All protocols

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.

Alcohol disrupts electrolyte balance, so ensuring adequate sodium, potassium, and magnesium can support brain and organ function. Electrolytes can be taken the night of drinking before sleep and again upon waking the next day.

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.

Hangover severity is described as scaling with congeners rather than sugar content. Beer and gin are described as less likely to cause hangover than whiskey, while rum and red wine are more likely, and brandy is described as highest on the list.

Folate and other B vitamins, especially B12, may partially reduce alcohol-related increased cancer risk, but do not completely offset it.

Absolute recommendation; no alcohol is considered safe during pregnancy.

He rejects the myth that some alcohol types, such as champagne, are safer than others, such as beer, 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.

Used as part of strength and power assessment, including jumping off a box.

Exercise regularly for brain health and Alzheimer’s prevention; meaningful benefit requires more than minimal public-health recommendations. In the discussed context, increasing activity from sedentary to about 15 MET-hours per week—roughly three 1-hour brisk walks per week—was associated with about a 50% lower risk.

Attia prefers yearly endometrial ultrasound in women on HRT to monitor uterine lining.

Attia says women on HRT should be having a pap smear every year.

For women who cannot tolerate oral or systemic progesterone, can provide local uterine progesterone protection while using systemic estrogen.

Used only when estradiol gets too high; Attia says it must be real microdoses, compounded at 0.1 mg, perhaps 0.1 mg two to three times per week. He aims for estradiol roughly 30–50 and avoids suppressing below 25. Also referred to as Arimidex/Aromidex.

Attia sometimes has men cycle testosterone on and off; one example protocol given is 8 weeks on testosterone, then 8 weeks on HCG, alternating endogenous and exogenous support.

Attia uses injectable testosterone cypionate for TRT, usually at low physiologic doses; typically not more than 100 mg/week. He prefers splitting dosing twice weekly rather than large infrequent doses, and uses subcutaneous rather than intramuscular injection.

Specified as about the smallest needle that can still push testosterone oil through; size range is 5/8-inch to 1-inch, 25-gauge.