Behaviors

If using an eye mask, make sure the room, bed, and sleeping environment are cool enough to avoid overheating.

Practice lower-intensity cardiovascular exercise using purely nasal breathing to improve ability to nose breathe during sleep. Ways mentioned include taping the mouth shut, holding a gulp of water in the mouth without swallowing, or deliberately keeping the mouth closed and insisting on breathing through the nose.

If using lithium treatment, monitor blood levels extremely carefully because of toxicity risk, especially during the first three months of treatment.

Use observations from family members or close others to help determine whether someone has bipolar disorder, what stage they are in, and whether they are improving, worsening, or moving toward manic or depressive episodes, because self-report may be unreliable.

Get treatment early in bipolar disorder to try to prevent longer-lasting neural circuit changes.

For bipolar disorder, combine medication treatment with talk therapy rather than relying on talk therapy alone; talk therapy on its own is rarely, if ever, effective for bipolar depression and bipolar disorder.

Use alongside drug treatment; involves family members to help identify whether someone is improving, worsening, or moving toward manic or depressive episodes.

Use alongside drug treatment; focuses on relationships and social rhythms across family, work, and school to help navigate and predict conditions that can trigger episodes.

If considering TMS/RTMS, do your research, prefer clinics associated with research institutions, and talk to other patients who have undergone treatment.

For bipolar disorder, treatment should be navigated by a board-certified psychiatrist, especially given suicide risk and the need for prescription drug management.

Two to six months of abstinence can allow alcohol-altered neural circuits related to habitual and impulsive behavior to return toward normal; ideally longer. More broadly, zero alcohol is described as healthiest overall, and moderate/heavy drinkers are urged to move away from drinking and ideally quit entirely.

Eating before or during drinking slows alcohol absorption into the bloodstream and reduces how quickly one feels drunk. A meal containing all three macronutrients—carbohydrates, fats, and proteins—appears to slow absorption more than one or two macronutrients alone.

Starting alcohol later in life lowers risk of later alcohol dependence; he specifically notes waiting until legal drinking age, 21 in the US, as preferable.

Recommended during alcohol reduction and for post-alcohol anxiety or stress. He refers broadly to behavioral, nutritional, supplement-based, and exercise-based tools for stress modulation that do not involve alcohol.

He cautions that aspirin, Tylenol, Advil, and related drugs can affect the liver, immune system, and gut microbiome, and may not be a great idea after drinking.

Avoid using alcohol to treat a hangover, as it may temporarily relieve symptoms but can delay recovery and worsen the hangover.

Maintain proper electrolyte levels before drinking. While drinking alcohol, drink water—preferably 2 glasses per alcoholic drink—and water with electrolytes is even better for helping the next day.

Recommended because different alcoholic beverages differ in expected hangover severity.

Absolute recommendation; no alcohol is considered safe during pregnancy.

Applies regardless of sex; based on alcohol increasing aromatization of testosterone to estrogen.

Get screened early in life; Attia specifically says even a 20-year-old should be checked. Include Lp(a), which is genetically determined, a major driver of atherosclerosis risk, and generally only needs to be checked once.

If a blood marker comes back looking bad, recheck it before reacting; blood tests are snapshots and may need confirmation.

When making interventions or monitoring changes, Attia says patients may check blood two to four times per year to see whether a drug or other intervention had the desired outcome.

Use body weight tracking between annual DEXA scans to get a sense of changes over time.

Use measurable targets such as VO2 max, strength, and stability when backcasting from desired late-life function.

Higher muscle mass is associated with much lower all-cause mortality compared with low muscle mass.

Strength is emphasized as even more important than muscle mass for lowering all-cause mortality risk.

Attia says people should not obsess over supplements or diet nuances until VO2 max is at least at the 75th percentile for age and sex.

Used as a strength benchmark; clinic standard is about 2 minutes at age 40 for both men and women.

If formal testing is unavailable, use online estimators based on running, biking, or rowing performance.