The personal blog of Peter Attia, M.D.

2016 update

2016 update
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Yes, I know, I haven’t written a blog post since ‘nam. Unfortunately (for anyone looking to read a new one) I’m not about to start now. But…I do have two things to offer in the place of treatises on cholesterol (yes, I know, I didn’t finish the Straight Dope series), insulin resistance, hypothyroidism, and a dozen other topics (not including “what I eat, circa Q12016”): first, a series of updates (most of you will want to skip this section if you’re only here for the hardcore science talk); second, a few recent podcasts I’ve done.

Update 1: Work, then

I am no longer at NuSI. I left NuSI at the end of 2015 after four great, albeit very challenging, years. The work we started is still going on and in the following years I look forward to seeing the published research as it becomes available to the public (which I am now a part of).

Update 2: Work, now

Today I am working Peter-part-time (30-35 hours/week) on my medical practice, which is located in San Diego and NYC. It’s a very small practice and sort of referral only. It is not a “ketogenic” practice whatever that means (though people seem to ask me that). The focus is longevity and healthspan, for which nutrition is but one of eight components. I love this work more than I can describe, but I have no plans to scale this practice. For now I’m more content to build a few Ferrari’s a year than a thousand Toyota’s. Nothing against scalable, mass-produced reliable cars, but I’m obsessed with perfection, and I can’t perfect much more than a small handful of patients at a time.

The other half of my time is spent working on things I’m not ready to talk about publicly yet, but they are very much related to my interests expressed in the practice.

Lastly, I am (slowly) working on turning my 10,000 word longevity manifesto (circa 2014) into a book. No, I’m not willing to share the manifesto, but I hope it will be worth the wait when/if the book ever comes out.

Update 3: Exercise

Because I get asked a lot on the blog and through social medial…here goes:

I hung up the bike in January 2015 (from a competitive standpoint). I simply could not travel 140 days a year (which I did last year), work 60-80 hours/week, spend time with my family, and be a quasi-serious wannabe time-trialist. And if I could, I don’t think I wanted to. So the past year marks a first, since the age of 13—it’s the first year I have not competed in something. It felt horrible for a few months, but I’m at peace with the fact that I can’t FTP at more than 4 watts/kg and probably never will again (especially since I think it was actually shortening my lifespan, not lengthening it). I will ride socially a couple of times per month, and find the experience fun and humbling simultaneously. I’m swimming Master’s zero to three times per week, depending on my travel (on my two weeks/month in NYC, it’s zero; in SD it’s 2-3). To fill the some of the endorphin void I’ve take up bootcamps—Barry’s in NYC and OTF in San Diego. Lastly, I’ve re-discovered my obsession with heavy squats and deadlifts. So total exercise volume is low-ish by my historical standards varying between 8 and 12 hours/week with nothing constituting “training” except for squats and deadlifts.

Because I know someone will ask, here is my favorite squat/deadlift set: after a thorough warmup of 7-10 sets ascending in weight, the main set is 5 sets of 5 reps, followed by 4 sets of 10 reps, following by 3 sets of 20 reps. Pat Jak introduced me to this set. Another cool variation, which I did yesterday, is ascending sets of 5 reps until failure (i.e., keep increasing the weight until you can’t get 5 reps), then dropping down to a “test” weight (I use 315 on deadlift and 275 on squat) and going to failure. Then, drop to a second, lighter “test” weight (I used 275 on deadlift and 225 on squat) and go to failure once more. Failure occurs when form breaks, not when you fall under the bar and the goal is increase the reps of those test sets each week.

I don’t possess the vocabulary to explain what this does to my glycogen reserves.

Do not—repeat—do not do this if you don’t know how to squat and deadlift perfectly. If you’re looking for an education, I can’t recommend Mark Rippetoe enough. His book, Starting Strength, is a bible for anyone who wants to correctly lift heavy weights. I also plan to take his 3-day course for a little tune up. I’ve been doing these exercises since I was about 15, and was fortunate to be coached by wonderful people, but you can’t be too perfect in these movements.

Update 4: Displacement

People who meet me often assume I’m uber-competitive. Actually, I’m not and I don’t think I ever have been. I’m obsessed with mastery, though, yet I consider that very inward. Swimming and cycling were amazing ways to scratch that itch and so was surgery, mathematics, and virtually everything I’ve ever done. So in another effort to fill that mastery void, now that I’m no longer training hard enough to master anything, I’ve been putting more time into another passion—auto racing.

SE30

I could write three or four blogposts about this obsession! Last year I managed 9 full days on the track (Laguna Seca and Buttonwillow, above in spec E30) and this year will probably be the same, but the game-changer is my simulator. Using iracing software and a professional simulator built my Mike Wagner (see pic, below, including my shrine to Ayrton Senna) which is the most realistic sim out there, I can actually spend 60-90 minutes per week in the sim and continue to fine tune every detail of the technique necessary to drive a car at its technical limit. The best part (besides hydraulic pedals)? I can practice with my coach, Thomas Merrill (that hyperlink is to a cool test drive he did in a 458), virtually, for hours on end. I’ve never done anything that requires so much concentration and through which I lose all sense of time. Sometimes I tell my wife I’ll be “simming” for 45 minutes only to have her come out and tell me it’s been almost 2 hours. Another added benefit is that I get to teach my kids about driving while they sit on my lap. Fun for the whole family, really. Except my wife, although she has learned to fly through the corkscrew at Laguna in a Miata. I initially planned to put the sim in our bedroom, but that idea was vetoed in favor of the garage. Better than nothing, but I don’t see why the bedroom was such a bad idea.

On the track, my best blooper so far was an amazing failure of metallurgy going into turn 2 at Buttonwillow. Admittedly I tried to cheat and shift from 4 to 2, instead of 4 to 3 to 2, but still… c’mon…

Sim

Update 5: Family

Speaking of family, and since I do get asked (thank you very much), my family is doing great and especially happy to see me under much, much less stress than when I was a full-time fundraiser. And as far as kiddos go, it’s still amazing to think there was a day when I didn’t want them (in the abstract, not my actual kids). So glad I was talked into it. The little guy is, officially, a monster. At his 18 month check-up he was 99th percentile in height and 91st in weight. Probably not going to be a great jockey. Big sis adores him and hasn’t (yet) got sick of him. She plays drums like it’s her job and he dances like it’s his.

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Update 6: What I eat (the only update you care about…)

In 2015 I did a 6 month experiment of exactly one meal per day (23 hours of fasting, then ~1 hour of eating at dinner). Very interesting. I’m sure I discuss it in at least one of the podcasts, below. These days I’m eating about as freely as I have in 7 years. I’m still carb-restricted by the standards of most Americans, but nowhere near the ketogenic lines of 2011, 2012, and 2013. I almost always skip breakfast, and lunch is usually a salad (“in a bowl larger than my head,” if possible). Dinner is usually a serving of meat with more salad and veggies. I’m more liberal on fruit and even occasionally rice or potatoes. Also, in moments of weakness I sometimes lean into my kid’s crappy food.

The biggest “news” on my eating front is that I now wear a 24-hour continuous glucose monitor (CGM) 24/7. This was the result of one of the most fortuitous flights of my life. In the fall of 2015 I was flying to NYC and half way through the flight, needing a short break from work, I went to one of my favorite watch sites. The fellow next to me made a comment—clearly he was part of the cognoscenti—and we got ultra-deep into watch idiotness. After a while I asked him what he did only to find out he was the CEO of Dexcom, the company that makes the best CGM device on the market. Fast forward a week and Kevin has introduced me to his amazing team (Christy Pospisil is awesome!) and I’m hooked. CGM is a game-changer and it does warrant more discussion than I can provide now. The insights have been staggering. I’m pretty obsessed with it (shocker, yes) and I aim to keep my 14-day running glucose around 90 mg/dL with spot-check standard deviation less than 10 mg/dL. By keeping average glucose low and glucose variability low, I can reasonably assume my insulin AUC (area under curve) is low.

Below is a printout of my last 14 days. As you can see my measured average glucose was 92 mg/dL, which imputes an A1C of 4.8%. At some point I may write about the dozen insights gleaned from CGM (and I think I mention a few in the podcasts), but here’s one: measured A1C is probably directionally valuable (you know, the difference between, say, 5% and 9%), but that’s about it. If your RBC (red blood cells) live longer than 90 days—mine live much longer since I have beta thal trait—your A1C will artificially reflect a higher average glucose. Conversely, if your RBC are large, the opposite occurs. (For those wondering, MCV, which is part of a standard CBC, shows you RBC size).

My A1C in standard blood tests routinely measures 5.5% to 6.0% (courtesy of my tiny RBCs), which poses a problem when applying for life insurance (prediabetic is defined as 5.7% to 6.4%). But with CGM, which is calibrated 2-3 times daily, my imputed A1C, which is much more reliable, varies from 4.6 to 4.9%. Big difference, huh? As an aside, I can’t talk about my beta-thal without hearing my med school roommate, Matt McCormack referring to them as “shite for blood” in the best Scottish accent ever. As if it’s not bad enough having an artificially high A1C… you gotta have shite for blood.

And that’s the least amazing part of CGM. I’m not sure I’m at liberty to discuss the next generation of CGM. Admittedly, not too many people want to wear the device I wear, but in two years, well, that’s when it will get amazing.

And that’s just the tip of the iceberg when it comes to why this device is adding insights and actionable data at a geometric rate. In two years this device will evolve into something everyone can wear.

Peter Attia CGM

And lastly…

Ok, I can’t think of any other updates so with that below are three podcasts I’ve done in the past 3 or 4 months. By some coincidence all of them have gone live in the past week, which is what prompted me to do this post-that-is-not-really-a-post.

Here they are in the order they were recorded.

  1. Rhonda Patrick and I spoke in Fall 2015. Here is the link to the video, which she nicely annotates. I believe this is also available on iTunes.
  2. Ken Ford and I spoke in January of this year. I was honored to be the first speaker in IHMC’s STEM series. Here is the link.
  3. Chris Kresser and I spoke in February of this year. We planned (before the talk) to discuss lipoproteins, but I don’t recall doing so. Here is the link.

I hope these three podcasts—all of which were really fun discussions—keep you occupied for a while. I have not listened to them, but my recollection is that there will be overlap between them, especially the latter two.

I’ve been asked a lot in the past few months to do other podcasts but I’ve politely declined, noting that I’m a bit podcasted out. I’m sure the energy will return next year, assuming I have something to say.

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About the Author:

Peter Attia, M.D., is a physician in private practice in NYC and CA. His practice focuses on longevity and healthspan. His clinical interests are nutrition, lipidology, endocrinology, and a few other cool things.

Discussion

  1. Gary  March 16, 2016

    Great to hear from you, Pete. Was the break away from NuSI because you were overworked and wanted to do your new practice, or is it because of something else? Just curious as you were so passionate about it in the past.

    Hope you can come back semi-frequently to update us.

    PS – That car sim looks like the most fun an adult male could have.

    (reply)
    • Peter Attia  March 16, 2016

      The sim + hex bar + squat rack + bumper plates = most fun a guy can have alone in his garage!

    • Piyush Dimri  April 18, 2016

      It have been following you from quite a long time. I really liked your idea about LCHF diet and your pursuit of cracking insulin resistance/ Type2 diabetes epidemic.

      I just read newly published paper in nature w.r.t Cause of Insulin Resistance in Type 2 Diabetics (http://www.nature.com/nrendo/journal/vaop/ncurrent/full/nrendo.2016.46.html)

      My father had Type 2 diabetes and i think i have pre-diabetes/Insulin resistance with fasting blood glucose of 105.

      I knew beforehand that high carb and sugar is the leading cause of diabetes, so i had reduced the carb intake and increased the fat intake. I have always been an active guy and do rigorous strength training and weight lifting performing high volumes and high intensity,still my fasting blood glucose came high.It was a shock to me!

      Thereafter i was wondering, why even after cutting down on carbs/sugar and excising regularly my blood sugar was on upper side.After reading the new nature paper, it gives insight that High fat intake and along with high BCCA supplements is detrimental to insulin sensitivity.

      I had started high fat diet an year ago (i am vegetarian but i eat lot of eggs, cheese and butter ) and had BCCA intakes along with my Protien shakes which by itself has BCCAs in them.We also know that proteins also break down into BCCAs. I had reduced the carb intake and increased the fat intake.

      Before starting high fat diet with BCCA my FASTING. blood sugar was in 90’s.

      I thought of sharing my health and metabolic profile to you after reading this Paper. Are we missing/ignoring something in our fight against insulin resistance.Please share your suggestion.

  2. Bret Scher  March 16, 2016

    Hi Peter. I am blown away by your approach to health and longevity. I have very similar goals to you in my part-time practice of a small scale, individualized health promotion and disease prevention practice. I am not looking to create a global institution, but I am looking to be part of something amazing that helps people in ways that cannot be done elsewhere. Since I started this process a year ago, I have been looking to organize or join a team that could accomplish this better than any individual. As luck has it, I am in San Diego (I have even run into you at the Bay Club). Now that I see you are delving more into clinical practice, I feel I need to stalk you until I can convince you to sit down with me and chat. Although I will readily admit I am not near your stratosphere of intelligence and detail in your thought process, I also have to admit that I am as passionate and committed as anyone when it comes to truly helping others make a positive difference in their lives. I bet you didn’t know you had a job opening, yet here I am applying for it. Let’s sit down and if you think I’m full of hot air, so be it. But I bet with my help you could reach more people with more success and perfection than you realized. You’ve got nothing to lose and potentially a whole lot to gain. Plus I’m getting tired of looking all over the gym every time I am there to try to find you!

    (reply)
    • Peter Attia  March 16, 2016

      Ha ha… I’m not at Bay Club that much these days, as I swim elsewhere and often lift in my garage. Plus, with travel, I might only life there 5 times a month.

  3. Wab  March 16, 2016

    Welcome back!

    At one time, you were insulin resistant. Obviously, you are currently very insulin sensitive. Now that you’re not restricting carbs as much, what do you think changed in your physiology (i.e., which adaptations do you think persist despite an increase in carb consumption)?

    Did you gain any insights into the cascade that led to your insulin resistant state?

    (reply)
    • Peter Attia  March 16, 2016

      Great questions, but too much to answer quickly. Yes, I have insights into how I ended up where I did in 2009.

    • Terri  June 8, 2016

      I echo Wab’s comments Peter. I believe I am also insulin resistant. I so enjoyed your podcast with Tim Ferris. It is the sole reason I started taking berberine; you were the catalyst and thank you for that.

      Any chance you can tell us how reintroduction of carbs has been for you? I think I listened to a podcast of why you decided to reintroduce carbs occasionally but can you expand/illuminate?

      I am toying at moment and following the “Eat Stop Eat” program. I am hypothyroid but I was a competitive tennis player (played college tennis) and I love exercize., Flash forward, I am now almost 52 years old (and take one tablet of desicated thyroid every day (60 mg Armour) and until recently, I wsa the heaviest I have ever been since I gave birth. Hmmm… I have lost 15 pounds the last 3 months doing Intermittent Fasting (Eat Stop Eat). The fasting has not been an issue for me (I like the structure and the fact I don’t have to worry about food the two days I fast). I have also started lifting again and I feel much better. This will be a lifestyle change/journey for me but any advice you can share would be most welcome.

      Thanks in advance for your help!

  4. Marcus Harbaugh  March 16, 2016

    Thanks so much for the update and of course for all the great information you’ve provided for so many years!

    (reply)
  5. Steve Altfillisch  March 16, 2016

    I just listened to the great podcast with Rhonda. You help remind me that there are no simple causes or solutions to chronic health issues and so much more to learn. Thanks for sharing your knowledge.

    (reply)
    • Peter Attia  March 16, 2016

      Complexity is a bitch, huh? Too bad we live in a world where folks only have the attention span for bumper stickers.

  6. Cyndi  March 16, 2016

    Does the CGM play a role in your daily food choices?

    (reply)
    • Peter Attia  March 16, 2016

      In the most unbelievable way… can’t imagine life without it.

    • Justin  May 24, 2016

      Is the CGM device you used available to the public? Can you give the specs?

    • Peter Attia  May 27, 2016

      Yes, Dexcom G5.

  7. Ryan  March 16, 2016

    Great blog post Peter.

    I’m highly envious of the weather in all these pictures! Even the family pictures, don’t think I’ve seen palm trees and puffy winter jackets together before…well maybe at the Dubai indoor ski hill.

    You have better luck with your in-flight seating than I ever have, most interesting guy I sat next to snored so loud the noise cancelling on my headphones couldn’t even cope with it.

    Re Squats, you ever used a safety squat bar? Pretty much the only thing I can use due to some shoulder and elbow issues…probably down to years of bad posture.

    Cars; open driving invitation if you ever end up in the area during the non skating rink seasons.

    -Ryan

    (reply)
    • Peter Attia  March 16, 2016

      Ha ha, Ryan…I’ve had many of those flights, too! The invitation is very appealing.

    • Christopher Grove  April 8, 2016

      “non skating rink season”

      You a Canuck too, Ryan?

  8. PJinLA  March 16, 2016

    Thanks for the update, looking forward to the book. By the way, I’m very jealous of your racing-sim rig, my wife would never allow such a (fun) extravagance. Before marriage I would spend hours on Grand Prix Legends – nothing like spending months trying to master the majestic Nurburgring Nordschleife in a Lotus 49. The demands on concentration alone give you enormous appreciation for the guys who risked their lives in the real machines on real roads, but also why they did it.

    (reply)
    • Peter Attia  March 16, 2016

      Yea, my respect for these guys is at another level. If you haven’t seen it, the documentary “1” about the evolution of F1. I’ve seen it somewhere between 23 and 25 times…mostly when wifi dies on airplanes and I reach for the ipad.
      To think that Niki Lauda went sub-7 min on the Nordschliefe in the early 70’s is unreal. I won’t tell you how long it took me to do it the first time in the sim… I have two more years before I’m ready to go to Germany and give it a shot.
      My ultimate goal is Formula 2000, which my coach thinks is doable in 2 years.

  9. Andy Benkert  March 16, 2016

    Your 14 day glucose chart is effin insane, I’m incredibly jealous! I wear a Dexcom, too, and it’s radically changed my T1 diabetes management in a huge way. I can’t say enough how much it has helped me better manage my disease, and I thought I was doing a pretty good job prior to getting it. I’m coming up on my first endo appointment since having it for more than a couple weeks, and I’m looking forward to seeing the results of how this device has helped me.

    I am very interested in, and excited to see the next gen CGM that you suggest in the post. If they need some very active people to do some field testing of the new system, please pass along my name and email address. I do a lot of running and hiking, and would probably be a good tester for any new system they have in development. 🙂

    Thanks for your continued posting and the information you pass along, Dr. Attia, it is much appreciated. Best to you and your family!

    Andy

    (reply)
    • Peter Attia  March 16, 2016

      Andy, don’t be jealous… I have a freakin’ pancreas, man! I did comment to another reader about the amazing work of Jake Kushner at Texas Children’s. Look him up. He’s getting incredible results in his T1D kids. A1Cs in the 5’s without hypo.

  10. Lloyd Ignacio  March 16, 2016

    I’m a Type one diabetic and only wish that my health insurance would cover a CGM. My A1C is always in the low to mid 8’s with my endocrinologist on my back all the time. I have been limiting my carb intake and exercise 6 days a week cycling 3 days a week avg 60-90 miles and weight training the other three days. My cholesterol is within good rages without medication and BP is within normal range. I’m 68 years old and consider myself to be in good health at 5’11” and 210 lbs. except for diabetes. Any suggestions in obtaining a CGM?

    (reply)
    • Peter Attia  March 16, 2016

      Lloyd, I wish I could help with this. I think everyone with diabetes–T1 or T2–should have CGM. Jake Kushner who runs the T1D program at Texas Children’s has the Dexcom on all of his patients. They have A1Cs in the 5’s without hypo episodes. Maybe reach out to Jake and his team?

  11. JonnyV  March 16, 2016

    Hey Peter, thanks for the update! Very cool stuff. I’ll be looking forward to hearing more about your CGM experiments – I have flirted with the idea of doing that when I read about it in The 4-Hour Body.

    Is NuSI working on finding out whether certain blood marker results (like LDL-P) can mean different things based on context, such as diet? I.e. does a high LDL-P under a ketogenic diet display a different level of CVD risk vs. the same number, but with a standard American diet?

    (reply)
    • Peter Attia  March 16, 2016

      Not to my knowledge, but of course I have very limited knowledge…

  12. Marcus Wolford  March 16, 2016

    Thanks for the update Peter, I would love to know more about the insights you have gained from CGM both from a health standpoint and possibly for exercise/sport performance. I loved your talk with Rhonda, just wished it was longer, was actually taken back when it seemingly abruptly ended. Then again, I use “Overcast” to listen to podcasts which shortens/eliminates pauses in conversation so it was sped up a bit.

    4 Questions:
    – Have you or will you explain why you left NuSI
    – Have you done any research or used an HRV device like “Omegawave”?
    – Do you still hold to the insulin model? If so, have you or might you give a response to the seemingly convincing 3rd hypothesis put forth by Stephan Guyenet, found here – http://wholehealthsource.blogspot.com/2016/01/testing-insulin-model-response-to-dr.html

    Thanks for all you do Dr. Attia! You are in the fortunate position, to be able to benefit so many more people then those who actually respond and say thank you… in other words, more then you realize 🙂

    – Marcus

    (reply)
    • Peter Attia  March 16, 2016

      1. I’ve said all I want to say about NuSI
      2. I’m pretty interested in HRV, but struggling to find the “right” device. Ditto for a great sleep device that can accurately record stage III and IV of sleep.
      3. Do I look the kind of guy who want to spend 20 hours on a back-and-forth blog debate? If I want to debate this topic, I just call Stefan and we discuss it like a couple of gentlemen.

    • Bill  March 16, 2016

      “…struggling to find the “right” device. Ditto for a great sleep device that can accurately record stage III and IV of sleep.”

      Peter, have you seen this? Steve Gibson is quite remarkable, if you don’t know him:
      https://www.grc.com/zeo.htm

      And this, for the sleep aid supplement Steve developed with the help of the Zeo:
      https://www.grc.com/health/sleep/healthy_sleep_formula.htm

    • Peter Attia  March 17, 2016

      I’ve already got what I consider the best sleep cocktail on earth, which I supplement as needed. Still in search for a great monitor. I’ve outsourced that my good friend Kirk Parsley. He’s still looking.

    • David Holmes  March 17, 2016

      I would so fund a Kickstarter campaign to have Peter and Stefan have that insulin discussion as a video/podcast.

    • Peter Attia  March 17, 2016

      David, that might be the funniest freakin’ comment I’ve heard in as long as it’s been since I wrote a damn blog post!

    • Sara  March 17, 2016

      Would fund kickstarter…

    • Craig  June 11, 2016

      Hi, Peter, thank you for all of your hard work. Besides phosphatidylserine, what is in your “sleep cocktail?”

    • Peter Attia  June 14, 2016

      I use Kirk Parsley’s sleep cocktail in addition to P-S.

    • Alex Fergus  August 12, 2016

      Hi Peter,

      Regarding your comment re the Sleep device, you need to check out the OURA Ring.

      I’ve tried and tested so many devices over the years (fitbit, jawbone, beddit, various iphone apps etc) for myself and my clients, and the OURA ring is by far the best.

      As soon as they launch their coaching platform I will be switching all my clients over to it.

      It looks a bit ugly at first, but you could simply use it only at night and take it off during the day if you just want to track sleep.

      I actually have a comprehensive review on my site with a few videos and an interview with the OURA founder.

      https://www.alexfergus.com/blog/the-one-wearable-to-rule-them-all-oura-ring-review

      I know this probably sounds like a sales pitch, but it’s not. I’ve been a long time reader of your site (I discovered you a while back when you were on Ben Greenfields show). Anyway where I saw your comment about the sleep device I just wanted to give you a heads up about the ring because it may be the solution that you’ve been looking for.

      All the best.

      Alex

  13. Michael Rupp  March 16, 2016

    Great to hear from you, Dr. Attia! Thanks for updating and sharing your life with your loyal community. It sounds like things are going great and only changed for the better for you in 2015. Looking forward to your coming longevity tome!

    (reply)
    • Peter Attia  March 16, 2016

      Me, too. I think producing it will, of course, reduce my own longevity.

  14. Dan Walker  March 16, 2016

    Good stuff as always!
    I don’t believe I had heard of the IHMC until I began following you and Dominic, but I keep wondering if I had ever run across something about them a long time ago seeing how I graduated from the University of West Florida in 1994. Computer Science and Psychology were very large and well funded sections of the uni though. That was well known. I was, however, always way in the back of the campus in the Biology and Chemistry building. Although I did spend many nights studying in the very nice 24 hour computer lab on campus. The poor physics department was always overlooked as it was relegated to a small space on the 3rd floor of the monster Psych building. UWF is an interesting campus because it is also a very large state nature preserve which enabled our field biology professors to find interesting ways of dragging their lab classes all over the far corners of campus and keeping us for the full 4 hours or so allotted for labs.
    Interestingly enough too my Mom drove a brand new, manual transmission, 325e that my Dad got them for something like 10 or 15 years and when they finally sold it I think it was to somebody that was going to set it up for racing. My Dad always said that Eta engine ran like a perfect sewing machine. My Mom loved that little car. That was the first vehicle I ever got up to just over a hundred miles per hour while driving on one of the back roads at the beach. Lots of on demand torque but you had to watch that red line because you would get there fast. I actually got her hand me down Datsun 810 which had the same straight 6 that was in the same generation Z of the day. The Nissan/Datsun designers had even reverse engineered the Bosch fuel injection system for that engine. Good times.
    Maybe do a post sometime on watches and your horological opinions. I fear it may become a lost art one day now that we all carry tiny supercomputers in our pockets these days. Always good to hear from you.

    Dan

    (reply)
    • Peter Attia  March 16, 2016

      Dan, the first car I ever drove was a 1988 E30 325 in 5 speed. As a 15-year old I would sit in the garage and practice shifting for hours (it was my older cousin’s and he kept it in our garage). So it was really cool last year to transition to this car…
      One day I should do a post on my other obsessions…watches, pens, Secretariat, Senna,… I’m a pretty obsessive guy. Thanks for humoring me.

    • RickT  March 18, 2016

      I think it’s hilarious that the engine blocks in the early-80s BMW M12 F1 engine that produced close to 1500 BHP, were taken from the 2002 series road cars that had at least 100k km on them. From 80 BHP to 1500. I guess you can make a silk purse out of a sow’s ear.

      https://www.youtube.com/watch?v=t5Dbp_SuMHE

  15. PhilT  March 16, 2016

    Thanks for the update. Your comments about beta-thal resonate with me as I have microcytic anemia and elevated HbA1c. I’ve also coincidentally been dabbling with continuous glucose monitoring using a device called the Freestyle Libre which is intermittently read via NFC from a phone or dedicated reader (ie not a continuous display). Being from the North of England with Viking heritage perhaps I may have some beta-thal trait. Must dig into that.

    (reply)
    • Peter Attia  March 16, 2016

      Drives me nuts that most docs (or insurance companies) don’t understand this…

  16. Andy  March 16, 2016

    Thanks for writing again. Always loved reading your work and hearing about your experiments.

    (reply)
  17. Julian  March 16, 2016

    Thanks for the update. Curious: what were the consequences of your 6 months of 23:1?

    (reply)
    • Peter Attia  March 16, 2016

      Lost ~10 pounds, but at least half of it muscle… meal timing did me in. There is a way to do it, I think, without such loss, but it requires sort of cheating.

    • Jane  April 13, 2016

      Dear Peter,

      Your report of muscle loss with 23:1 fasting is alarming!

      For all those experimenting on their own with fasting protocols,
      Would you please explain your belief that the link was due to your meal timing?

      Have you seen Jason Fung’s essays on fasting to reduce insulin resistance? He blogs at Intensivedietarymanagement.com
      Fung is a practicing nephrologist in Canada who has written a series of very clear explanations of a model of the hormonal causation of obesity and type 2 diabetes — a persuasive elaboration of the insulin hypothesis.

      Lots and lots of people, including both women and men of all ages, are fasting in efforts to reduce insulin to improve their health. (or, perhaps, to look like fitness models?)
      But if significant muscle loss is the result, then their efforts might backfire. They’d be failures again, just like they were after trying, and trying again, to follow Weight Watchers and other low-fat calorie-restriction diets.

      Help! They need to learn what they can about fasting from you too.

    • Peter Attia  April 17, 2016

      Context matters, Jane, so please don’t get too upset! Jason is treating people with T2D. If they lose a few pounds of muscle, but everything gets better, that’s a huge win. I’m starting from a very different (already very insulin sensitive, low body fat, etc.). I can’t, in a short comment, provide more insight into this, but I’m sure I will at some point in the future.

  18. Tim C  March 16, 2016

    I’m glad things are going well and that you seem to have found more balance in your life. It’s not easy trying to fit work and family in, and it seems like you were unimaginably busy!

    (reply)
    • Peter Attia  March 16, 2016

      Thank you, Tim. Not sure I have balance, but better than before.

  19. Mike Gopsill  March 16, 2016

    Great to hear an update Peter. I noticed you were no longer on the NUSI site so was interesting to see what you are focusing on. Auto-racing sounds very cool!! I wish my parents could have taught me to drive on a sim racing around Laguna Seca!
    As always, interesting to hear how you are eating. I think I’ve followed a similar ketogenic path. There’s something about the perfectionist pursuit of very low-carb and ketone-tracking, but relaxing the restrictions a bit, especially by skipping breakfast, makes compliance a bit easier and stress-free for me. Though now you’ve peaked my curiosity in this GCM tech!
    Looking forward to your book and good luck with it!

    (reply)
  20. Justin  March 16, 2016

    Can’t wait for the book!

    (reply)
  21. David Dosoudil  March 16, 2016

    Hi Peter,

    I’ll take a liberty of being the first one to comment, thanks to, I guess, living across the Pond and having a chance to read this before the sunrise in US 🙂 Even though (I feel for you) after spending about 30 hours in the air last week, “living somewhere” is a very abstract term.

    First of all, thank you very much for putting together an update. I know you’re a very busy man and I know from my own experience, even the greatest hobby can eventually become a biggest burden when taken seriously and presented publicly. So take your time and do whatever suits you. Your articles are great information source and a motivation like no other. It changed a lot of what (and how) I and people around me do. It’s something that’s dearly missed, but it can’t be at your expense. If I have to wait for a book, I will 🙂 But one is very much needed – a humble kind request.

    To your points:
    1. Could you elaborate? Is it lack of time, your priorities, or something with NuSI? I really hope the frustrations with the grand task and its funding wouldn’t mean the end of the project too soon. The research ongoing is very important for us all.

    2. You couldn’t have possibly stretched your “office” more spatially, could you 🙂 I think it’s a great idea and a logical consequence of the last years. I wish you all the best and I really hope everything you do is going to be well documented and possibly replicated and enhanced in the future. Any apprentices you’d eventually consider that are perfectionist and enthusiastic enough? I think “cloning” Peter Attia is the only viable solution for you and us all 🙂

    3. Time, time, time…doesn’t it catch with us all eventually?

    4. I too have a friend, who thinks he’s making the best driving sims out there. And as for what I’ve tried, I actually think he does. Hell, they’ve been already cloned by Russians 🙂 You might find it quite interesting – Check this out: http://www.motion-sim.cz

    5. All the best!

    6. What an exciting news. I know you’re not allowed to elaborate, nor would be Dexcom CEO. But I’m really, really hoping that people like this talk extensively with companies like Apple, who have the manpower and budget to put all these kind of health monitoring sensors into mass produced devices, that people will actually want to own and use in daily life. I really honestly think the potential of these sensors, hardware like Apple Watch and a good database linked to capable software could mean a little healthcare / lifestyle revolution if its capabilities are properly exploited. The best time for healthcare professionals to closely talk with the technology leaders.

    All the best Peter and many thanks for an update. Your podcasts are a great way to fill the void.

    And most of all – live your life as YOU like it and don’t care about us. You’ve left a lasting legacy already.

    (reply)
    • Peter Attia  March 16, 2016

      The world needs another Peter Attia like I need another hole in my head…just ask my wife. Splitting life between NYC and SD is a great way to experience two extremes, each of which I love in moderation.

  22. MJ  March 16, 2016

    so great to hear from you, Peter. enjoyed the Kresser podcast. you touched a bit on calorie depravation, — I’m wondering if you have an opinion on fasting — not IF — but real fasting, for brief periods of time; 3 days, 5 days, more? there’s so much buzz about intermittent fasting, that it’s difficult to unearth (and parse) good content on longer periods of fasting for health.

    (reply)
    • Peter Attia  March 16, 2016

      Until we have an mTOR integral I don’t see how we can differentiate between 5:2, hypo 7:0, or any other fasting protocol. This is, in my opinion, the single biggest gap in this space. Might even justify another 2016 blog post.

    • BobM  March 16, 2016

      In an effort to reduce my insulin resistance, I started IF (intermittent fasting) about a year ago. I consider 3+ days of fasting to be intermittent fasting (or at least I’ve not seen a definition of IF that excludes those). I’ve done a bunch of 3-3.5 day fasts, one 4.5 day, one 5 day, and one 5.5 day fast. One thing that occurs with 4.5 day fast is that your TC, LDL, HDL, triglycerides, etc. get wacky. I’ve had test results after a 12 hour fast then after 4.5 days (the same week), and the results are all over the map (LDL,HDL + tri are much “worse” for instance, blood sugar plummets, and insulin becomes unmeasurable). However, this effect seems to be transitory. Over the last three years, my TC, LDL, HDL, Tris, have all improved (assuming any of these matter, and I have my doubts) while eating low carb, high fat. (Can’t tell about LDL-P, as I have to pay for this myself and have only one of these taken while not fasting for 4.5 days.) IF has also caused my blood pressure to plummet, more so than did just low carb.

      Additionally, I perform IF daily now (no longer eat breakfast on most days), and have multiple smaller IFs during most weeks (usually 16:8 daily, 22:2 sometimes, 1.5+ day fasts). I haven’t noticed much difference between shorter and longer fasts, other than perhaps some digestive issues with longer fasts (5 days means I have a lot of water in me) and a slight tendency toward having less concentration after about 3-4 days. In fact, in many ways, the longer fasts are easier to do, as the first two days tend to be the hardest.

      Dr. Jason Fung, who advocates fasting for diabetics, says that longer fasts lead to quicker results, but otherwise they’re similar. Is he correct? It’s hard to tell. But for me, I don’t have much problem either way. I do know that I haven’t been able to do a 7 day fast, as that means I wouldn’t be able to eat with my family or have my normal single drink on Fridays or Saturdays. That’s a bit too much to give up for now.

    • Peter Attia  March 17, 2016

      Hard to know. Jason is primarily using fasting for treatment of T2D. My interest in fasting is more for longevity, where we can’t measure direct results and must use proxies–the most important of which we don’t even have a measurement tool for.

    • BobM  March 16, 2016

      For instance, here are my results for a recent fast (2/29 = 12 hours of fasting; 3/4 = 4.5 days of fasting):

      Date TC LDL HDL TGs Non HDL Glucose HbA1c
      Chol
      2/29/16 168 103 52 65 116 97
      3/4/16 188 121 36 157 152 74 5.2

      The 2/29 test is from the doctor’s office, and he refuses to order an HbA1c test or other tests like LDL-P; says we test too much. I paid for the 3/4 out of my own pocket. For a different 4.5 day fast, I got a blood glucose of 63 (and I couldn’t feel any adverse effects) and an insulin level that was not measurable (3.8 uIU/mL is a value I received for insulin for a normal, 12 hour fasted test; I have to pay for the insulin test myself, too, so I don’t have it done often).

    • BobM  March 17, 2016

      If you’re interested in life extension, then it would be nice to know the interplay between autophagy and length of fasts. I don’t think that’s been adequately examined, though. Dr. Fung discusses this a bit here:

      https://intensivedietarymanagement.com/fasting-and-autophagy-fasting-25/

      Personally, I think that for all we know about the body, we still know next to nothing. Does cardiac muscle have autophagy and if so what causes/contributes to this? And, how does fasting contribute (or not contribute) to this process? Dr. Malcolm Kendrick is having a series on what he thinks is the process for heart disease. I tend to think he’s correct, as his theory makes the most sense to me, but no one really knows.

      The problem with fasting is that it’s considered to be fringe, even more so than eating a high fat diet. I’ll tell people I’m eating a high fat diet (e.g., when they ask me how I’ve lost so much weight), but I don’t tell them I also fast. People can understand eating different foods (even if it goes against everything they’re taught — you’ll be kook but maybe not crazy), but if you tell them you fast, you’ll be ostracized and considered crazy.

    • Peter Attia  March 17, 2016

      That’s why we need an A1C-like integrator of mTOR activity.

  23. Alexandra M  March 16, 2016

    It’s so good to hear from you!

    (reply)
    • Peter Attia  March 16, 2016

      Good for another year, right?

  24. Gretchen  March 16, 2016

    1. “In two years this device will evolve into something everyone can wear.”

    Not everyone can afford CGMs. Even people with type 1 diabetes have difficulty getting insurance to cover them. Medicare won’t.

    2. Please clarify relation between thalassemia and RBC lifetime. I thought thalassemia was a form of anemia and RBCs lived a shorter, not longer, time.

    (reply)
    • Peter Attia  March 16, 2016

      I don’t have full on thal, just that trait, so my RBC are really small, which means they don’t get degraded by liver/spleen as quickly as normal sized RBC.
      Re: CGM cost…time will bring this down.

  25. Marlene E.  March 16, 2016

    How great to hear from you!! I didn’t know you lived in San Diego; can I treat you to a coffee and brain-picking session some day? I’m in San Diego as well 🙂 Your family is beautiful! I’m sure they’re not that smiley all the time, but even so. Interesting to read that you’re now doing intermittent fasting. I have tried, but even after nearly 2 years on a ketogenic diet, I still cannot go beyond 4 hours without having to eat again, which is an enigma. On the Dexcom? I would love to be on one, as I believe thereby lies the answer to my food-neediness. Not a diabetic, so I cannot get authorized by insurance. Hopefully, if Dexcom is now making a CGM that everyone will wear, it will be affordable by everyone. Wouldn’t it be awesome if it monitored glucose, insulin, and ketones simultaneously??

    (reply)
    • Peter Attia  March 16, 2016

      Yes, unfortunately insurance will not approve for non-T1D. As the technology gets better I’m hopeful cost will get closer to something everyone can afford–ideally less than a cup of coffee a day. The technology also works for lactate and BHB, but there isn’t a big enough market (yet) for those.

  26. Chris Woods  March 16, 2016

    Dr Attia

    Great update.

    I watched your interview with Dr Rhonda Patrick yesterday which you indicate here was filmed in the fall of last year. In the interview, you claim that ApoB/LDL-P is the chief driver of atherosclerosis and CHD risk following smoking. Yet on Dec 8, in a comment on this site, you write:

    “…I’m changing my tune a bit on particle size. I think the analysis I previously shared re: size vs. number may be flawed the way other studies of highly correlated variables can be flawed, especially if using ROC for the analysis.”

    There are a lot of folks in the ApoE4 community challenged by LDL-P / insulin resistance conundrum; where when they try to minimize IR chiefly with lower/low carb diets, LDL-P increases. I can certainly see cases where there is not inconsistency in your statements. Just more clarity on this from resources like you would be helpful.

    Best wishes in your new pursuits. You have been a tremendous resource for me and lots of folks I know.

    (reply)
    • Peter Attia  March 16, 2016

      Chris, I don’t think those views are contradictory. Particle number is a huge driver. My point is that I once felt size was *irrelevant* once corrected for number. I am not sure that is correct. But that doesn’t negate the importance of particle number. Hope that clarifies my thinking.

    • Chris Woods  March 16, 2016

      Dr Attia

      That’s what I anticipated. Thanks so much.

      If you are ever interested, the ApoE4.info web forum would love you have to “stop by” for an interview and guest post. Dr Dayspring was gracious enough to do so about a year ago. The dialog and learning was immensely helpful.

      Given your particular insight into AD and lipids, we would love to have you. Dr Patrick is on our list of guests to invite as well 🙂

      Again, thanks so much for all you have done. All the best.

    • Peter Attia  March 16, 2016

      With Rhonda and Tom on board I can assure you I have little to add. They have that area covered!

    • Daria  March 16, 2016

      I feel for you because I’m the same boat here! Unfortunately, cutting carbs is never enough to address ApoE4 with IR. Fat, esp. saturated, has to go down and significantly so. NMR Liprofile done at various points during changes in the diet supports that (particle number of 600 with very little SATURATED fat becomes 1500 with addition to cream, butter, fatty cuts of meat. So between the rock and a hard place, so to speak, – it’s either cutting calories in general by the virtue of cutting BOTH carbs and saturated fat, or displacing a great portion of these macros via protein (with all the mTOR and IGF-1 rabbit hole that ensues). With increased protein satiety is pretty good, but longevity… Exercise with addressing both ApoE4 AND IR will have to be modified intelligently, possibly with preference being given to addressing neurogenesis and BDNF, so at the very least not shying away from “chronic cardio” with adequate intensity and duration. But you probably know all that, anyway!

    • Daria  March 16, 2016

      Just to clarify my earlier reply, I’m ApoE3/E4.

    • Chris Woods  March 17, 2016

      Hi Daria

      You may want to consider checking out the forums at ApoE4.info. It’s a really great community of individuals, mostly carrier on of the E4 genotypes who are, like you, on a quest to determine what’s the best lifestyle approaches and other therapies to prevent or delay AD onset.

      It appears you have made great progress on your own. We would love to have you.

    • Daria  March 17, 2016

      Thanks you for your reply, Chris, – has been periodically visiting the site you mention for some time now. I have to admit I have to dose carefully the exposure to all this stuff. Found out my status right before turned 41, got pregnant a year later. Which also reminds me that we do need to distinguish between men and women when we talk even about heterozygous ApoE4, not only because it impacts men and women differently, but also because women have to maintain fertility levels in juggling cholesterol and IR. My goal with fine tuning saturated fat and added fat, in general, has never been to beat cholesterol into total submission because of its vital importance for hormone production. Also, I’m not a person who considers high fasting BS an acceptable sign even if you are low carb. I maintain carbs at around 75g per day, very rarely go into 100g per day. My HDL is around 90+, trigs are in the 40s. Again, thank you for the invite, didn’t mean to hijack the discussion here.

  27. Simon Hunter  March 16, 2016

    So if understand the A1C reading correctly, with a larger RBC you get a lower reading and vice versa. What value of MCV is the cutover? So in theory what value would MCV be to get an accurate A1C? I have an MCV of 91 so that means my A1C reading will be artifically lower correct?

    On a side note I raced in Spec E30 for many years, awesome racing.

    (reply)
    • Peter Attia  March 16, 2016

      I can’t get enough of the SE30…it’s actually faster around Buttonwillow that my E92 M3 with modified airflow which brings BHP to 450. As you know (but most people don’t), races are won by how fast you corner, not fly down straightaways. Seems like a metaphor for life, actually.
      “Normal” MCV is 80-100. My MCV is about 60, so really small. What I’m seeing is that folks with low MCV have higher A1Cs than you would predict by glucose, insulin, and OGTT. Reverse is true for folks with higher MCVs.

    • Bill  March 16, 2016

      “What I’m seeing is that folks with low MCV have higher A1Cs than you would predict by glucose, insulin, and OGTT. Reverse is true for folks with higher MCVs.”

      Peter, do you find this to be true even with MCV within the “normal” range? If so, I wonder why HbA1C’s aren’t (or couldn’t be) corrected for MCV.

    • Peter Attia  March 17, 2016

      I do wonder that, Bill, but I have not seen enough data in that range to really know. I am sure other factors besides MCV impact RBC survival, though.

  28. gretchen  March 16, 2016

    An example of how diabetic patients are endangering their health in an effort to get CGMs.

    http://www.healthline.com/diabetesmine/letter-my-insurance-company-id-rather-not-die-today#3

    Peter, no need to read. It’s long and I’m sure you already know this. I post for benefit of others.

    (reply)
  29. Mary Varillas  March 16, 2016

    Thank you Peter for taking the time to give us an update!

    After 3 years of following a very restricted ketogenic diet I realized that my obsession to keep a very very low carb diet was giving me more problems than fixing them, so now I am following same approach as you, still restricting carbs and avoiding processed food. I can eat fruit without feeling guilty and for those days of weakness, I take advantage of that extra glycogen on my muscles by going to the gym and hitting the weighting room harder. So bottom line is: balance….

    (reply)
  30. Joey D  March 16, 2016

    Great to have you back, and thanks for catching us up! If you ever need a Guinea pig in San Diego let me know I’d be happy to participate, I’m a 51 year old OCR runner and am always self experimenting with diet and training to hopefully counteract my bad genetics, so far so good, just did an echo stress test yesterday. I tried the keto training but my body and blood work didn’t like it so I backed off a bit and now simply do a 12 hour fasted morning session. I’m trying to maintain a balance between muscularity and endurance (the wifey doesn’t want a skinny husband!) and constantly evolving.

    I look forward to your book, and particularly your work with CGM, enjoy that young family they are the real reason life is worth living.

    (reply)
  31. Michael  March 16, 2016

    Congratulations on your endeavors.
    I am intrigued by our parallel interests: This weekend will be my Novice SCCA training in a Miata, and I have just started my search for a simulator (thanks for your post). My PA’s note that for years I have been advocating a similar diet recommendations (low carb, supplements, intermittent fasting), and heavy weights (even for geriatric….where heavy may be 10#). I am also intrigued with and have been trained in various health and so-called Age Management medical and nutritional treatments.
    This is just a note to say hello, and keep up the good work. By optimizing yourself as a series of one experiment, I look forward to hearing/reading of your shared insights.

    (reply)
    • Peter Attia  March 16, 2016

      Michael, get on that sim! Definitely connect with Mike Wagner in MN. He’s built a lot of the sims used by pros. Very happy with mine.

  32. jason  March 16, 2016

    What are a couple of your dream watches Peter? Favor vintage or modern issue?

    (reply)
    • Peter Attia  March 17, 2016

      Oh boy… I got really lucky last year when my “adoptive” dad gave me a MINT calibre 321 Speedmaster that he received as a high school grad present in 1969. It sat in a shoebox (as he wore his Timex) until last year when he gave it to me. That was always dream and I didn’t know someone so close to me owned one until he walked down the stairs and gave it to me! When I took it to the Omega boutique on 5th ave they said it was the best one they had ever seen and they would trade me for any watch in the store. Obviously, I declined.
      If I could afford it I would love a Newman Daytona (any of 6239, 6241, 6262, 6263, 6264 or 6265). I also love the Breguet Hora Mundi in platinum with North America at the center, but it’s pretty steep. At some point I will get the Patek Calatrava 5196. I still plan to get the Grey Side of the Moon though I already have four Speedy Pros…just love those. As you can tell, I’ve wasted a lot of time on this hobby I mean obsession I mean disease. All this said, my next watch is almost certainly going to be JLC reverso with dual time. And at some point I’d like a minute repeater, too, because, well, who doesn’t right?
      I’m in the watch penalty box this year, though. No watches until 2017.

    • Naren  March 18, 2016

      As an auto racing enthusiast, what do you think of RM? Hodinkee is indeed a pleasure to peruse, I especially love their video interviews with collectors. Your buddy’s buddy (maybe your friend too), Kevin Rose has been on there, as you probably already know.

    • Peter Attia  March 20, 2016

      RM is pleasant, too!

    • RickT  March 19, 2016

      I am nowhere near the watch geek you are, but you mentioned a couple that have been on my list for a long time, the Calatrava 5196 and the Reverso. I almost pulled the trigger on the JLC when I lived in Japan several years ago, but cheaped out and bought the reissue of the 1964 Heuer Carrera instead. It’s been a workhorse, and I love it, but the mainspring just broke, and the small city I now live in doesn’t have anyone who can repair it. 🙁

  33. Mike  March 16, 2016

    Excited to learn of your transition to private practice, though your public initiatives have been invaluable. As a fan of your work and with a similar data and self-experiment focused orientation, I would be interested in consulting with you. How might that be considered? Thanks for your consideration.

    (reply)
    • Peter Attia  March 17, 2016

      I don’t do consulting, Mike. Sorry.

  34. Nicole Esposito  March 16, 2016

    Hello Dr. Attia!
    Clearly you have been missed! I am excited most about the dexcom. I am a school nurse caring for 2 type 1 kiddos (kindergarten and 3rd grade) I can’t begin to say what a lifesaver the dexcom has been! I was just wondering about using one on myself for tracking my low carb adventures – you have put me on the path of experimenting and researching- and I am now working to become a certified diabetes educator – hoping to help people with both type 1 and 2 (as well as myself and my 7 year old rwin girls!) live a better life through better carb choices – so thanks for all that you do and best of luck with all of your plans!!!

    (reply)
    • Peter Attia  March 17, 2016

      Glad to be of any help, Nicole. CGM changes everything, huh?

  35. Tyler  March 16, 2016

    Thanks for the update Peter.

    What sort of markers would you look for, other than fasting insulin, to indicate that your nutrition guidelines are more or less working? What should people who have a lack of medical data about themselves look for? Could you get a decent picture from just how you feel, your weight, keto breath in the morning or basic measurements such as blood glucose/ketones?

    (reply)
    • Peter Attia  March 17, 2016

      Oh, man I would need a very long blogpost to even attempt to answer this question. Not even sure where to begin.

  36. David  March 16, 2016

    Most excellent. That was like a letter from an old friend, a sentiment many of us who follow your blog probably share. Glad to see family is well and you are diversifying you “obsessions.” Looking forward to more of your insights on the issue of longevity and, of course, the book “when/if” it comes out.

    (reply)
    • Peter Attia  March 17, 2016

      Thanks for remembering the “when/if” clause, David…

  37. Ben Greenfield  March 16, 2016

    Love it, Peter. You supersetting those squats and deads or separating them? Rest periods?

    (reply)
    • Peter Attia  March 17, 2016

      Thanks, Ben! No supersetting. D/L on Monday; squats on Friday. Rest is typically 2-3 minutes for the heavy stuff and very short for the lighter stuff. In between (i.e., Wednesday) is conjugate movements courtesy Louie Simmnons. Big fan of single-leg leg press, glute-ham raise, lateral squat, etc.
      As you can attest to, it so much easier to do these movement when you’re not competing with 200 miles a week of riding!

  38. Colleen  March 16, 2016

    Thank you for taking the time for an update. You have a beautiful family (and two kids that look a lot like you!). I look forward to your book, future podcasts (they must be easier than a detailed post?), and the future of CGM!

    (reply)
    • Peter Attia  March 17, 2016

      Thank you, Colleen. Hopefully more podcasts when I have something new to talk about and yes to the future of CGM!

  39. Michael  March 16, 2016

    Dr. Attia –

    I’m glad you’re back in clinical practice.

    I found your blog a few years ago and began down the path of weight loss in an effort to control my Type II diabetes. With so much conflicting information – I just settled on a more lower/moderate carb approach based on a gut feeling you were not full of sh*)$! or pushing an agenda.

    It’s worked marvelously. Thank you for sharing your knowledge. I haven’t been this healthy in decades.

    I believe you’re one of the few people in the health space that are really trustworthy.

    While you are working to make a few thousand ferrari’s per year in your clinical practice – just remember the little people out on the Web – that are looking forward to your next post, podcast and update.

    It was a real joy listening to your podcasts – I literally took notes and am researching and learning more about lipoproteins now.

    In good health,

    Michael

    (reply)
    • Peter Attia  March 17, 2016

      Thank you, Michael. I’m happy to know there are other lipoprotein addicts out there. I just did my CME (recertification) today on lipids and it was like pure bliss to brush up on that great stuff. Congrats on your health.

  40. Sherri Close  March 16, 2016

    Hi Peter,

    Oh how I wish I had found you and the ketogenic lifestyle earlier! I had gastric bypass in 2014, lost 125 lbs and am still trying to get the last 25 off. Still trying to figure things out as there isn’t a lot of research on folks who have had gastric bypass and choose to follow this lifestyle.

    I’ve got a lot of looking around to do on your site but wanted to take a moment to thank you for all you’ve done! It’s really nice you’ve shared so much of your life with us. Adorable children too!!!

    I live in the DC area and would give anything to have a doctor who concentrates on whole health rather than just putting medicinal bandaids on everything that comes through their door. I think it’s coming though.

    Thanks again Peter!

    Best,

    Sherri Close

    Oh, and if you ever get into drag racing…let me know!

    (reply)
    • Peter Attia  March 17, 2016

      Drag racing, huh? I guess I’ll never say never, but I love me some formula cars and windy tracks. Sorry I don’t know anyone great in DC. Check with Jimmy Moore’s site.

    • Maryann  April 4, 2016

      Hi Sherri, Dr. Tara Dall is in VA but she also has a virtual practice and phone consults. She advocates low carb, functional medicine, and is a renowned lipidologist who can do all of the advanced testing and interpretation Peter educated us on in his cholesterol series. Part X coming soon 🙂 Her website is avancemd.com. Tell her maryann sent you. Best wishes!

  41. Chris Macker  March 16, 2016

    Thanks for the update Peter. I’ve taken Mark’s three day seminar in NYC and I only have good things to say about it. He alternates between lectures and hands on instruction. A lot can be learned (or relearned) if one keeps good notes, asks lots of questions, and records video of the hands on portions. As an aside, I recommend your blog posts and Starting Strength among my top resources on understanding and improving health. Along with the others here, I am definitely looking forward to your book. By any chance have you heard of or talked to Aubrey De Grey and Dominic D’Agostino? If so, do you have any thoughts on their work?

    (reply)
    • Peter Attia  March 17, 2016

      Chris, if you’re including this blog in the same breath as Rippetoe’s Starting Strength, well, damn, you just made my month. I am dying to do it. Amazingly, my wife wants to join me so I was thinking of getting this as a b-day present for her (she doesn’t read my blog, so no loss of surprise here! if anyone reading this knows Jill, keep it shut on the b-day gift please). I know Dom very well and think his work is exceptional. Dom and I have worked on a few things together and will continue to do so. One of the nicest human beings I have ever met. I don’t know Aubrey personally but of course am familiar with his work. He’s a bit out there for me.

    • Naren  March 18, 2016

      I second Chris on including Ripp and Peter Attia on the same level. It would be internet-breaking material if Peter and Ripp were to become best buddies and do collab-videos to help us get our learn on.

      Big fan of Ripp’s including his wit, which I’m sure you’re familiar with, but if not,
      http://physicalculturist.ca/strength-quotes-mark-rippetoe/

      A few gems,
      “A guy asks if hack squat is useful since his college does not have any squat racks only squat machines,
      Rip: I recommend that you change colleges.”

      “On resting in between reps: It varies with the length of the set. 5s or fewer get a breath to reset. Longer sets might take 2 breaths. During the last few reps of a true 20RM squat, just do what Jesus tells you. Trust me, if you do an honest 20 rep program, at some point Jesus will talk to you. On the last day of the program, he asked if he could work in. ”

      “There are few things graven in stone, except that you have to squat or you’re a pu**y. ”

      “On the possibility of a failure to deadlift resulting in stroke:
      Deadlifts that are too heavy to pull generally don’t take very long; the bar just kinda lays there. So if trying to move immovable objects was dangerous from the standpoint of stroke, the history of the human race would be littered with stupid people’s corpses. ”

    • Peter Attia  March 19, 2016

      Rippatoe is a national treasure. I am not. Flattered, though.

  42. Norm  March 16, 2016

    Hi Peter,

    Many thanks for the updates.

    Glad to see the clarification about A1C that it’s not written in stone. I’ve got my eyes on CGM for a while, hope soon I would be able to afford it. How about fructosamine to clarify artificiality of A1C?
    Is your main carb source is fruits and veg? No legumes/beans?
    How long does it take you to do sets of squats?
    Any comment on slow burn which recommends only one set of slow reps until failure?

    (reply)
    • Peter Attia  March 17, 2016

      I don’t find fructosamine very helpful. That squat (or D/L) set will take 35-45 min. It’s a grind. I thing super slow is great for some people and I actually did it exclusively for one year as an experiment. It’s not for me, long term, but a great tool for folks who don’t want to learn to do heavy compound movements or who don’t love weights.

  43. MapleGuitar  March 16, 2016

    My Endo doc has some sort of relationship with Dexcom whereby I was able to use the G5 CGM for 7 days at no cost. During that time I ate my typical meals and learned many interesting things. First and foremost — and the main reason I wanted to try the CGM — was that I confirmed a discordance between my A1C numbers and the CGM numbers. Moving forward, I won’t be as stressed about the A1C, knowing it’s off by about one full percentage point (higher than the CGM results).

    (reply)
    • Peter Attia  March 17, 2016

      See what I’m sayin’… in a future world everyone will wear one.

  44. Travis Koger  March 16, 2016

    Peter,

    Great update and what sounds like an awesome change in life. My current favourite unwind activity is Forza 6 racing. Spend more time ‘relaxing’ with this than sleeping I think.

    Travis

    (reply)
    • Peter Attia  March 17, 2016

      Travis, don’t neglect your sleep, my friend.

  45. palo  March 16, 2016

    Hi Pete, great to have you back. I’m glad you have adjusted your personal life in a way that maximizes your happiness.

    I’m curious, what are your swimming strokes, distance and times?

    (reply)
    • Peter Attia  March 17, 2016

      Now? Ha! I just try to stay with the people in my lane. Drafting is my friend. When I did swim I was ok at ultra-distance freestyle (but horrible at anything below 5 or 6 miles); breaststroke (only stroke I could reach top 10 in USMS); and IM (due to breast and ok fly). My achievements in swimming are modest at best and only relevant because I didn’t learn to swim until I was 31. Had I swum growing up I probably would have been an ok breaststroker, flyer, and IMer. I got lucky with breast because Ed Moses (gold and silver medal in 2000 Olympics and first person to break 1:00 in 100 LCM) is a good friend and we used to train together when he was attempting a comeback in 2012. Those were the days. His stroke is breathtaking. Check out the race in this video: https://www.youtube.com/watch?v=584KIyeKCO8. He broke the WR again in this race. This was an amazing phase of Ed’s career. I think he broke the WR 8 times in 2 years. Ed is also such a great teacher and he even did a charity clinic for me at the YMCA back in 2011.

  46. JB  March 16, 2016

    Hi Peter, Great to hear from you! The family looks great. The Halloween cop and prisoner are pretty hilarious.

    The podcast with Rhonda Patrick was a fun tour de force. If you ever watch it you will crack up at how many subjects the two of you tried to discuss while constantly being reminded of what else it was that was so interesting about this other thing. I mean that in the best way. I really enjoyed it and got a lot out of it.

    I have a question about something you said in IHMC STEM series podcast. I know you didn’t listen to it, but here’s the context and your quote and then my question. You were talking about bhrt in women, and griping about how the media pitches relative vs. absolute risk ( a complaint of mine also) per the Women’s Health Study and you mentioned that testosterone was the dominant androgen in women. Then you spoke about how the media pitched the 25% increased risk in breast cancer on hrt and said, “Of all the things that can exacerbate that risk….specifically the use of unopposed estrogen and progesterone. So the lack of testosterone I think probably explains that more than anything although it could be the synthetic progesterone.” (at 1:00:30) I fully understand unopposed estrogen and need for progesterone to oppose it (and not progestin). But were you saying that somehow testosterone also opposes the dominance of these other two (or of just estrogen)? I’m unfamiliar with testosterone participating in the regulation of dominance as it were; ie. in balancing/clearing the receptors in the same way as estrogen and progesterone, and if you were really saying that, can you just drop me a quick lead where I might read about that? I couldn’t find anything in a first attempt. Or were you just saying that without testosterone (if it’s low), that hrt without it isn’t really 1) going to get the job done and 2) could explain some of the hrt risk reported in the WHS? Thanks.

    How does one find out about becoming a patient in NY?

    (reply)
    • Peter Attia  March 17, 2016

      What do you mean Halloween?
      The lit is “mixed” on the role of testosterone in HRT for women, but of course it’s just as bad with respect to estrogen and progesterone (per my comments on WHI). The “negative trials” on T didn’t even use bioidentical T, so it’s hard to take them seriously.
      I do think I should write a post on this topic. It won’t happen soon, but it’s one of my top 10 clinical interests.

  47. Ash Simmonds  March 17, 2016

    Mate of mine races in various exotic car cups and has a simulator in his basement. A few years ago I was due to go for a weekend sprint session, so spent an evening using his simulator on the track I was going to, and funnily enough the first couple laps I did out of the gate were the fastest I did all weekend – I never really got that much better after ~15 more sessions on the real track.

    Couple vids/pics:
    http://ashsimmonds.com/2012/11/11/lotus-111r-at-phillip-island-piarc-sprint-november-2012/

    As to the CGM, do you think something along the lines of the “Healbe GoBe” will be tenable soon? If you don’t know much about it, basically it’s a wristwatch contraption which purported to measure blood glucose through galvanic skin response and various voodoo. I bought into the kickstarter but they took like 2 years to fulfill and by then I’d moved countries – but from what I heard it was pretty shoddy. Other stuff I’ve heard of is contact lenses and such, dunno.

    (reply)
    • Peter Attia  March 17, 2016

      It’s a very hard sport to master. I doubt I’ll ever get there. You’d need scientific notation to count the number of laps I’ve done on Lime Rock and I still can be perfect for 60 consecutive seconds. But that’s what’s so great about it.
      In theory it should be possible to measure glucose non-invasively (we can do it with SaO2), but I think it will be tough. I think firm contact will be necessary vs. loose contact.

  48. Zach  March 17, 2016

    Thanks for the update, Peter. It’s good to hear from you.

    Have you seen any significant changes in blood work since moving away from a strict keto approach? I am specifically interested in testosterone and thyroid levels.

    In addition, any changes in mental sharpness/acuity? That seems to be a common argument for ketosis – the benefits to focus and cognition.

    Thanks!

    (reply)
    • Peter Attia  March 17, 2016

      Yes, but there are other confounders so it’s hard to really draw firm conclusion. Clearly TG is up (used to be in the 20s or 30s; now typically in the 40s to 60s) and HDL-C is down. Also, I was a very favorable keto responder. As far as focus/cognition, there are too many changes in my life–some for better, some for worse–that I can’t compare subjectively. I unfortunately didn’t do objective cognition testing at the time.

    • Wab  March 17, 2016

      I bet lap times on a racing simulator would be a good reaction time test. 🙂

    • Peter Attia  March 17, 2016

      Not necessarily. Great drivers are never “reacting” to anything, when it looks like they are. They fully anticipate every bit of tire slippage and know how to control it perfectly.

  49. Paul  March 17, 2016

    Hey Peter,
    Great podcasts! Come up to Gig Harbour, WA and do the Starting Strength Seminar July 15th-17th…We’ll deadlift and squat and talk frickin biochem. woohoo
    Paul

    (reply)
    • Peter Attia  March 17, 2016

      Kinda hoping for NYC or Balto…

  50. barry fisher  March 17, 2016

    This is pure unadorned opinion. There is nothing “cool” or “obsessed” in any scintilla of it, nor even a dollop of perfection to be found. Attia, I’ve been around 71 years and intend to die sooner or later, whichever comes first. Having read your opinions, expression, situations and so forth I find myself feeling sorry for you, dismayed and amazed at you. You are young. You like to have “fun.” You are educated. I keep feeling sorry for you. This makes little sense without a diatribe of incidental quantification. Still, I keep feeling sorry for you. I’ve been into keto for a long time. We are in a similar camp and indeed your info informs me in pleasant ways. Not cool ways. Not obsessive ways. Simple pleasant useful ways at times. What causes me to keep feeling sorry for you, someone I inherently like? Who knows. I simply wanted to mention it. Thanks. Barry Fisher

    (reply)
    • Peter Attia  March 17, 2016

      Barry, when you find out–if you find out–let me know, but only on the condition that I can do something about it.

    • Wab  March 17, 2016

      For some reason, I thought about this post this morning.

      Some people want to “dent the universe.” Peter Attia is one of those people, and the founding of NuSI was proof of that.

      He will not be satisfied building “Ferraris.” He has helped many of us. Geeks on the net who followed his experiments and tried to absorb his insights. We are the first “Toyotas” to roll off of his assembly line.

      Peter, your work is unfinished.

    • Peter Attia  March 17, 2016

      You’re very kind, but I don’t think I want to dent the universe, at least not as an explicit goal. That seems a sure recipe for misery. History determines if anyone or thing dents the universe. If I ever catch myself thinking of it, I kick myself (or ask my wife to kick me). Fix people, fix your family, fix yourself.

    • Joshua  March 24, 2016

      Barry – I would say that I feel sorry for Peter only because he is human, flawed like the rest of us. Maybe not JUST like, but you know what I mean. 😉 I have a lot of respect for Peter, and I think it’s easy to put people you respect on a pedestal and then be disappointed when they turn out to be just a regular ol’ human.

  51. Holly  March 17, 2016

    If one wanted to be a patient of yours in San Diego how could we find your office? Can’t seem to find a doc who understands low carb and will look at other lab values than LDL cholesterol . So great to hear from you. You have a lot of friends here.

    (reply)
  52. Sara  March 17, 2016

    Are there any other weird factors that can affect altered MCV and HbA1c readings? I’m wondering if high mcv would also result in high HbA1c… even in the absence of b12/folate deficiency/use of chemotherapy agents. My partner never had a glucose reading higher than 4.6mg/dL (usually ~3.8 to 4.4), high-normal MCV (high 90s), but HbA1c consistently in the high 5s. Never has hypo symptoms even when his blood glucose drops below 3 when he’s fasting. I’m puzzled. Is HbA1c even a valid measurement for the corner cases?

    (reply)
    • Peter Attia  March 17, 2016

      I think it’s directional valid, as I noted. 5% vs. 9% likely has real meaning. However, I think it’s communicated–via a decimal point–to unrealistic levels of precision.

  53. Aaron  March 17, 2016

    In your podcast on FoundMyFitness you mention a patient with chronic sinusitis. Your description of her matches my experience exactly (frequent augmentin courses, multiple surgeries). Do you have any resources/reading you can recommend for someone in this situation, or tests/interventions I could bring up for discussion with my doctor? Thank you.

    (reply)
    • Peter Attia  March 17, 2016

      In her case, her CRP was through the roof–really high–along with other inflammatory markers. She’d been “structurally” fixed, so we fiddled around with her diet until we identify what we’re like the causative agents. In her case, symptoms alleviation (and normalization of markers) required shockingly strict adherence to zero wheat (in any form) and zero dairy.

  54. Pia  March 17, 2016

    Hi Peter,
    Thanks for the update,
    But for the ones that follow you I think we are a bit lost with the NUSI initiative, Can you explain what happened , you seem very enthusiastic and now you just drop off the wagon. Is something related to Taubes? Is because this new studies about low carb diets like the one published by Kevin Hall in Cell last year? .
    Please let us know, It seem that you change your believes about the ideal diet and I think we deserve more information.

    (reply)
    • Peter Attia  March 17, 2016

      My departure from NuSI has nothing to do with anything you ask about. Time to move on, Pia. I have.

  55. Steve R  March 17, 2016

    Hello Peter,

    If/when you decide to take on another NYC patient, I would love to get on the waiting list. NYC doctor have become a conveyor belt, where you do an initial visit with an MD who leads the practice, then never see him again because all future visits are with one of a rotating army of DOs. I requested the test below be done when I came in for my physical…I could tell they didn’t even know what a few of them were. The guy laughed and said “You don’t need any of that stuff! You are young and healthy!”
    Well…I’d like to keep it that way! So if you can squeeze in a new client who cares about being informed, please reach out. If that isn’t in the cards, a referral would even be appreciated! Barring that…keep spreading the knowledge!

    full lipid panel
    Testosterone
    Cortisol
    Hemo a1c
    Fructosamine
    Fasting insulin level
    Homocystine
    Vitamin d
    C reactive protein

    (reply)
  56. Nicolas  March 17, 2016

    Hello from Paris ! I didn’t read the whole comments section, so maybe it has aways been asked, but can you tell us more about your 6 months eating one meal a day fasting 23hrs ?? You said it was very interesting so it’s kind of frustrating that you don’t tell more about.

    (reply)
    • Peter Attia  March 17, 2016

      Yup, addressed (sort of) in response to another question. But, dude, you gotta get over that frustration. Am I working for you?

    • Nicolas  March 17, 2016

      If you were working for me I would’nt ask you if you can tell more, I would command you to tell more 😉
      Frustrating was probably a strong word, but I’m still very curious about it since I’m used to eating that way for a little while.

    • Peter Attia  March 18, 2016

      Only so many hours in the day boss.

  57. RickT  March 17, 2016

    I can imagine the WTF look on your face when you suffered the “amazing failure of metallurgy.” LOL!

    Looking forward to the book!

    (reply)
    • Peter Attia  March 17, 2016

      You said it, Rick! I kept looking at the shifter half expecting it to re-attach.
      I got so lucky it broke in neutral so I could drift off the track and get towed back to pit. Crew fixed in one hour and I was back to biz…

    • RickT  March 18, 2016

      No doubt you’ve seen it, but on the remote chance you haven’t, the documentary “Senna” is a must see.

      http://www.imdb.com/title/tt1424432/

      Even though I knew what was going to happen, part of me kept hoping for a different ending.

    • Peter Attia  March 19, 2016

      Yes, I have that same reaction every time I watch it.

  58. Tomek  March 17, 2016

    Thanks, Peter, for such a great blog post and few recent podcasts. In your talk with Chris you guys spent few minutes talking about meditation as stress reducer. In your busy life do you have everyday set schedule for it? Also in your post above you stated regarding quitting competitive cycling, “especially since I think it was actually shortening my lifespan.” There is more to it than being exposed to passing 60mph sometimes only few feet away cars? Thanks again for taking your time to share your findings and replaying to all the comments! Best greetings.

    (reply)
    • Peter Attia  March 18, 2016

      1. Yes, I schedule time for TM
      2. Yes, more the the risk of competitive cycling than cars. Check out James O’Keefe.

  59. Dahlia  March 17, 2016

    Peter, it is very kind of you to keep up with this blog considering all the duties of a doctor and researcher – thank you for your work. I searched through but don’t know if this question has been asked yet, I apologize if it has.

    I am a bioinformatician, considering medicine, but I am afraid of not being able to treat patients in the way that it seems you do, and having enough time to do so. You note that your current practice is set up such that you can focus on only a few patients at a time. This is my dream. Is this type of a practice possible with any residency specialization (I know you come from a surgery background), how easy was it to make the switch from surgery to what you do now? Best of luck!

    (reply)
  60. William  March 18, 2016

    Hi Peter!

    How would you recommend one go about to make an informed decision on what supplements to take? I’m currently only taking a multivitamin, krill oil and iron (because I’m a blood donor). Are multivitamins any good at all or just a waste of money?

    (reply)
    • Peter Attia  March 20, 2016

      Too complicated a question, but MV = waste of money.

  61. Melissa Eaton  March 18, 2016

    Thrilled to see the maniacal genius of two immensely influential & inspiring folks (Attia/Rhonda Patrick) sit down together for a podcast (and unabashedly geek out). Two leaders that certainly show up and kick the door in on the nutritional ideology of yesteryear, paving the way for a healthier & more informed public. Thank you, Pete! Love reading your insights. Keep it up.

    (reply)
  62. Ralf  March 18, 2016

    Peter, thanks for the update, love your new/modified holistic/big picture approach.

    I know keto is no panacea but I’ve always thought of it as something that’s virtually always a good idea (barring late-stage diabetes / ketoacidosis) so when you mentioned in the STEM pod that some of your patients did not do well on it —and that you’ve moved away from it yourself— that was pretty disconcerting…

    Do you have any inkling at this point as to the reason for its potential inefficacy, and are there good indicators that would allow me to find out if it’s working for me, short of a blood test? I feel fine but of course that doesn’t say much lipid-wise. If bloodwork is necessary to get a reliable picture, how long should one wait with this, knowing that it takes a while for the benefits of keto to take effect?

    Thanks so much for your work and insight.

    (reply)
    • Peter Attia  March 20, 2016

      I’ve only moved away from it from a logistics standpoint, not because I felt it was posing any threat to my health.

  63. newbie  March 18, 2016

    Hi Peter,
    No questions, although I’ve asked on this blog before.
    I just wanted to say that it amazes me that you continue to put a part of yourself out there.
    I think it would difficult, so many people wanting a piece.
    I just really wanted to tell you that there are those of us who do care about the entire post, not just the very end.
    All the best.

    (reply)
    • Peter Attia  March 20, 2016

      Indeed….appreciate that you appreciate it.

  64. Paul Arena  March 18, 2016

    Hey Peter,
    I’m curious how much you think the placebo effect plays in all of the interventions you do to your lifelong N=1 experiment? Any intervention we do to ourselves has to have some level of expectation that can possibly drive a positive outcome. Probably unknowable. Example: the Phosphatidylserine you take at night. What percent of the effect is belief? I love the literature on the placebo effect.
    Paul

    (reply)
    • Peter Attia  March 19, 2016

      Always a possibility, though hard to imagine it’s all placebo, given the huge reduction in sleeping glucose levels.

  65. Michael Weishaar  March 18, 2016

    Love hearing about the E30… I had many great days in my E30M3. If you get a chance take one for a spin. I still regret selling mine, but it was a “if you love something set it free” situation where I wasn’t able to take it to the track anymore due to a new family of my own at the time. That was 15 years ago, and I still think about it. That racing sim looks incredible. Thank you for all the hard work you’ve put into your passions.

    (reply)
    • Peter Attia  March 19, 2016

      I would love to get into an E30M and especially and E36M spec.

  66. Stephen  March 18, 2016

    Hi Dr. Attia,
    I was wondering why you do so many sets of squats and deadlifts? I was under the impression that for pure strength development at most 5 sets of 5 reps was necessary. Is there some strength (or otherwise) benefit from doing a greater number of sets, or is there some other parameter you are addressing besides increasing strength?
    As an aspiring MD, you’ve been a tremendous inspiration to me. Thanks for your making yourself available.
    Best, Stephen

    (reply)
    • Peter Attia  March 20, 2016

      Yup, 5×5 is probably sufficient for strength. I just love the extra volume since I do so little elsewhere. Also, I love the test set approach.

  67. Naren  March 18, 2016

    Peter,

    Was the podcast with Rhonda filmed before you started squatting and deadlifting, and/or when you were well into 23/1 fasting?

    While you look super lean (goddamn serratus showing through shirt!), you don’t show the size I’d expect compound lifts would help pack on.

    (reply)
    • Peter Attia  March 19, 2016

      I’d have to go back and look at what I was doing then. It might have been a transition.
      Keep in mind, I prioritize strength and metabolic conditioning over hypertrophy.

  68. Naren  March 18, 2016

    While we really enjoyed learning what you’re eating these days (despite your holding back macros, portion sizes, or even total calories hehe), what we’d enjoy even more is a “week in the life of Peter Attia”.

    While your NuSI workload and travel may be gone, how are you still fitting all this (racing/simming, coast-to-coast travel, family, medical practice, manifesto, projects in stealth mode, lifting, TM, and more) into those 168 hours?

    How much sleep are you getting?

    Because of you, I’ll never have an excuse. hehe.

    (reply)
    • Peter Attia  March 19, 2016

      It was and remains tough. I don’t do much of anything else and I’m pretty efficient, I suppose.

  69. David  March 18, 2016

    Always a pleasure reading your posts! I was planning on getting the Dexcom g5 but may wait for the next generation you have alluded to. I would love to know how every aspect of my life impacts my glucose numbers real time. Keep mastering everything you put your focus on, it’s all about continuous progress 🙂

    (reply)
  70. Ketobreath  March 18, 2016

    What about the other compound movements?

    (reply)
    • Peter Attia  March 19, 2016

      Just the big 2 for me. I use dumbbells for other movements.

  71. Ruth  March 19, 2016

    Hi Peter
    I just wanted to thank you for the information you invest your time in sharing. It has been key to building my understanding of my body. Congrats on your endeavors and your continual adaptation and learning. It is an awesome example to learn from. I am one of those people pushing my body to extremes it probably wasn’t built for, but insist upon seeing if it can at some point, adapt, or at figure out that resistance is futile.

    I hope your medical practice goes well, I know i’m one of those folks who would travel to NYC to sit down and talk to an actual doctor who understands, or at least tries to understand, what it means to build a body and a life style meant for moving, with purpose. GOOD LUCK!

    (reply)
  72. Gabriel Penfield  March 19, 2016

    Seriously, a leader without a following is just going for a walk. I read everything I could find on this subject and watched everything starting with Big Fat Fiasco and even seeing you in the lab rat chamber. I am one of the thousands who have effortlessly watched 20 lbs fall off without joining a gym. I have inspired a handful to drink the kook-aid (sugar free) and join this way of thinking about what we put into our mouths.

    Big Thanks!!

    P.S. Your know dis are cute!

    (reply)
  73. Michael  March 19, 2016

    Glad to hear from you Dr. Attia! Quick question- can you eloborate on what your “sleep cocktail is”? Look forward to reading your posts in the future.

    Michael

    (reply)
    • Peter Attia  March 20, 2016

      It depends on my needs. A bit too complicated to delineate in a comment. Kirk Parsley’s sleep supplement is a great base.

  74. Richard Cardona  March 19, 2016

    Hi Peter. How your research could benefit MS patients?

    (reply)
    • Peter Attia  March 20, 2016

      I have read anecdotal reports of KD and/or exogenous ketones providing benefit, but too soon to tell, I suppose.

  75. Bob Lamb  March 19, 2016

    Peter,

    Discovered your website about a month or two ago and it has been very informative.

    I’ve done a 21:3 IF diet 6 days a week (with some minor variations for social things) for the last 7 month. I lost 42 lbs (sw 252, cw 211, age 54, 6’1″). I got my fasting blood sugar level to be mid 80s to mid 90s after it was above 120 for a year or two before I started the diet. I went from bp of 14x/90x to 10x – 11x / 6x – 7x also. I had some Inbody measurements done and after about 4 months, it said I had lost about 5 lbs of muscle. I started taking 50g of whey protein at night and started lifting twice a week and the latest measurement said I had gained all the muscle back (not sure how accurate readings are but I can tell my arms are not shrinking but getting bigger). I do cardio (3xweek – walk/job and lift twice a week). I plan on doing something very similar to what your doing now and do a 5 (16:8) / 2(21:3) type of diet when I hit maintenance weight and will make my food low carb tell dinner where I will allow carbs (even some sugary stuff) as I do now.

    Have you teamed up with any university’s quantitative biology programs? They are doing some very interesting physical systems dynamics modeling of biological processes. I’m a control theory guy (MSECE from UC Santa Barbara) and have worked in that field. I think there is a lot to learn by applying advanced mathematical models to biological systems.

    Thanks for your insights.

    (reply)
  76. Hemming  March 19, 2016

    Hi Peter,

    Following on from the developments in CGMs. Do you think that we’ll ‘soon’ see devices that can tell you exactly what to eat based on constant measurements of the body (maybe with some AI/learning feature to take into account that days are different) ? E.g. training might increase carb/protein intake etc.

    (reply)
    • Peter Attia  March 20, 2016

      I don’t think that’s coming very soon. Measurement is one thing; interpreting quite another…

  77. Emily  March 19, 2016

    Great post! I’m a dietitian and found the CGM very interesting. You’re numbers are incredible. I stumbled upon your site, youtube talks, and other low carb advocates out of frustration/dissatisfaction with the current nutrition recommendations (and my overall profession). I found it interesting that you’re now eating some carbs and was wondering if you do food combining – carbs with protein, fat, fiber? Or do you find more that glucose and insulin response is individual dependent? Thanks for all the great information.

    (reply)
    • Peter Attia  March 20, 2016

      I do find that a fixed CHO bolus vs. CHO + protein/fat has a different glucose response (as one might expect).

  78. H  March 19, 2016

    Thanks for this post, Peter. I think I’ve got some stress hormone, cortisol, etc, related issues all my life (I’ll be 40 this year). After reading this post and listening to the podcasts, I added phosphatidylserine in evenings for three nights. I’m almost sure that in my case, it’s good to lower cortisol and other stress hormones. However, what I found out with my experiment was that the phosphatidylserine kept me awake most of those nights, so I stopped taking it. I just wonder why this might happen. One might expect that just lowering cortisol would have the opposite effect.

    (reply)
  79. Mark Scheurer  March 19, 2016

    Peter,
    I have a preventive medicine practice right next door to you in Coronado.

    Part of my practice is teaching people how to lift weights — I pretty much learned everything I know from Rippetoe — after I had read all his books, I went to Wichita Falls to do his 3 day training course http://coronadopreventivemedicine.com/blog/2015/06/24/strength-and-health/

    I would strongly suggest you attend one if you have the time. 12 hour days but well worth it in terms of gaining additional knowledge, plus listening to Rippetoe’s continuous humorous commentary is very entertaining. He doesn’t pull punches!

    If you have time at some point to grab coffee or a workout and compare notes on the best way to do this type of practice, please feel free to reach out — Mark

    (reply)
    • Peter Attia  March 20, 2016

      Yes, I need to get out there and do the 3-day course.

  80. KJ  March 20, 2016

    Peter,
    Thank you for your contribution towards a movement which influenced many in adopting a better life style. I am sure the book will have some fascinating insights as most of your blog post does and therefore I am very Excited to hear that news.

    For the folks interested in knowing more about the effects of fasting would love the following finding.

    72 hour Fasting Triggers Stem Cell Regeneration & Fights Cancer
    https://news.usc.edu/63669/fasting-triggers-stem-cell-regeneration-of-damaged-old-immune-system/

    (reply)
  81. Tommy D.  March 20, 2016

    Hi Peter!
    I am a recently graduated medical doctor in Spain, and have been following your work for a few years now. I just wanted to thank you for all the great information you put out there; as someone who knows how scientific data often seems contradictory, I appreciate your opinions and when you talk, I tend to listen.

    Had a question about the CGM. Getting one in my country is next to impossible, and since you have been using one for a while now, do you think that (within the variability of, say, three/four working days, if you daily routine is pretty consistent) you could get similar information about glucose disposal by checking your blood glucose by a standard monitor every hour or so, or adjusted by individual activities? I imagine that while sitting down and working on a desk levels should not vary much. Sleeping might be a different story though, right?

    Thank you so much for sharing your insights!
    Take care!

    (reply)
    • Peter Attia  March 20, 2016

      Unfortunately, I think it would be difficult to get the same insight from intermittent checking, especially while sleeping (which I find really helpful).

    • Simon  April 5, 2016

      Have a look at Abbott’s FreeStyle Libre as an inexpensive pseudo CGM (mentioned already in the comments). The sensor stores BG readings every 15 minutes for up to 8 hours. You can read it out manually whenever you like.

  82. jw  March 20, 2016

    re: Metallurgy:

    I haven’t seen that look of helmeted bewilderment since TG’s Stig tried to comprehend mass transit…

    We have been amazed at what you have been able and willing to produce on this site, gratis, and although addicted, we look forward to anything that can give us in your own good time. (Unless, like in Sleeper, in addition to deep fat and steaks, cream pies and fudge are the keys to longevity, then update us immediately…).

    (reply)
    • Peter Attia  March 21, 2016

      Ok, jw, that is the compliment of the year…to be mentioned in the same sentence as Stig…

  83. Brent Maddin  March 21, 2016

    Hello Doc,

    Good to see you back…
    Had a question on a come to you made regarding gaming the system with glucose disposal.
    Can you elaborate some on that topic?
    Maybe take it 15/30 mins b4 a resistance training w/o, during the w/o or after the workout?
    Would Dextrose be the best or would you suggest fruit which has fructose and sucrose?

    I’ve tried the TKD and consumed dextrose b4 and during lifting, usually 15/25 g along with a whey shake of about 30g of protein to spike insulin a little b4 and during lifting and then I Dont eat any fat for 2 hrs after .
    Not sure if his is optimal and was wondering what your timing and carb intake is like.

    Thanks…

    (reply)
  84. Brent Maddin  March 21, 2016

    Hello Doc,

    Good to see you back…
    Had a question on a comment you made regarding gaming the system with glucose disposal.
    Can you elaborate some on that topic?
    Maybe take it 15/30 mins b4 a resistance training w/o, during the w/o or after the workout?
    Would Dextrose be the best or would you suggest fruit which has fructose and sucrose?

    I’ve tried the TKD and consumed dextrose b4 and during lifting, usually 15/25 g along with a whey shake of about 30g of protein to spike insulin a little b4 and during lifting and then I Dont eat any fat for 2 hrs after .
    Not sure if this is optimal and was wondering what your timing and carb intake is like in regards to excercise to cheat the system.

    Thanks…

    (reply)
  85. Francisco Marshall  March 21, 2016

    Dr. Attia ,
    My Name is Francisco Marshall, an Engineer deeply interested in finding fat loss optimization in human bodies.
    I’ve bee experimenting for 3 weeks with Nutritional Ketosis + pressing with all my strengh specific fat deposits, every day.
    Results are amazing so far. Treated area show almost 50% reduction in skinfold measurment (using calipers) iin the treated area vs untreated area using calipers. I have photos and measurements to provide, and the texture of fat is super soft in the treated area vs hard in untreated area.
    My hypothesis are related with M1 macrophage accumulation in hypertrophied adipose tissue and that the mechanic rupture and stimuli generate inmune activation ( M2 Macrophage?) , enabling intense bloodflow to target area and thus enabling spot-specific lipolysis. Spot Reduction is a myth in today’s paradigm of fat-loss (without surgical intervention).
    I want to take my research one step forward and I want to get in contact with you.
    my mail es fcoarturo.marshall@gmail.com I’ll gladly provide pictures and my own protocol to back up my experiment’s results. I hope this could catch your attention and curiosity, I’m pretty excited about this.

    Best Regards,
    Francisco

    (reply)
  86. Martin  March 21, 2016

    Peter, in the recent interviews you seem to present slightly different views on how to set the carbohydrate limits. In the one with Chris Kresser, you say to set it at the maximum tolerable level and when talking to Rhonda Patrick you speak of the minimum amount one can do with. For a healthy person this gives still a narrow range of ~20-150g and there doesn’t seem to be necessarily a conflict between these two recommendations. It seems like people holding different beliefs might like to pick their variants, e.g. Chriss Kresser vs Steve Phinney 🙂

    (reply)
  87. Stefan K  March 21, 2016

    Hi Peter! I’ve been reading your blog and also watching some of your videos on youtube. My father has parkinson’s disease. My question is.. do you think it is a good idea to put him on ketosis? I do not want to ask you for medical advice or treatment.. I’m just asking if you would do it on yourself.. like a personal opinion. There are not too many choices right now for this disease unfortunately.
    Thank you!

    (reply)
    • Peter Attia  March 22, 2016

      I can’t give medical advice, Stefan. I’m sorry.

    • Stefan K  March 22, 2016

      Hi again! Ok, I understand. Then maybe you can help me with this question.. Is ketosis “more” neuroprotective than supplements such as curcumin, caffeine.. or others?
      Can you get the same neuroprotective benefits from other sources rather than ketosis?
      I really appreciate your answers.
      Thank you
      Stefan

  88. Marc  March 21, 2016

    Peter,

    Many thanks for your fascinating insights, and good to see that you haven’t completely given up blogging.

    I have a question on ketogenic diet and ketosis – although you personally seem to have moved on towards a more relaxed dietary regime. Essentially, my question is this: since I’m not in true ketosis after four weeks of rather strict ketogenic diet – consuming certainly less than 50 g carbs per day, a moderate amount of protein, and a lot of fat – is there any evidence for a hypothesis that this might be caused by: 1) poorly functioning liver; 2) chronic overtraining; or 3) very low body fat percentage?

    Despite four weeks on keto diet (preceded by several months on a relatively low carb diet – probably around 100-150 g/day and plenty of daily exercise), my glucometer gives readings of only 0.5 mmol of ketones (in the morning, before breakfast). I will neither try to explain my long personal history, nor the reasons why I’m testing keto now, but I indeed do have had slightly elevated liver transaminases for the past 20-30 years, chronically very low body fat (probably 5-6% now), and chronic very long-lasting (30+ years) overtraining symptoms (including low but still “normal” testosterone).

    Thanks!

    (reply)
  89. Butch Pornebo  March 22, 2016

    In one of the podcast you listed in your recent blog, you mentioned that you are now allowing yourself to eat around 100+g of carbs.

    Is this daily or on days after resistance training as part of a post workout meal ?

    And, with leucine, you sip the drink while you are doing your lifting session ?

    Do you take another 5g dose of leucine after post workout ?

    (reply)
    • Peter Attia  March 22, 2016

      1. Varies
      2. Yes, sip during
      3. Sometimes, but not always.

    • Martin  March 22, 2016

      John Kiefer also promotes Leucine as the most important of the BCAA amino acids with 2 strong effects: stimulating muscle protein synthesis and rapid insulin secretion. The latter leads to quick blood glucose disposal but also supposedly increases insulin sensitivity also in the context of otherwise LC diet.

    • Butch Pornebo  March 23, 2016

      I guess your answer on #1 and #3 would rely on how heavy of a workout you did.

  90. INDRO Mazumder  March 22, 2016

    After hearing/reading about UCAN from you Dr. Attia, I attempted to replicate Dr. Volek’s data(as a snack) as shown on page 4 of this paper: (The red line)
    https://www.generationucan.com/pdf/technical-breakthrough-sports-innovation.pdf
    I used the average of two Glucometers and 8 data points over 3 hours. My results, I was very happy to note, were very similar to the red line. This was good news for me, a pre-diabetic, and a runner. UCAN bars are a part of my daily regimen now. But I do wish I had access to a CGMS, the results would have been more dependable and convincing.

    (reply)
  91. JJ Bell (Scotland)  March 22, 2016

    Powerful Peter Attia!

    Peter, thank you for the update, I am sure you wonder at times why you bother but trust me, the few who follow your pursuits are bloody inspired as you are one unique snowflake.

    Every time I see your writing/hear you speak I (sadly) find more reasons to like the way you are or conversely to excuse my own behaviour/idiosyncrasies (obsession with themes of your manifesto and nutrition/drug/lifestyle related health interventions, mastery (usually random new pursuits), self-improvement (athletic (including resistance training) and otherwise) and self-experimentation, watches(!), approach to work – my firm takes the few Ferrari’s vs multiple Toyotas etc. etc…)

    You have also gifted me such simple but powerful actionable knowledge over the years (for free!) which I was only able to trust because I know how cautious you are, your attention to detail and because you take the time to dumb down the science enough without obliterating it (e.g. you helped me sort out sleep via Vitamin D deficiency, my keto experiment lead me to lower carb adjustment, mood ?, health markers ? (weight was already healthy), my 84 year old grandfather lost around 12KG without trying to (still a big man) and my brother who I gradually brainwashed lost around 15KG (he had gained a similar amount due to lifestyle over 3 years previous), awesome coffee recipe (vanilla/chicory/cinnamon). All of this = tip of the iceberg. I can only imagine the impact you have had on others.

    I only mention this to emphasise the guilt I feel, probably shared by others and the desire to give something back. You ask for nothing and give so much of yourself for the same. Consider your book (should it transpire) pre-purchased and if you ever feel the need to do more of this kind of stuff and need to justify it, I am convinced it could be done commercially (though it sounds like you have your lifestyle pretty well in order so I do not blame you for dipping in and out of the blog/podcast waters only occasionally).

    Sadly (again), also need to thank you for my favourite podcast of all time with Rhonda Patrick (my second favourite public facing nutrition/researcher person (not sure how to label you guys)). I (even more sadly) dreamed that you might cross paths one day and could have listened to you go off on random tangents for hours.

    Rant over and if you survived it, thank you finally for your patience.

    (reply)
    • Peter Attia  March 22, 2016

      Why all the sadness, JJ?

    • JJ Bell  March 23, 2016

      Could replace ‘sadly’ with ’embarrassingly’ basically caveats to pre-excuse my geekness.

      General message was along the lines of, Thank you thank you thank you, you are far too kind 🙂
      (and please keep doing this kinda public facing stuff if you can, we love it!)

  92. Phillip  March 22, 2016

    “…struggling to find the “right” device. Ditto for a great sleep device that can accurately record stage III and IV of sleep.”

    Hi Peter,
    The “Zeo” can do this. (Another commenter mention this as well.)
    The upside for the Zeo is that it is mature technology, developed over more than a decade. A sleep-purposed EEG device in a head band that communicates over bluetooth to an android app. It detects light sleep, REM and deep sleep as well as waking.
    The downside for Zeo is that the inferior “actigraphy” based devices out competed them. The company that makes the Zeo went out of business.
    There was a large batch of them sold on Ebay about a month ago. I’m sure you could come by one to try if you cared to. Fairly trivial to export the data from your android device using another app “ZeoCSV”. You can tinker around with the CSV, or use a PC program, “zeomonitor” to provide higher res (30 second rather than 5 minute) time slices.
    Steve Gibson has a good info page on the Zeo:
    https://www.grc.com/zeo.htm


    Phillip

    (reply)
    • Peter Attia  March 23, 2016

      Has it validated against gold standard? The folks I’ve spoken with said it doesn’t really work as well as reported.

    • Phillip  March 29, 2016

      “Has it validated against gold standard? The folks I’ve spoken with said it doesn’t really work as well as reported.”

      Really? They were specifically talking about the Zeo?

      Looks like a Zeo agrees with a “trained polysomnology lab techs” 75% as to the stage of sleep. With these lab techs agreeing with each other about 83% of the time. I think the latter counts as the “gold standard” unless there is something considered better that came about in the last few years.

      Considering the cost to obtain a Zeo was fairly low (~$100 when it was available commercially and $40 when a large batch of them was being sold on eBay) and you can still download and use the android app to control the device I’d say it is a reasonable investment of time and money for anyone interested.

      Studies have been done. Some are listed here:

      https://www.quora.com/How-accurate-is-the-sleep-data-from-the-Zeo

      This looks like a good review:

      http://www.hindawi.com/journals/isrn/2012/768794/


      Phillip

    • Peter Attia  March 29, 2016

      Cool, I’ll check it out. I hope it works.

  93. Christopher Grove  March 22, 2016

    Hey Canuck!… I am absolutely THRILLED that you are having a chance to DE-stress with your family!
    I know… we are always wondering about WHAT you eat and enjoy the exploits, but in fact, your two lovely children need their dad more than we do! 😉

    We can always bug D’Agostino if we have questions about Keto! LOL

    Enjoy! 🙂

    (reply)
  94. Marc  March 22, 2016

    Peter,

    Sorry to insist, but just in case you missed my question, it was this:

    Do you know of any evidence / have an intuition on whether entering into ketosis could be made difficult by:

    1. Poor liver function
    2. (Chronic) overtraining/stress
    3. Very low body fat (5-6%)

    Thanks!

    (reply)
    • Marc  March 22, 2016

      …and I meant to say: thanks IF you have TIME to answer…

    • Peter Attia  March 23, 2016

      Certainly poor liver function seems like it could interfere with endogenous ketone production, but of course, the severity probably matters.

  95. Susan  March 22, 2016

    Hi Dr. Attia,
    I tuned in to a presentation you gave at Keto-Kademy last weekend. So much information (new for me) and am excited to learn. I am now searching and learning all things low carb, keto, etc. Thank you for sharing and all the best to you.

    (reply)
    • Peter Attia  March 23, 2016

      What’s keto-kademy? and when did I get such a presentation?

  96. Bruce  March 22, 2016

    So good to hear from you again Peter! Miss your regular blog posts & interviews. Your materials have been instrumental in turning around my health.

    I have ALMOST reversed Metabolic Syndrome, after an 18 month course of mostly ketogenic eating and IF. With so many contradictory viewpoints out there, i cannot tell you how re-assuring it is to be able to to use your learning for my own guidance. I basically triangulate my information and direction from you, Robert Lustig, Tim Noakes, Dom D’Agostino and a few others. Finally, we non-MD folks have enough materials from scientifically minded folks to form a basis to build on for good health!

    There is one question burning in my mind, that you may have some helpful comments about.
    The question is, to what extent burning off liver fat & pancreatic fat is instrumental in restoring people with metabolic syndrome to a more “normal state”

    Roy Taylor’s work out of Newcastle explains the dual mechanism of liver & pancreatic fat, and they also have a trial that showed dramatic effects:

    http://www.ncl.ac.uk/magres/research/diabetes/documents/BantingDiabeticMed.pdf
    http://www.ncl.ac.uk/magres/research/diabetes/reversal.htm

    While ketogenic eating has definitely helped, and maybe 80% cured me, I feel there is still room to improve (based on liver tests, TG levels, BMI, etc…). Perhaps it would be beneficial to “completely burn off” the excess liver & pancreatic fat to completely reset the system. You can do long & slow with strict ketogenic eating, more moderately with Taylor’s approach, or more quickly with Jason Fung’s protocols. I am thinking that Fung’s protocols may be the most effective (3-7 day fasts) if they can be tolerated by the patient. Only the first few days are hard. Contrast that with a few years of ketogenic eating, or several weeks of <800 calories!

    (reply)
    • JJ Bell  March 23, 2016

      Re sipping of leucine, would this be Bio Steel perchance (another discovery I neglected to thank you for!)?

    • Peter Attia  March 24, 2016

      I add a bit of pure leucine to the biosteel HPSD.

    • JJ Bell  March 25, 2016

      Ah makes sense now, wondered how you managed to get to the 5g but also sip.

    • Peter Attia  March 27, 2016

      So-called, “advanced moves,” JJ… 🙂

  97. Marc  March 23, 2016

    Thanks, Peter. Sounds logical to me, as well, that if liver doesn’t work right, it may have a hard time producing ketones. But this remains just speculation.

    I think I’ve seen suggested that overtraining and stress could interfere with ketosis.

    Well, I’m steadily at my 0.5 mmol “ketosis”, consuming 20-30 carbs per day. Judging by how I feel, I was probably in ketosis already some months ago with 100-150 g carbs. Mentally great, but training is not great.

    I’ve never met a human body as weird as mine – probably I should donate it to the scientific community for plenty of surprising and groundbreaking discoveries 😉

    (reply)
  98. Myles  March 23, 2016

    Thanks for the update! I am glad your family is doing great. My kid is beasting right there with yours (she is 99% height, and 91% weight, but when your dad is 6″4″ that happens). I always knew you were a closet car guy. Most of us engineers are. Well, I actually started out an enlisted DTR in the USAF then changed to engineering, but still. I run SSM and enjoy track days in my turbo miata. I manage to squeeze in some drag racing too, and I’ve only been able to make it to Laguna Seca once, but it is by far my favorite track. (Video games don’t do that damned corkscrew justice).

    (reply)
    • Peter Attia  March 24, 2016

      iracing does the corkscrew lots of justice if you’re in a good sim!

  99. Ken  March 23, 2016

    Playing video games and lifting weights in the garage like a teenager is not what most of your loyal blog readers would expect to read but I find it refreshing. It is a personal blog. Glad to hear you have more time for family and personal interests.

    I could easily see you getting into Olympic weightlifting. If you’re passionate about mastery then lifts like clean, jerk, and snatch are right up your alley. Of course, do this with a trainer if you haven’t done them before.

    Did you know that Dos Equis is recasting its ‘Most Interesting Man in the World’? I think you could do justice to the role. You have a peculiar career path and look ethnically ambiguous. Think about it.

    (reply)
    • Peter Attia  March 24, 2016

      Ken, I grew up powerlifting (good squat and dead; horrible bench) and did quite a bit of O-lifting until 3 years ago. Agree that clean and jerk might be the most beautiful movement on earth.

  100. Byron Allen  March 24, 2016

    Dr. Attia,

    I am Dr. Matthew Allen’s ( former McKinsey ) dad and, per his recommendation, am an avid reader of your articles. I need a recommendation for increasing HDL. I do not have metabolic syndrome as you define it as I have low blood pressure in the 60-65 range, 36″ waist, low A1C, normal glucose level, but I do have chloresterol of 230 and HDL of 40. I take 10 mg Crestor each day and have been on statins for 30 years. I have been on the high fat , zero carb diet, and fast walk at least 3 miles per day ( I am 68yrs old) for the past year but my HDL remains the same. I want to lose weight and raise my HDL. Any suggestions?

    Regards,

    Byron Allen
    Friendswood, tx

    (reply)
  101. Hakim  March 24, 2016

    Peter,

    Are you giving any talks at UCSD or other academic institutions. I know you had given one last year at UCSD. Appreciate all your work. May also have a prospective patient. But not sure how selective you are.

    (reply)
    • Peter Attia  March 24, 2016

      Last talk I gave at UCSD was about 9 months ago. Nothing planned at this time.

  102. Kevin M Quirk  March 24, 2016

    Thank you for the update and the links to the new podcasts. I really enjoy your approach to diet, health and medicine.

    I am writing to ask if you are familiar with the recent work of Larry Smarr at UCSD. He is an cosmologist/astrophysicist/computer scientist. Part of his background is using supercomputers to crunch massive data sets as a cosmologist . He is now applying these techniques to the microbiome. He is working with the Craig Venter Institute to creating a massive data base about the flora of the microbiome by taking frequent stool samples from around 100 people, so far, (he started with the N=1 approach) and then sequencing the DNA of all the microorganisms in the samples. This gives him a full picture of the flora of the individual’s microbiome over time. They are creating a massive database which they are using to identify how the population of the gut flora is related IBS, ulcerative colitis, and other conditions. They are also looking at mass extinction events and other cascading sequences that occur in the microbiome. He is also partnering with researchers at the UCSD School of Medicine. It seems like the kind of thing you would find interesting.

    He started on a personal quest to improve his health. Being a scientist, he felt the need to create a database to track his progress. Like you he was wearing monitors and constantly testing his biomarkers.. He felt he really needed to understand what was going on in his microbiome. Being a big data guy, he came up this a way to create a massive data base about his micobiome that he could analyze. His personal journey is quite interesting. In many ways, he seems like your kindred spirit. If you are not familiar with his work, I recommend you take a look. As an MD with an engineering/math/stats background, I think you might find his research very interesting.

    Here are three links to talks that he has given:

    Here is link to his talk called: Quantifying The Dynamics of Your Superorganism Body Using Big Data Supercomputing.

    https://www.youtube.com/watch?v=Da_BPAduPoY

    Here is link to his talk called: The Human Microbiome and the Revolution in Digital Health.

    https://www.youtube.com/watch?v=NdkVDKWrmOQ

    Here is link to his talk called: The Human Laboratory: One Researcher’s Quest to Personalize Medicine with Larry Smarr.

    https://www.youtube.com/watch?v=37u0SPZGK6Q&ebc=ANyPxKpyI9kqlBRueSzs2FZa1etOjXpEGNkWA7rtaMWS3CLRJCmZm97lzAF-q5Sf9LGG6qCHcH2l4cNq-6L1ObVNOeF_Ohjvbg

    He details about he started down this road by testing himself.

    (reply)
    • Peter Attia  March 24, 2016

      I know Larry very well. Many a meal has been shared discussing his work.

  103. Joshua  March 24, 2016

    Thanks for sharing Peter!

    I eagerly await the findings that will eventually come out of NuSi, but I can’t blame a man for getting out of the fundraising business. Sounds like sales only worse.

    I miss your more frequent postings (good nutrition blogs seem hard to find), but I understand that everything you post here is a gift. I admire and am inspired by your ability and willingness to live YOUR life YOUR way. Your private practice sounds like an amazing job/service!

    (reply)
  104. Ryan  March 25, 2016

    Hi Peter, those were great interviews! Fascinating discussion topics.

    I’m curious to learn more about your leucine intra-workout regimen and your stance on total protein intake/methionine intake with longevity and optimal health in mind.

    I’ve tried Ajipure Unflavored BCAAs in the past, but found the taste *remarkably* bad. I’ve also tried Biosteel HPSD in the past, but at the time they were using Sucralose and synthetic folic acid, which turned me off. I’ve since been using Xtend Free (20g supplies 5g leucine + 2.5g isoleucine + 2.5g valine + ~3.5g glutamine.) Are you targeting a 2:1:1 BCAA mix, or something higher in leucine? What are your thoughts on Xtend Free / Raw?

    I suppose building leaning muscle mass and chasing after the benefits associated with calorie restriction / protein restriction are directly opposing goals? Are you actively limiting methionine / total protein to some intake target, or supplementing anything like glycine?

    Thanks for all the great information over the years! Keep up the good work, doc.

    (reply)
    • Peter Attia  March 27, 2016

      Very tough for those of us not genetically blessed to add lean tissue while reducing fat tissue and/or doing CR. As for BCAA, most are basically fake. Anything made by Ajinomoto is legit, which is usually reflected in the price. Also, you can build your own AA by AA through Sigma, but cost is very high.

  105. Guy  March 25, 2016

    You have a beautiful family. That was my take away from this post.

    (reply)
  106. Justin  March 26, 2016

    Thanks for the update. It’s great to see the different things going on in your life. As a second year medical student, I find metabolism absolutely fascinating (and have for quite some time)! Unfortunately, there are still some poorly scientifically-supported ideas being taught. Two examples: 1. We were taught ketosis was a dangerous state (while I’m sitting there thinking I’m in ketosis right now and healthy) and 2. In another lecture we were told saturated fat is bad for your cholesterol then shown the journal article “Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet” by Shai et al. (2008) in which the Atkins diet improve cholesterol levels. With my clinical years are starting soon, I would like to train with clinicians who seriously examine the evidence/literature (regardless of what science eventually determines about metabolism and nutrition) and not just repeat the same rhetoric that has been perpetuated. Unfortunately (again), I am not aware of any in my area (which could just be my own lack of knowledge). This might be a weird place to ask this, but I was wondering if you had any ideas of such clinicians in the PA-NY-NJ area that would be willing to take a student for a 4th year elective (for when I eventually get to 4th year)? It would be an honor to train with you of course, but I understand that you are very busy. Continue your great work!

    (reply)
    • Peter Attia  March 27, 2016

      Justin, that’s just too painful. I can’t say I feel your pain, b/c when I was in your shoes I wasn’t thinking about things the way you are. I just don’t know when you are going to find the right mentorship. You may need to perfect the art of learning this on your own and out of session, and polititely and deferentially brining the lessons to your teachers.

  107. Zach  March 26, 2016

    If your goal was hypertrophy over strength/muscular endurance, how would you approach this from a nutrition standpoint?

    A follow up question would be what do you think is the “safest” way to eat in a caloric surplus? I am fairly underweight and would like to add weight (mainly muscle, of course). I feel like eating an adequate amount of protein with most excess calories coming from fat would be the best route because the body can store it more easily/safely. While carbs might help muscle growth A LITTLE (although some research is coming out that might suggest otherwise), do you think a keto setup might be “safer” for overfeeding/muscle growth?

    Thanks!

    (reply)
    • Peter Attia  March 27, 2016

      I don’t consider myself expert in that problem at all, having never considered hypertrophy a goal. Every sport I’ve ever done has tried to maximize strength while minimizing mass. That problem I understand well!

    • Zach  March 28, 2016

      Fair enough. But, do you have any opinion on my second question regarding the safest/healthiest way to add muscle/size? Maybe not necessarily the most optimal, but the least stressful on the body?

    • Naren  April 6, 2016

      I realize you haven’t studied hypertrophy as much as you have maximizing performance with minimum size.

      But say one day you do decide to go after dem gainzzz,. Which of the following would you adjust as a starting point?

      Increase Carbs (from current state of only eating as much as tolerable)
      or
      Increase Protein (from current state of only eating no more than needed).

      I presume it won’t be fat as it”s not so much a higher need for energy (kcal) but rather the building blocks and triggers (insulin?) of muscle.

  108. Geoff  March 27, 2016

    Peter. I first found your website over a year ago, and have greatly enjoyed your posts on nutrition, especially. A little over a year ago I went on a LCHF probiotic and ketogenic diet (limiting carbs to under 50 games), and have had amazing results. I have lost 20 lbs, my sys has dropped from 152 to 117, my blood glucose dropped from 100 to 75, my HDL went up to 130 and triglycerides down to 50. With results like these, I intend to never stop. You seemed to have similar results. Why did you stop? When should I stop?

    Second, I have recently adopted velocity based training concepts. I am 67 and have a passion for golf. I have been training in the gym at the “speed-strength” point of the curve to increase my swing speed. Any thoughts on velocity based training?

    (reply)
    • Peter Attia  March 27, 2016

      Yes, Geoff, I had similar results, including the lowest body fat of my adults life (can’t ever compare to high school…). And for 3 years I enjoyed it greatly. The challenge for me was caloric requirement. I was consuming 3500 to 4500 kcal/day (average TEE was between 3750 and 4150 kca/day), which meant 85-90% of my kcal were coming from fat. After a while, I just got tired of being so restrictive in my eating, especially as someone who travels so much (well over 200,000 miles/yr in the air). To be a little less restrictive was a small price to pay for a great deal more flexibility.

  109. Dougie Boxell  March 27, 2016

    Hey Peter, I just wanted to say thanks so much for the update. I’ve been hoping for some new content, despite only finding about you in the last 6-8 months, and still not having caught up with all the posts and podcasts (same can be said for Ben Greenfield………between you two, uni, footy and work (none of which is relevant to my degree or my passion in life), suffice to say, I’m struggling). Thankyou so much for taking the time to let us know how you’re going and what you’re up to. I look forward to more blog posts in 2016, and much more of everything in the future.

    I would like to ask one question though – have you had a crack at mastering football? (I mean australian rules football, real footbal 😉 )

    (reply)
    • Peter Attia  March 27, 2016

      Doggie, no, I have made no attempt to master Aussie rules football.

  110. Jacqueline Parker  March 28, 2016

    Hi Dr. Attia, I am a third year medical student at Cornell Medical school in NYC. In fact, I have just returned after taking 2.5 years off to compete in road cycling. As I am in the midst of my medicine clerkship, I have been contemplating what field/residency program I should pursue. While there is a strong emphasis on disease treatment in my medical training, I am equally (or more) interested in health promotion and maintenance as it relates to nutrition, lifestyle, sleep etc. I am wondering what fields of medicine you believe offer the best training in these regards. I anticipate that I will ultimately like to combine practice and research with a healthy helping of free/play time and family time. Thank you for any advice/insights you have to offer, and although I image it is unlikely you would have the time for me to shadow or meet up, I will be at Cornell until May 2018.

    (reply)
    • Peter Attia  March 29, 2016

      Jacqueline, I wish I had something to offer you. Even if I did, I’m pretty sure it would not be accredited since I am not affiliated with Cornell or another medical school. Bummer that med schools don’t work harder to encourage this sort of freedom.

    • Geoff  June 17, 2016

      This is a very late response so I hope you get it. Two doctors you might want to check out are denversdietdoctor.com and drcate.com. Also, try dietdoctor.com. Hope this helps.

    • Eli  December 21, 2016

      Jacqueline,

      Have you looked into PM&R? Or perhaps a Family Medicine residency with a fellowship in preventive medicine or Integrative Medicine might fit your interests well.

  111. Chase Anderson  March 28, 2016

    Peter, I find ketosis really interesting. Any suggestions on who to follow to keep up with the latest research?

    (reply)
  112. Jacob Anstey  March 29, 2016

    Peter,

    What defines gluten sensitivity?

    I eat about 200 grams of carbohydrates a day, workout and non-workout, through these sources: vegetables (spinach, carrots, kale, broccoli and cauliflower), lentils, quinoa, blueberries, apples and sweet potatoes.

    One hour after lunch (two chicken thighs, 1/2 cup lentils, 1/3 cup walnuts, about two cups of spinach), my glucose was 78 mg/dL.

    About an hour after that, I do an hour of resistance training, following of which my glucose was measured at 82 mg/dL.

    I ate dinner about an hour an a half after that (chicken breast, 3/4 cup blueberries, sweet potato, broccoli and cauliflower, 1/2 avocado), in which an hour afterwards my glucose was measured at 81 mg/dL.

    Would it be right to say I tolerate carbs fairly well? I don’t do any junk carbs. Don’t care for them; never have.

    Thanks for your blog posts. I certainly learn a lot from them. Keep up the good work.

    (reply)
  113. JJ Bell  March 29, 2016

    Peter, as a 34 year old with borderline low testosterone (464 ng/dl), looking to optimize for longevity (some strength/lean mass would also be nice). Any thoughts on appropriateness of trt or better to make every effort to improve via lifestyle in the first instance? Feel I have already made a fair effort at the lifestyle stuff e.g. Sleep, stress (as much as one can), diet (though realise increasing calories might help), vitamin/mineral deficiencies etc. One of the reasons I ask is that I had an undiagnosed varicocele for many years so not sure if the boys capable of performing as they should. FYI, not medical advice I am looking for, only suggestions, any ideas or refer me to any good resources if you can (pretty please!)
    Thanks
    JJ

    (reply)
    • Peter Attia  March 29, 2016

      Beyond the scope of my time-limited responses, but I am very reluctant to use exogenous testosterone as a first line agent. 90% can be fixed via other means.

    • JJ Bell  March 30, 2016

      Really helpful, thanks – was only looking for gut pointer in right direction. Will explore other means as far as I can.

    • camraman  February 20, 2017

      JJ,
      Things I would suggest would be protein and sat fat intake, be well nourished (as in perfecthealthdiet.com approach) and in particular vitamin D and vitamin K2.
      cm

  114. Adam  March 29, 2016

    Peter –

    Most enjoyed the update on your continued “evolution”…it was very helpful, for me, to reinforce the importance of change and growth!

    I own a beloved E46 M3, and am a big fan of the brand in general. If you have never checked them out, Enthusiast Auto in Cincinnati OH–(http://enthusiastauto.com/)–is a solid operation that usually has a very impressive inventory for those “who needs a 401k anyway” moments we can go through. Nothing about an M car is cheap, but when you buy quality, you only cry once!

    (reply)
    • Peter Attia  March 29, 2016

      Ha ha, I love that line! Must use it with my wife more often, “But honey, this is the only time you’ll cry about how much money I just wasted I mean spent on racing…”
      There are some uber sweet cars on that site. The E36 M’s are out of control.

  115. Su-Chong Lim  March 30, 2016

    Peter:

    I first heard of you a week ago through a Tim Ferris interview, and I chased through several intermediate references to find more information, lost the trail and then Eureka, found you again here.

    I am a retired physician in Calgary in your country of origin, and at the time of retirement in 2012 I was a good runner, but decided to up the ante, and learn to swim and bike, and compete in triathlon. The swimming has been my primary challenge, and I’m still hacking away at it, but last year I made a profound discovery. I underwent respiratory gas analysis while treadmill running. This demonstrated that at the lowest exercise intensity, Zone 1, I was only obtaining 11% of my energy via fat metabolism. I was advised to switch (from my typical high carbohydrate) to a low carbohydrate, high fat diet and spend the majority of my training at Zone 1 and 2 intensity, or risk running out of steam in a 6 hour endurance event. This ran counter to my instincts and what dietary information I had learned in medical school and a 40 year career in family practice. However, it did fit in with my prior experience of repeatedly “bonking” at the 3 hour mark in numerous marathons. I was a little nervous, too, about compromising my lipid health so I did a rapid review of the literature, and was astounded to discover that the standard “official” dietary recommendations of the past 30+ years for Canada and the US were based on epidemiological findings based upon blood lipid levels but extrapolated to dietary manipulations that were assumed to work, but never really borne out by proper research and trials. In fact, now that I was looking back, there was some dissent at the time the dietary recommendations were being formulated, but the dissenters got shut down, in favour of the consensus which was for lipid restriction and high carbohydrate in the recommendations.

    I went on a restricted carbohydrate, generous fat diet, and modified my training to be strict about the proportion of Zone 1 and 2 intensity activity, and in 12 weeks a repeat test showed that my Zone 1 metabolism was now 62% fat oxidisation! I was convinced. I did my first two Half Ironman races last year and did not bonk.

    I have maintained this diet since, although it was quite flexible, mostly based upon whether or not it was convenient. However, on listening to your interview, and reading a few of your prior blogs, I have become intrigued at the idea of how low a carbohydrate content my diet should get to for maximal performance, and whether I should formally embark on a ketogenic diet. I suspect in the past year I have been intermittently in ketosis. I have purchased the books by Volek and Phinney and have gained further insight. However, I still have further unanswered questions — do I need to be in ketosis to maximise the benefits of low carbohydrate diet, particularly with respect to prolonged endurance and high power output? What foods to use while refuelling on the bike and on the run? Would oral ketone supplementation help? Would the carbohydrate in rehydration formulas such as Skratch Labs product (42 g carbohydrate, 720mg sodium per litre) be enough to interfere with the lipid oxidising metabolism that I am trying so hard to protect? I have entered a full Ironman event in Coeur d’Alene, Idaho in August, so the stakes are high!

    At the moment I don’t care about longevity, cardiovascular disease, diabetes or cancer prevention — I just want to compete well. However, I’d be delighted to give feedback, if it helps, for your work on longevity, perhaps if it relates to activity. I train like a fool right now, with a view to trying to get my swimming and biking up to snuff for August, but with a 10k (run) race coming up in 2 weeks and half Marathon in a month, also trying to get my speed-work up to scratch, and trying to keep up my martial arts training as well, it’s a bit of a logistical challenge. Sadly, my 1976 Porche 911 sits neglected in my garage for years, as do my guitars…

    (reply)
  116. INDRO Mazumder  March 30, 2016

    Here is a timely story on powerlifting:

    http://www.newyorker.com/news/sporting-scene/the-accidental-weight-lifting-world-record-holder

    (reply)
    • Peter Attia  March 30, 2016

      This is *awesome*…just tweeted.

  117. steve  March 30, 2016

    Hi Dr. Attia:
    1. Love your goal of achieving mastery
    2. In listneing to your talk with Rhonda Patrick I think you hit on what may be the most compelling statement i have heard in the nutritional/health wars: Max Carb intake inline with your glucose tolerance; and Min protein intake to maintain muscle mass.
    3. Cholesterol question: Where might i find info regarding why when on a low fat diet i make far to much LDL-P whether on a low fat or low carb diet? A1c is 5.3, BG runs 83-90 and NMR says never insulin sensitive so i am sure it is not an IR issue. Trgs even on hi carb have never been higher than 80. LDL-P only controlled with meds.
    4. Do you think IF makes sense for the over 60 yrs old cohort?
    5. Longevity is great goal, however, i am only interesting in avoiding morbidity. However long i live with quality is that matters. I will also add that tepid economic growth coupled with the enormous entitlements needed to support an aging population is actually stealing from the next generation and as a parent i find that very distressing.
    6. Lastly, how much sleep do you get per night?
    Thank you for your thoughtful views.

    (reply)
    • Peter Attia  March 31, 2016

      1. Thanks
      2. Glad you appreciate it…the religious I mean nutritional wars seem to miss this
      3. Lots of other factors control LDL-P, including de novo synthesis of sterols and LDL-R expression
      4. Yes, but the animal data suggest not for “longevity” gains. Complex question, actually.
      5. Amen
      6. I strive for 7.5 to 8 h, but sometimes get less.

  118. Patrick Snook  March 31, 2016

    Hello Peter,

    Enjoyed these podcasts hugely.

    You note that the oldest persons (90+) generally die of the same things as everyone else, with one significant difference that the onset of disease is delayed (and hence the longer survival, or longevity).

    Thanks to you, I’m enjoying the information (podcasts etc.) about sleep generated by Kirk Parsley too.

    Do you have any idea why, given the importance of sleep stages 3 & 4, those two stages tend to disappear from the normal sleep of the elderly?

    Does that square somehow with the later onset of disease? (If so, it’s counter-intuitive, if those stages are associated with immune-system tuning, hormonal replenishment and optimization, etc.)

    Thanks again!

    Patrick

    (reply)
    • Peter Attia  April 2, 2016

      Good question. Not sure I know the answer. Is this fact well documented or merely suggested buy sub-optimal data?

    • Patrick Snook  April 3, 2016

      Peter,
      I read about the phenomenon (the same day I heard one of your podcasts, along with one of Doc Parsley’s) in Sara Mednick’s book “Take a nap!” (2006). And here’s what a quick wikipedia search shows, in the article on slow-wave sleep (or SWS, or the Stages 3 & 4 I took from Sara Mednick–now both, it seems, elided as “Stage 3” in the literature): “Aging is inversely proportional to the amount of SWS beginning by midlife and therefore, SWS declines with age.” (The same article says that there is much variability across sexes and lifetimes.) Furthermore, SWS repairs and grows the body, and promotes memory consolidation, and is “essential to life”.

      This is all my simplification, but it’s an interesting oddity that generally we should lose it as we get older, when we ought to need it at least as much (more injuries or disease exposures, more memories, etc.).

      Perhaps rather the longest-lived *do* retain the ability for SWS, against the trend, and hence live longer. Or perhaps SWS late in life promotes the later onset of disease; or both effects combine producing longevity. (Who knows, maybe they get even more SWS?) It seems right to guess that the onset of decline in SWS would be delayed in the long-lived, correlating positively with the delay in the onset of diseases.

      And yes it’s possible it’s all based on sub-optimal data. I’ve no experience in the field, no knowledge. I’m merely a lay-reader or listener. But it’s interesting. Thanks for your response!

      Thanks again!

      Patrick

  119. Niall dewar  April 1, 2016

    Since your most recent update, I would like to ask about some of your older lectures on YouTube. Is there anything you have learned and regret saying in a video? We’re you totally wrong about anything you said that you would like to set right?

    (reply)
    • Peter Attia  April 1, 2016

      I can’t imagine I’d ever be able to go back and look at a single video of me. Except maybe the one from my first birthday on 16 mm.

  120. JJ Bell  April 1, 2016

    Pete, heard reference to your website via Rhonda podcast, am I right in thinking this is still under construction?
    Thanks
    JJ

    (reply)
  121. Dan Walker  April 2, 2016

    I saw this CNN article earlier this evening on Dan Spitz one of the guitarists from the heavy metal band Anthrax. If you haven’t seen his story about becoming a master watchmaker after he got out of music you should definitely take a look. Hodinkee has a good article from 2012 about him. How awesome would it be for you and Jocko to connect with him and go out to dinner one evening. I can’t imagine that not being an utterly fascinating conversation. The guy even designed his own custom benches for working on movements.

    (reply)
  122. Dennis  April 2, 2016

    Thanks for the wonderful information on this site Peter!

    Do you think it is possible that humans are optimized for a season dependent diet? (Ketogenic during winter and including more vegetables, fruits and berries during the summer).

    I think that would make sense from an evolutionary standpoint. I am no expert, but I could imagine that for example sunlight exposure could affect how micronutrients are absorbed. Vitamin D could also play a role taking in account the very wide effects it has on the human body.

    What do you think, is this a silly hypothesis?

    (reply)
  123. Vance  April 2, 2016

    Hey Peter,

    I posted a pretty lengthy comment that also had a couple questions back around the 25th or so. I know you are a very busy man but is there any chance that you could let me know if you saw it and just haven’t had time to respond or if it somehow didn’t get submitted and I need to re-submit it?

    Thanks

    Vance

    (reply)
    • Peter Attia  April 2, 2016

      No idea, but I don’t respond to most comments if I can’t do so in a few min.

  124. Jessica  April 2, 2016

    Hi Peter,
    Thanks for the update and for all that you do. It is very much appreciated. I noticed in one of the comments above you mentioned the “best sleep cocktail on earth”. Was wondering if you could elaborate. I’ve already made attempts with lifestyle, good sleep hygiene, benadryl and ambien but haven’t had long term success. Thanks again.

    (reply)
    • Peter Attia  April 2, 2016

      Kirk Parsley’s formulation. One can add other things to it, as needed.

    • Jessica  April 3, 2016

      Thank you once again!!! It’s so helpful as I had never heard of this product. Please keep doing what you do. Your work is not only beneficial to others but also an inspiration.

  125. Anna Rozanova  April 3, 2016

    Dear Peter,
    Being a registered dietitian (and I need to say an unconventional one, since I consider a lot of the mainstream nutritional advice currently promoted by the academy to be outdated or very loosely based on research to put it mildly) I have been following your blog and various video presentations and podcasts with you for some time and I admire the relentless pursuit of understanding of the ability of human body to self-heal.
    This week I have stumbled upon a term (in one of the latest podcasts) I was not familiar with before and as usual investigated a little bit into what this term means. I am writing now about Transcendental Meditation or TM technique, which you (perhaps inadvertently or purposefully) promote. I have to be frank and to my sadness once I probed into the facts I quickly realized that TM is nothing but a cult movement and your credibility immediately plummeted in my mind.
    It is extremely sad for me, since I have many friends and acquaintances including clients who turn to me for help with dietary guidance and whom I advised to use your blog as both source of information and inspiration.
    I feel at this point that I have fallen into some kind of trap and that I have pushed into this trap people who put their trust in me.

    (reply)
    • Peter Attia  April 6, 2016

      Anna, you probably should do a bit more homework before spouting off about something behind a cult. Whether you find value in meditation, be it TM or otherwise, is an entirely different issue and one worthy of debate. But a cult? Like Jim Jones? Are you serious? Do you even know the definition of a cult? The sine qua non of a cult, its strict sense, involves a religious devotion to a person or object. Neither of these remotely resemble what’s going on with TM (or mindfulness, open monitoring, etc.).

  126. Carol  April 3, 2016

    Peter,
    Wonderful information that you present! I’ve been on a keto diet for 6 weeks or so & it’s working great for me. Your website is a terrific source of information for my family members who think I’m damaging my health by eating this way. Your personal journey also clearly illustrates that the number of calories taken in is not what is most important, but the composition of those nutrients in the diet.

    One question, do you have any insight into Lipedema?
    It is an adipose disorder affecting women, that appears to be hormonally driven. I am of “normal” body weight, but disproportionally larger on the bottom half. The keto diet is working well for me, but I do have reservations about the saturated fat, as that is recommended to be avoided for Lipedema. Thanks for your insight.

    (reply)
    • Peter Attia  April 6, 2016

      Boy, that’s a great question (which is code for “I wish I knew the answer, but I don’t”).
      I can only say that most reconditions I’ve seen to restrict SFA are not actually based on real data, so I’d at least call into question this one.

  127. Dennis  April 4, 2016

    Peter, I want to lower my glucose levels as part of my strategy against prostate cancer, and dietary ketosis is not an option because I’m pursuing a vegan diet as one other part of that strategy. So, I’m weighing Metformin vs. a BHB supplement, and was wondering how you’d compare the two. Tks!

    (reply)
  128. Dennis Erdman MD  April 4, 2016

    Hi Peter
    Thank you for all the great information you have provided online. I have found it very helpful. Really looking forward to your book. Do you have any thoughts about the Cardio IQ vs NMR Lipoprofile for advanced lipid testing? Do you prefer one over the other and if so why? Thanks again

    (reply)
    • Peter Attia  April 6, 2016

      Dennis, I’m not familiar with Cardio IQ (I think I knew what it was at one point, but have since forgotten). So I’m preferential to NMR, though I don’t use Liposcience directly, but rather another lab that has the rights to their NMR.

  129. Maryann  April 4, 2016

    Thank you for taking the time to update us Peter, I am so glad you are well and happy. I think you would be challenged by and just as hooked on a flight simulator. You should get your private pilot license just for fun, even if you don’t intend to fly as a hobby. You would love the skill, science and math required. Your kids would love the simulator too. It is right up your alley.

    (reply)
    • Peter Attia  April 6, 2016

      Maryann, I think you are right. I have a few friends who fly and they say the same thing. I was once a mechanical engineer and have always obsessed over flight. But…..I think one sim is enough for now!

    • Maryann  April 7, 2016

      Dear Peter:
      This is Maryann’s husband John. I have been in the shadows all these years listening to Maryann tell me about all your endeavors and teaching me about your cholesterol series etc. Give up that race car simulator and do something really skillful and hard to learn. That is flying (for real). Maryann bought me Microsoft flight simulator in 1999. I got good at it and in 2000 I learned to fly for real (age 44). Then I got my instrument rating and multi-engine commercial rating(and by the way I’m not a pilot I am a self-employed CPA). I can’t tell you how rewarding the feeling of flight is. It is like nothing else. You would enjoy it because of the math and geometry involved in instrument flight (flight on instruments with no visual). If you buy the flight simulator you will get an idea of what it is like to see from the air and how different it is. Learning to fly visually and what things look like from the air is completely different from you experience on the ground. I would be happy to coach you. I know you can reach Maryann through this email link. We will be forever grateful for you recommending us to Dr. Dall. I would be happy to repay the favor. John

    • Peter Attia  April 7, 2016

      John, I need another obsession like I need more visceral fat!

  130. Mark  April 4, 2016

    Do you take in caffeine these days? If not, why did you give it up?

    (reply)
    • Peter Attia  April 6, 2016

      Yes, I still consume caffeine, though I suspect is has little to no effect on me. It’s more a function of the fact that I love (good) coffee and tea.

  131. Daniel Zbarski  April 5, 2016

    Great to have you back online sir! What’s your take on:
    1st heat rate variability and longevity and this paper:
    http://circ.ahajournals.org/content/129/21/2085.full?utm_content=buffer2c0dd&utm_medium=socialutm_source=twitter.com&utm_campaign=buffer
    and 2nd: this curious case study of centurions:
    http://www.sciencealert.com/scientists-are-investigating-why-people-in-this-tiny-italian-town-keep-living-to-100
    Can’t wait for you’re book!

    (reply)
    • Peter Attia  April 8, 2016

      Definitely interested in HRV. Still a bit on fence about its utility, though.

  132. Tyler  April 5, 2016

    Dr Attia,

    I recently heard you speak on getting out of conventional medicine for a multitude of reason but including the discontent you have for resident traing. As a FM resident myself, I’d be interest to hear you elaborate if you have a minute. Appreciate your work. It has helped shape my idea of medical practice.

    (reply)
    • Peter Attia  April 6, 2016

      I just fundamentally disagreed with the system of residency. It was time-based, not competency-based. Similar gripe many have with current system of education. There were half a dozen other issues, but I’m trying to purge them from my memory.

  133. thhq  April 6, 2016

    Your new focus on longevity interests me. There are so many people that have developed diets – from Hohensee to Atkins to Pritikin to Davis – who achieved weight loss but didn’t live as long as Harland Sanders and Julia Child.

    For this reason I pay great attention to Ancel and Margaret Keys, and I hope you give them their due. Cherry-picking Italy as the best of the 7 Nations, moving there, and and living the Mediterranean life for 50 years served them very well.

    (reply)
  134. Michael  April 6, 2016

    Really glad you’ve moved on to heavy strength training! However, why that rep scheme? I would have thought that with your obsession with mastery and dedication to research you’d be using a highly periodized powerlifting template. I can’t recommend “The scientific Principles of Strength Training” by Dr. Mike Israetel enough — I’d love to send it to you if you’d like!

    (reply)
  135. T. Black  April 6, 2016

    Hi,
    Do you still take berberine ?

    (reply)
  136. Ben  April 7, 2016

    Nice to hear from you, Peter!
    1) Re longetivity, are you familiar with the research on body iron levels and aging-related diseases, including cancer, neurodegenerative diseases, insulin resistance etc? If so what are your thoughts on iron & blood donations?
    2) Are you familiar with Cynthia Kenyon’s research (she made C.elegans live 6x longer by manipulating/disabling insulin and IGF-1 pathways)? If so, to what extent do you think a person could achieve that by being in ketosis?
    I read a study on children with epilepsy who were on ketosis, their IGF-1 dropped (insulin too presumably), and they grew slower than control kids. As per growth-longetivity tradeoff, ketosis might be good for extending lifespan once you’re grown up.

    (reply)
    • Peter Attia  April 7, 2016

      Very familiar with both. The data on iron aren’t great, but I must say mechanistically it makes sense and I do recommend my patients donate blood when iron levels get high.
      I discuss the IGF stuff in at least one of the podcasts. Too lazy to repeat.

    • Su-Chong Lim  April 8, 2016

      Are you saying that within the normal range (not talking about hemochromatosis) of iron levels, lower levels correlate with greater longevity? How strong is this association? Probably not ideal to lower iron levels by periodic donation if you’re a serious competitor in endurance sports. (Unless you’re storing and re-infusing prior to competition LOL.)

    • Peter Attia  April 8, 2016

      Upper normal or high levels. Evidence is not great, actually, but downside is negligible (except in circumstance you note). Mechanistic evidence better.

    • Christopher Grove  April 8, 2016

      Ben… a couple years ago, my brother was dying of brain cancer and, hungry for knowledge, I read Peter’s blog, “Is there a way to exploit the metabolic quirk of cancer?” (Peter was then kind enough to put me on to Dom D’Agostino) I remembered that that blog dealt a tiny bit with IGF-1.

      Re longevity… As someone who has tried to follow a Paleo diet for a number of years now, I’ve come to the conclusion that being in Ketosis is a normal and NATURAL state BUT that paleolithic man would have cycled in and out of it seasonally with either winter or dry seasons. THAT may be a clue to longevity… maybe “hovering” around the ketogenic line, back n forth, back n forth… often using glucose but never very high and often in ketosis… was healthier than either always using glucose or always using ketones. ???

  137. Michael  April 7, 2016

    To Dennis and Peter –
    Re Liposcience ; they were bought by LabCorp in 2015, so LabCorp now owns the NMR technology ; Cardio IQ was the Berkeley Labs method of lipoprotein analysis that used ion mobility as the means of separation ; Dr Dayspring has some technical details that compare the separation methods on his Lecture Pad website

    (reply)
  138. T. Black  April 7, 2016

    Hi Again,
    Care to share what were some of your surprise glucose “spikers” ?

    (reply)
  139. Ryan  April 7, 2016

    Dr Attia –
    Thanks for the blog and all of the helpful information that you share.
    Are you going to be making your presentation with Dr. Lustig at yesterdays conference in Hong Kong available to watch/listen to?

    (reply)
    • Peter Attia  April 7, 2016

      I doubt it. It’s up to C-S and I have no idea if they will post.

    • Naren  April 8, 2016

      That’s too bad, I would pay to watch it!

      Aside, but care to share what was on your wrist at the Credit Suisse conference (dark case, dark dial)? I love it when I spot a cool watch on someone I admire.

      – Watch Idiot.

    • Peter Attia  April 8, 2016

      Ha ha… you were there! I was wondering how you knew I was there since I didn’t see any media specifically mentioning it. I was wearing a ceramic Panerai GMT. Us watch idiots need to stick together…

    • Naren  April 8, 2016

      Don’t know about Ryan who asked the question originally, but I only wish I was there.

      Spotted the watch in this picture, https://www.credit-suisse.com/microsites/conferences/aic/en/blog/low-sugar-high-fiber-add-longevity.html

      I hope we get to see the Peter Attia collection in the form of a Hodinkee interview some day. And I love how the rest of your attire is also always on the same level as what’s on the wrist. Even when you’re dressed casual (Rhonda podcast).

    • Peter Attia  April 8, 2016

      I hate doing podcasts and interviews, but let me tell you, Naren, if Hodinkee called…man would I answer!
      Thanks for finding this picture. Hilarious! It looks like I’m talking about driving.

    • Ryan  April 8, 2016

      I wasn’t there either – As it was not really advertised, I only knew of the presentation from being in the banking industry and stumbling across a link on the CS website.

      I reached out to them about obtaining a video file and they indicated that they would send something to me… so I’m more than happy to share what I receive.

    • Peter Attia  April 8, 2016

      I can’t imagine it’s worth the time. Very little detail covered in this session.

    • Christopher Grove  April 8, 2016

      Ya know, Peter, you’ve gotten so much cred over the years now that Hodinkee would probably consider a glucose and keto monitoring watch, trading in on your celebrity status!

      😀

      BTW… I hope your de-stressing with you’re kids is going well!

      Oh… and have you broken any more shift sticks?? 😛

    • Peter Attia  April 8, 2016

      Well, that would be cool.

    • Ryan  April 13, 2016

      Link to the above mentioned presentation in Hong Kong:

      https://www.credit-suisse.com/microsites/conferences/aic/en/media-hub/virtual-aic/eating-dangerously.html

    • Naren  April 16, 2016

      Is it a PAM 441?

      Would love to hear your quick thoughts on/experience with the brand; I love the Panerai look (thanks to Sly, Arnold, Statham) but a bit wary given the PAM 318 scandal.

      Thanks.

    • Peter Attia  April 16, 2016

      Guilty as charged, Naren… I’ve never liked Panerai till I saw this one. My most recent addition and I’m impressed so far. Was torn between this and the 8-day.

    • Naren  April 18, 2016

      What are some of the other “tool” watches in your collection or on your wishlist, if you’re comfortable sharing?

      Others besides the SS Daytona, Speedys, PAM that have already made an appearance (pictures/videos).

      Sorry for hijacking an EATING academy thread, hehe.

    • Peter Attia  April 18, 2016

      You missed one that has already made a public appearance (Hint: was a picture in a previous blog post commemorating a special day). In addition to that one there are a half dozen others in the collection. Maybe more fun to bring them out in pictures!

    • Naren  April 19, 2016

      The JLC perpetual in the Pi day picture? I thought of it more as a dress watch than tool.

      Bringing them out in pictures sounds FUN!

      Wear them in good health, Peter.

    • Peter Attia  April 20, 2016

      LOVE that we are distinguishing “tools” from dress watches!

    • Naren  April 25, 2016

      Peter,

      You have the JLC Master Ultra Thin perpetual; when getting this, did you consider the Master 8 days perpetual?

      Currently deciding between the JLC MUT perpetual (or 8 days perpetual) and the. VC 1921 American. Would love to hear your thoughts.

      Thank you.

    • Peter Attia  April 25, 2016

      I sure did! Went back and forth a lot, but ultimately wanted the thinner of the two since I’m light on dress watches. I have a picture in the NYC JLC boutique with both watches on at one point!
      When it comes to VC I prefer Overseas (have you ever seen the Overseas Chrono PC?).

    • Naren  April 27, 2016

      Thanks for sharing your thoughts. The VC American was out of the running shortly after I posted the question.

      It finally came down to the JLC Master 8 days perpetual (1612520) and the IWC Portuguese perpetual (5033), with JLC emerging winner. The IWC was just too big for a thin wrist; I felt.

      Somehow, the Overseas line has never sung to me like some of its counterparts (AP RO, e.g.), but I did look up the perpetual chrono. In precious metal on strap does look very nice, but is a completely different price point (2x equivalent JLC). On Rhonda’s podcast, you were wearing a watch that was SS (or WG), on bracelet, and white dial. Was it an Overseas?

    • Peter Attia  April 27, 2016

      116520 Daytona.

    • Ben  May 12, 2016

      I wasn’t able to get to the discussion in person, we need more of this type of thing in Hong Kong for sure!

      Here is the panel discussion:

      https://www.credit-suisse.com/microsites/conferences/aic/en/media-hub/virtual-aic/eating-dangerously.html

  140. Christopher  April 8, 2016

    Peter, you’re probably going to hate me for bringing this up. Lol.

    Your youngest seems incredibly healthy and being in the percentile he is in seems to agree with that.
    Is there anything specific you feed him (K2, D, all that). Since some of my friends have had kids, some healthy, some not, I’ve been pretty interested in the topic of optimizing growth at those younger stages.

    Ty for all the hard work.

    Chris

    (reply)
    • Christopher Grove  April 8, 2016

      LOLOLOL
      This cracks me up! 😀
      Peter… you may as well stream a video camera from over your dinner table!!! LOL

    • Liz E  November 18, 2016

      Peter, I too would be interested in if/how all your personal research has influenced what you feed your children (aside from the avoidance of pre-made tomato sauce, juice/sodas, etc.). With a 15 month old, it’s hard for me to keep the Weston Price photos out of the back of my mind.

      Thanks for all you continue to share.

  141. Leah  April 8, 2016

    Thank you, Peter! Best app for tracking blood sugar, food, exercise, etc?

    (reply)
    • Peter Attia  April 8, 2016

      Nothing tracks glucose like Dexcom CGM.

  142. Jacob  April 9, 2016

    Hello Peter,

    I am interested to hear your thoughts on university training tables for students and, more generally, dining halls at universities. How should a student approach this? Just want to focus on learning.

    Thanks.

    (reply)
  143. Roger Germann  April 9, 2016

    No question, just the biggest thank you! I stumbled across your blog googling in January after a diagnosis of hypothyroidism and prediabetic. I share a love of science and math and am generally skeptical of expert opniions without an explanation of why and how things work. Really appreciate all the drawings, graphics, and math backing up your analysis and explanations.

    (reply)
    • Peter Attia  April 16, 2016

      Thank you very much, Roger.

  144. Caleb  April 10, 2016

    Dr. Attia,

    I’m a big fan of your work and I wanna let you know that you’ve been an inspiration to me. I watched your TED talk speech in 2013, and it encouraged me to use my college education to become a medical researcher in nutritional science. That being said, I would love to work with you in any way possible in San Diego.

    (reply)
    • Peter Attia  April 16, 2016

      Caleb, I’m honored to be a part of your journey. I don’t have an opening at the moment in SD.

  145. Louise  April 10, 2016

    Thanks for sharing your knowledge and insights generously Peter.
    I consider everything you have to say (including the Panerai but minus the motorsports!) as you are a beautiful mix of smart and wise!
    I also work in clinical medical practice (sport and exercise medicine) and am experienced enough (read “old”) to recognise that, if there is no heart-felt purpose to life (meaningful work, valued relationships etc), patients will not care deeply about health or longevity (or anything requiring uncomfortable behaviour change), and those that care obsessively about it, are often disconnected from a purpose beyond themselves.
    Private practice offers the opportunity and privilege to dig deep into personal values and stories, to guide people in behaviour change that scaleable tools just don’t allow- knowledge being a very weak motivator.
    I hope you keep posting cool scientific information and new ways of thinking about health, and also that you are enjoying this next phase of your work.

    (reply)
    • Peter Attia  April 16, 2016

      Thank you, Louise. I will do my best to keep folks posted on what I can.

  146. Rona Cushman  April 10, 2016

    Any thoughts regarding the Ketone supplementation –> KETO//OS by Pruvit? Ingredients: MCT powder, Beta Hydroxybutyrate, natural flavor, malic acid and stevia.

    (reply)
  147. Tynamaria Schwaegerl  April 11, 2016

    Hello Peter,

    I am a Paraprofessional at John Stark Regional High School and I help students in Biology. We just watched your TEDMed video about your personal experience having insulin resistance. I think it’s great that you were able to share your emotional journey as a doctor with a patient that had her foot amputated. I was wondering if she ever contacted you or if you ever saw her again. I hope she has forgiven you. I think it’s wonderful that you are doing all you can to dedicate yourself to finding a way to help and research how to help people instead of judging them.

    All the best!

    Tynamaria Schwaegerl

    (reply)
    • Peter Attia  April 17, 2016

      Thank you very much, Tynamaria.

  148. Carlo  April 11, 2016

    ‘The practice applies nutrition science, lipidology, four-system endocrinology, sleep physiology, stress management, and exercise physiology to minimize the risk of chronic disease onset, while simultaneously improving health span.’

    Hope you forgive me Peter, but after reading this description I could not refrain from making another stochastic calculus/ finance analogy: if financial products were not in such disrepute, one could say that Attia Medical should be renamed AAA Medical… a longevity optimisation practice… as randomness (in its most philosophical sense of limited knowledge) lurks everywhere, let Peter get you in the safest tranche…

    Although less direct than a Var/ constrained optimisation analogy, I found default risk renders the context much more vividly…

    Silliness aside, I wonder if you have ever discussed your ideas/ had exchanges with Nassim Taleb? Antifragility seems like a pertinent framework.

    (reply)
    • Peter Attia  April 17, 2016

      Carlo, I love it. I tell patients that I’m trying to deliver as much alpha as possible…
      I’ve never met or spoken with Nassim, though I’m familiar with his work of course.

  149. Stephen  April 12, 2016

    Since you’re in NYC, beware of nutrition ‘expert’ Gary Null (if you haven’t heard of him already…).

    (reply)
  150. Brent Rice  April 13, 2016

    Just curious on your obsession with squats and deads, are you driven to hit new highs or are all your goals related to glycogen levels? Is the squat/dead program you outlined one which you found to be most effective for increasing your weights?

    I’ve been following the old school 5×5 (I use the Stronglifts app, has to be the best designed app out there) and love it. Once I plateau I’ll be looking for my next routine.

    (reply)
    • Peter Attia  April 17, 2016

      5×5 is great, too. I’m currently most interested in finding 10 rep max. Wondering if I can get near high school levels when I did this seriously. Physiologically, I’m interested in glycogen turnover, increasing IIB fibers, mito density, etc.

  151. Dan Walker  April 14, 2016

    Have you found any dietary solutions (not main-lining loperamide) to deal with lower GI upset from Metformin? Chia seed works well for me, and it doesn’t take crazy amounts just 5-10 grams a day generally speaking, but I have been reading that soluble fiber affects Metformin’s absorption in the small intestine. Is it just going to end up being a compromise with no great solution?

    Thanks!

    (reply)
    • Peter Attia  April 16, 2016

      Gentle introduction, starting in evening.

  152. Jody  April 15, 2016

    I wait expectantly for a post on your insights from the Dexcom. I am a 44-year-old female, fit by average standards and BMI of 19 (I’m getting that Rippetoe book and going to start shifting from predominantly cardio to more weights!) yet I am prediabetic. I’m taking metformin. I’m trying to get my numbers down – postprandial fairly easy to control with reduced carbs but that fasting number is so stubborn. Would love if your post would address us normal weight people with prediabetes – almost everything you read connects it to being ‘out of shape, overweight, lack of exercise’ … the advice to lose weight and exercise does NOT help me. Though, like I said, I’m going to get more into building more muscle, so maybe that will help more. Thanks for your blog!

    (reply)
    • Peter Attia  April 16, 2016

      If you are prediabetic by A1C, and PP levels are low (typically below 125 or so), even if fasting is “high” (100-110), I’m betting imputed (real) A1C is lower than measured. By all means, build muscle like it’s your job, but CGM could help you find out if you’re really pre-T2D or not.

  153. B  April 15, 2016

    Hey Peter,

    You love pens, F1, cars, race driving, swimming, and powerlifting?!! Me too! I’ve found it’s a rare combo of interests.

    1) Is there a ‘driving style’ you try to adhere to? Or, instead, what is your favorite book on driving?

    I think that many people chase the theoretically fastest style and end up losing too much speed on entry relative to classic, constant radius lines, which are easier to reproduce lap after lap and easy to diagnose driving errors by seeing where you end up on the exit. (In reality, I think the car and track dictate the style , and we just have to have the discipline to commit to the line.)

    I’m also toying with the idea of treating braking, turn in, throttle and track out as a timing exercise, like in music. Hit the note at the right time instead of always being tethered to your fear/risk response. Because at a certain speed you have to use your mind to overcome your instincts and ‘trust’ the car. Things happen so fast you have to do things in the car before you have time to take in what just happened.

    2) I think this tension between optimal, or theoretically best style, and what is humanly reproducible for the best performance or outcome, runs through all of these technique driven individual sports and pursuits, including nutrition and especially swimming.

    Couple of recommendations (if you haven’t seen them)

    Behind the Wheel with Jackie Stewart. It’s about driving on the road and is on youtube. Show your kids before they get their licence.

    Also anything with Rob Wilson on youtube.

    Don Palmer, a road and track driving instructor in the UK, has free, basic track driving info here: https://web.archive.org/web/20070306114918/http://www.donpalmer.co.uk/cchandbook/index.htm

    He also has a good road driving page. He talks about things that aren’t taught in US driving schools really. Again, good for the kids and family when they drive.

    https://web.archive.org/web/20111005223723/http://www.drivinghandbook.co.uk/

    Cheers, and THANK YOU!!!!!!!!!

    (reply)
    • Peter Attia  April 16, 2016

      I think I’m too early in my experience to know my style. I will say I’m really focused now on a few things…earlier braking into corner and sooner back to throttle; smoother on/off with brake and throttle; longer field of view. I agree, to me this is part art and part science. And I freakin’ love it. Behind the Wheel is excellent and so is “Weekend of a Champion” if you haven’t seen it (I’m sure you have). God, I’d love to meet Jackie…

  154. Michelle Camper  April 16, 2016

    Hello Peter. It’s great to hear that you and the family are doing well! You are a huge influence in mine, and a lot of folks lives. Thinking of a project on ketogenic diets ( not cyclic ) and power athletes, Olympic Weightlifters, Power Lifters etc. What are your thoughts on the ability of an athlete in this category to excel and progress on a strict “modified” (25-30 g protein) keto diet in this genre? Given the lack of information in this area I feel it is much needed. Should I ditch the project, or does it hold some promise? Appreciate your opinion! Keep up the awesome work!

    (reply)
    • Peter Attia  April 16, 2016

      I don’t think I’m close enough to the space to offer an insightful opinion one way or the other. Maybe others?

  155. Ryan  April 16, 2016

    Hi Peter!

    I’m curious about your conscious tweaking of carb intake around activity since tracking CGM data. I’m also curious about the post-prandial effects of eating one large high-fat meal/d.

    Do you have any tips (aside from CGM tracking) for how to best incorporate carbs in a LC diet around activity without fluctuations in glucose (do you still supplement SuperStarch pre-workout/intra-workout or have any particular foods combination/timing tips for pulling this off consistently?)

    When you were eating 1 large meal with very high calories in a small eating window with lots of fat, would this lead to a large increase in post-prandial TG and lipoproteins? Is this rise in post-prandial lipids not a risk factor for cardiovascular disease like it is when seen with fasting cholesterol? If this is a risk, did you develop any tips / tricks for attenuating this effect?

    Thanks!

    (reply)
    • Peter Attia  April 16, 2016

      I didn’t have CGM when I was doing the 1 meal per day.

  156. Chen  April 19, 2016

    Hey Peter great to read you again. If its not too much to answer, but from longevity, mtor, igf perspective, what is your opinion about consuming all your caloric intake in one meal. I ask it bc im doing IF with ketogenic diet, trying to sync it with my circadian rhythm (sleeping 00:00-08:00 workout 17:00 and eating in one meal about 90 min before bed) from mtor view to consume more than 80gr of protein in one meal not trigger the mtor too much? The fasting compensate it? Sorry for my bad english and thank you..

    (reply)
    • Peter Attia  April 20, 2016

      Great question, but not answerable in a short comment. It’s an entire blogpost..

  157. Andrew Yossef  April 20, 2016

    Hello Peter,

    Great posts. I have been listening to whatever I can get my hands on from you. Very insightful and informative. I am also looking forward that your book when it gets released!

    Now I am just curious, are you Egyptian/have Egyptian origin? I know random question, but I am very curious. 🙂

    Thanks,
    Andrew

    (reply)
  158. Wiebke  April 20, 2016

    Hy Peter,
    I just recently discovered your website while searching the web for some quality content on the first law of thermodynamics in corolation with carbonhydrate consumption and google let me to you website. After reading most of your blog post I just wanted to thank you for your work. Combining exercise and nutrition is something most doctors lack. So, that is pretty awesome. I was wondering if you have any contacts (website or real doctors) here in Germany, which also think the way you do? I would appreciate a hint 🙂 Because sometimes it’s pretty hard for a personal trainer without a medical Univerity diploma (by background is just engeneering…) to influence some of my clients and convince them to consider going low carb. Thank you and hope to read you soon 🙂

    Wiebke

    (reply)
    • Peter Attia  April 20, 2016

      Wiebke, I wish I did…I’m sorry.

  159. Lukas  April 21, 2016

    Thank you for the update Peter.

    It’s my first blog comment, on any blog for that matter, but I just felt compelled to let you know how important this blog has been for me as regards finding a ‘voice of reason’ among much screaming that I am witnessing online. I am a European and while I understand the necessity to stand out from the crowd and the stiffness of competition on all fronts in the USA, my mind just cannot seem to be able to switch off the skeptical mode when confronted with the rhetoric on ketosis-related issues that often ends sentences with exclamation marks.

    I have had reasonable success staying ketogenic, but if anything, reading blinded pro-ketogenic evangelism on other sites, discussion forums, reddit etc. make me almost ashamed to admit this is a lifestyle I am trying to adhere to. So, again, thank you for providing my perpetually doubting mind with a discourwe that I can relate to, and one that is both very scientifical (way over my head in many cases), and open to challenging views.

    There was another impetus for writing this– one subject you touched upon in this update that mentions red blood cells. I have just gotten some bloodwork results today and had my GP calling me back regarding hemoglobin markers that to them signal anemia; my hemoglobin is around the 100 mark, which, apparently, is less than what is considered the lowest acceptable value for a pregnant woman. 🙂 Since having read that RBCell is the sole type needing glucose exclusively, I began to wonder if this could be in any way linked to having stayed ketoic [for about two months now]. Having said that, I haven’t had this type of blood tests done in years I think, and I am a circa 8 percent body-fat guy who used to run close to 80km / week during my peak, and have now settled at about 30. Which, indeed, makes me wonder if I could have been even more severly deficient some years ago when I had been clocking those distances…

    (reply)
    • Peter Attia  April 23, 2016

      Lukas, I’m laughing out loud reading your first paragraph! (exclamation point and all) It’s a crazy world I’m trying to not be a part of it.
      The problem you describe (low Hb) is referred to as anemia (as you note). This is different from what I wrote about and does warrant medical attention. Iron deficiency is one (of many) causes, but an explanation is in order.

    • Lukas  April 23, 2016

      Thank you for the heads up Peter. 🙂

      (And indeed, I have now been put on what i researched seems a 40.000 % daily recommended dosage of iron supplementation while the causes are yet to be understood by my doctor…)

      keep the occasional posts up, you’re being an inspiration (to many).

  160. Alejandro  April 21, 2016

    Dear Dr Attia

    This might not be the correct post to ask this but I do not know how else to reach you. I have been on this Keto diet but one of the side effects I am getting is loss of sleep. Have you ever suffered from this? I can fall asleep very easily, but wake up really early (3-4am)

    Any advice would be greatly appreciated

    (reply)
  161. adrian  April 22, 2016

    All the information here has been extremely helpful.i have since read volek and phinney’s work,steffanson the fat of the land and listened to most podcasts of the people that use the ketogenic approach.i am a young cardiologist with important obesity in both my family lines and according to 23andme i have multiple mutations that seem to corelate (i am guessing on a normal diet) with obesity.So 5 years ago i started restricting carbs and lost in about an year 25 kilos from 105 to around 80(suplemented with some form of exercise).For me it is very easy to see what carbs do.When i go on vacation and eat more carbs even though i exercise i put on 3 kg in 2 weeks or more.After experimenting with low carb 6 weeks ago i decided to give ketosis a try(had some arguments with diabetologists that think it is putting strains on kidneys but i do not think they know what they are talking about ).So for more than a month i am in ketosis -documented i mean by a lot of blood testing and feel very good.I exited ketosis after drinking too much wine but reentered in less than 12 hours(happened twice).I only have some unanswered problems.i am apo e3/e4 and their is no consensus on apo e4 and high fat diets.i was wondering what your view is on the apo e4. you have not mentioned it in any podcasts.i also ave ppar alpha and ppar gamma mutations that seems to be associated with fat metabolism deficiency and supposedly i should up my intake of omega 3 over the normal recomendations(which i already do).Have you come to any conclusions over the apo e4 mutation.i was thinking that people with it myght actually really benefit from ketosis.from data i found it seemed to appear along with homo erectus ,which also was as the name suggests the first true biped and a reall runner(nuchal ligament etc) who may have practiced persistence hunting.So along with the morphological adaptions to long distance running my hypothesis was that maybe apoe4 was his metabolical adaption to long distance running.That doesn’t seem to explain why apoe3 reappeared 200k years ago o apo e2 even earlier.i am really curious what is your take on this or other people on the forum.

    (reply)
  162. Norm  April 22, 2016

    Hi Peter,

    While eating one meal per day, how much protein were you consuming?

    What about going without food AND water for about 20 hours a day? Can it affect kidney function or cause dehydration? Drinking enough water during 4 hours window can compensate for it?

    (reply)
  163. oph  April 22, 2016

    Hi Peter,

    It’s good to hear that you are thriving with all that changes in your life. I just wanted to assure you that it’s not only “what you eat” makes me to check for updates on your blog. 🙂
    Longevity is extremely interesting subject. Please continue to keep us posted.

    All the best.

    (reply)
    • Peter Attia  April 23, 2016

      I’d much rather talk about longevity than what I eat!

  164. Derek Alfaro  April 23, 2016

    Hi,
    Nice post. I recently appreciated something you said referring to salt intake from one of the podcasts you where part of. Since starting to eat for ketosis I salted all of my food (meals), but I don’t think I came to the same numbers you mentioned, 2-4 grams supplemented for my daily intake. I still need to quantify that amount and then start to use it, although I was wondering if you suggest that amount for any person eating keto, as if size of the person did not matter?

    Secondly, I have heard you refer to insulin in a podcast. What is too low of a fasting insulin? I recently had blood work and it measured 1.3uIU/mL, while I have been adhering to a low carb/keto diet. The low end of the range given started at 2 units and then I thought to myself that I have never heard any keto proponent give a number for fasting insulin. If possible, more than just a number indicating what’s too low, what does too low insulin mean while eating low carb?

    Thanks

    (reply)
    • Peter Attia  April 24, 2016

      Provided your pancreas works, there is no such thing as too low of a fasting insulin…only too high.

  165. Chris Fryer  April 23, 2016

    Hi Peter, I was pointed your direction from Tim Ferriss. My wife learned to swim from him on his TV show Tim Ferriss Experiment. I have a rare genetic disorder called Hypobetalipoproteinemia. The result of this disorder is that my cholesterol is very low (total is 73, HDL is 43, and LDL is 22). This has caused my liver to swell in the past because this disorder leads to NASH due to inefficiency of lipoproteins in shuttling triglycerides out of the liver. I followed Tim Ferriss’ version of the ketogenic diet and as a result my liver became less fatty (evidenced by a major drop in liver enzymes in my blood). I also began doing CrossFit and became obsessed with performance. But I’ve realized 2 things 1) My body is not very energy efficient and 2) my testosterone is low (low 200s). I’ve tried to talk with specialists about this but they all assume that I am fishing for TRT and do not take me seriously. I’ve done a ton of research around the correlation of Hypobetalipoproteinemia and low hormone production and found a lot of research that strongly supports a link between the two. So my question is (sorry for the long lead up) have you seen anything that might support this link and/or can you point me in a direction that might lead to more info? I appreciate any advice or even just a note saying you don’t see a connection. I’m at my wits ends and feeling frustrated that so many doctors have been unwilling to take my concerns seriously. Thanks!

    (reply)
    • Peter Attia  April 24, 2016

      I don’t have data for you, Chris, without looking, but I take you seriously! If cholesterol is very low, it seems at least plausible that cholesterol-dependent hormones could be low. Of course, a more exhaustive workup (DHEA, DHEA-S, E2, progesterone, FSH, LH, etc.) is warranted. As far as your hypobetalipoproteinemia, nothing will be more productive than fructose and alcohol avoidance.

  166. Stacy  April 23, 2016

    Hi and than you for your blog,
    even though you don’t post that much what you do say is usually mind blowingly interesting!

    I laughed my ass of at the car video! Thank you for that! I can’t wait for the book!
    I’m glad you’re finding a better balance in your life.

    (reply)
    • Peter Attia  April 24, 2016

      I’m glad you liked my blooper!

  167. Jim  April 24, 2016

    Just wondering about berberine. I am a long time multiple myeloma and really I’d like to win outright. Would it be useful for me to consider supplementing?…thanks in advance. I am just in awe of your intellect …J.

    (reply)
    • Peter Attia  April 24, 2016

      It actives AMPK like metformin, but probably less potent. May also have some activity against PCSK9.

  168. Sue Robertson  April 25, 2016

    Re alcohol e.g. wine, cognac .. Does an alcoholic drink immediately/always throw you out of ketosis? Is there a ‘sneaky’ way of enjoying a glass of wine while still being in ketosis e.g. eating something with the drink that would act as a buffer so that the body is still in a fat burning state? I would love to hear your feedback on this point, Peter.

    (reply)
    • Peter Attia  April 25, 2016

      Not always, depends on type, volume, velocity, and metabolic state. Trial and error is probably best bet.

  169. Diana  April 25, 2016

    Hi Peter. I just “met you” by watching my first TED talk. I have many more lined up to watch, but you will be a hard act to follow. Excited to see you are in San Diego. I live/work in East County. I’m a veterinarian, dogs/cats. I’m especially interested in endocrinology. I can’t say I share the surgery bug, though!

    I’m writing because I’m bitter 😉 Over the last 5 yrs I’ve morphed my diet to be much less processed, and organic when I can. About 3 years ago I kicked a bad habit: daily lunchtime Dr Pepper. My neurologist essentially begged me to stop caffeine. I couldn’t bear to stop morning coffee, so DrP had to go. Surprisingly, my daily headaches were much improved. I still drink coffee. I really miss Pepper and I still indulge 1-2 times per month.

    I’ve experienced steady but slow weight gain since pregnancy 9 yrs ago. What I’m bitter about is that the gain has dramatically accelerated in the last 3 years. I get that there are so many factors that the correlation of weight gain and no daily soda is bound to be coincidence. I’m 45, I’m “of age” for my hormones to be working against me. I could focus on calories and exercise more. I feel stressed often. Plus there’s long-standing, but supposedly treated, hypothyroidism.

    So I’m tempted to resume Dr Pepper and see what happens. Maybe a month, 3 months? I have other non-chemical headache treatments in place now.

    Are there situations or body chemistries that would respond this way to the removal of a large daily dose of sugar? I know, I’m probably just in denial.

    (reply)
    • Peter Attia  April 25, 2016

      I’d have a hard believing the removal of Dr. P is the cause of your weight gain. I would treat your hormone system as the main culprit until proven otherwise.

  170. Ben  April 26, 2016

    Here’s a treat – a paper on a supervised 382 day fast!
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2495396/?page=2
    The guy went from 456 lbs to 180 lbs during the fast and 5 years later was still at 196. Blood glucose was consistently around 30 mg/dl but the patient was fine. I remember reading that one should go into coma below 40 mg/dl, I guess ketones offset that hypoglycemia.
    Can’t imagine the levels of autophagy on such a fast.
    Do you know, Peter, if it is necessary to go on a fast for autophagy to kick in, or can you get the same autophagy while in nutritional ketosis?

    (reply)
    • Peter Attia  May 1, 2016

      Yes, one of my favorites. Almost wrote a post about this one three years ago. So much interesting stuff in here to consider.

    • Yossi Mandel  May 15, 2016

      If you’re really interested in fasting, check out everything from george cahill, especially his own review of his career. Mainly work from the sixties and seventies. Pretty sure he set the standard for this kind of research.

  171. Steve  April 26, 2016

    Hello Peter. I appreciate all the work you’ve put into this site and the information you’ve made available.

    Back in October 2015, I was diagnosed pre-diabetic with fasting glucose around 105 and had a sedentary lifestyle. I knew I had to make a change before that and had looked into LCHF previously. This was enough to make me pull the trigger as my father died at 48 from a heart attack due to being diabetic and having heart disease. At 38, it was time to course correct. Even though it’s been a while since I’d eaten “poorly”, now understanding that my body doesn’t even like the whole grains, rice, and beans I’ve been feeding it made me see all the wrong I was doing while thinking it was right. Your site helped me understand that and I was amazed at the energy and response the LCHF diet gave me.

    I’ve been on the LCHF diet since that October and have had great success dropping 35 lbs. I started walking and jogging recently which really helped drop the last 15 lbs. Currently I’m at 200lbs, 5’7″, about 28% body fat, and a fasting glucose around 90; I’ve got a good 20lbs to go to get to where I want to be (more if possible). I joined a CrossFit gym last week and am liking the full-body resistance training and I know I need to put on lean muscle. I’ve been advised to take in some protein after a workout to “feed my muscles” but I can’t seem to see anywhere on your site where you follow this traditional line of thinking. Even in some of your “What I eat” posts, you’ve worked out at 7AM and not eating until 3PM. Do you have any feedback to the validity of post-workout protein? FYI: I currently shoot for 1700 calories, 142g of fat (75%), 85g protein (20%), and 21g of carbs (5%). I eat more on workout days, but haven’t found where that balance point is yet. Many thanks! – Steve

    (reply)
    • Peter Attia  May 1, 2016

      It all depends on your goal, Steve. If the goal is lean mass preservation, yes, you’ll need some “protein” during and following the workouts (“Protein” in quotes because it’s quite specific which amino acids help most, starting with lucine).
      If your goal is continued weight loss (and you’re willing to give up some lean mass along they way), fasting is ok.

    • Naren  May 2, 2016

      As fw-up to Steve’s question; in the past you’ve mentioned BioSteel HPSD and some aminos you buy from Ajinomoto. Do you also supplement with protein powders – whey isolate and such? Would you be willing to share your brand of choice?

      Thank you, Peter.

      Naren

  172. Mauricio Trambaioli  April 27, 2016

    Dear Peter,
    Ive heard from your talk with Rhonda that you was interested in apoE combinations and associated risks.
    this recent review might be useful for you.
    http://www.sciencedirect.com/science/article/pii/S0960076016300589
    Regards,
    Mauricio Trambaioli

    (reply)
  173. Roger Kaza  April 27, 2016

    Hi Peter,

    I was led to your blog via your interesting interview with Chris Kresser. I was wondering if you were familiar with the work of Dr. Luigi Fontana, a researcher friend of mine in St. Louis. He has documented remarkable disease-reversal among DR (formerly “CR”) exponents, and is often quoted whenever the media covers the topic. Here is a summary of his work:

    http://www.thefutureofscience.org/uploads/b83a1faffc94942d1b3c2dda33923659.pdf

    The “Cardiometabolic Risk Factors” slide is particularly enlightening.

    Keep up the good work.

    (reply)
    • Peter Attia  May 1, 2016

      I am. I think he paces more emphasis on CR than it warrants in “real life.” Yes, many risks go down, but a bunch on non-linear ones go up.

  174. Whitney  April 29, 2016

    Hi Peter!

    Long, long, long time fan of your work. Even tried to join your team at NuSI, but alas, was not meant to be for either of us it seems.

    I am so happy to hear you are simply focusing on your practice and getting back to passion projects. You did something incredible with NuSI, and I am really hopeful they will carry on your mission, without ego or assumption.

    So, my ask is, can I refer my husband into your practice? We live locally in SD, even dabble in some orange theory, and my husband needs some help. I know his general practitioner is not going to take the right tests, and I sense something deeper is happening with him, and he is a skeptic of my what he deems “hippie” ways of no sugar (well low low low), high fat, avoid toxins lifestyle. But every time I talk to him about the things I learn from you, he is uber curious and less annoyed. He has been complaining about pressure in his stomach now and then, headaches on and off, dull back pain (that could be from a pickleball injury), and just not feeling great. His job his high stress, his diet is decent (particularly in comparison to SAD), but I am concerned, because he wants a doctors appt just to “check things out”.

    Sorry for my ramble, but I figured since I’ve read thousands and thousands of your words and listened to hours of you on podcasts, we are even now. If I can refer him to you, that’d be surreal because I know he’d connect with your obsession with mastery, funny you never mention golf… And if that’s not an option, if you have any ideas of a doctor locally who could do the right tests, I know he’d dig it. So long as they are a real doctor with real data.

    Thank you for reading this ramble andddd your podcast with Rhonda was interesting. Wouldn’t mind if she let you speak more and insert less. 🙂

    Your babies are beautiful.
    Whitney

    (reply)
  175. Anthony  April 29, 2016

    This guy challenged Peter to a Bike Race Mt Washington…WOW…
    https://www.youtube.com/results?search_query=peter+attia+debunked

    (reply)
  176. Dan  April 30, 2016

    The dexcom is not accurte in the sense that margin of error can be easily be 20 mg/dl off. So you can be running 90 on the dexcom and yet your are really 110. In addition, it is less accurate when you eat and about 1 hour afterward.

    As far as I am concerned, the A1C is much more accurate.

    I don’t see how you can put so much faith in your dexcom readings and this quick aside our A1c. The A1c is demonstrating the glycation of a protein in your body. That tells you much about what is happening.

    In the future when this technology improves, things might be different. But at this point, Dexcom is really useful for a type 1 diabetic like me to see blood sugar trends. But I never trust the reading on my dexcom to make decisions about food intake or insulin dosage. I always have to resort back to my blood sugar test. And when I do, sometimes the dexcom reading is close, sometimes it not. In fact, it is often not close.

    Trust your a1c reading. It is telling you something. Size of your red blood sells interesting but not definitive.

    (reply)
    • Peter Attia  May 1, 2016

      I disagree, Dan. I calibrate my G5 multiple times daily (I initially did every measurement in duplicate, one with Ultra OneTouch and one with Xtra). I’ve also calibrated those meters with actual blood draw. The difference between the two meters was more or less negligible, but One Touch was slightly better so now all calibrations are done with that. Over the past 5 months, if you have average out every spot check and calibration reading I’ve done the delta is less than 8 mg/dL. The calibrations have been in all states. In my case, by far, the worst performance is late afternoon *before* dinner.
      A1C is only accurate when a RBC “lives” for 90 days. If one day less or more it loses accuracy. Sure, the difference between 5% and 9% is real, but I am not at all convinced–having seen a thousand of these readings in patients over time–there is a difference between 5.1 and 5.6%, yet people get so phosphorylated over this difference.
      Now, all of that said, I am also convinced the G5 may work better in some people than others. Though I’m now only talking about an N of 10+, I see differences and wonder how much has to do with differences in the composition of fat tissue.

  177. Martin  May 2, 2016

    Any thoughts on this: NuSI Hall Study: No Ketogenic Advantage (ICO 2016) (https://www.youtube.com/watch?v=MiUyjMjuLl0) ?

    (reply)
    • Ryan  May 3, 2016

      Would be very interested to hear Peter’s thoughts on this also, as I’m sure everyone who reads this blog would be as well.

    • Tim C  May 4, 2016

      I’d like to add my vote to this as well (that is, if polling is open).

      The thing that really concerned me in viewing Dr Hall’s overview was that the 80% fat ketogenic diet contributed more to lean tissue loss than simple reduced calorie at the same caloric intake. My thoughts have always been that ketogenic diets are muscle-sparing…

    • Bob Niland  May 6, 2016

      We really need to wait for the paper, and any supporting data, to be published.

      A brief casual interview with one PI known for having a specific advocacy on CICO, is basically fodder for wasted debate. I suspect this trial resulted in some learnings, perhaps multiple, but we don’t yet have the full picture.

    • William  May 7, 2016

      I’ve been following the ketogenic diet for two years now. I first discovered it when stumbling across Peter’s Ted talk. Watching this video I’m beginning to question if eating this way has really been worth it. I would also appreciate a comment from Peter.

  178. Sam  May 3, 2016

    Peter, I noticed that Chris Ochner left Nusi after just four months as CEO. Seems like the organization is in turmoil. I hope the mission is intact. I find it hard to donate funds to an organization that lacks stability. Can you add any color?

    (reply)
    • Peter Attia  May 4, 2016

      I have no involvement with NuSI, Sam. You’ll need to contact them directly.

  179. Martin  May 4, 2016

    It reminds me a bit of the True Grit movie (there is a post with a similar title on this site) . Sorry, if it appears off topic.

    (reply)
  180. David  May 5, 2016

    Regarding the straight dope on cholesterol:
    Peter, why do you write 9 articles in a 10 part series and then never finish the project? Are statins beneficial or not? If you don’t know then just say so or did the statin companies “request” you not to publish the information? If you are not going to finish the series I suggest you either remove the 9 posts or alert readers to this fact in the beginning of post 1.

    (reply)
    • Peter Attia  May 5, 2016

      “…remove the 9 posts…” Are you high? What kind of ultimatum is that? Seriously? How about a tincture of gratitude, ok? When last I checked I wasn’t working for you.
      For what it’s worth, David, there are probably 9 more parts in these series and I’ll finish them when I feel like it. Is that ok with you?

    • Betsy Ray  May 6, 2016

      David,
      Stop dissin the only guy out there besides Gary who gets it and just have a little patience and love… jeez

    • Yossi Mandel  May 15, 2016

      Wow. The ingratitude.

      Never mind the series will never finish, because of huge leaps ahead made every year in lipid research. Really, with what the series gives, more than enough to read on our own and fill in the blanks.

  181. Palak Kundu  May 6, 2016

    Hi Dr. Attia,

    Hope you are family are doing well. I’m a SMS student with personal interests in nutrition, but I’ll be applying into rad onc. My long term interest is in reforming medical education and clinical training though, especially since physician behavior can sometimes be more of a bottleneck to beneficial changes than patient behavior. I’m revisiting your blog once again to think about how physicians could be better educated on and more rigorously apply nutrition, statistical interpretation and some other topics you’ve touch on. Are there any particular posts or articles (by you or others) that you feel are currently mission critical to read by students and new trainees? Thanks again for thoughtfully and humbly sharing your thoughts on such misunderstood and complex topics for all these years.

    Best,

    Palak

    (reply)
    • Peter Attia  May 7, 2016

      Nothing I’ve written has been geared to that particular audience, but I guess bits and pieces of several posts are relevant.

  182. Betsy Ray  May 6, 2016

    Peter… truly… you rock.
    I would love to chat with you. You are the only MD (besides my amazingly open Endo) I would really like to get a couple of hours with (I’ve had 398 over 50 years).
    It’s a dream I have… to dialogue with you…
    I’ve been in the trench for 50+ years as a T1D and might be able to give some further insights from the applied science+research arena. When you’ve been attached to CGM technology or it’s approximations for a lifetime it reveals a lot about the environment.

    If you feel inclined to make a dream come true you can reach me at 720-298-4209.
    Betsy Ray
    Founder/CEO – Diabetes Activist
    http://www.diabetesactivist.com

    (reply)
    • Peter Attia  May 9, 2016

      Thanks, Betsy. Very kind words. Have you met Jake Kushner at Texas Childrens? Or Richard Bernstein?

  183. Scott Maxwell  May 6, 2016

    Dr. Attia, Thanks for all the great content. I started following you after watching Dr. Andreas Eenfeldt’s video on youtube about 3 years ago and have been eating LHCF ever since. I was really struck by the similarities in what you were going through with my circumstances and it was the inspiration for me to develop a way of eating polar opposite of my previous 25 years (LFHC). Since then I have dropped about 80 pounds, but in the last year I have gained 20. This is because I converted from 6 hours of cardio a week to using Mark Rippitoe’s Starting Strength protocol to guide my training program. Coincident with your comment above, I am actually signed up to attend his SS seminar in Wichita Falls in June! Also coincidentally I began following Dr. Rhonda Patrick about 2 years ago after hearing her on another podcast. I’m curious since one of the main themes of your recent interview with her was longevity, if you discussed the effects of sauna use with her offline. I thought for sure that was going to be a topic since she discusses it and its benefits so frequently (I do about 4 hours a week now @ 180 DEGF).

    Sorry for the rambling
    -Scotty

    (reply)
    • Peter Attia  May 7, 2016

      Scotty, we didn’t get to discuss cold or hot, unfortunately. I’ve been a fan of WBC (whole body cryo), but primary for addressing DOMS. The data for that are pretty good, but I don’t think we (read: I) have a clue of the impact on longevity, health, etc.
      I’m even less familiar with the clinical literature on heat.

  184. Kevin  May 7, 2016

    Dr. Attila,
    I recently tried to go into NK and after a few weeks had a few issues that made me decide return back to my normal LCHF diet. A little background…I lost about 40 pounds following a primal/pale style diet over the course of about 2 years. I’m 6’2, 173lbs and fat 8-10%. I road cycle and mountain bike 4-5 days a week, mostly 1 hour sessions with a longer 4 hour session once a week. I do not count calories but my macros seem to fall about 60% fat, 25% protein, 15% carb.i would estimate about 2200-2800 calories depending on the day. I have roughly 2 servings of starchier carbs (mostly a sweet potatoe and apple/banana) in addition to a lot of non starchy veggies per day. I cut the 2 servings of starchier carbs out in an attempt the try going ketogeninc. After about 3 weeks I started feeling flat. Weight stayed the same but fat increased up to 12%. I also was experiencing afternoon tiredness that made me nap. Most odd though was sore breasts?!? Appetite went way down during the day but I was hungrier by mid day. Looking for a possible explanation or your thoughts.

    (reply)
  185. Jack  May 8, 2016

    Hi Dr. Attia,

    I just wanted to say, “Thank You” for all the work you’ve put into this blog. I’m a 2nd year medical student, have been following along since undergrad in 2012. I have learned more than I can even articulate from your writing and speaking, and appreciate the positive influence you’ve had on my medical career, so far. Not just in interpreting and understanding hard science, but also on leadership, career navigation, work-life balance, and objectivity in medicine.

    I’m glad to see things have gotten more streamlined with work and that you can spend more time with your family. Congrats on the little monster and his musical sister. Great to see how well things are going with the whole crew.

    I look forward to potentially hearing more about the practice if you choose to share more. I can really relate to the desire to produce Ferrari’s. As a former college athlete, it’s hard for me to ever get completely pulled away from chasing that perfect balance between health, performance, and longevity.

    Finally, those recent podcasts have been awesome. Your framework of longevity is the most sensible and applicable I’ve ever seen. Looking forward to more, but regardless of when the content comes, I’m always coming back to the old articles for refreshers.

    P.S. Please don’t EVER take down the first 9 articles on cholesterol.

    (reply)
    • Peter Attia  May 9, 2016

      Thank you very much, Jack. I appreciate your kind words (and the endorsement for leaving parts I – IX of The Straight Dope up…).

  186. Sam  May 8, 2016

    Hi Peter,

    I am a researcher in Chester, UK and have been fascinated with the great implications of the ketogenic diet. However, I am contacting for some personal advice with regards to my Grandad who is currently undergoing chemotherapy for prostrate cancer. As I am learning more about the benefits of a keto diet for cancer, I was wondering whether there was anything that should hold me back from suggesting this to him? Apparently his consultant has told him to stay clear of foods such as bacon, eggs and soft cheeses. This seems counter-intuitive to me based on the reading I have done and from what I have learnt from some of the podcasts on which you have featured. I understand that you can not give medical advice but would be interested to gain your opinion on whether the diet he has been recommended would be the same one you would recommend?

    He is 78 years of age and was relatively active prior to the diagnosis. He is currently in the 8th round of chemo for info.

    Thanks in advance,
    Sam

    (reply)
  187. Bruce Rash  May 8, 2016

    Thanks for all your good work Peter. You (and Tim and Dom) have inspired me to do keto-diet and intense metabolic tracking and not feel like a two headed freak for doing so! 64 y.o., dropped 25 lb. in 4 mo., sick of sticking my fingers and can’t wait for the glucose device of the future!

    (reply)
  188. Faigy  May 9, 2016

    Hi Dr. Attia,

    I found out I was insulin resistanct borderline prediabetic in the quest for any information as to why my body failed in lactation after giving birth. After spending hours googling and research I read that insulin resistance can cause low milk supply and insulin resistance during puberty can disrupt breast & glandular development.

    Do you have any insight into any ways of correcting now what went wrong during puberty?

    (reply)
  189. Iris DeAngelo  May 9, 2016

    You are providing so much help to people like me.
    I have further my health education by reading your blog.
    Along with the science and medical information you blog is full hope and inspiration.
    Hope you continue your good work.
    Is there any way to find your practice in NYC?

    (reply)
  190. Iris DeAngelo  May 9, 2016

    I’m currently using a CGM.
    Is quite empowering to know what’s happening at all times.

    (reply)
    • Peter Attia  May 9, 2016

      Agree.

    • Martin  May 10, 2016

      In what sense empowering? Can you better control the spikes or the mean? Are you able to adjust factors like food, exercise or stress?

    • Peter Attia  May 14, 2016

      All of the above.

  191. Jeremy  May 9, 2016

    Hey Peter,

    Thanks again for all your amazing, thoughful insights into a whole range of issues. Your 9 part series on lipids was one of the more interesting and insightful blog posts I’ve come across. You have such a beautiful writing style, which makes an extremely complex topic a joy to read!

    If you are happy to disclose this, I’d love to know the specific model of the Dexcom CGM you are using? I understand the main advantage of the CGM is more as an overall picture of your BGL, but how accurate do you find the CGM in comparison to your standard blood glucose meter? My endocrinologist told me there was a delay with CGM of about 20 minutes between your actual blood glucose reading and what the CGM is reading, did you find this to be the case?

    I’ve been interested in getting one for a while, to help me manage my Type 1 Diabetes. However, the overall costs of running it have up until this point deterred me.

    (reply)
    • Peter Attia  May 10, 2016

      Jeremy, happy to disclose. I have the G5. I do suspect the kinetics are different in me than someone with T1D. My “spikes” are very gradual, so the difference between my meter and my FS are usually close, even in times of rising and falling glucose. Does your insurance not cover it? Obviously, I pay out of pocket, but I assumed folks with T1D would have this covered.

    • Jeremy  May 10, 2016

      Thanks Peter, I’ve personally looked at the G5, it’s a great device. Unfortunately, regardless of your level of cover, Australian (I’m based in Australia) insurance companies do not currently cover CGM devices . They do cover insulin pumps, but for one reason or another have not jumped on the bandwagon with the CGM technology. I think they feel it’s ‘unnecessary’ in terms of good control.

      That’s great point about the kinetics, I’ve read anecdotally a few different reports from T1D but overwhelming most people seem to say it pretty much mimics the reading on their hand held blood glucose meter.

      Given it seems like an area that is constantly being improved I’m hesitant to pay out of pocket at the moment, particularly as there seems to be a few really interesting advances on the horizon in the coming few years. I’d hate to have to replace it in a year or two…

    • Peter Attia  May 14, 2016

      Well, it’s a shame that a person with T1D can’t get this paid for. It’s actually more variable cost than fixed cost. The sensor is changed every 7-14 days and the battery/transmitter is changed every 90 days. The only other cost is the receiver.

  192. Dan Walker  May 10, 2016

    I was listening to NPR’s Here & Now on satellite radio in the car this afternoon and they talked about an ageing study using dogs and I thought you might find it interesting, if you haven’t already heard about it, because they are using low dose Rapa and then seeing how the dogs make out over the course of their lives and see if they can determine if they indeed end up living longer overall. The researchers also mentioned a study that showed something about improved cardiac performance in older mice that had been placed on low dose Rapa. It would be interesting to see how mTOR specifically in cardiac muscle tissue plays a role in ageing of the heart. It is 2 researchers out of the University of Washington’s HALo Institute (Healthy Ageing and Longevity Research Institute) that are conducting the whole thing.

    (reply)
    • Peter Attia  May 10, 2016

      By some miracle I happened to listening to NPR today, also, when this came on. The challenge with all of this research is going to come down to figuring out how to dose rapa to get the most selective inhibition of mTORC1, but not mTORC2, and to preferentially avoid inhibition of mTORC1 in the skeletal muscle. This is such an exciting space and I can’t wait to watch this unfold.

  193. Maureen  May 10, 2016

    I’m not even sure how I got to this website (from a link about low carb and back pain?). But I’m glad I did. What I have read in the posts and the comments have been very interesting.

    I’ve learned a lot by paying attention to what I eat and how I feel. It started with the realization that I am like an alcoholic with sugar (Potatoes Not Prozac by Kathleen DeMaisons, PhD). I used guidelines from her experience to help me find what works for me.

    There’s science and data and all kinds of facts, but the proof that helps me is in how I feel and acts! I learned to turn to the “eat” in creative writing to help me manage my food instead of food managing me. I found that weight loss was a great side effect of being in control of my impulses and moods.

    Now that I crave good health more than sugar (and refined carbs), I’m finding out a little more of the science behind what I did. Thanks for what you and others have shared. My journey went from impossible to I’m Possible. Yeah. The I’m Possible Journey: Learning to Live with Sugar addiction is my best cellar foundation for continuing my journey of good health. Because it’s good to remember while looking ahead. Best wishes to you.

    (reply)
  194. Paul  May 10, 2016

    Peter, regarding sleep, you mention direct activation of GABA but discourage drugs like Ambien. Could you briefly clarify? Do you think same for eszopiclone? Thanks for all that you do!

    (reply)
    • Peter Attia  May 14, 2016

      Perhaps in another post. Too complicated for now. Short answer: avoid ambien

  195. Daniel Zbarski  May 10, 2016

    Dr. Attia
    You talk about decreasing insulin/igf1 signaling and how it relates to aging mechanisms. It occurred to me that IF induces inc. IGF-1 through Growth Hormone. Would U say that it is different due to low insulin lvls hence inc. IGFBPs which is why calorie restriction through IF might be beneficial despite inc. IGF-1 signaling?
    BTW hate to say it but I love your podcasts and the unfinished 9 part cholesterol story too ;).

    (reply)
    • Peter Attia  May 14, 2016

      Daniel, if IF raises IGF through GH secretion it’s very transient and is more than offset by the periods of low IGF. Best to think of IGF and insulin as AUC vs. single point in time.

  196. Bill  May 14, 2016

    Peter,

    Even Kevin Hall seems to say that low-carb diets offer an advantage in randomized trials. He says it could possibly be due to an effect of ketones on appetite. Do you think the results we are seeing in his study confirm that, while the diets do work, they are not due to the fact that the diets result in greater EE, but rather simply a reduced intake of calories over time? Could the overall decrease in intake and body mass also be the cause of the decrease in EE over time?

    Bill

    (reply)
  197. Matt  May 14, 2016

    Thanks for the update Dr. Attia. You are truly a national treasure. I must admit though, I find it hilarious you do not consider yourself “competitive.” Not sure what that makes the rest of us. Oafish, indolent losers?

    Please do humanity a service and prioritize publication of your “manifesto.” Don’t let the perfect be the enemy of the good! There’s a surfeit of terrible, counterproductive tomes on the market now. Even if yours is only 70% as good as you would prefer, it’ll be a tenfold improvement upon existing tracts.

    (reply)
    • Peter Attia  May 16, 2016

      Matt, I’m really not competitive at all, unless you consider inner competitiveness a form (perhaps it is). I am prioritizing the book, which will be better than the manifesto.

  198. Caitlin  May 15, 2016

    Peter – I definitely empathize with your perfectionist gene. But I also hope you know that by simply writing this blog (nothing more, no further demands for posts) you piqued the curiousity of many intelligent people to further explore and question the nutritional dogma that’s been handed to the general population. So thank you for that. You certainly got me thinking critically about what I eat and why I eat it. I stayed in ketosis for about 6 months and stopped when I noticed it was no longer benefitting me in the same ways as when I first started. I also think it has a different effect on women than men that just doesn’t have enough research. I now think of ketosis more as a tool than a lifestyle. I still avoid sugar and highly processed vegetable oils as much as possible, but I allow for a small amounts of carbs and indulgences. It has to be something really good though – like your post about eating dessert at your favorite restaurant. I conduct a mini cost-benefit analysis if you will… 🙂 Anyway, thank you for this blog and for being a truth-seeker that simply asks the same of your readers. I wish you and your family the absolute best and everyone in my family will be getting a copy of your book for Christmas whenever it comes out! We are on a very exciting frontier of science and you are in the thick of it. I hope you continue to follow your passions, spend time with the your family, and inspire people to think critically.

    (reply)
    • Peter Attia  May 17, 2016

      Caitlin, you might be right (with respect to women vs. men), but I hope to find out one day definitely.

    • Caitlin  May 19, 2016

      I hope more research is conducted on women vs. men. I noticed that my body began to show signs of stress after awhile. I never got dangerously underweight or anything (since keto doesn’t really let you go there anyway) but there definitely came a point when my body was not happy that I wasn’t storing fat anymore.

  199. Jonathan H  May 15, 2016

    Dr. Attia, I am a family practice resident, and have been reading your blog for a long time. Thank you for all of the time you have put into it. I was hoping you could provide some guidance on how one could best educate themselves on lipidology. Would you recommend just grinding through every video on lecturepad? You mentioned taking a CME course to re-certify in lipidology, could you perhaps share the information for that? With all of the resources and information out there, it can be daunting to decide where to start. Any advice is appreciated. Thank you!

    (reply)
    • Peter Attia  May 16, 2016

      There is no harm in the grinding strategy, though you’ll likely get more benefit from a “problem-based” approach. If you haven’t done so, my series on lipids a good place to start.

  200. Jonathan H  May 16, 2016

    I have read the series, multiple times. It is fantastic. Thank you for the response!

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    • Peter Attia  May 17, 2016

      Alright, you’re in good shape on the basics. I think you’ll get great value out of all of Daysping’s lectures on LecturePad. Other folks to read closely are Allan Sinderman and Ron Krauss.

  201. John  May 17, 2016

    But what about your opinion on one of the greatest garage warrior issues of our time…
    Hex bar, handles up or down?

    (reply)
    • Peter Attia  May 17, 2016

      I think it depends on femur length, so probably no “right” answer. Probably reasonable to mix it up.

  202. Allen Carriker  May 17, 2016

    Hi Peter. A recent issue of lipidspin contains an article titled “Worsening Lipoproteins on a Low-Carb Diet” by GREGORY S. POKRYWKA, MD. (https://www.lipid.org/sites/default/files/lipidspin/2016_sela_lipid_spin_final_0.pdf). Do you have any additional comments or insight you could share on this topic – in terms of what mechanisms might be causing this, and a framework for determining if this should be a concern ? regards, Allen

    (reply)
    • Peter Attia  May 19, 2016

      Yes, I think Gregg references me somewhere in there (he sent me an early draft). I’ve addressed this in a post somewhere.

    • Anon  May 20, 2016

      Hi Peter-
      I’m one of the folks whose LDL-C/P went from low/normal to cartoonish levels despite looking and feeling the best I can ever remember. You were kind enough to advise on Dr. Daysprings excellent case writeup, I responded (LDL) similarly but didn’t feel quite as good. Anyways, if there is ever further data on the risk profile of that response, would sure be interesting!- Thx for what you do, Cheers-

    • Allen Carriker  May 23, 2016

      thanks Peter, I found your comments on your (Random finding (plus pi)) page. I have also read a recommendation that cholesterol measurements should not be taken during the weight loss phase of a LCHF diet… that the cholesterol levels may be “shifting dramatically” during weight loss, and then return to normal once weight loss has ended. Any thoughts/theories on this point? I wonder if routine fasting of 14-16 hours/day (i.e. skipping breakfast) could cause the same dramatic shifting as a weight loss phase. thanks again. Allen

  203. Rob Rowe  May 18, 2016

    I find it curious that with all the discussion of biohacks going on that so little attention has been paid to the very simple biohack of drinking Kangen water. If you don’t like the vendor specific term of the Enagic company, we can say Electrolyzed Reduced Water or ERW. I am aware part of the reason for this is that so much bad information has been disseminated in the marketing of water ionizer machines that some doctors and scientists refuse to take the subject seriously. However there is a multitude of documentation on pubmed mostly by Japanese scientists citing the benefits of ERW. I personally know dozens of people who have improved or reversed many diseases and conditions including cancer and diabetes. Obviously this is not science but these people don’t care, they are thrilled to have their health back. This is a pretty well done presentation summarizing over 600 studies on the health benefits of hydrogen infused water (which is what Kangen water is) by biochemist Tyler LeBaron: http://www.molecularhydrogenfoundation.org/videos/. These are the parts I found particularly interesting if you don’t want to watch the whole thing:
    40:47 Molecular Hydrogen For Athletes
    45:55 Molecular Hydrogen in drinking water protects against traumatic brain injury. (maybe this is why so many UFC fighters are KW drinkers.)
    48:00 discussion of MH in drinking water in regard to Alzheimers protection.
    If you want even more hydrogen than what is present in KW, it’s a simple matter to dissolve a hydrogen tablet in a bottle. Tyler explicitly refrains from any use of trademarked terms to maintain vendor neutrality. Ty Bollinger in The Truth About Cancer dedicated a whole segment to the anti-cancer benefits of ERW. If you would be willing to consider and discuss this further I can provide a great deal of documentation. You might find it interesting that Kangen water specifically is endorsed by many UFC fighters and other professional athletes. There is even a FB page call Kangen Water Fighters. There has got to be a reason and it is not money. The Enagic company does not do paid sponsorships to athletes or anyone else. Thanks for your time, Rob

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  204. Julia Gillespie  May 19, 2016

    Hi Peter,
    I have been experimenting with a “macro diet” lately (turned out to be just a low fat diet) and had numbers of 135 g Protein, 200 g Carbs, 50 g Fat–I know what you must be thinking and already know what happened-it was crazy and initially helped me lose weight (as they kept cutting my carbs) but I was insanely hungry and once I lost weight started having crazy sugar binges. I cross trained with heavy weights, cardio, intervals and for a brief moment never looked better and gained strength I never thought I was capable of! However, it wasn’t sustainable. I have begun following you and Gary Taubes’s articles and books. I have a question though since you are also very knowledgeable about sports. For protein intake, the general rule of thumb I understood was you should consume one gram of protein per body pound. So for me 135g per day. I want to maintain/gain muscle esp because I am training with heavy weights but I am curious about guidelines for minimum protein intake in order to do so?
    Thank you!!!
    Best,
    Julia

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  205. Gabrielle Oldmeadow  May 21, 2016

    Its no small thing you’ve given us all these years.
    Profound thanks.
    Gabrielle

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  206. michael slifka  May 21, 2016

    Whats up with your supplement protocol? Any changes since the last post ie MCT oil, Potassium, Magnesium, Probiotics, Vitamin D, Sodium ?

    (reply)
  207. michael slifka  May 22, 2016

    also curious if you still not using a multivitamin, what about Micronutrients?

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  208. Stan L. Rodgers  May 22, 2016

    Thanks for sharing your pursuit to understanding more about heath in humans. It’s been a great source of information and inspiration for me and my family group. We went to a paleo diet in 2012 and HIT training. We are always learning and tweaking our exercise and diet. Please keep sharing, it is much appreciated.

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  209. Samantha Baker  May 23, 2016

    Hi Peter-
    Your podcast with Rhonda Patrick was fantastic. I just got all my raw data from 23andme back and ran it through Promethease and Rhonda’s Found My Fitness calculator. Talk about fascinating.

    If you had to pick the Top 5 or 10 SNPs/Genes that a newbie nerd like me should learn about, what would they be? I’m going to guess here and say that APOE would be in that list? Any others? I got lucky, I have the 3/3 combo. Very happy about that.

    Thanks for all your amazing blog posts and contributions, they are much appreciated.
    Samantha

    (reply)
    • Peter Attia  May 23, 2016

      I did the exact same thing, but I must say I found the insights as useful as a warm bucket of hamster vomit. Even when I screened for GWAS with HR>2.0 not one–not ONE–meaningful insight was gained.
      I’m less likely to have back hair. Great to know. I lack the genes for empathy. Really? My eyes are likely dark. No way! I guess my point is (and yes, I should do a post on this at some point) I think these test are pretty much unhelpful at this point. I can get more relevant and actionable info on my patients with a very thorough family history, select genetic tests (<10), and great phenotyping.

  210. Samantha Baker  May 23, 2016

    Cannot stop laughing at the warm hamster vomit. LOL. I bet your wife is happy about the back hair gene though.

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  211. Daniel Zbarski  May 23, 2016

    Dr. Attia
    Any possible benefits with ketgenic hight SFA or keto low SFA diet afa Dementia prevention is concerned? My grandfather has been diagnosed with Azlheimer’s… Thx

    (reply)
    • Peter Attia  May 27, 2016

      Complicated, but even addition of MCT, which is all SFA, without keto helps some.

  212. Anne Baker  May 24, 2016

    Hi Peter,

    I couldn’t decide which of your posts would be the most appropriate framework in which to situate this question, so I just settled on what appears to be most recent. Hopefully that works.

    I see numerous questions throughout this site in which women have asked, “Does ketosis affect women differently?” “Does [insert rule here] apply the same way to women?” and so on. I want to preface my comment by saying that I am not trying to ask another version of that question — that’s what n=1 experiments are for (and I’ve been conducting my own for nearly a year). What I’m looking for is just a clearer understanding of endocrinology, which no endocrinologist I’ve spoken with seems capable of providing.

    That said: I’m curious if you have any insight into how low leptin levels might impact the female endocrine system differently than that of a male. It seems like low leptin (in concert with falling insulin, of course) following from sustained ketosis would create a much larger cascade of endocrine disruptions in females, due to the menstrual cycle. If a woman’s leptin level falls low enough to the point she’s skipping menstrual cycles, is the solution still as simple as adding back more carbs? When you factor in maintaining a delicate balance of FSH:LH and progesterone/estrogen, thinking through all the feedback loops starts to seem a lot more complex. It’s a system. Everything is related to everything else. Right? Change one thing, change every other thing.

    So…
    First question: What’s happening to the other sex hormones as leptin levels reduce?

    Second question: Is it possible that low leptin could negatively impact another hormone (or set of hormones) such that raising leptin via increased carb intake would not be sufficient to establish hormonal balance (and, consequently, sustained weight loss/maintenance)?

    Third question: If carbs aren’t the solution…what is? (Or, at least, what do you imagine might be?)

    Thanks for this terrific resource, and for your dedication to thinking critically about health and wellbeing. I look forward to your response!

    Anne

    (reply)
    • Peter Attia  May 27, 2016

      Anne, all great questions, but it will be a month before I have the time to give thoughtful answers, assuming I have any.

  213. Jonathan H  May 27, 2016

    Would you recommend the education and credentialing offered by the American Board of Clinical Lipidology? (http://www.lipidboard.org/home)

    I discovered them through the website http://www.lipid.org, which seems very educational. It was however, slightly disappointing that this site had sub-optimal dietary recommendations (low fat, food pyramid, etc).

    Any thoughts are appreciated, thank you!!

    (reply)
    • Peter Attia  May 27, 2016

      Depends on your objective, I guess. Hard to answer that question.

  214. Tim Donahue  May 29, 2016

    Thank you for your great blog Dr. Attia!!

    Quick question: Do you think that eating acidic foods could have an appreciable effect on LDL-P?

    I haven’t seen the issue of alkaline vs. acidic diets addressed anywhere as far as LDL-P discussions and wonder if you think there could be a serious correlation? I’m wondering if acidic foods could equal more inflammation which could equal more cholesterol production to heal the body, which could result in high LDL-P.

    I’ve been trying to figure out my high LDL-P for a couple years and even though I’m pretty low carb and low sugar, good weight, etc, the LDL-P persists. Thank you in advance,
    Tim

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  215. Su-Chong Lim  May 29, 2016

    Peter:

    I finally watched the whole HK Credit Suisse “Eating Dangerously” Video with you and Rob Lustig. Excellent and densely packed with well explained information. I was interested in the lactose question.

    In my quest to stay easily in ketosis I now generally avoid milk, preferring cream, butter, sour cream, and yoghurt if necessary. I’m driven a little by some genetically related (I’m Chinese) lactose intolerance, but the levels I avoid are well below my symptom threshold fro this latter problem. The question is, is there any way I can sort out my innate genetic ability to metabolise lactose directly through the lactate pathway without too much extensive testing? It’s not a big deal; avoiding the approximate number of g of CHO in milk as lactose assuming all will be treated 1 for 1 as part of the CHO total is easy enough, but I thought it might make my life more convenient to sort it out.

    (reply)
    • Peter Attia  May 30, 2016

      I don’t believe we “need” dairy to be healthy, so it’s really a question of tolerance.

  216. Jack  May 30, 2016

    Hi Peter, thanks for the interesting 2016 update and impressive photos. I’ve been an advocate of LCHF eating for two years (which successfully lowered my blood glucose) and I’ve been following you for about a year now and enjoy your work immensely. I’m 69 and in a few weeks I’ll embark (with a couple of biking mates) on a 435 mile bike ride on a dirt road in the Northern Territory (‘outback’) of Australia. The ride will take about 12-14 days and there are only a few places where we will have access to fresh and LCHF foods. Do you, any of your colleagues or readers have any ideas or experience in what foods would be appropriate to take on such a ride, noting that I may have to deviate from my normal LCHF eating regime for some of the ride. We will probably ride about 4 hours a day and the temperature at that time of the year will be 90-95F and we hopefully we should have some vehicle support. I will definitely be taking some of that UCAN Generation ‘Superstarch’ with me.

    (reply)
    • Peter Attia  May 30, 2016

      You are probably already quite fat adapted and, assuming you’re not red-lining the whole time, hydration and electrolytes will probably matter most.

  217. Martin  May 30, 2016

    Peter, it has just occurred to me that you talk very little about ketones as the longevity promoting factors.

    BHB is reported to lower the risk of getting ill or dying from a range of conditions (like cancer, brain injuries, neurodegerative diseases, various types of toxicity and even radiation, etc).

    You obviously have very specific thought on this, don’t you?

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  218. Kim  May 31, 2016

    Hi Peter.

    My god your mind and tenacity and passion are amazing. Thank you so much for sharing all of your effort and results.

    I am finally recovering two years after 2 brain injuries that crashed my hormone system (which was already weak after 7 years of nursing and no sleep with two kiddos). For two years I was barely functional (and gained 65 pounds without over eating). Finally after every other doctor/practitioner I saw couldn’t figure out how to help me – a local functional medicine doctor finally tested ALL my hormones – saw how messed up I was and got me back to normal energy levels with nutrition and supplements. The only piece remaining to be healed is the weight gain. Literally every diet I have tried in the past two years did not work at all. My doc put me on the ketogenic diet and I am so excited to say that I am actively losing weight on it.

    Now that I have been on it for 6 weeks and am having success – I am starting to geek out on information from you and Volek and Phinney and the like. But I have one question I cannot seem to find an answer to…I know this is a question that belongs on your posts from years ago… but I am really having a hard time figuring out the minimum amount of protein I should be having daily on a ketogenic diet. 15% of my diet in protein would be 56 grams a day and while I feel fine on it – I am just worried its not enough based on all the different opinions out there. Do you have any short answer or suggestion for where I can find out the minimum amount of protein my body needs? I am currently 200 pounds / 43 years old / female and my goal weight (or where I had been most of my life with A LOT of effort b/c of my crappy genetics) is 140.

    Thanks!
    Kim

    (reply)
    • Peter Attia  June 3, 2016

      Whatever is necessary to maintain muscle mass, but no more.

    • Bill  June 4, 2016

      “Whatever is necessary to maintain muscle mass, but no more.”

      Peter, from your experience, can you offer any general insights about the appropriate level of protein consumption to achieve this? Would be very useful for those of us without access to nitrogen balance studies or accurate means to evaluate muscle mass changes over reasonable time periods.

      I imagine the needs of people who strength train are different, though authorities don’t even seem to agree on the direction of the difference (e.g., maybe more muscle mass => higher dietary protein requirements to support it, or maybe as some suggest strength training => increased efficiency of protein utilization and thereby lower dietary requirements).

    • Daniel Zbarski  June 10, 2016

      Dr. Attia already answered but if U a more extensive answer – here’s excellent lecture by prof. Garnder on protin req https://www.youtube.com/watch?v=xL-_YnbiqSs bootm line: it’s less than U think 😉

  219. Roger  June 1, 2016

    Peter –

    Curious if you could open up a forum here on EatingAcademy.com for your many blog viewers. I believe it would be helpful to the community to post our stories/comments/questions and we can help each other out. We are very limited on space and topics if we comment on individual blog entries. I believe it would also draw a ton of new people to your data. What do you think?

    (reply)
    • Peter Attia  June 2, 2016

      That would require some work on my part…

  220. Robert  June 1, 2016

    Dr. Attia- Just finished prepping for a workshop Friday, and realized you’d likely appreciate the feedback, from a very different quarter than the one in which you typically work. I’m an aerospace engineering prof, and spent my 20s & 30s as an experimental test pilot. Bi-annually, I teach a workshop on engineering and professional ethics to grad students at one of the international test pilot schools. I approach the subject from a virtue-based perspective, using Richard Paul’s formulation: intellectual humility, intellectual empathy, intellectual courage, confidence in reason, curiosity, etc. Stories from my own career and those I admire figure prominently. I use your TED-MED talk to illustrate what these virtues look like when aggregated. Thanks for your candor and example; it’s instrumental to what I want these young professionals to embrace.

    (reply)
    • Peter Attia  June 2, 2016

      Robert, thank you so much for your kind words. I would not have imagined that talk could benefit your peers, but I’m humbled that it does. Thank you for sharing this with me.

  221. Sally  June 2, 2016

    My question requires a bit of a lead up. I have felt not quite right for about 10 years ……ever since I discontinued the depoprovara needle for birth control. I actually felt great while I was on that much to the surprise of the Dr. who put me on it but I felt after all the years I took this needle that at my age it was probably time to take a hormone break. As soon as I stopped this medication I started to feel off and I also started to slowly gain weight. Not a huge amount all at once but about 8 pounds a year until after 10 years it was an 80 pound gain. I had lots of other symptoms too during that time from an itchy leg rash to headaches to constant yeast infection to hair loss to dizzy spells and heart beat flutters and edema of the feet and ankles. Before that I had remained the same size for 30 years. After medical test upon medical test I was diagnosed with Diverticulosis which turned into Diverticulitis 3 times, Estrogen Dominance, Metabolic syndrome which required me to start on Metformin and then a large Ovarian Cyst and a uterine Fibroid. In February both Ovaries and Uterus had to be removed. Neither were cancerous after the pathology and even though I have had a few hot flashes I have so far remained hormone free. Because of all my other issues I had already been eating in a fairly restricted manner since sugar, grains and young dairy were bad for all of my conditions. Even though I had been eating this way I never really lost much weight. After my surgery I decided to really buckle down and try to turn this train around and I started to lean towards a more ketogenic diet. I also started to get more strict with my caloric intake fasting for 18 hours a day and eating in a 6 hour window and trying to keep my calories between 800 and 1200 depending on how much exercise I get in the day. I have lost 24 pounds since February but my concern is that my fasting blood sugar readings have gone up even on my Metformin and the Edema of the feet and ankles is there everyday. Not crazy high but between 8 and 9 and sometimes higher for my morning fasting reading. My doctor just tells me to loose weight with no advice on what more I can do. My endocronologist wants to do a gastric bypass. I don’t want to do that. I feel I can get this under control if I just know what exactly I’m not doing right. At this point my macro ratios are about 10% carbs, 30% protein and 60% fat and I try to drink about 6 to 8 glasses of water per day. I have been trying every home remedy I can find as well from apple cider vinegar to cinnamon to magnesium to alpha lipoic acid and green tea and raspberry ketones and ginger and dandilion. I just need someone look at what I’m doing and tell what Im not doing right. Please Help me ……I am desperate.

    (reply)
    • Sally  June 2, 2016

      Oh P.S. if you ever needed someone to try experiments I would be interested…….Just not surgery. I need to lose at least 100 pounds ………….the 80 I gained and I was already over weight to begin with. More would be even better.

  222. Christy  June 2, 2016

    Your information has helped me significantly. I was always pretty lean pre-pregnancy, but craved&gained a lot during that phase. I had no success losing postpartum weight despite lots of running, lifting, and calorie cutting. It was phenomenally frustrating and my thyroid was tested 3 times, all results being normal. If I hadn’t read about insulin resistance, I’d still be spinning my wheels. I’ve had great results since starting keto a couple of months ago.

    What I’ve found, though, is that many folks – otherwise seemingly knowledgeable folks in the realm of nutrition – seem to believe that this is some kind of nutritional voodoo. And they’re quite defensive about it. I don’t care because it’s working for me, but I wonder if you know why it’s treated as such blasphemy. Why are people so attached to the calories in/calories out model as the only equation?

    (reply)
    • Peter Attia  June 3, 2016

      Million dollar question, Christy. Not sure I care anymore, though. Help the folks who want to be helped.

  223. Bill  June 4, 2016

    Peter,

    If one is experiencing hypoglycemic feelings (dizziness, low energy, anxiety) after 30-45 minute runs while being in ketosis, what are some possible paths of troubleshooting to take next, aside from adding carbs back in the diet? Is exercising in a fasted state one of those paths of experimentation?

    (reply)
  224. Juan  June 8, 2016

    Dr Attia

    I am writing you from Bogotá, Colombia. I just wanted to thank you for sharing such an amazing amount of information, what I like the most is that you support everything you say with science and experimentation, however, always being humble about wether people should believe you or not. In my case, I find every bit of your information (blog + podcasts) really useful and mind opening. It is such a shame that in third world countries there are not as many studies about insulin resistance+Ketosis+Metabolic desease and so on. Longevity is a field that we all want to learn about, and do something to increase. Thanks again and I hope you keep multiplying the knowledge as you have been doing so far.

    (reply)
    • Peter Attia  June 10, 2016

      Juan, I hope to get a book done in the next few years that will give you a bit more to chew on.

  225. Heidi  June 8, 2016

    Dear Dr. Attia,
    I am curious to know if the keto diet will increase a woman’s vulnerability to breast cancer with regards to alcohol ingestion. I read that ketosis competes with the same enzyme that breaks down acetaldhyde. Would that lead to increased levels of acetaldhyde in my blood and or cells? Wouldn’t this increase the risk of breast cancer and if so, why is this not being addressed in available information regarding the risks of ketosis diet and women’s health.
    Thanks much, Heidi

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  226. Vladimir  June 9, 2016

    Hello Pitter
    Thank you for running that blog. I’ve read quite a lot I thought, but then found out the blog is huge!
    Anyway I haven’t found any hints to answer my questions. Would be grate if you’d have anything to say about them.
    I’ve been on keto diet for 2-3 months now. Now, on my 3rd month I can definitely see only one improvement – the flaking on my forehead and between brows has vanished! I have sever dandruff and it has decreased but not vanished yet.
    But the questions I have are about other things.
    1. When I eat fat, just pure fat like melted fat or lard, or melted lard – I immediately feel sick. The fat has not even made its way through esophagus, but I feel sick anyway. I remember I have had it since my teens. I checked my liver and gall-bladder – nothing. They found a bit of bile esophagitis but not so big to make any problems.
    I love fat, lard and I can eat it with bread – no problems, but also not much, then I get that sick feeling. And now I don’t eat bread of course, and lard, fat, mutton fat make me feel sick.
    May be you have anything to say about it?
    2. We live in a relatively hot climate – we live on Cyprus. Since May till October it’s quite hot here. And how to make yourself eat fat food? Usually I don’t really eat during the day. Morning: 2 espresso half by half with 30% fat cream; on lunch I can have bacon and eggs, not much; and the dinner, yes, it’s a real meal for me. But the more hot the less fat/meat you want to eat…
    What to do? How to stay on keto-diet with all that? And I also think with such a ration I lack some calories I have to get according to my weight…
    Thank you!
    Vladimir

    (reply)
  227. Dan  June 9, 2016

    Peter,

    I always enjoy your posts. Thanks for taking the time.

    Are you still using UCAN? If so, does it raise your glucose significantly?

    (reply)
    • Peter Attia  June 10, 2016

      I don’t train in a way that requires supplemental glucose any longer, but I should do a test with the CGM. I’m guessing it will have minimal impact.

  228. Virginie Landre  June 11, 2016

    Peter,

    Is Insulin Resistance reversible or not, before diabetes strikes? I am looking for the peer reviewed medical literature on this subject and cannot find it. I read extensively how blood glucose and Hem A1C can be “managed” and brought in the proper range with LCHF or fasting, even “cured” according to Dr Jason Fung (a play on words it seems). The LCHF diabetics crowds say that they are doomed, that IR will never change, the fasting crowds believe they will recover. But does the insulin resistance itself DIMINISH with time, when the body is in an environment of low glucose and low insulin? At least before diabetes? Are there studies on the subject?

    Thank you! Virginie

    (reply)
    • Peter Attia  June 14, 2016

      Several, but few are well controlled with huge parallel arms free of confirmation bias.

  229. Justin Barnes  June 14, 2016

    If you ask me I have followed you for several months. In reality that means three at most. Your view on nutrition and exercise have stoked a fire in me that was there but just burning coal before. I love driving cars. The fact that you can give me so much knowledge on something I was less aware of (nutrition) and relate on cars (I have owned two E30’s) just really makes me happy. I look forward to your work with NuSI and I know you will get results. Thank you.

    (reply)
    • Justin Barnes  June 14, 2016

      P.S. I work full time at a bicycle shop.

  230. Fred  June 16, 2016

    Peter,
    I owe you a debt of gratitude for your work. Let me provide you a little background. I am 48 year old with two children and live in Vancouver. I was pretty fit into my mid-20’s and then got busy with life and my exercise consisted of cycling and an annual 160km bike race in Penticton BC. I started playing lacrosse again last year and promptly pulled my groin. I am 6’1” and my weight creeped up to 230lbs one year ago. It was at this time that I came across your information and started to follow keto. Fast forward one year and I weigh 175lbs resumed playing lacrosse and am keeping up with kids over half my age. Losing the 55lbs was relatively easy and I continue to follow keto for the consistent energy levels and how my stomach feels.
    In my rehab. journey with the groin injury I came across Starting Strength last fall and squats and deadlifts have done wonders for my groin injury as well as knee pain.
    The keto information that you provided on your blog was the foundation for the changes that I have made and I can’t thank you enough.
    With kindest regards,
    Fred

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  231. Bobbert  June 16, 2016

    Hi Peter, I was wondering if, after using the CGM for a few months and paying close attention to it, you would be able to extrapolate your blood glucose levels within a reasonable degree of error based solely on subjective criteria (how you felt at a given moment). Basically, can you wean yourself off of it and just “listen to your body?” Lastly, what single item of food did you find MOST detrimental to your blood sugar, and what surprisingly had little effect despite seeming like it would? Thanks so much for your time.

    (reply)
    • Peter Attia  June 17, 2016

      Getting better, but not there yet. I can’t even answer your second question as there are so many factors involved.

  232. Andre  June 20, 2016

    Hi Peter, interesting changes in your life. With a toddler now we have relaxed our strict VLC diet ourselves. Some questions related to the discussion with Rhonda.

    1a) Do you monitor anything else than Glucose on a regular basis?
    1b) In extension: Do we know in 2016 what blood labs can be done to measure effectively your inflammation load? (probably it is not CRP but more advanced stuff) – that which affects your longterm cancer risk, probably ALZ risk, ageing speed…

    We know what impacts inflammation: low carb, moderate activity, nutrition, meditation, sleep, low blood glucose, low insulin etc – but what should we measure in 2016 (generally available labs) to validate how much inflammation / bad load we really face (due to stress, toxins, suboptimal nutrition, etc).

    2) How do I get the Dexcom without Diabetes?

    3) Is there any proxy test for ApoE-related risk or ApoE expression for E3/E4 and E4/E4 ?

    (reply)
    • Andre  June 20, 2016

      Small question in extension: Did you learn anything from monitoring your glucose 24/7 that is worth sharing?

  233. Craig  June 23, 2016

    Wow to your squat and deadlift workout. That is a huge amount of volume, especially for deadlifts, 20+ sets???? I was thinking you were probably going pretty light, until you mentioned backing off to a ‘test’ set at 315. So not only is that a lot of sets, but it sounds like you are using a lot of weight given your size.

    Since you mentioned Rippetoe, his program has you work up to a one top set of 5, and maybe you do a 10% backoff set if you are craving some additional volume. And from following his posts, I know his personal program is quite minimal – he squats OR deadlifts once a week, alternating between the two, basically working up to a heavy top set of about 5 reps. Of course, he is close to 60, but still… quite a contrast to the volume you report. Just curious about the rational for doing so much? For most people, the cumulative low back fatigue would likely set up an eventual injury.

    (reply)
    • Peter Attia  June 24, 2016

      I listen to my body and never hesitate to bail on a lift if my form feels “off” or if I sense anything not being just right.

  234. Michael  June 24, 2016

    Hey Dr A – “Ever since Kresser” . What I am saying is that once you did a podcast with Chris Kresser I have gone down the rabbit hole exploring the differences of allopathic (conventional) versus functional/integrative medicine . I am an FP in practice for 30 years . While I have respect for the idea that conventional medicine falls so short in so many ways, I am deeply suspicious of the sales oriented approach I see in so many of the integrative practitioners – Kresser, Romm, Hyman , Ruscio, Brogan to name but a few . All of these docs seem to be selling their services and advice in an aggressive manner. I have read several of Chris’s ebooks on various conditions and I find them thought provoking at times but I also believe he cherry picks the info he wants out of studies ( and don’t we all , I know ) . I read Kresser but I also hear John Ioannidis reminding me that so many studies are flawed .
    What do you think of the integrative medicine movement?

    (reply)
    • Peter Attia  June 25, 2016

      Not all that interested it “nice neat” summary titles that don’t mean anything. There are good and not-so-good doctors under any set of titles. This one is no different.

  235. EVE  June 26, 2016

    Hi Peter, what do you think about honey as a substitute for table sugar? I read that you use xylitol in your icecream recipe…is that your preferred sweetener? Since honey is more slowly absorbed and natural, can it be a replacement for sugar in moderation? Thank you for sharing your knowledge

    (reply)
    • Peter Attia  June 26, 2016

      Honey is not biochemically very different from sucrose, except that it has more fructose and less glucose per unit mass.

  236. Nani  July 2, 2016

    Hello Peter,

    Love your blog. One question, are you still promoting ketogenic?

    (reply)
    • Peter Attia  July 2, 2016

      Not sure what this means. I’m in favor of using hammers when the task is putting a nail into a piece of wood, but not sure I’d say I’m promoting hammers.

  237. iona fisher  July 7, 2016

    In the revised talk you briefly make a comment something like “Don’t even get me started about salt” which made me wonder if there is a whole low-sodium lie that has been perpetrated, much like low-fat lie-fat you discuss in detail. Any suggestions of where to start reading about that topic?

    (reply)
  238. Stephen  July 14, 2016

    Hi Dr. Attia,

    I have a simple question for you: what do you think is the most promising area of study in human health at the moment– nutrition, biochemistry, public health, or something else? I’m trying to figure this out for myself applying to graduate school, but I was wondering if you could lend me your wise opinion as someone I consider to be ‘the most’ ‘in the know.’ In other words, if you were to get a M.S./PhD what would it be in and why?

    I would greatly appreciate any thoughts you have on this manner!

    Best wishes, Stephen

    (reply)
    • Peter Attia  July 15, 2016

      Nothing interests me more than the study of rapalogs and selective mTORC1 inhibitors.

  239. Marc  July 29, 2016

    Dear Dr. Attia

    Thank you very much for creating such interesting and informative content !
    I would be very grateful if you would find the time to answer these two questions.

    Question:
    ———
    – Do you think physiological insulin resistance induced by low carb eating should be avoided in the quest for longevity ?
    – If yes, this should mean that someone with physiolocial IR should increase their carb intake until their FBG lowers into a more favorable range, e.g. sub 90mg/dl as mentioned during your pod cast with Ronda Patrick ?

    Background (if needed):
    ———————–
    – I’m 31 and quite muscular and lean (clearly visible abs).
    – Paleo diet but including rice and potatos since 5 years
    – Roughly 150g of carbs per day, Starches only for dinner
    – Physically very active: Strength training 1-2h per day.
    – HbA1c 4.6%
    – Fasting insulin 5.1 mIU/L (one time reading 2 years ago)
    – Fasting blood glucose from 100-120mg/dl
    –> self diagnosed physiolocial IR as increasing carbs brings the FBG down

    Thank you so much in advance!
    Best wishes from Switzerland
    Marc

    (reply)
  240. John Reeves  August 2, 2016

    Peter,
    I’m devouring this website after accepting and denying my metabolic syndrome for 20+ years. Yours is an inspirational story in many levels and I’d like to express some commonality with you, though I’m 12 years older. I can work out like a fiend and still have a chubby physique. I wish I’d have listened a little closer to Dr G Berenson, principal investigator of the Bogalusa Heart Study, who you cite indirectly in your post on fatty streaks in childhood. It was a yearly update in 1980-84 for us. Seeing you’re from Hopkins, I had Donlin Long as one of my board examiners. Not one of your immediate mentors but an icon from Johns Hopkins. Finally, Mark Rippitoe is a good friend. I’ve worked with him on and off for years and you will learn how to do a squat and dead lift, believe me. If you come to his town I’d love to meet you.

    (reply)
    • Peter Attia  August 9, 2016

      Wow, John, that’s a lot of cool connections. I never worked with Long b/c in general surgery we only did one month of neurosurgery, but his legend was enormous and technical proficiency often discussed. How cool that you know Ripp (I don’t…just a few email exchanges, but I’m a fan).

  241. Stuart Mather  August 4, 2016

    Hi Dr. Attia,
    You mentioned that you enjoy discussing selective mTORC1 inhibitors and rapalogs. So just wondering if you know of any way other than eyedrops for getting trehalose past the trehalase G. I. tract degradation so it has a chance to do its autophagic mitochondrial magic instead of just ending up as glucose ? i suppose injecting it intravenously would work too, but for daily doses that won’t work long term Apparently trehalose makes wonderful moisturising eyedrops too.

    (reply)
  242. Bob  August 5, 2016

    Hello! Since you’re into racing now, have you seen Adam Corolla’s documentary on Paul Newman’s racing career? It’s amazing. Newman was outracing young whipper snappers at the age of 82yo. Please check it out. I must note, I’m not affiliated w Corolla or any of his enterprises. I’m just a fan of Paul Newman and I know any racing fan would be a fan of this documentary. I hope you enjoy. And I’m really looking forward to your book.

    (reply)
    • Peter Attia  August 6, 2016

      Yes, and it is fantastic. Newman was so impressive in this regard. The performance at Le Mans was from another world, given how late he came to the sport. Really inspiring to someone like me who can never be a Senna…

  243. Beau  August 6, 2016

    Any recommendations for dosing on the phosphatidyl serine? And is it cycled, used as needed, or every day?

    Thanks for the post!

    (reply)
  244. Carolyn  September 4, 2016

    As a 56 year old, mother of two, who has been a type 1 diabetic for 35 years, I know the problems too much or too little insulin can cause. I have used the Dexcom CGMS for about 5 years, it is the best thing that has happened to diabetes management since I was diagnosed in 1981. Since I also use the Omnipod, insulin pump, my blood sugars and insulin usage can be downloaded and analyzed to understand how my metabolism changes from day to day, week to week and month to month. There can be a 25% swing in insulin usage without any explanation. Not sure why this happens, cannot blame this swing on excess exercise or too many carbs. What I have learned in the last 35 years is that exercise is the key to using insulin effectively and weight is controlled by what we eat. You cannot exercise away bad nutrition!

    (reply)
  245. Cath  October 1, 2016

    Hello Peter,

    I have been soaking up The Art and Science… along with others, as well as watching various presentations. Not going for gratuitous flattery here, nor casting aspersions upon the many other wonderful presenters I’ve watched – but my husband, my mother and I have been especially enjoying yours. Knowing ‘why’ is important to me, but with not much more than year 12 Biology under my belt, I appreciate your clear explanations of the various mechanisms involved.

    I won’t bore you with my history, suffice to say that at 40 I find myself at some 115kh. I had hit 135, and through very low fat dieting reduced this – but I was extremely hungry, irritable and didn’t feel 100%. I’ve fallen into the Metabolic Syndrome area for some 15 years now thanks to persistently low HDL, high TG and waist circumference, with fasting glucose only ever just off being diagnosed as diabetic.

    I know I need to turn this around, I know I need to lose weight – and I have in fact just completed my first week of moving in to a state of nutritional ketosis. What I find interesting, and what watching your interview with the Diet Doctor just brought home – is that all of a sudden I am not focussed on the weight loss and the diabetes et al risk reduction. Why? Because I am utterly blown away with the vastly increased feeling of mental acuity! Peter, I’d been frightened I was heading for early dementia or Alzheimer’s – I’ve been foggy and tired and had a frequent feeling of being ‘unable to find my words’ – I’ve felt dumber, dimmer, and had been having trouble following even quite simple conversations at times, particularly when stressed or even more tired than normal. Cut my carb intake to under 20gms, kept my protein moderate, added more fat in a week than I think I have eaten in the past decade – and I feel extraordinary, I feel like ‘me’ again – so much so, that I said to my husband that I couldn’t care less if I didn’t lose another gram if I could feel as sharp as this. This N of 1 likes it, she likes it a lot! 😉

    It’s inadequate, I know, but thank you to you and to all the others talking about this, explaining, researching and asking for further research, listening. I feel on the cusp of an enormous life change – I feel that I’m going to have my life back – a fulfilling, active, enjoyable life that I thought was lost to me. I don’t know what an accountant from Australia could possibly do, but I feel a burning urge to ‘help’ in some way… and I love that I have the energy to even think that! Thank you again.

    Cath

    (reply)
  246. Tony Giugni  October 8, 2016

    Peter, in the spirit of a recent Tim Ferris podcast on the art and science of learning anything faster, what might your recommendation be for a practical text or other resource on the fundamentals of biochemistry? (Of course, your blog is a great start!)

    (reply)
  247. JS  October 16, 2016

    “The TSC1- and TSC2-encoded proteins modulate cell function via the mammalian target of rapamycin (mTOR) signaling cascade, and are key factors in the regulation of cell growth and proliferation.” … Does Rapamycin disrupt cell proliferation through obstruction or through annihilation? Why do they see improved cognition and increased white matter? Most studies show lifelong treatment as necessary. “mTORC1 pathway disruption ameliorates brain inflammation following stroke via a shift in microglia phenotype from M1 type to M2 type”, “Macrophage mTORC1 disruption reduces inflammation and insulin resistance in obese mice”. I am hopefully not the only person interested in a “Attia Academy” discourse on Rapamycin. Kind Regards.

    (reply)
  248. David  October 19, 2016

    Hi Peter,

    Absolutely loving your podcast interviews! You were referenced in a podcast I was listening to some weeks back and I am really glad I tracked down some of your interviews.

    You have a great knack of taking complex ideas and making them more digestible – no pun intended – especially for those not coming from a science background.

    Would love to hear some more thoughts on MTHFR and what this really means for those with the gene mutation.

    Keep up the great work.

    (reply)
  249. Bill  October 20, 2016

    Wow. How do you maintain your weight/bodymass? Skip breakfast, a big salad for lunch and some meat and veggies for dinner. I’m doing LCHF and can’t keep my weight up.

    (reply)
    • David  December 30, 2016

      A belated comment … if you easily lose weight you may be an ectomorph like me. I eat 3 times/day when not exercising or 5-6 times/day when I am. I’ve never counted calories because I’ve never gained significant weight even if I stuff myself … although I cease to be hungry after a moderate-sized meal whereas some people seem to keep eating for longer.

      On this food intake, I just about maintain my weight of roughly 63 kg. I weigh about the same as when I was 18 (I’m now 63). I’ve been trying to gain muscle weight but the gain has been limited even with quite a lot of heavy lifting.

      HTH.

  250. Sonny  October 27, 2016

    Re: Easter Island Podcast
    if a horse is eating, is like…if a Nav is eating.
    if a horse is hungry, is like if a Nav is eating.
    if a horse……happy; is like if a Nav happy
    ….
    whole lotta Nav in that podcast 😉

    (reply)
  251. William  November 2, 2016

    Peter – I’ve searched around PubMed for evidence that glutamine post weight training actually has an effect, but have found little evidence if any to date – which supports what many bodybuilders profess (that it doesn’t have any effect). Do you take it based on some more recent evidence or do you recall seeing studies which support it? Thank you kindly.

    (reply)
    • Peter Attia  November 4, 2016

      No, I think the evidence points to leucine as the main driver. The other BCAA, valine and isoleucine, and perhaps glutamte, don’t seem as directly relevant. However, they may allow for more “leucine sparing” for the most important role—mTORC1 activation.

  252. Dave  November 7, 2016

    Peter,
    A quick, nonetheless heartfelt, thank you for the extremely generous sharing of your knowledge and ongoing experience. It is so difficult to find a clear, intelligent, passionate, sober and considered voice (with a sense of humour!) among the din. Deeply grateful for your work, and inspired by your sincerity & generosity.
    Dave

    (reply)
    • Peter Attia  November 10, 2016

      Dave, thank you so much for the kind words. Glad you find this stuff helpful.

  253. AdaptiveChange  November 11, 2016

    Hi Peter,

    I liked your response above with the metaphor of the hammer.

    If targeting a specific goal which seems, from my reading, to be a variable by-product of very low carb induced insulin reduction, would you recommend starting with a hammer, or start by just putting some pressure on the nail manually by slowly working down the level of carbs (+ increasing fat accordingly) to see if the nail moves a bit at any point?

    Specifically I am interested in it from a borderline diastolic BP perspective, being “otherwise healthy” and at (or marginally below) my desired weight.

    Thanks!

    (reply)
  254. Balu  November 16, 2016

    As I mentioned in one of my other comments, I’ve recently started experimenting with ketosis given my metabolic-syndrome symptoms and have been thoroughly enjoying your blogs. Thanks.

    One question: In your personal journey you mention:
    Two things jump out at you, I’m sure: I eat virtually all of my calories in the form of fat and my total caloric intake has actually gone up by about 50%. Let me reiterate, I don’t exercise any more today than I did 2 years ago. In fact, if anything, I probably exercise a bit less (i.e., down from 3-4 hours per day to 2 to 2.5 hours per day).

    Since you did not explicitly address the (new, i.e., 2011) energy budget (and compare it to the old, i.e., 2009, energy budget), (a) is it that your new (2011) basal metabolic rate is much higher than in 2009? (b) are ketone bodies excreted in urine significant?
    Cheers

    (reply)
  255. Rick  November 18, 2016

    Hi Peter, thanks for your tenacity as that example is one I have had to adopt to be on a path where I can eventually achieve results. I am also a perfectionist in what I am trying to achieve with my body but am on the beginning of my journey in weight loss but not in the basic biology of the practice. I have only been overweight for a few years but before when I was 10 years younger and in my 20s I could just torture myself without any real plan and lose the weight after building muscle lifting weights, typical bodybuilding but I would still take it to far and then have adrenal problems. Now that I have eliminated gluten and grains my gut has healed which is a first step but now with my 3rd attempt at going very low carb I have hit a wall at the same point I did last time at 14 days in and am getting enough sodium although one or two days I may have had a bit less for a total of 3 grams but am really trying to keep it at 5. I ran out of blood ketone strips and so have not checked this two week cycle but like last time when I never got above .4 with 20 grams carbs or less with 75 percent fat (I am currently upping it) I suspect this time I am also having trouble reaching a suffient level of ketosis to sustain energy as I actually was bonking when I woke today and did a few days ago too but extra sodium seemed to help then but there is not way I can still need sodium so I had a kiwi for breakfast and then a few ounces of berries which got me to quit passing out. Even after this horrible second week of bonking from lacking ketones, I am not ready to quit but may add in more berries to reach at least 50 grams a day for the next few days. Extremely frustrating when I know I am doing things right enough to be rewarded with some fat burning/ketone action but my fat is some stubborn stuff at age 37 now, do you have any suggestions?

    (reply)
  256. Lee  November 19, 2016

    Peter,
    Thanks for your insights, I’ve found them very helpful and enjoyable. I don’t know if you’ve covered this elsewhere, but what are your thoughts on the consumption of alcohol (wine) with a meal regarding and its resultant suppression of glucose?
    When I measure my blood glucose after drinking a glass of wine with a meal, I see a significantly lower glucose response, so I’d expect to see a lower insulin response.
    Thanks,
    Lee

    (reply)
  257. John  November 20, 2016

    Peter,
    I have not visited your site in quite a while and been catching up. I have been following you since the beginning. I was surprised that you are considering auto racing. Makes perfect sense. I wanted to give you a warning..Its very difficult to quit once you start. I starting racing late in life about 17 years ago..It started out with just fun weekends with other guys my age. 43 at the time. It slowly morphed into more intense racing. Starting with Skip Barber, then Barber Dodge Pro cars, Star Mazda,GT cars, Daytona Prototypes, and then LMP2 including Le Mans this year. This is one of the reasons I started following you. I needed a nutrition strategy for car racing. I needed to be lean, light and have plenty of mental and physical energy The car has to be a minimum weight, but not the driver, so 10-20 pounds is “free” total weight reduction.. I went from 175 to 155. 6 feet tall so very lean. I started as a high carb, gel eating and sports drink drinking race driver and morphed into a low carb ketogenic athlete. My energy levels and focus(important driving 200 mph) were good stint after stint. I am 60 now and have pulled back from racing at that level anyway.. I am taking some time off to think about further racing. I just wanted to let you know how addictive it is and hard to stop.;-) I never intended to go this that far with racing. Just a warning.The sim is great too. ..Good guys at IRacing and really usefull. If I can be of any help in your pursuit in auto racing please let my know. I have track notes and a lot of in car videos that might help.If I can be of any help please let me know. Its the least I can do you all the help and insights I have received from reading your blog and listening to your interviews. Sorry. Off topic, but had to say it. From what I know of you, you would be a great race car driver.Thanks again for all you do

    (reply)
    • Peter Attia  November 22, 2016

      LMP2???? Are you kidding me??? Indeed, this is totally addictive. I’m eyeing a Formula Renault 2000…

  258. Benas  November 22, 2016

    Hi Peter,

    Hope things are going well.
    I read 3 recent studies about cancer, I think you will find them interesting! They are connected and say that lactic acid protects cancer from glucose restriction and helps it survive when glucose is low. So at first cancers exhibit Warburg effect to build up lactic acid, then it protects the cancer, and the cancer switches to non-glycolitic metabolism. However, if you deal with lactic acidosis (they did bicarbonate (baking soda) infusion into tumor), then cancer becomes much more sensitive to glucose deprivation and it worked great on humans with liver cancer tumors.
    The 3rd study below on humans with liver cancer showed that combined TACE(blocking nutrients to cancer) + Bicarbonate reduced tumor volume 6 times more compared to just TACE. And patients had 100% objective response rate to the combined therapy, while TACE had 40-60% response rate. From that I think ketosis/fasting could be combined with sodium bicarbonate infusion (or other means to deal with lactic acidosis) for great results.

    Here are the studies:
    1. https://www.ncbi.nlm.nih.gov/pubmed/22190257 – Central role of lactic acidosis in cancer cell resistance to glucose deprivation-induced cell death — The ability of cancer cells to resist glucose deprivation-induced cell death is conferred, at least in part, by lactic acidosis, and we envision that disrupting the lactic acidosis may resume the sensitivity of cancer cells to glucose deprivation.

    2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4018627/ – Beyond Warburg effect – dual metabolic nature of cancer cells — When cancer cells are under regular culture condition, they show Warburg effect; whereas under lactic acidosis, they show a nonglycolytic phenotype, characterized by a high ratio of oxygen consumption rate over glycolytic rate, negligible lactate production and efficient incorporation of glucose carbon(s) into cellular mass. These two metabolic modes are intimately interrelated, for Warburg effect generates lactic acidosis that promotes a transition to a nonglycolytic mode. This dual metabolic nature confers growth advantage to cancer cells adapting to ever changing microenvironment.

    3. https://elifesciences.org/content/5/e15691 – Previous works suggested that neutralizing intratumoral lactic acidosis combined with glucose deprivation may deliver an effective approach to control tumor. Bicarbonate markedly enhances the anticancer activity of TACE (TACE is transarterial chemoembalization, i.e. procedure to restrict tumor blood supply, presumably for glucose restriction).

    What are your thoughts on this? I feel like lactic acidosis is not getting a lot of attention in cancer research, but maybe it is the missing piece of the puzzle.

    Benas

    (reply)
  259. John  November 22, 2016

    What do you think is the optimal dose of cardio exercise to promote longevity? In one of the Tim Ferris podcasts you mention a Copenhagen study that concludes running slow-moderately 3x a week with a total of 1 to 2.4h is optimal in terms of longevity. Other studies imply you should run 7-8h per week including running hard some of the time.

    What would you recommend?

    (reply)
    • Peter Attia  November 24, 2016

      Too complicated for comments section. Will be discussing in book.

  260. Byron Allen  December 11, 2016

    Dr. Attia, I am 69, 68″, and mildly overweight ( 36″ waist) but eat a high fat, high protein diet and avoid carbs. I am having trouble losing weight and wonder if i should just reduce portions, or fundamentally change diets to only low fat, low carb food limiting intake to less than 1200 calories per day unitl I drop the weight. I have an unusual ability to gain strength rapidly as at age 62 began lifting for the first time in my life, and at age 64, could bench 315 5 reps. I think you know my son Matt.

    (reply)
  261. Meredith  December 24, 2016

    My question is if you have come across many patients with insulin resistance that took atypical anti-antipsychotics.. Hope holidays are going well. Your TED talk brought me here.

    I’m also sharing a bit of my story on having a Insulin resistance. In hopes it will be helpful to you or your readers.

    Back in 2002 when I was 14 years old I discovered I have bipolar 1-when a reaction to Prozac sent me to the psych ward. I had a manic episode triggered by the drug.(I had shown symptoms of bipolar before that) I was treated with risperdal which worked well in bringing me back down. I ended up gaining 30 pounds in month from risperdal. After several months of feeling down and devastated by the predicament I was in. I decided to get active again-I was told the weight would be pretty easy to lose. I started weight lifting, did spinning classes, had a trainer, trained for a backpacking trip. Changed my diet did not lose a pound. Was not in till my freshman year of college when I lost my menstrual cycle that I got diagnosed with PCOS (polycystic cystic ovary syndrome) The weight was gaining was almost uncontrollable. Root cause is theorized to be an Insulin resistance. I was prescribed metformin. Luckily I don’t Ever have to take risperdal anymore other drugs work. Has for my weight still a struggle but stable just like moods. My cravings, Diet unfortunately are affected by my mood at times. One adavatage in being diagnosed so young was very few bad habits and years to develop healthy coping skills.

    http://www.nytimes.com/2009/10/28/business/28psych.html
    My question is if you have come across many patients with insulin resistance that took atypical anti-antipsychotics.. Hope holidays are going well. Your TED talk brought me here.

    I’m also sharing a bit of my story on having a Insulin resistance. In hopes it will be helpful to you or your readers.

    Back in 2002 when I was 14 years old I discovered I have bipolar 1-when a reaction to Prozac sent me to the psych ward. I had a manic episode triggered by the drug.(I had shown symptoms of bipolar before that) I was treated with risperdal which worked well in bringing me back down. I ended up gaining 30 pounds in month from risperdal. After several months of feeling down and devastated by the predicament I was in. I decided to get active again-I was told the weight would be pretty easy to lose. I started weight lifting, did spinning classes, had a trainer, trained for a backpacking trip. Changed my diet did not lose a pound. Was not in till my freshman year of college when I lost my menstrual cycle that I got diagnosed with PCOS (polycystic cystic ovary syndrome) The weight was gaining was almost uncontrollable. Root cause is theorized to be an Insulin resistance. I was prescribed metformin. Luckily I don’t Ever have to take risperdal anymore other drugs work. Has for my weight still a struggle but stable just like moods.

    http://www.nytimes.com/2009/10/28/business/28psych.html

    (reply)
  262. Jason Hendrickson  December 31, 2016

    Hi Dr. Attia. I’m curious to hear more about your decision to stop racing bicycles (as a 42 year-old masters cyclist myself). I try my best to stay up on the current long-term endurance training/heart disease connection, both because it’s fascinating and because it’s obviously applicable to my life.

    I’m curious, if you can expand briefly enough in a blog post, what your primary reasons were, and if you have time/interest, your thoughts on this study: http://www.athletesheart.org/2016/04/in-the-medical-news-does-heart-function-suffer-in-long-term-endurance-athletes/

    Lastly, have you ever contemplated (or has anyone else for that matter) a potential link between sugar-based energy supply (sugar being something that causes systemic inflammation in the body) and these seemingly recent discoveries of increased risk of heart disease in long-term endurance athletes (who presumably fuel with primarily with sugar-based foods before/during/after activity).

    (reply)
  263. neckbeard  January 9, 2017

    I’ve been obese since i was 6 yrs old. Now trying ketogenic diet, without a gallbladder. No ill effects on week 2. IBS gone, GERD gone. 150 lbs to go. Reading your page has waned me off the worst fears of this diet, feeling better so far. Many thanks.

    (reply)
  264. amy  January 24, 2017

    Hi Peter,
    As a diet dr.pepper addict, I am looking for yet another reason to abstain…. I think i recall somewhere that you indulge — or at least did– occasionally… Did you learn anything of value regarding glucose readings, insulin sensitivity, in regards to aspartame or any other artificial sweetner while wearing the cgm? If so, i just may have to wear one to solidly break this habit! thanks.

    (reply)
    • Peter Attia  January 25, 2017

      Fair questions, but I don’t drink enough diet beverage these days to see an effect.

  265. Peter Steele  January 27, 2017

    this is probably a longshot, but does anyone know where to find more info/discussion (by Peter) about how his 2015 intermittent fasting “experiment” went (for 6 months he only ate for 1 hour a day, fasting the other 23 !) … he mentioned above that maybe he talked about it in one of his recent podcasts, but i haven’t been able to find anything yet….

    (reply)
  266. Michael Ye  February 3, 2017

    Hi Peter,
    I’ve started taking 120mg lithium orotate and have noticed positive effects on my anxiety and mood. What dosage do you take, and is it necessary to take it daily?
    Similar question with phosphatidylserine, what is your daily dosage if you use it daily?
    Opinions on n-acetylcysteine before bed and dosage?

    (reply)
  267. Simone  February 7, 2017

    Hi Peter, I sent a message to ‘contacts’ but thought this may be an easier way to get in touch…
    My background is in environmental science but I have always had a keen interest in nutrition and always want to learn more about what is beneficial for our body and how different foods affect our cells and system overall.
    In order to learn more details, I would like to take some sort of nutritional certification course, however, looking around on the internet I often come across courses and coursework I don’t agree with or that is too focused on e.g. raw foods or vegetarian diets.
    Do you have any recommendations for an institute or course that is more in line with a ketogenic diet or nutritional basis? I am located in HI and an online class would be ideal.
    Thank you!

    (reply)
  268. TMac  March 7, 2017

    Dr. Attila,

    Any updates on Dexcom? One year ago you said it’ll be a game changer for everyone it two years. Still on course? Seems exorbitantly expensive for non diabetics when insurance will not cover.

    Thanks,

    Tim

    (reply)
  269. Samantha Baker  March 26, 2017

    Peter,
    Just got my hands on a Freestyle Libre CGM. Any advice/ideas/experiments you recommend with it to maximize my learning? Planning to try a range of foods with it. I’m fat adapted and have been well into ketosis for the last year or so.

    Should be very interesting to see what happens. My friends think I’m crazy.

    (reply)
    • Nima  March 28, 2017

      Hi Samantha,
      I got one too and I am doing a keto diet as well. Right now one of my objectives is to improve my sleep to make it more restorative and refreshing. Some nights, specially when I skip dinner, right after I go to sleep my blood glucose goes down to the range of 50s and remains there for around 2 hours (apparently that is the time when most of deep sleep happens). Well I don’t die because I suppose there is enough ketones in my blood. Have you observed something like this and if yes how was the (subjective) quality of your sleep? On a similar topic, do you see any difference in BG during the day as a function of presence of this night time hypoglycemia and/or (subjective) quality of sleep?

  270. Lynn  March 27, 2017

    Hi Dr Attia,

    I discovered your presentations by chance and could not stop a reading streak in this blog for days. Really great works. As someone who also has this obsession digging into the details and optimisation, I have some questions about keto-adaptation. As you have mentioned previously in some of your comments, you found that after the initial general adaptation that takes about a month (which I suppose is the completion of mitochondrial bio-genesis?), there are actually 2 following stages in the adaptation, which are the big performance improvement 3 months in and “better than ever” performance after 18 months. Do you have some deeper insights about why was that (if I happen to miss something in this blog, my apologies)? Could there be “deeper ketoadaptation”? And how deep can it be?

    Also you have mentioned you have been in and out of ketosis due to several experimental periods that you have conducted (like the IFIK times). Would you say that have done anything to the level of your adaptation? Could lowering protein, zero-carbing, or intensive IF improve/affect ketoadaptation respectively? Sorry about these many questions and hope they dont disturb you much.

    Yours faithfully,
    Lynn

    (reply)
    • Lynn  March 27, 2017

      Dr Attia,

      P.S. to my last comment, Dr. Lagakos once suggested in this post:
      http://caloriesproper.com/long-term-fat-adaptation/
      that keto adaptation does not get any further after the initial 3 weeks mitochondrial biogenisis period. I wonder whether that is true. Also, is there an indicator of how much does the level of beta-hydroxybutyrate concentration affect the mind status and performance? Like, 0.5 mM is considered ketosis, but 4-5 mM all day long should be something totally different right? Thank you very much.

      Yours,
      Lynn

  271. Nima  March 28, 2017

    Hi Peter,
    You are one of the people who triggered my interest in physiology and medical science. Similar to some of the people above I got a Freestyle Libre CGM as well. Such a cool gadget with incredible potential. It is already giving me amazing insight about my physiology. I am of Iranian origin with the beta-thal trait as well and I dream of a platform that allows and facilitates collective experimenting. I think there is a need for paradigm shift about how medical research is done (or at least guided) and how health recommendations/decisions are made. It is not fair to a different minority because they did not manage to move the “average” enough in random trials.

    (reply)
    • Samantha Baker  April 7, 2017

      Nima,
      I haven’t received my CGM yet, should arrive today. Once I get some data regarding sleep, I will update my post here. Thanks for the idea, I will definitely check it out!
      Samantha

  272. Chris N  April 11, 2017

    How does your body react to fasting in terms of the rate of fat burn? I think the idea of compounding is very powerful (i.e., consistent, daily actions can lead to outsized result over longer periods of time). That said, I’ve also read and heard you talk about the role of fasting. For example, considering the following…eating 1800 calories/day for 7 days or eating 2100 calories/day for 6 days and then fasting for 24 hours. Calorically, they both amount to 12,600 total weekly calories. Are these equivalent regimes in terms of how your body burns fat?

    (reply)

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