#393 ‒ AMA #85: A guide to medications and supplements: determining what to take, what to skip, and how to know if they're working for you

**Peter Attia** (0:10)
Hey everyone, welcome to a sneak peek, Ask Me Anything or AMA episode of the Drive podcast. I'm your host, Peter Attia. At the end of this short episode, I'll explain how you can access the AMA episodes in full, along with a ton of other membership benefits we've created. Or you can learn more now by going to peterattiamd.com/subscribe. So without further delay, here's today's sneak peek of the Ask Me Anything episode.
Welcome to Ask Me Anything AMA episode 85 Today we're talking about medications and supplements. This is one of the topics I get asked about more than almost anything else. And I think it's also one of the easiest areas to go wrong. People tend to ask me whether something is good or bad, whether they should take it or not. But those are, I think, kind of the wrong questions. The right question is whether a specific intervention makes sense for a specific person with a specific problem. And that's what I'm gonna try to get to today. So in this episode, we'll cover why defining the problem matters more than picking the intervention, the different jobs a medication or supplement can do, and why the evidence bar should move depending on the job, how to tell strong evidence from weak evidence, and why mechanism alone isn't enough, why baseline risk changes everything, and how relative risk can mislead you, how to think about the real downside of taking something, side effects, yes, but also cost, hassle, and opportunity cost, how to determine whether the supplement you're taking is having any real effect, how to stop taking something, why supplements specifically deserve a lot more skepticism than people give them, and finally, the short list of over-the-counter supplements that I think are probably worth the risk-reward trade-off. So without further delay, I hope you enjoy AMA number 85

**SPEAKER_1** (2:03)
Peter, welcome to another AMA. How are you doing?

**Peter Attia** (2:06)
Very well, thanks.

**SPEAKER_1** (2:07)
Good. We will get right into it today on AMA, all-around medications and supplements. So first question, before someone takes any medication or supplement, how do you think that they should define what the problem is in a way that increases odds that they look for and pick interventions that actually benefit them and reduce risk opposed to at best waste money and at worst cause other harm that they don't know about?

**Peter Attia** (2:36)
I think this is actually one of the biggest challenges from a sort of mental model standpoint is plaguing most people when they think about supplements in particular, but I think also, frankly, pharmaceuticals. So people are, I think, typically defining the problem at the wrong level of abstraction. So they'll say things like, I want to be healthier or I want more energy or I want to pursue better longevity.
And the challenge is that those are not really actionable problem definitions. They're vague, difficult to measure, very difficult to falsify and things like that. So I would suggest that we reframe this discussion around what would be actionable metrics or actionable parts, right? One would be a metric that can be studied, two would be a threshold against which you would measure, and then I think a third potential one would be a time horizon. So what am I measuring? What level tells me that there's a problem and by extension, a solution and when do I expect that to happen? And so if you can't come up a priori with some sense of those things, you're probably not in a good spot to start anything. So for example, let's use a tangible example. Instead of saying my cholesterol is bad, you would say my ApoB is 130 milligrams per deciliter. I want to get it below 60 milligrams per deciliter and I'd like to do that in the next six months. Instead of saying my sleep is bad, you might say it takes me 60 minutes to fall asleep on four or five nights a week and I want to make that under 10 minutes to fall asleep within two months. So that's a real problem definition.
The next question is the counterfactual. What happens if I do nothing? Does this problem meaningfully increase risk, reduce quality of life or create some downstream consequence? So I think this question is important because it separates real problems from things that merely feel actionable. And it matters because poor problem definition almost guarantees some positive. So if the problem is vague, almost anything can look like it helped. You sleep a little better one week, your energy is a little better on Tuesday, one lab improves a little, and now you're telling yourself a story. And we all do this. I mean, we're storytelling machines. And I think that's how people end up taking things for years without ever knowing if they've solved anything real.