NOT undo the disadvantage of diabetes, undercutting the longevity hype.
- Attia stopped taking metformin five years ago after noticing it elevated his resting lactate and likely blunts hypertrophy and strength.
- Metformin has repeatedly FAILED in the rigorous Interventions Testing Program (ITP), while rapamycin, acarbose, canagliflozin and 17-alpha estradiol succeeded.
- The nicotine study's twist: all subjects got the same low dose, yet brain activation scaled with what they were TOLD they received.
- Belief about nicotine dose changed actual thalamus-to-prefrontal-cortex brain activation, not merely subjective experience.
- Attia surprises Huberman by switching his planned paper at the last minute, choosing a simpler epidemiology paper for broader appeal.
Worth remembering
- You and I sitting with normal blood sugar have only about five grams of glucose in our total circulation.
- The difference between metabolic health and profound type 2 diabetes is roughly one teaspoon of glucose in your bloodstream.
- Sleeping only four hours a night for a week can cut your glucose disposal by about half, inducing profound insulin resistance.
- The Bannister study used 'informative censoring,' dropping metformin patients who progressed, which inflated the drug's apparent benefit.
- In the ITP, rapamycin extended lifespan ~15% even when given to 60-month-old mice, late in life.
- Hotel workers told their work counts as exercise lost 12% more weight than a control group, with no difference in actual movement.
- Nicotine increases signal-to-noise of sensory information via nicotinic receptors in the thalamus, sharpening perception.
- Medical students develop a warped sense of disease prevalence, fixating on rare 'zebras' like sarcoidosis and situs inversus.
- Men hugging a thermos to their body in restaurants worldwide are likely Uruguayans drinking yerba mate after meals.
- Attia frames the brain as a prediction machine where your beliefs about a drug are themselves an important input.
More from Andrew Huberman
All 3803 recommended