The personal blog of Peter Attia, M.D.

I have an idea…

I have an idea…
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You might not realize this from my dearth of blog posts over the past year, but I do miss blogging. I’ve got a few dozen ideas for great posts, in large part reflecting the ever-evolving nature of my understanding of nutrition and health, and a few other tie-in topics such as exercise, sleep, and hormones.

That said, the topics I want to cover aren’t amenable to short posts (or, as Mark Twain or Blaise Pascal might have pointed out—I don’t have the time to write short posts). Indeed, I don’t really have time to write long posts, either.

I have tried to keep up with comments, and I appreciate everyone’s patience as I try to respond to as many comments as possible.

So what’s the distraction? There are several, and I only touch on them to make the point I’m still excited (more excited, actually) about the topics above. Between my NuSI work, a growing medical practice, a new baby (sorry, I can’t resist a few gratuitous shots of the little guy and big sis, below), some attempt at training/competing, and a greater attempt to have a meal here and there with my family, there just aren’t enough hours left in the week to blog intelligently (particularly so, given my recent appreciation for the restorative powers of sleeping more than 5 hours per night; thank you Dr. Kirk Parsley).

Given all of the above, I have two projects of my own to discuss—one short term, one long term – and then an exciting NuSI project for which I’d like your help.

Starting with my long term project, what’s currently occupying much of my time is my research for a book I hope to write on longevity and anti-aging. My interest in this project initiated with a (very long) manifesto I wrote on the subject last year and then a slew of conversations that grew from it. I’d like this book to accurately reflect the current best understanding of the science, and then extrapolate from there to a best-bet program of nutrition, exercise, sleep, supplementation, hormone manipulation, stress reduction and pharmacology that will have the greatest possible effect on both delaying death and optimizing life. Of course, doing so has turned into a typically obsessive job of reading everything available that addresses these questions and speaking with as many experts as possible. I think this project still requires about 2,000 hours—hence the “long term” comment, above, but I hope it’s worth the wait. And because I know someone will ask—sorry, I’m not willing to share the manifesto publicly at this time.

As for my shorter term project, I realized something last month while doing a podcast with Tim Ferriss. Tim and I spoke for two hours over the phone, a pretty easy thing to do, and voila a podcast appears. I haven’t listened to it, but the feedback on his site and social media suggests folks dug it as a good vehicle to share insights and commentary (isn’t that really all I do on this blog?).

Here’s a link to the podcast with Tim. I’ve never been a big podcast guy, but this one was fun, and it occurred to me that a podcast here and there might be a way to address some of the things I enjoy thinking, writing, and speaking about, minus the overhead (i.e., time) of producing lengthy Attia-style blogposts. Tim and I will be doing a part II, so if there are topics you want to hear about as a natural extension of part I, please note them in the comment section. We’ll try to address them.

Beyond that I’ll try to think of a non-annoying way to do some “in house” podcasts. (The challenge is doing these without an interviewer in subsequent batches—but I may twist a friend’s arm into doing so.) Or maybe Tim will want to do more. Either way, I’ll try to generate a bit of content this year that doesn’t require writing long blogposts.

Exciting NuSI project

I generally try to keep NuSI out of this blog since it is a personal blog. I prefer that NuSI chatter occur on NuSI’s site. Since I’m already shamelessly showing pics of my kids, though, I figure I might as well go all in on this one and shamelessly promote something very exciting we’re doing at NuSI.

In late 2013 NuSI convened its annual meeting with our scientific advisory board to discuss our research agenda for 2014 to 2018. A number of ideas were hotly debated for two days. In the end our research agenda was shuffled and what emerged was a new roadmap. One area that rose to the top of the priority list was a condition that is growing at epidemic rates—non-alcoholic fatty liver disease (NAFLD). In Q1 2014 we spoke with nearly 40 experts around the country who study NAFLD and in Q2 and again in Q3 we held two-day meetings with a large subset of them to facilitate their design of a NAFLD program. The result was three studies that we hope to conduct in the next few years.

The same week Tim and I recorded the podcast, he wrote a post about the NuSI project. The post not only discussed NAFLD, but also kicks off a fundraising campaign for the first of the three studies. Since this post went up, we’ve had three large donations made as matching challenges. I hope you’ll read his post and think seriously about contributing. Every donation counts, so don’t avoid participation because you can’t kick in $50,000 of your favorite appreciated stock.

I hope you’ll consider this project worthy of your philanthropic energy. By NuSI’s standards, it’s a relatively inexpensive study. Like everything we fund, though, it’s a unique project that is greatly needed to clarify key questions about how our diet effects human health, and we expect the results to help us change the world.

My favorite distractions

During my wife’s pregnancy, our daughter kept coming up with names for her soon-to-be brother. The names were completely random (and highly amusing).  One night over dinner she declared that she had found the name. It was a combination of two names she really liked, Michael and Jackson. So his name would be Michael Jackson Attia, she declared, in the most serious manner possible.  Now, despite my appreciation for the King of Pop, and the constant amount of music we expose our daughter to (she’s a budding little drummer), she had no idea why I nearly spit out my dinner laughing. This story is only made funner by the fact that the little guy arrived 2 weeks early–on August 29th.  I’ll leave the rest to you.

My favorite part of this picture is how he’s beating me in a stare-down contest at the age of 6 weeks! God help me when he’s 16.

1

The little man nearly doubled his birth weight by his 4-month check-up.

2

Big sis just adores him. She’s struggling with the concept that in about 12 years he’ll be bigger than she is. She keeps insisting, “But daddy, I’ll still be older than he is!”

3

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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. Tim C  January 13, 2015

    Your baby boy looks a lot like you. Congrats! Looking forward to more podcasts

    (reply)
    • Peter Attia  January 13, 2015

      Hopefully he doesn’t inherit my shortcomings.

    • Colleen  January 14, 2015

      I was going to say Peter Jr. Ditto on the podcasts.

  2. PeteJ  January 13, 2015

    Congrats to the Attia’s on the birth of Michael Jackson Attia.

    (reply)
    • Peter Attia  January 13, 2015

      Imagine how much mileage I’ll get out of that for years to come, up to an including his wedding.

  3. Dave  January 13, 2015

    Congratulations Peter!

    (reply)
  4. Karen Bridgwater  January 13, 2015

    Congratulations Peter and family! What beautiful children! Thankyou for the updates, look forward to hearing more.

    (reply)
    • Peter Attia  January 13, 2015

      Thank you, Karen. Updates to be continued.

  5. Bruno Szendy de Erkenez  January 13, 2015

    Peter,
    Congratulations in the family addition, and wow! What a beautiful kids you have. I am always checking up in your blog for useful info, and I am happy to be the first to give you the compliments.
    I am really looking forwarding to your book and the second part of the podcast with Tim Ferriss.

    Cheers,

    Bruno

    (reply)
    • Peter Attia  January 13, 2015

      Thank you, Bruno. If you have specific questions for the podcast, please let me know.

  6. Alec Collins  January 13, 2015

    I think I’m becoming a little worried about, perhaps even dissappointed in, NuSi. Could it not stop revising it’s plans and just crack on with answering the question of calories Vs macronutrients (well, carbs and sugar) with regard to obesity?

    (reply)
    • Peter Attia  January 13, 2015

      I like your impatience, Alec!

  7. Mike  January 13, 2015

    A podcast of some sort sounds like a great idea as a low-friction way to talk about what interests you. Writing can be a huge time-sink, for sure.

    Regarding NuSI, I’d like to ask as respectfully as possible: how come none of this information is on the NuSI site, which seems to have been pretty static for the last year or more? Or sent in a NuSI newsletter? How come NuSI hasn’t said anything about the Energy Balance Consortium pilot study? If the website is correct, the study ended over 6 months ago.

    I see NuSI did tweet about the NAFL thing, bringing the official twitter account up to a whopping 22 tweets in 2+ years. I contributed to NuSI in 2013, but opted to donate elsewhere in 2014 due to the great wall of silence about anything going on. If NuSI is looking for donations from more than just billionaire philanthropists, NuSI needs to engage with the public.

    (reply)
    • Peter Attia  January 13, 2015

      Noted. Do keep in mind, though, when a study is finished it typically takes a year to gather, analyze, and publish the results. Can’t be tweeting stuff ahead of that due process.

  8. Brent Rice  January 13, 2015

    Congratulations!

    (reply)
  9. Occam  January 13, 2015

    Good to hear from you again.

    If it mean more Peter Attia more often, I am all for the podcast format.

    Keep up the good work (and the good life),

    – Yannick

    (reply)
    • Peter Attia  January 13, 2015

      Thanks so much, Yannick.

  10. bill  January 13, 2015

    I’m sure he’s a real thriller.

    (reply)
    • Peter Attia  January 13, 2015

      Ha ha! Keep the wise cracks coming. If he gets too rowdy, I’ll make him beat it.

  11. Laura Schultz Jaymes  January 13, 2015

    So…no joke; you really did name this baby Micheal Jackson Attia? Or was that just an off the wall comment?

    (reply)
    • Peter Attia  January 13, 2015

      Ha ha…no, it’s just his nickname.

  12. Duncan  January 13, 2015

    Congrats Attia family!

    We are expecting the arrival of our second in six weeks, can’t wait:)

    Did you go with Neocate in the end?

    Thanks, Duncan

    (reply)
    • Peter Attia  January 13, 2015

      Congrats, Duncan. I couldn’t find a variant for his age so the one I have he’ll have to try later.

  13. Janknitz  January 13, 2015

    I second the urgency for addressing the issue of NAFLD. Last night my clicker “landed” on one of those shows where a 600 lb patient underwent gastric bypass surgery. They almost canceled the procedure when they went in laporoscopically and found a severely cirrhosed liver. After the surgery the doctor kept admonishing him that he was going to need to watch is fat intake because of his liver condition. It will be good to have some definitive data on what contributes to NAFLD. My understanding is that it’s carbs, not fat.

    (reply)
    • Peter Attia  January 13, 2015

      It may be, or it may be both under the wrong circumstances. This is why we need to know the answer.

    • Dave Nelsen  January 19, 2015

      If I eat a lot of carbs and get fat, my liver gets fat too. I don’t drink very much, so i know that isn’t the case. When it first happened to me in the mid 90’s, I wasn’t way over weight (BMI 26), but my doctor had no idea how to treat it. He told me to not drink alcohol and get my liver enzymes rechecked every 6 weeks. This one hits home with me.

  14. Marlene E.  January 13, 2015

    He is your clone! And… he’s hopefully fully keto-adapted at this point, I suppose 🙂

    (reply)
    • Peter Attia  January 13, 2015

      I don’t think he’s anything other than breast milk and formula adapted…

    • Naren  August 24, 2015

      Would you be willing to share what kind/brand of formula you’ve chosen for your son (and/or chose for daughter when she was young)?

      Thanks, Peter.

  15. Alec Collins  January 13, 2015

    It’s a fair cop.

    Is there lots of discussion on the NuSi site about the studies and how they’re going and such?

    (reply)
    • Peter Attia  January 13, 2015

      NuSI will have a new website in the coming months. Some of these issues should be addressed then/there. But remember–good science takes time. It took 60 years to create this mess, we’re not going to solve it in few years or with a pilot study (the study you refer to was a pilot study).

  16. Beverly Hackett  January 13, 2015

    Thanks for the update and link to the podcast. I’ve become podcast addict which meshes nicely with my addiction to walking my dog. It makes those frigid walks much more enjoyable! Feeds the mind and works the body!

    (reply)
    • Peter Attia  January 14, 2015

      I’m a huge podcast junkie, too. When I listen to really great ones (e.g., EconTalk, IQ2, Freakonomics) I get the feeling I don’t want to try making my own since they will fall so far short, but maybe being half as good as those is better than nothing.

  17. Marcella Pitter  January 13, 2015

    Hi Peter, Congratulation on your new family addition. They are beautiful children. God bless you and keep you always. From your old friend.

    (reply)
  18. Brian  January 13, 2015

    You are an incredible thought leader with a wealth of knowledge, yet humble in your tone and approach. Keep it up my man, you’re making a difference!

    (reply)
    • Peter Attia  January 14, 2015

      Not sure I agree with your kind statements, but I get enough arrows thrown at me that a few roses can’t hurt, right? Thank you, Brian.

  19. Joan Mercantini  January 13, 2015

    Congratulations to all. What a beautiful family. Good health and happiness in the New Year.

    (reply)
  20. Jon  January 14, 2015

    Work / Life balance is a hard thing to master! Congrats to you and your family, looking forward to reading more from you in 2015.

    (reply)
    • Peter Attia  January 14, 2015

      Harder than almost anything I’ve attempted…but worth every bit of effort.

  21. Paul  January 14, 2015

    Congrats on the new addition!

    You mentioned perhaps doing podcasts on this website. One podcast format that I enjoy is Robb Wolf’s Paleo Solution podcast. It’s basically a Q&A format with listeners sending in questions ahead of time. They cover four to eight questions in about an hour. Just a thought…

    (reply)
    • Peter Attia  January 14, 2015

      Paul, that may be a great way to do things. Thanks for reminding me.

    • Laura Schultz Jaymes  January 14, 2015

      Agreed! Robb’s got it down. No need to reinvent this wheel.

  22. Dan Walker  January 14, 2015

    I got to listen to the T. Ferriss podcast a couple of weeks ago over the holidays and I really enjoyed it. One of the best parts, of many, I thought was when you two began discussing the longevity stuff and I thought the concept you were explaining of the possibility of the heart muscle stretching in athletes and how it could be affecting the natural pacemaker nerve bundles in their hearts, and that being a possible cause for A fib, to be particularly interesting. So you potentially writing a book on longevity I think is a fantastic idea and I hope it comes to pass. I don’t think I can really say this enough but Thank You yet again for the time you are able to give us, your loyal readers. I, for one, greatly appreciate the knowledge and wisdom you share. I always mean to ask too because I think it’s something you really enjoy, but to you ever still get to perform surgery much anymore?

    Thanks again!
    Dan W.

    (reply)
    • Peter Attia  January 14, 2015

      Thank you, Dan. If you want to read more about the exercise-induced a fib stuff, James O’Keefe is a guy to read (he’s a cardiologists at Madison Wisconsin). I do not opeorate at all, but I do still practice medicine about 10 to 15 hours per week.

    • JB  February 3, 2015

      I thought the podcast you did with Tim was excellent and it made me want more. And man, you’re so totally the guy who’s book on longevity I’d want to read, so thanks in advance for that. So much of currently applied longevity is a grand leap of logic from animal models. Would be great to have your measured approach.

      Your son is a mini-you for sure. The photo of both the kids is so cute.

    • Peter Attia  February 4, 2015

      Thanks, JB, both about the book and my little kidos. I just wish I didn’t have to be away from them 50% of the time!
      I’m excited about the book, but a bit overwhelmed about actually going form poorly-written manifesto to excellent book. Be patient, but I hope I can make it worth the wait.

  23. Chris  January 14, 2015

    Congrats your new son! Adorable!

    I was wondering if some of the topics you’re going to talk about in the future are PEO or “parent essential oils”. I’m asking because there’s seems to be a push for that over fish oil since there seems to be better results due to more oxygenated cells and other reasons. (Most of the push is probably due to marketing push for products.)

    Since they’re not processed like fish oils and come from plants, to me, they would seem better. I didn’t read through all the research articles or even be able to understand the articles, but seem logical in.

    -Chris

    (reply)
    • Chris  January 14, 2015

      (accidentally submitted comment before done)
      … , but seem logical in their conclusion. What are your thoughts on PEO’s as compared to Fish Oils?

      -Chris

    • Peter Attia  January 14, 2015

      Unless they come from marine plants, my understanding is that they don’t contain EPA or meaningful quantities of DHA. The issue with fish oils, typically, is the contaminents that may accompany the omega-3 FA if one sources large fish (large fish = more time to accumulate toxins). So ideal sources of EPA/DHA are small (e.g., bait) fish.

    • Chris  January 14, 2015

      I don’t know the research behind the studies. But the reason for PEOs is that they are the “parent” of all the other essential oils and your body can create what is needed for EPA, DHA, GLA and etc, from these “parent” essential oils. They also mention that EPA/DHA/etc are more for deep cold water fish because of the antifreeze ability which doesn’t cope with human 98 deg temps and that they reduce the ability for cells to transfer oxygen though their cell membranes. They say that low cell oxygen is the cause of certain modern diseases and people should instead consume oxygen friendly oils, which is bad for products/supplements because oxygen dramatically shortens the shelf-life of these products.

      I obviously don’t know what right or would know what to look for in the research documents, but logically they sound right. But again it could be just a marketing push, but then so were Fish Oils and statin cholesterol lowering drugs…

      Source: http://www.cambridgemedscience.org/articles/medhyp-08.pdf
      “It is our hypothesis that long-term hypoxia of cells in the body, measured in years, is the primary trigger for cancer. We believe that the hypoxia, which has to meet Warburg’s findings of a critical 35% reduction in intracellular oxygen levels to initiate cancer, is linked to the incorporation of adulterated, non-oxygenating, or inappropriate polyunsaturated fatty acids (PUFAs) into the phospholipids of cell and mitochondrial membranes. Such incorporation causes changes in membrane properties that impair oxygen transmission into the cell. Trans fats, partially oxidized PUFA entities, and inappropriate omega-6:omega-3 ratios are all potential sources of unsaturated fatty acids that can disrupt the normal membrane structure.”

      I don’t like posting links but just in case, you want to look more into:
      http://www.brianpeskin.com/
      http://oxygen4cells.com/

    • Peter Attia  January 14, 2015

      It’s just clear we can produce reasonable levels of EPA, DHA from ALA, for example.

  24. Jeff C  January 14, 2015

    Hi Peter – Good to see a new post and congrats on the new baby. You and your wife are blessed.

    I’m the guy who said hi on the United flight on Monday. My wife has seen similar fantastic results to me since we embraced low-carb paleo. Our boys are young (10 and 7) and when she was diagnosed NAFLD it was a wake-up call. Now, it’s completely gone. N=1 and all, bit it’s amazing how eating real food can completely reverse such a debilitating condition.

    Great to see NuSi tackling this and really looking forward to reading more.

    (reply)
    • Peter Attia  January 14, 2015

      Jeff, what an amazing coincidence to wind up on the same flight. I’m humbled by your personal journey and honored to have been a small part of it. Hope to you next time flying the friendly skies.

  25. Terri High  January 14, 2015

    Congratulations on that beautiful boy!
    You and your family are always and forever in our hearts and prayers.
    Sending love from Maryland.
    Mark Edmunds & Terri High

    (reply)
    • Peter Attia  January 14, 2015

      Terri, so great to hear from you. I was *just* telling Mark’s story to friend a week ago. Still gives me chills. You, too, are often in my thoughts. (Talk about a podcast story!)
      Give Mark my best, also.

  26. Colleen  January 14, 2015

    Loved the TF podcast — idea for Round 2 — You have mentioned on the blog your supplementation in the past, have you changed anything? What are your current thoughts on supplementation?

    Great book idea, can you suggest any reading material for the scientifically minded lay person on hormone manipulation?

    Congratulations on your son and thanks for sharing. I always like to hear what you have to say about your daughter as mine is just a little younger — so fun the things they come up with!

    (reply)
    • Peter Attia  January 14, 2015

      Yes, they are so amazing. I’m sure all parents agree…living the world through their eyes is a gift. All points for follow up–yes my supplementation regimen is different today than even a year ago.

  27. Mark McQueen  January 14, 2015

    Your blogs have been missed.. many times when I have a free moment and want to focus energy on myself instead of my work I will bounce over to see if there is something new to absorb and further research. The energy and passion that you have I am sure is spread thin with the addition of the little bundle of joy. It was my 2nd Heart attack with a son 11 months old that made me start caring more about my health and working to improve my odds by eating healthier, but it wasn’t until I started reading your blog that a lasting change happened.

    Since leaning from your blog and applying the knowledge, I have dropped and kept off for a year 40lbs (240lbs down to 200lbs) and more importantly, I have helped educate many other friends and doctors to do the same thanks to the information you have provided via this site eatingacademy.com. Thanks to your efforts to share your information you have given some of us a chance to spend a few more years with our little bundles of joy. For that I thank you and my children thank you. It is bath time now for my little guy.. I will happily go spend some time with him. I hope you get to spend as much time as possible with yours! Congrats on the healthy, happy, beautiful baby and thank you for both your past work and anything in the future you find time to share.

    (reply)
    • Peter Attia  January 14, 2015

      Mark, wow, that’s quite a turnaround. Very happy for you. Heart disease is so preventable…it’s such a tragedy that it’s still the #1 killer in the U.S. Here’s to many more years with your family.

  28. Boundless  January 14, 2015

    On sleep, and probably the life extension thing … do consider, if you aren’t already, the growing “blue light at night problem” (melatonin suppression initiated at the recently rediscovered intrinsically photosensitive retinal ganglion cells {ipRGCs}), if not also the wider “blue light hazard”.

    Those light bulbs in your article banner are tungsten incandescents, now being legislated into history – a win for energy consumption, but a loss for SPD (spectral power distribution). Edison bulb output in the blue range is low. They are being replaced by compact fluorescents (CFLs) and LEDs, which (excepting some quality LED brands) usually have a nasty spike right at the blue wavelengths that screw up melatonin.

    Wearing blue blockers as I type this, I suspect that a non-trivial part of staying healthy (and sighted) longer, is going to have to include making our exposure to light, like our diets, a good deal more ancestral.

    (reply)
    • Peter Attia  January 14, 2015

      I’ve found having iflux on my electronics to be a good help, also.

  29. E Tryfonos  January 14, 2015

    Congradulations on your new baby. As a father of an 8 month girl I find myself struggling to figure out on what is best to feed our little girl. During pregnancy my wife avoided sweets for the most part and she is still breastfeeding, the big question is what else to add. There are all these “bio” products and it seems that it is almost impossible to avoid wheat/grains. Any suggestions? You could add a section called “What Michael Jackson Attia Eats”, that would be helpful. 🙂

    (reply)
    • Peter Attia  January 14, 2015

      Ha ha..I love that title! I don’t feel I have enough insight or authority to produce anything meaningful on what a baby should eat–beyond sharing our limited experience with two–but perhaps that can be a podcast question. Of course, I’m more interested in hearing what others have to say on this topic.

  30. Colby  January 14, 2015

    Congratulations on your new addition! You have two beautiful children.

    As a huge fan of all of your work and of the diet you and Richard Bernstien have led me to, and also as a 24 year type 1 diabetic, I would love to hear you talk (or write) more about entering/maintaining ketosis as someone who injects exogenous insulin. I still can’t wrap my head around which is more true- losing weight because I’m simply not using as much insulin or losing weight because my calories derive mostly from fat. Kind of a “which came first, the chicken or the egg” situation which I’d love to understand better.

    (reply)
    • Peter Attia  January 14, 2015

      Colby, I do know some folks with T1D who have entered and maintained nutritional ketosis (it’s technically not very difficult with no endogenous insulin). But it’s very delicate and I’m not sure it’s idea. More of my clinical experience is with T2D than T1D. Your question is a great one and may be worthy of an entire podcast! Short answer–I suspect both issues are driving your net fat flux OUT of fat cells. In other words, there is feedback and feedforward loop that creates a negative fat balance, which in turn probably reduces your appetite.

    • Michael Belliveau  January 16, 2015

      I am a T1D and “biohacker” and used ketosis to deal with T2D before I realized it was T1 for about 2.5 years. I did produce very little insulin and not quite enough to keep blood sugars low enough.

      I am not nearly as versed in the complexity metabolically as needed to give you a “good” answer and I am not sure anyone is yet. Hopefully work in line with what NUSI is working on changes that!

      In short before and after taking insulin there was a change in weight, my fasting insulin was not enough to keep my sugars low but did keep me from wasting away, I could keep and build muscle and little tummy fat. I gained 10-15 lbs within 2 weeks once I started taking insulin … luckily my body fat % did not really change.

      Possible reason for that is shown here with portal vein insulin release (such as pancreas going through liver first) vs our injection in to peripheral tissue leading to a larger peripheral tissue/circulating insulin levels and for longer than that released by the pancreas/injected into portal vein). http://www.ncbi.nlm.nih.gov/pmc/articles/PMC293132/?page=1 … that could give an explanation for the possibility of the insulin itself leading to weight gain …

      From my experience as T1D N=1 only having used no insulin and then insulin yes there is a difference, ATM I am about 30lbs more than I was pre insulin use (I can raise and drop the weight easily) but pre-insulin I could not easily gain more weight than I had so at minimum the use of insulin injections (amounts used) will alter/raise circulating insulin levels and affect the window with which you can move your weight … less insulin lowers the window while more insulin raises it …. given a similar amount and type of daily feeding/activity.

      Besides that mechanism for weight loss/gain. You are entering into the very questions NUSI is looking in to … I do have some personal experience with that but there are likely too many variables to be of much use here 🙂

      If you read this Peter, man I really dig you and Tim … nice to see guys as extreme (at least) as I am with the personal experimentation.

      No guys 2 month fast can not really help T1D LOL funny though I was able to process food better for a few weeks following that … though that is likely due to the intense need my body had for proteins and glucose to rebuild tissues and basic energy stores … I do not recommend any one try that!

  31. Anders F. Thomsen  January 14, 2015

    Hi Peter,
    Thanks for the blogging you have done over the years, the recent sparcity of posts is quite understandable.
    A longevity book from your hand would be great!
    For the TF podcast part II: I would be interested in hearing you talk about your experience with nutritional ketosis and athletic (and maybe also intellectual) performance in more debth than in part I. Like, what level of ketosis is optimal for which purpose, ect.
    A lovely pair of kids! Thanks for posting.
    Anders

    (reply)
    • Peter Attia  January 14, 2015

      Thank you, Anders, and your questions are noted.

  32. Anders F. Thomsen  January 14, 2015

    that would be “more depth” – english is not my first language..

    (reply)
  33. Norm  January 14, 2015

    Hi Peter,

    Many congrats on the gorgeous Mr Attia! All the best for the future. Podcast is a great idea, loved the one with Tim. Nusi would be the first choice whenever Im able to donate. Would be great if the following could be addressed in the next podcast:

    1. What mainly determines the fuel partitioning in the body?
    2. Oversensitivity of adipocytes to insulin in weight reduced people.

    Thanks

    (reply)
    • Peter Attia  January 14, 2015

      Norm, these are great questions. In fact, I had dinner last night with Steven Smith (scientific director for the Translational Reserach Institute) and we discussed–in excrutiating detail–question #2. It’s a very complicated question, of course, because blanket statements about “sensitivity” or “resistance” don’t factor in the differential tissue responses (e.g., muscle vs. fat).

  34. André Lambert  January 14, 2015

    Peter,

    I would really like to know more about your personal approach to endurance sports, why you train mostly high intensity and what is your opinion about lots of volume and a low heart rate style (Maffetone).

    Please see if you can cover these subjects on the podcast.

    Thank you!

    André

    (reply)
    • Peter Attia  January 14, 2015

      Andre, I’m certainly happy to share my views on this. I’ve experienced and experimented across the entire specturm of training in terms of volume and intensity.

  35. Alec Collins  January 14, 2015

    Thanks Peter.

    Congratulations on your new addition, and it’s good to have you back.

    (reply)
  36. Chris  January 14, 2015

    Congratulations for both of your kids. You are an accomplished man Peter.

    Since I do know that you have a specific passion for details, I’m looking forward to see how you will tackle them in the upcoming podcasts. Did I understand correctly? Peter, are you going to do monologue podcasts? I think it’s a good idea.

    (reply)
    • Peter Attia  January 14, 2015

      I haven’t decided the format yet.

  37. Tony Johnson  January 14, 2015

    Congratulations from Scotland, Peter and a big thank you for all your work. I loved the T Ferris podcast and am very much looking forward to part 2. As a recovering endurance athlete who has really reduced my cycling in the last year, I was fascinated to hear of your admittance that the mental component and rewards of your chosen sport make up for the plain old truth that chronic cardio is something to be feared as one ages. (And I laughed when you admitted your wife’s lack of interest in your http://FTP..) I’ve previously measured my years success on miles ridden and now struggle to quantify my gains, I’m tackling years of lacking cross training, not something you suffer from… One question for your follow up is to do with the biomechanical component of disease which is a field Katy Bowman is exposing, her book Move Your DNA has revolutionised my approach to movement as opposed to exercise and I wondered if you’ve any thoughts regarding that aspect of health? Keep up the good work.

    (reply)
    • Peter Attia  January 14, 2015

      I will check it out. My wife doesn’t know what FTP stands for–and she’s heard me explain it 50 times! But I do love her.

  38. Allen  January 14, 2015

    Congratulations to you and your family! All the best of health and wealth.. God Bless!

    (reply)
  39. Christopher Grove  January 14, 2015

    August 29th??? MJ??? OMG!

    I think, referencing your earlier bemusement at your daughter’s insistence, the gods decided to mess with you a bit. hehe

    I’ll definitely listen to Ferriss’s podcast. I had just listed to his interview of Tony Robbins and was a bit put off that it seemed more of an infomercial for Robbins’ new book and vowed never to listen to another of his podcast’s again (I have Tim Ferriss’s books and Tony Robbins’ books so I know that I don’t really mean it!) 😛

    Peter, you are at least as much of an inspiration as either Tim Ferris or Tony Robbins. Because of people like you, I try to be more and more inspiring myself!

    I was curious as to why the gap in blogs. Now we know and am happy for your family’s good fortune!

    Namaste,
    Christopher Grove
    “Inspiration, not desperation, is what attracts.” -can’t remember who… hmmm

    (reply)
    • Peter Attia  January 14, 2015

      Thanks, Christopher. Very kind words.

  40. Avner Taieb  January 14, 2015

    Hi Peter,
    Give my congratulations to your newborn for having you his father. A small tip, forget your engineering approach when raising kids, it doesn’t work :). Humans, especially kids, don’t meet the specifications. This is why it is so hard to manage people.
    I listened to the TF podcast and enjoyed it a lot, it is a perfect way to spend driving time, so I encourage you to do more. Beside the good ideas that were mentioned here for questions to be covered in the podcast, I am interested to hear on the possible reasons that some people don’t loose weight/fat on low carb diet, and what they can try to do about it.

    Thanks for your blog and for the podcast to come.

    (reply)
    • Peter Attia  January 14, 2015

      Avner, this is a very important and interesting question. I won’t claim to know the answer, but I do enjoy discussion some of the reasons behind this often-observed phenomenon.

  41. Birgit  January 14, 2015

    Congratulations on your son!
    I’m looking forward to hearing more about what NuSI is up to.
    I’m wondering if anyone is publishing research on glyphosate and how it affects human health (diabetes, NAFLD, brain health…) as our government seems to ignore the existing research and not even track it (in the fields, in our bodies, in breast milk, in our food).
    http://healthimpactnews.com/2015/federal-government-annual-report-on-pesticide-residues-excludes-glyphosate/

    Birgit

    (reply)
    • Peter Attia  January 14, 2015

      When I last looked into this question I could not find a compelling case that glyphosate was the root of the problem (or other pesticides for that matter), at least in terms of the overall epidemic.

  42. Shane  January 14, 2015

    Is there any way to see the email that you and Tim refer to in the podcast. Have any thoughts on posting it?

    (reply)
    • Peter Attia  January 14, 2015

      Not at this time, Shane. Besides, it’s reallllllly long.

    • Sean  March 4, 2015

      No, we all need to $$$ support the good doctor when he rolls that looong email into a book 🙂

  43. AJ  January 14, 2015

    Hi Peter and subscribers!

    Just found this blog today and after reading Gary Taubes’ book. Really exciting stuff. Looking forward to learning lots.

    Can someone point me to a link that teaches you how to ensure you’re in ketosis (or actually even getting into ketosis for that matter) without having to measure blood BHB? I know ketostix is unreliable because of the type of ketone measured.

    Many thanks

    AJ

    (reply)
    • Allison  January 16, 2015

      Hi,

      I found it impossible to confirm that I was in ketosis without blood testing (the Ketostix are indeed pretty useless). The meter is not expensive, but the test strips are ridiculous. I order mine online from a site in New Zealand (I think), where they go for $2 apiece instead of $6 apiece as in the US. I test twice a day. If you tested once a day, it would run you $60/month. Not cheap, but for me the cost is worth it to monitor my health. You could also use them briefly, for a month or two, just to make sure you’re hitting your targets. I get my best test numbers right before dinner (you might as well get the most bang for your buck). If you want the link to the New Zealand site, email me at al@davepmiller.us.

    • Peter Attia  January 18, 2015

      They are getting cheaper in U.S., I’ve noticed in the past few months. Getting very close to $2/strip again. But still…that’s an investment.

    • AJ  January 19, 2015

      Thanks to both of you for the kind info.
      AJ

  44. Emma  January 14, 2015

    Hi Peter, congratulations on the birth of your son, he is a wee smasher!

    You mentioned in your 2012 post “what I actually eat: part 2” that you were looking into probiotics and their impact on health. Is this still something you are looking at? I make milk kefir and kombucha which have made a huge positive difference to my digestion ad overall health, after years of problems with IBS, candida and autoimmune disease. I am interested in your view on gut health as it seems to play such a crucial role in immunity and well being.

    Looking forward to your book, and further postings/podcasts!

    Emma

    (reply)
    • Peter Attia  January 14, 2015

      Yes, I do use a probiotic and have experimented with several. Probably a good discussion for a podcast. Thanks for brining it up.

  45. JA  January 14, 2015

    In the second podcast, it would be great if you could discuss more actionable items that we can do each day (diet routines and fitness routines) to maximize health and well being. With the detailed level of research you do, it’s easy for readers to get lost in the details, so some summarized plans would be helpful. I’m sure this will be in your book also, can’t wait!

    (reply)
    • Peter Attia  January 14, 2015

      Fair point, JA, but it must be juxtaposed against the nuance of what we’re talking about and the constant amount of optimizing one must do and trade-offs one must make to determine individual steps to achieve these goals. But I think I can certainly speak from experience a bit more.

  46. Oded  January 14, 2015

    Mazal Tov!

    (reply)
  47. Richard King  January 14, 2015

    Lovely kids. But just wait till they grow up! (Just kidding, they’ll be worth every minute of time you can spend with them.)

    I have to confess to being somewhat less enthusiastic than most about podcasts. The trouble is, an hour-long podcast takes an hour to listen to, and there is nothing that can be done to speed that up, whereas with a text document you can skim it, skip over bits that are too detailed if there’s a lack of time, easily flip back a few pages if you need to refresh your memory about what was said, etc. For me, spare time is my scarcest commodity.

    But I don’t want to imply that you shouldn’t proceed with the podcasts, just thinking aloud that I’ll have to find a way to actually listen to them. My problem, not yours!…

    (reply)
    • Peter Attia  January 14, 2015

      Yup, I hear you, Richard. Maybe I’ll try to make really short ones.

    • Kerok  February 2, 2015

      Richard,

      Many “Podcatchers” (Podcast phone apps that help you download and manage podcasts) have the ability to listen at variable speeds (up to 3x in some cases).

      For the iPhone, “Overcast” has a custom audio engine that processes the voices so they have minimal distortion even at 2x, as well as removing gaps of no audio. It is free for the basic version, as well as testing of these more advanced features. If you want the advanced features, it is a $5.00 upgrade. Well worth it in my opinion as a satisfied user. I have no relationship with the developer.

      My congratulations to Dr. Attia and his family. All the best!

  48. Esther  January 14, 2015

    Congratulations, Peter! I second Andre’s question about training volume and intensity. Am also curious to hear about your experiences regarding the variability of responsiveness to carb restriction in improving metabolic markers and weight loss among those you’ve helped. (For example, I recall you saying that about a third of people do an isocaloric swap, a third eat less (because their fat cells are freeing up more fuel for their body to use), and a third eat *more* when they restrict carbs. I realize your sample is (relatively) small, but would love to hear any patterns you’ve observed in the people you’ve helped. Thanks and congrats again!

    (reply)
    • Peter Attia  January 14, 2015

      I think as my sample size has increased and the copmlexity of cases I’ve seen has increased I would say the numbers probalby lean more to folks eating less (without hunger). But I’ve also seen how much more complex the problem is is a large subset of the population.

  49. Mark Donaldson  January 14, 2015

    Podcast Part II question:
    I’m interested in fatigue (and how to avoid it!)
    You guys referred to “all day pace” at one point, citing a 65% effort level, and how you might be able to keep that up for 10-12 hours.
    Essentially, I’m interested in what it is that is preventing me from running all day, i.e. 24 hours. If what I think of as the three basics are taken care of – fuel, electrolytes, and hydration – and barring mechanical failure, what is preventing someone from running an all-day pace all day?!

    (reply)
    • Peter Attia  January 14, 2015

      Well, I don’t want to suggest one can run/bike/swim at 60-70% of VO2 max out of the gate–it certainly takes time to become conditioned to it. But having “crewed” and coached many athletes in 12-24 hour (and longer) races, I would say that fuel partitining makes the short list of things that get in the way of success.

    • Mark Donaldson  January 14, 2015

      Thanks for the teaser answer. I have run that far/long in the past, and am preparing for other efforts – one being a 24 hr race the end of this year – and am trying to dial in as many of the variables as possible. It’s all a very interesting puzzle. I haven’t gone down the ketosis road yet, and suspect that would help, but doubt it’s a magic bullet. As long as I’ve been doing these ultra-distance races, it’s still such a mystery to me why I feel the way I do after 10 hours or so. Fuel? check. Electrolytes? check. Hydration? check. So why is it so much harder at hour 14 than it is at hour 4?!?

  50. Mike  January 14, 2015

    A podcast topic I’d be interested in hearing more about is your stress reduction journey. There doesn’t seem to be much we can do besides just not attempting to get done all I want to get done (and getting enough sleep and exercise).

    Meditation seems difficult for the reasons mentioned in the podcast and I’ve experimented with using heart rate variability and breathing exercises to get some sort of metric to guide me. I can really relate to what you expressed in the podcast. this just seems harder than it should be.

    As if work and family aren’t enough responsibility, I’ve had to reinvent the way I eat and live from scratch because something as basic nutritional science is so poor I can’t trust my doctors (or government) and I have to research this on my own. You sharing what you have investigated gives me a head start on figuring out what’s best for me.

    (reply)
    • Peter Attia  January 15, 2015

      Ah, you’re going after my weaknesses! Definitely happy to share my experience.

  51. Beth  January 14, 2015

    I chanced upon your blog whilst trying to research Crohns and the Paleo diet. I have Crohns and my diet was heading in that way whether I liked it or not due to not tolerating so many foods..My usual gastroenterologist is sceptical that diet has much influence beyond either Elemental – a complete drink that contains all you need, supposedly. And current ‘healthy balanced diet’. Digging deeper in my research I kept coming back to very low carb diets as a way of decreasing inflammation. The marker I was interested in is TNFalpha as that’s what the drugs, like the Humira I’m on, reduce, or inactivate. A few short term studies noticed it almost as a side effect and said it should be revisited as something to look at for Crohns, MS, and similar auto-immune diseases.
    Taking the plunge into ketosis, as an experiment for 3 months maybe – you can see where this is leading… It’s made such a huge improvement to everything about my health that it s no-longer a wacky experiment into the realms of quack diets (if you believe the headlines of tabloid newspapers in the UK), because I have nothing else to try that looks even half as plausible. But it is for life. A complete lifestyle change.
    So this is a plea that as well as studies and research into diabetes, insulin resistance, etc, that you are also looking at the wider picture like Crohns and MS, because as another gastroenterologist I saw recently said referring to diet and research: there’s no money in it so it isn’t going to happen.

    Thanks for your blog. And congratulations on the new rugrat!

    (reply)
    • Peter Attia  January 15, 2015

      Beth, that’s great to hear. Of course, the million dollar question is what factor or factors in your dietary change led to your improvement?

    • Beth  January 15, 2015

      I think the biggest single effect, so far, was dropping wheat completely. Improvement seemed to plateau after a few weeks but I was still eating other carbs. So I looked at how to continue improving as it felt like I was moving in the right direction. Dropping the other carbs, rice, sugar – not that I was having much, and tweaking my diet to get into ketosis is making gradual continued improvements. My goal is to utimately to come off Humira, which a year ago was unimaginable. I was then injecting every 10 days and needing it badly, now I’m at 21 days interval and happily symptom free. Blood tests show CRP still down at 4 – where normal is 0 – 6 here. And I’m able to eat more foods I couldn’t before without issues.
      There’s something to this, but as you say, I don’t know which particular bit. I’m not the only Crohnie to find this as in my research I’ve found others finding the same. I just don’t know how to put this out there to help other folks without sounding like a nut-case! going against all current dietry advice.

    • Peter Attia  January 15, 2015

      In the N of 1 case (you), of course, the net result is all that matters. In thinking how to apply to others, that’s where the “why” becomes more interesting.

  52. Hakim Hakim  January 14, 2015

    Podcasts are great and your a great speaker so should be good!

    Do you have any articles or books to recommend on hypothyroidism and low carb. Hard to find anything on this?

    And about the concept of feelings of euphoria when having elevated levels of Ketones. Saw something about BHB and GHB being linked as a possible hypothesis.

    http://www.ncbi.nlm.nih.gov/pubmed/17011713

    (reply)
    • Peter Attia  January 15, 2015

      The issue really isn’t about low carb, it’s about weight loss, but it’s a topic worth discussing.

    • Hakim Hakim  January 15, 2015

      Any blogs articles books you can point me to in the thyroid issue.

      Low carb/ketogenic diet that can lead to weight loss healthy living for people with thyroid issues. Or is that lifestyle not conducive to those people.

    • Peter Attia  January 15, 2015

      I haven’t found much in the blogosphere that captures this. My education is more in the thyroid literature and clinical experience. Not to say it’s not out there, but I’m not a good reference for where.

    • Boundless  January 15, 2015

      > … hypothyroidism and low carb.

      The 2014 book Wheat Belly Total Health might be a place to look. Dr. Davis, the author, is himself hypothyroid. The WB diet recommendations are presently right at the glycemic/keto border (in my opinion). There are multiple page references for hypothyroid in the Index (which is visible in the Amazon look-inside feature).

  53. Ron  January 14, 2015

    Congrats on the new arrival and I don’t envy that you now have another important priority requiring your love, attention and of course time – the one thing in all of our lives that is finite in supply and unlimited in demand.

    I am excited to hear that you are tackling longevity as a longer term personal project. I have been a fan of Dr. Perlmutter since I first read his book Grain Brain and have adopted many of his strategies for what he refers to as “modifiable lifestyle factors” which contribute to or even cause devastating diseases such as Alzheimers.

    This is probably a profoundly obvious point that longevity alone is necessary but insufficient to what matters most to us as social animals. Longevity must be accompanied by both physical (ie. strength + mobility) and mental (ie. brain) function which can support the type of activities that one desires to be doing as they age – whether at 50 or 80 or beyond.

    Peter this seems like a perfect fit for someone with your skill and intellect to look for an integrative approach to body and brain health science so that the research in both fields can be combined to build guidance on nutrition and training aimed at optimizing x (x=quality of life as we age or whatever outcome would be desired).

    Keep up the great work and best of everything with the new baby!

    (reply)
    • Peter Attia  January 15, 2015

      Very good points, Ron. I agree that purpose, engagement, and quite likely social support are necessary to maximize a high quality lifespan.

  54. Matt  January 14, 2015

    Great ideas Peter.

    I love the idea of a podcast, although your writing has a certain rigor to it that might be hard to replicate in audio form. Thus, looking forward to the book. As a researcher at The Buck Institute for Research on Aging, we take a very basic look at the question, almost exclusively in model organisms. One of the problems with this approach is whether or not the work is translatable to a much more variable organism, ie humans. So a few potential questions/ideas that I am interested in seeing explored.

    How do scientists/doctors/ourselves deal with human variation in the response to the same stimulus (diet, exercise protocol, etc)? and is personalized medicine feasible?

    How do we effectively self test/experiment on ourselves? and what are the major caveats to doing self experimentation and testing?

    If you were Calico, what direction would take your aging research program? Discovery? Interventions? Animal models?

    Lastly, while we use death as our marker of aging in model organism studies, what do you think is the best marker of “physiological” age in humans? This recent paper in J Physiology is related to this question http://onlinelibrary.wiley.com/doi/10.1113/jphysiol.2014.282863/abstract

    Looking forward to seeing your perspective on the aging literature and how it translates to humans.

    (reply)
    • Peter Attia  January 15, 2015

      This is probably 7 podcasts worth of Q&A! I have lots of thoughts on your questions, including what directions (plural) I would pursue if I were running Calico. In short, my framework would be a two-fold parallel approach where segregation is by timeline, not function/pathway/modality.
      Path 1 is stuff that can matriculate in the next decade; path 2 is stuff that is more likely to matriculate 2-3+ decades out. Within each pathway are multiple approaches.

  55. JD  January 14, 2015

    I wanted to echo my congratulations on the little man. A quick question: have you ever though to investigate the effects of a ketogenic diet on mental illness? For instance, I know that a ketogenic diet can be prescribed for children with treatment-resistant epilepsy. Many of the drugs used to treat mental illness are anticonvulsants.

    The ‘gold standard’ for Bipolar II is Lamictal. I know that I am making a jump here, in regard to any possible mechanism(s) of action, but there seem to be one or two studies that support the idea. The thought of nutritional ketosis healing the mind and body is a nice one. I just figured I’d put it on your radar if it wasn’t there already. Thanks again, for all of your hard work!

    (reply)
    • Peter Attia  January 15, 2015

      It’s a good question, JD, and I’ve seen/heart/read a lot of anecdotes across the spectrum of neurological and psychiatric illness, but it’s not something front and center on my radar beyond neurodegenerative diseases (e.g., AD).

  56. Birgit  January 15, 2015

    I want to second the idea of covering the topic of probiotics in a podcast that was mentioned above. This goes together with the topic I mentioned, the effect of glyphosate on gut bacteria from chronic more than short-term, exposure. I have hopes that damage to our gut-biome can be repaired with probiotics assuming the offending ingredients can be eliminated (for me that is all grain, legumes, non-organic produce and factory-farmed animal products). Whether this damage comes from glyphosate or from gluten or sugar I really don’t know, but I’m beginning to suspect that all play a role in causing inflammation.
    I’m exited about the idea of a podcast and I would not mind even very long ones as I love to hear your thoughts. I would love to hear what you have to say on insulin-resistance (of muscle cells, fat cells, liver cells).

    (reply)
  57. Justin  January 15, 2015

    Congratulations on the new addition to your family!!

    In the podcast with Tim Ferriss you both talked about your issues with meditation. I was wondering, have you ever tried “Box Breathing?” That is something I got from Ben Greenfield. I’d also tried everything to no avail and this works really well for me and it’s really simple.

    http://boxbreathing.org/

    I’d also love to hear a podcast from you. I think it’s a great idea and if you can find the time, do it!

    (reply)
    • Peter Attia  January 15, 2015

      Thanks, Justin. I have tried that. I’m currently working on TM, but always open to exposure to other techniques.

    • Naren  January 16, 2015

      TM as in Transcendental Meditation? How do you like it so far?

  58. Caroline  January 15, 2015

    Beautiful children! Thanks for sharing. Good to hear from you. Hope you can manage to not do too much so as to spend time with your family. Always a difficult balance.

    (reply)
    • Peter Attia  January 15, 2015

      Indeed…I’m sure many readers are in the same boat.

  59. Marina  January 15, 2015

    Your girl has grown up so much! Congratulations and I’m glad you’re getting some time off this blog for your family:) reminds me no to obsess too much over what the rest of my family are eating and ruin precious family time haha .. Such a special time for you as they grow up so quickly! Thanks for the update. Another exciting new year!

    (reply)
  60. Kirk  January 15, 2015

    Congratulations on the expanded family!

    The whole start of your post nicely illustrates many people’s problem. I teach Time Management and productivity to organizations. Most students tell me they they don’t have time to get everything done and usually steel time from sleep. I relay to them that current studies point to the average person needing 7-8 hours of sleep to be able to work at peak productivity. Less sleep typically results in reduced productivity, poor judgment, and declining health. So if you want to accomplish more, one of the easiest things to do is get more sleep.

    I am glad to see your blog again. I enjoy your posts on metabolism, had how our body stores and uses energy. I am looking forward to the coming year.

    (reply)
    • Peter Attia  January 15, 2015

      Couldn’t agree more. I work fewer hours today, given my desire for 8 hours of sleep most nights (I say this on the cusp of a few nights of much less), but when I do, it’s better work.

  61. Marco  January 15, 2015

    Wow, congratulations!!!

    (reply)
  62. Zach Morris  January 15, 2015

    Doc,
    First, congratulations on the second addition to the family! I’m happy for you! That, and the longevity and anti-aging book seem fascinating, I’m really excited to read that, and any information you can share with us.

    Second- I want to make myself available for helping with the production of your podcasts. I would be happy to record, interview, edit or do anything else that might make it easier and faster for you to share your share insights and commentary. I’m not a doctor, but I’ve read everything that you have written.

    Third- My father is on a low-fat vegan diet, with the hopes of reversing heart disease. My father looks at heart disease in a very particular light- as if clogged arteries are distinct from the overall markers of healthy body, like that one can have good cholesterol levels, triglycerides and insulin sensitivity, but still have clogged arteries. Anyway, You haven’t (to my knowledge commented on this very specific topic. Could you point me in that direction? It may seem kind of trivial, but I’m of the mind that there many people of my parents age that are concerned about this specific aspect of general due to heart attacks and what not, that may be guided towards vegan based programs, because they are supposedly guaranteed to “reverse heart disease”

    Thanks man, you are doing some incredible stuff!

    (reply)
    • Zach Morris  January 15, 2015

      Sorry man I got a bit anxious to turn in my comment without quit finishing that last part.

      *Anyway, You haven’t (to my knowledge) commented on this very specific topic. Could you point me in that direction? It may seem kind of trivial, but I’m of the mind that there many people of my parents age that are concerned about this specific aspect of health due to fear of heart attacks and what not, that may be guided towards vegan based programs, because they are supposedly guaranteed to “reverse heart disease”. That’s what happened to my parents anyway. It would be cool to hear any ideas you or explanations for the formation of plaque that you have. *

  63. Guido Vogel  January 15, 2015

    Congratulations with the birth of you son! I am looking forward to more content coming. It’s been the corner stone of my lifestyle changes.

    However, written stuff is much easier to reread, restudy and to quote from than podcasts. So it would be much appreciated if talk can be transformed to text (don’t know if any automated tools are available for that) and be posted on your blog somewhere.

    (reply)
    • Peter Attia  January 15, 2015

      That’s another interesting idea.

  64. Andrew  January 15, 2015

    Peter thanks for your work thus far. You blog has been instrumental in helping me turn around my own life.

    I’ve dropped 45lbs since I discovered your blog in July. Now I’m an avid blood tester, experimenting with exogenous ketones, and loving life (those ketones don’t provide any enjoyment–you sure didn’t exaggerate when describing the taste). Your back catalog has kept me entertained and motivated. I look forward to your work with NUSI, and will donate in the upcoming year. Thank you for your time and effort, it is literally helping change lives.

    (reply)
    • Peter Attia  January 15, 2015

      Thank you so much, Andrew. Glad you’re digging the exogenous ketones. Luckily they don’t sell the worst of them (which I have at home just for a parlor trick with unsuspecting dinner guests).

  65. Jim Kennedy  January 15, 2015

    Congrats on the beautiful children. Thank you for all your efforts on scientific information and research. I listened to the podcast with Tim Ferris. and just darn fascinating. It is surprising how little we understand about the effects of nutrition on the body. I love the quote about telling someone they are fat because they eat more calories than they expend is a s useful at saying Bill Gates is rich because he earned more than he spent. It hits the nail on the head.

    Training for a 50 mile trail running race in July – last year I missed the cut off at mile 30, the heat got to me 93F, – trying to feed my body correctly from now until then. (improve my lean body mass to fat ratio also doing a lot of MAF training )

    Thank you for your work.
    Jim

    (reply)
    • Peter Attia  January 16, 2015

      I can’t take credit for that one, Jim. I heard someone else say it once. I just can’t remember if it was Gary Taubes or Mark Friedman (NuSI’s VP of research).

  66. Richard  January 15, 2015

    Congratulations! I am so happy for you and your family. Peter you are making a difference. It is so hard to know what to believe when it comes to nutrition. Your advise led me down the right track. I scored an A+ on my recent health screening and I feel great. I owe so much of it to you.

    (reply)
    • Peter Attia  January 16, 2015

      Thank you, Richard, and congrats on your success.

  67. Christopher Kelly  January 16, 2015

    Hi Peter, congratulations! I too *really* enjoyed the podcast with Tim and absolutely you should do more. I’m a computer scientist partnered with a medical doctor and a food scientist, and together we run a new functional medicine practice. I already produce two podcasts and would be over the moon if you’d join me as a guest on mine: http://www.nourishbalancethrive.com/podcasts/nourish-balance-thrive/

    Additionally or alternatively I would love to be your co-host for your own show and do the heavy lifting, e.g. setting up iTunes, audio editing, getting transcriptions done.

    (reply)
    • Peter Attia  January 16, 2015

      Thanks, Christopher. Send me an email through contact form. I haven’t yet actually processed the logistics of doing podcasts.

    • Christopher Kelly  January 22, 2015

      Hi Peter, I sent my email in via the contact page a week or so ago, it’s chris@nourishbalancethrive.com

      If you can spare me a little time for an interview I’d be over the moon! I can make the scheduling really easy using this link: https://www.scheduleonce.com/nbtresults

      Or just let me know when you have time and I’ll make it work.

      Many thanks!

  68. Lee  January 16, 2015

    Since you seem extremely busy but like the idea of having a book, a guy named Tucker Max came out with a service called “Book in a Box.” It is expensive (15 -25k), but his service allows you to work with a professional editor and team who, after a 9 hour interview, help create your book. It’s a neat idea for those that don’t have time to write a non-fiction book, as it is a great way for you to get your first book out there. I believe that Tim Ferriss has used Tucker Max before in the past for his books (but as book marketing and only after Tim finished his first). So you may want to ping him about this idea. You can also check out one of his poodcasts on this subject (Ep 80 Tucker Max – James Altucher). http://www.bookinabox.com. Just an idea…

    (reply)
    • Peter Attia  January 16, 2015

      Lee, I’m such a control freak…it would never work for me. I’m sure they are good, but the amount of nuance I obsess over…I’d end up re-writing the entire thing any way.

  69. Svetlana  January 16, 2015

    You do still exist Peter! Was beginning to worry you disappeared for good.
    Congratulations on the family, they are just lovely.
    Thank you for all the work. I have learned a lot and keep rereading your work to get motivated when carbs sneak up on me.
    I can’t wait to see what Nusi will discover. I check often to see if anything new is published/posted.
    Best wishes on everything. Make sure to spend time with family. Will you be teaching your son the Tire Flipping tricks?

    (reply)
    • Peter Attia  January 18, 2015

      Ha ha…not sure if the little man will become a tire flipper.

  70. Allison  January 16, 2015

    Congratulations on your son! I was rather hoping it was something like that that was preventing you from blogging much. You reminded me of how when I was pregnant with our second son, his older brother insisted that he would be named Reginald.

    Two thumbs up for a podcast. Your site has been a huge inspiration to me, as I’ve been following Tom Seyfried’s diet for a year in older to control cancer. I think I speak for all your readers when I say welcome back, we’ve missed you!

    (reply)
    • Peter Attia  January 18, 2015

      Thank you, Allison. Hope Reginald is doing as well as Michael Jackson.

  71. Robert  January 16, 2015

    The podcast was great. Glad to hear from you again. Thanks

    (reply)
  72. Kenny Sabarese  January 17, 2015

    in the Tim Ferris podcast part two I would like to hear about muscle gain on a low carb diet when lifting weights. Power lifters swear by carbs and no one seems to address this in the low carb community.

    (reply)
    • Peter Attia  January 18, 2015

      Ok, thanks for bringing up.

    • Hemming  January 20, 2015

      My own experience powerlifting on a very low carb diet is that I’ve been able to build muscle and I’m tempted to say, lean out a little bit. Obviously, I can’t know if the muscle and strength gains would have been equal on a carb based diet. Moreover, my training has been focused on powerlifting, not bodybuilding. Low carb might be more effective for strength and less for muscle or there might be no difference. My point is that its possible to build muscle and strength on a low carb diet – the question is the rate of improvement vs. a carb based diet. Secondly, you could talk about health benefits etc.

    • Kenny Sabarese  April 9, 2015

      You mentioned this in the follow up podcast but I should have been more specific.

      For hypertrophy you said you need carbs. But for strength you mentioned that you might be sacrificing strength, so if one is focused on strength, not size, like for powerlifting, must you consume carbs? Can you just spike insulin with whey protein? Should you just go with lots of protein? Does it matter if you are KETO or not?

  73. Steve  January 17, 2015

    You have good taste in podcasts…. EconTalk might be the best one in the business. I bet Russ Roberts would be interested in having you as a guest, actually.

    I think a lot of people who read this blog would particularly like the episodes with Jim Manzi:

    http://www.econtalk.org/archives/_featuring/jim_manzi/

    (reply)
    • Peter Attia  January 18, 2015

      Steve, if you know Russ and want to suggest it… He’s a great interviewer.

  74. Ben  January 17, 2015

    Hey Peter, I really enjoy reading your blog posts and your take on nutrition. I just have one question, what do you think the environmental impacts of eating meat are? From some information I have learned, eating meat is one of the most harmful things we can do to our environment. By promoting a diet that involves meat and dairy, don’t you think that it will harm the environment? I personally eat a lower carb diet, but manage to do it as a vegetarian, and I have found it to work wonders. Here are some studies to throw your way: http://www.ers.usda.gov/topics/farm-practices-management/irrigation-water-use/background.aspx
    http://www.fao.org/ag/magazine/0612sp1.htm
    http://www.epa.gov/climatechange/ghgemissions/global.html

    (reply)
    • Peter Attia  January 18, 2015

      This is a tough question, and not one I will pretend to know the answer to. I’ve seen reasonable discussions on both sides of this debate. I’ve also seen (a greater number of) idiotic arguments on both sides. I’m fixated on a different question, though.

  75. KelleyB  January 18, 2015

    Congratulations to you and your wife and daughter on the handsome new addition to your family! Wishing you all the best.

    From your response to Beth, above:
    “In the N of 1 case (you), of course, the net result is all that matters. In thinking how to apply to others, that’s where the “why” becomes more interesting.”

    This touches on a major area of inquiry for me (by “inquiry” I mean study + contemplation) in my quest to improve my critical-thinking skills. I’m trying to formulate an answer to the question “what value does anecdotal evidence have?” As you know, much of “alternative” medicine relies on testimonials and anecdotes to buttress its claims rather than on rigorous clinical testing. Yet I encounter over and over (on so-called “skeptical” websites) the statement that anecdotes aren’t valid is scientific evidence. Still, no one argues with the notion that making observations of individuals is the basis of forming a hypothesis that can be tested. And self-experimentation has a respectable history in the advancement of medicine.

    Peter, you seem to have this question settled for yourself: you have been called a “relentless” self-experiementer, yet you also know the importance of well-designed and well-executed scientific research. I would welcome–from you and from readers of this blog–being pointed in the direction of resources that will help me answer this question.

    Also: I’ve committed to this journey (working on sharpening my critical-thinking skills) thanks in large part to this website, especially the post you made last May about “why we’re not wired to think scientifically.” That essay had a profound effect on me. Thanks.

    (reply)
    • KelleyB  January 18, 2015

      Correction 3rd paragraph of my comment: “…anecdotes aren’t valid AS scientific evidence.” (I’m an editor, so I can’t resist correcting my errors. 🙂 )

    • Peter Attia  January 18, 2015

      Very interesting question, Kelley, and probably worthy of an entire post. Medical history–as recently as the last few decades–if full of examples of self-experiments or N of 1s changing the course of history. Think about the story of Barry Marshall and Robin Warren.
      At the risk of over-generalization, these anecdotes provide the substrate to the reaction of scientific change.

    • Boundless  January 19, 2015

      re: “what value does anecdotal evidence have?”

      If it’s your anecdote, confirmed by isolated challenge testing, it’s all the conclusive proof you need.

      If it’s anyone’s anecdote, and is credible, it can falsify a hypothesis to the contrary. Invested advocates of the false hypothesis, of course, routinely fail to recognize this. The classic case is the patient who is egregiously noncompliant with the prescribed consensus diet, and presents to the MD with all symptoms resolved and no need for meds. Such a patient can expect no curiosity about what they did, and gets instead the vacuous “keep doing what you’re doing”.

    • KelleyB  January 20, 2015

      Boundless: thanks for your response.

      “If it’s your anecdote, confirmed by isolated challenge testing, it’s all the conclusive proof you need.”

      Are you speaking somewhat tongue in cheek? As in, “this is what most people assume (that ‘conclusive proof’ has been established) even though it may or may not in fact technically ‘prove’ anything at all”? Or are you speaking genuinely?

  76. Brandon  January 18, 2015

    Glad you haven’t left us. First off, congratulations on Michael Jackson, that was priceless! Now for some personal experience. I am in my first year of medical school and just had my lectures on nutrition. It was quite entertaining to say the least. I sat in my seat chuckling as I heard the lecturer rant about how saturated fats are a pure evil. I have to say, it feels a little ridiculous for me to be the sole advocate for dietary fat in a class discussion on how saturated fats are awful. For some reason my opinion doesn’t hold as much weight as the Heart & Stroke Foundation’s or every other heart healthy guideline out there, for that matter. I am curious, how would you interpret recent studies like the one below that still support minimizing dietary saturated fat by swapping them with monounsaturated or polyunsaturated fats?

    http://onlinelibrary.wiley.com/store/10.1002/14651858.CD002137.pub3/asset/CD002137.pdf?v=1&t=i52shbvv&s=a298e4dde58ff65a6fcfb56a326e9723d7b82fdc

    (reply)
    • Peter Attia  January 18, 2015

      Take a look at my talk on SFA and pull the recent papers on SFA vs. MUFA vs PUFA. This is one of them: Chowdhury et al. Ann Int Med, 2014;160:398.
      You’re gonna have to be the voice of reason in that class!

  77. Lydia  January 18, 2015

    No one should feel obliged to keep up a blog. We are all interested but we all know what pressures everyone is under (writing as a full time working mother of 5 and lawyer……. hardest time of my life was when we had 3 children under 5 years and both worked full time. Dead easy now they are teenagers and older).

    Anti ageing is fascinating. My brother, a doctor here in the UK, says the best indicator is your genes (i.e. age your parents die) which is probably true on many studies, but I am an optimist so I pick my mother’s few relatives who lived to 90 and say so shall I and my sister the huge pessimist probably quite sensibly says she will deteriorate and then die in her 70s like our parents (although in m mother’s case that was caused by smoking). I am sure eating less helps and exercise.I eat pretty much all paleo and only drink water and do bikram yoga. I am never ill and never take any pills.

    . In the UK a lady of 114 who was born in the era of Queen Victoria and lived under 6 monarchs has just died. She never drank nor smoked, but she danced all her life. That movement , getting out of breath, regular exercise, I am sure had an impact on the length of her life and we all know about those people eating 800 calories a day to live to 130 although probably don’t want to be quite as restrictive. Be wild in a sense and you will be well. I bought an island in Panama and we had ten lovely years of holidays until I sold it last year – not luxury holidays but survival, jungles, wildness, sun, sea, catching crabs etc.

    So post when you can. Many of us really appreciate it – intelligent useful postings gratefully received.

    (reply)
    • Peter Attia  January 19, 2015

      Lydia, your brother is right–genes trump anything else. Of course, that’s a not particularly helpful statement, since we don’t really even know what it means (e.g., which genes?, how to reproduce their effect?). That said, I prefer to focus on modifiable ways to increase lifespan (in duration and quality).
      And thanks for understanding my post-frequency issues.

    • KelleyB  January 20, 2015

      I’m reading Atul Gawande’s book Being Mortal, and last night came across this paragraph in Chapter 2:

      “It turns out that inheritance has surprisingly little influence on longevity. James Vaupel, of the Max Planck Institute for Demographic Research, in Rostock, Germany, notes that only 3 percent of how long you’ll live, compared with the average, is explained by your parents’ longevity; by contrast, up to 90 percent of how tall you are is explained by your parents’ height. Even genetically identical twins vary widely in life span; the typical gap is more than fifteen years.”

    • Peter Attia  January 21, 2015

      Atul took this passage, almost verbatim, from a 2006 article in the NYT by Gina Kolata: http://www.nytimes.com/2006/08/31/health/31age.html

      Life spans, says James W. Vaupel, who directs the Laboratory of Survival and Longevity at the Max Planck Institute for Demographic Research in Rostock, Germany, are nothing like a trait like height, which is strongly inherited.
      “How tall your parents are compared to the average height explains 80 to 90 percent of how tall you are compared to the average person,” Dr. Vaupel said. But “only 3 percent of how long you live compared to the average person can be explained by how long your parents lived.”
      “You really learn very little about your own life span from your parents’ life spans,” Dr. Vaupel said. “That’s what the evidence shows. Even twins, identical twins, die at different times.” On average, he said, more than 10 years apart.

      I’m not sure I agree with this assertion that genes are not very important in determining longevity. I think he’s taking this quote out of context. Just because identical twins die 10 year apart doesn’t mean their genes aren’t a major driver of longevity. If they die at 47 and 57 I’d say, odds are, they have bad longevity genes. Conversely, if they die at 87 and 97, I’d guess they have great longevity genes.

      Your parents matter a lot when it comes to your lifespan. But that doesn’t mean you can’t do a boatload to override (or enhance) bad (or good) genes.

  78. Chelsea  January 19, 2015

    Hi Peter,

    I am wondering, is it normal to have an oil slick/film on top of my urine in keto? (apologies for the grossness but i don’t know how else to describe it). My urine is clear, not milky or cloudy or anything like that. I’m 21 so i don’t think i could be having any kidney disease either. I checked the net and some said it’s the excretion of fat?! ( sounds quite incredulous to me)…hence the confusion. Do you happen to be able to enlighten my confused soul on this.

    Thanks alot Peter. I tremendously enjoy reading your blog.

    (reply)
    • Peter Attia  January 21, 2015

      Could be seen with stool, but I don’t see how with urine.

  79. Chelsea  January 19, 2015

    By the way just to add on, i notice this oil slick thing only when i’m doing keto.

    (reply)
  80. Alexandre  January 20, 2015

    Dr. Attia, congratulations on your newborn son and excellent work. May I suggest that you tackle the link between high insulin levels and the incidence of glaucoma? The two seem to be associated (see http://www.ncbi.nlm.nih.gov/m/pubmed/15651065/). I wouldn’t have suspected it, but after one year in ketosis I went for my regular eye check up and… surprise! My intraocular pressure, which has been borderline high for several years, is now comfortably safe. My eye doctor didn’t have a clue about how my diet may have helped, and I couldn’t find much written about it either. Since glaucoma is one of the leading causes of blindness worldwide, if a LCHF diet can help prevent it the world must know about it!

    (reply)
    • Peter Attia  January 21, 2015

      I did not know about that link. I wonder, though, if this phenomenon is limited to a (small) subset? Seems unlikely–though never impossible–that this would be missed if the relationship was strong. That said, and keeping in mind that I haven’t read the paper, you want to always look for an associate that isn’t especially causal. E.g., high insulin accompanies a lot of other things, some of which may be driving glaucoma.

    • Alexandre  January 22, 2015

      Well, a relationship between obesity, metabolic syndrome and intra-ocular pressure (IOP), which is a strong risk factor for glaucoma, has indeed been noticed before. Digging further for associated factors, as you suggest is the way to go, the authors of the paper found a link between insulin levels (HOMA-IR) and IOP that may help explain the previously noticed relationships.

    • Rob Coberly  February 3, 2015

      Re glaucoma, this is a review and speculation but I hope it will be of interest. There may be a retinal angle as well; the GPR109a receptor is expressed in retinal pigment epithelium, and BHB is an agonist at that receptor. Appears to have anti-inflammatory effect.

      1: Zarnowski T, Tulidowicz-Bielak M, Kosior-Jarecka E, Zarnowska I, A Turski W,
      Gasior M. A ketogenic diet may offer neuroprotection in glaucoma and
      mitochondrial diseases of the optic nerve. Med Hypothesis Discov Innov
      Ophthalmol. 2012 Fall;1(3):45-9. PubMed PMID: 24600621; PubMed Central PMCID:
      PMC3939735.

  81. Andy  January 20, 2015

    Hi Peter. You and the kids look great, and thanks for the blog post.
    I am on board with the NAFLD initiative you are furthering- I’ve been in internist for 17 years which is about the time it has taken this problem to become an epidemic. Certainly it is reflected in my practice. Good work!
    I would look forward very much to your podcast. I first learned of you from your interview with Tim Ferris and found it fascinating, A few possible topics:
    1) What is your definition of low glycemic index? What is your threshold for day-to-day eating? Tim Ferriss says avoid nuts and you do eat them. Just looking for some specifics from you.
    2) Do you have advice for vegetarians trying to eat a lot of fat and protein?
    3) Case studies of other athletes you have worked with (BTW as an athlete myself what if I wanted a consult with you?)
    4) What is the biochemical mechanism that the protein in your IFIK plan bumps you out of ketosis?
    Anyway thanks again and keep it up!

    (reply)
    • Peter Attia  January 21, 2015

      All good questions for follow up.

  82. Chris  January 21, 2015

    I know I’m not alone when I say we miss your regular blog post! But I’m glad that things are going so well with you!

    (reply)
  83. Whitney  January 22, 2015

    Please write that book.

    I just went through the process of writing a book, and I do not write quite like you in terms of length. The process took me a year to produce 150 pages. Start with an outline. Go from there.

    Best of luck and please write it, I already am dying to read it.

    (reply)
    • Peter Attia  January 23, 2015

      Yea, I estimate over 2,000 hours between me and said book… (to do it right, that is).

  84. Gabe  January 23, 2015

    Peter,

    Congratulations on the boy. Both of your kids are sure to be very Alpha.

    I very much enjoyed your podcast with Tim. So much so that my abductor and adductors (im not sure of the terms you used) are screaming. In part two of the podcast can you please go deeper into training these parts of the legs. I believe you mentioned the benefit being an aligning of the pelvis and hips. Anyway, Ive made some great strength gains and although there are many variables, the very girly “clam opener” and “thigh master” machines have been added to the routine. What else do you recommend for training these muscles.

    I apologize if you have covered this in your blog, im a newer reader, but can you delve into the ketogenic diet for fast twitch, power lifting and strength training. Im interested in looking and performing like the Hulk aka Bruce Banner aka Domonic D’agostino. I cant seem to gain weight while in ketosis.

    Can you please give some shortcuts to getting into ketosis while training a lot of high intensity intervals, how to combat carbohydrate cravings, and is there a sweet spot or happy medium when it comes to carbs, HIIT and ketosis. Ive only been able to reach Green and once yellow on the Ketonix.

    Lastly, how do you recommend I point the bow of my ship while in school? Im very interested in Ketosis, specifically performance and the anti cancer ideas D’agostino presents. Im currently a Kinesiology major and a certified health coach through IIN but im thinking of moving to something in the nutrition science area. Thanks so much for you awesome work Sir.

    Gabriel Rivera

    (reply)
    • Peter Attia  January 23, 2015

      You’re right about the hulk = Dom! Look, as far as I can tell, the ability to put on large amounts of muscle, which Dom can do on a calorie-restricted KD, is primarily determined by genes. I would not suggest that a KD is the optimal diet for the hypertrophy phase of bodybuilding, though.

    • Victor Björklund  January 24, 2015

      If you are strength traning / traning for muscles on keto I would also check out http://www.reddit.com/r/ketogains

  85. Norm  January 23, 2015

    Hi Peter,

    Does the meal timing have any effect on fuel partitioning in the body: majority of calries consumed in the morning would go to muscle instead of fat vs majority of calories consumed in the afternoon/evening would go to fat instead of muscle and vice versa?

    (reply)
    • Peter Attia  January 24, 2015

      I don’t know. Certainly in the extreme cases it could (e.g., one meal every two days or something), but not sure more generally. Lots of folks claim so, but I haven’t seen great evidence.

  86. Geo  January 23, 2015

    Hi Peter,

    Congratulations on your work. And thanks for sharing so much on internet.

    I would like to know if, among the books you have been reading about aging, could you name one or some that you like? So we could start reading something until your book comes to life.

    Thanks.
    Geo

    (reply)
    • Peter Attia  January 24, 2015

      Nothing in books, all in scientific papers. There is no shortage of stuff out there. Obviously, the key is separating the useful (small fraction) from the useless (large fraction).

  87. Michael  January 24, 2015

    Dear Dr. Attia,

    This may sound a bit extreme, but I really accredit you as the reason I know what I want to do with my life. I’m 19, an undergraduate sophomore, and I’m completing a multidisciplinary studies degree with concentrations in Neurophysiology, Cognitive Science, and Medical Philosophy. I hope to go to Military Physical Therapy school after completing my degree.

    Before that I was a computer engineering major, (because my parents told me to). I was overweight and unhappy with what I was doing. After I watched your TED talk, I found your blog and experimented with keto on myself, and that launched my whole expedition into the fitness world. On your recommendation, I read “Mindset” and “The Talent Code.” It wouldn’t be too dramatic to say that those two books changed my life.

    It’s funny you mention Dr. Kirk Parsley and anti-aging because I just read Nick Bostrom’s “Fable of the Dragon Tyrant,” and watched a podcast with Dr. Kirk discussing the importance of sleep and some of the hormones involved — things I probably wouldn’t have even looked into without you.

    Thank you so much for this blog. You may not think much of it, but you really have given me direction in life. As I learn more I will be rereading your more technical posts and re watching your podcasts. Please keep up your excellent work!

    (reply)
    • Peter Attia  January 24, 2015

      Michael, I won’t take any credit for your new found clarity of path–sounds like Carol D and Daniel C deserve that–but very happy for you, and glad you’ve discovered Kirk’s insights many years younger than I did.

  88. Ed  January 24, 2015

    Dear Peter,
    I’m a recent fan that has watch all your stuff and sent links to many friends. Thanks for all the information that you present in an articulate and humble manner.
    I have had a chronic cough for seven years prior to which I was always active at work and at the gym. My thing was lots of cardio including squash, running, various machines and rope skipping. At its worse I would cough almost nonstop leaving me always tired and unable to function well. My GP and four specialists tested my heart(ok). lungs (scope,biopsy and ok), allergies(none) etc…Puffers of different kinds helped little.The best treatment was always some duration of antibodies which would reduce or eliminate my symptoms for a month up to six months. Not wanting to become resistant to them I tried short three day water fasts and while I was at it a LCHF diet when I did eat. My condition improved and I am better than before but still have periods where I can cough up a storm, always with the goal of coughing something up.
    My question and sorry for being so wordy is how do you view longer fasts in respect to helping ones own body deal with illness? I take to fasting easily and actually enjoy the feeling after the first day and would like to try a seven to ten day one. Thanks for your time and comments from my friends always include how much they admire how well you and Mr. Noakes first treated yourselves and then wanted to help others.
    ps…LCHF diet resulted in 40lbs lost and $120 won from my buddies and it was effortless!

    (reply)
  89. Trey Milligan M.D.  January 26, 2015

    Dr. Attia,

    As an avid consumer of your writings and video presentations, as well as those of Tim Ferriss, I was very excited to hear about a podcast featuring both of you. I decided to listen to the podcast while on a bike ride which is always a great way to distract myself from the pain of Wingate Sprints. Of course, I almost rode into a curb while laughing uncontrollably when Tim referred to a fecal transplant as a “s—- swap”. The podcast was informative and enjoyable with a style that was relaxed and enjoyable, like two old friends catching up on what’s new and intriguing to each other. It was a little bit of science, a dash of high tech and just a touch of Beavis and Butthead. Nice mix.

    Anyhow, as a fellow self-experimenter and coach/trainer of those who wish to be experimented upon (www.sciencefit.net), I’ve both used personally and recommended to others UCAN Superstarch and KetoForce for use in cycling training and events. On your next podcast with Tim, it would be enlightening if you could discuss your current thinking on the use of UCAN and KetoForce (or other Ketone supplements), alone or in combination, for your own cycling needs and/or for athletes you might be coaching.

    As always, I enjoy the wealth of information available in your blogs and the maniacal attention to detail you exhibit in your writings. Keep up the great work and pump out some more podcasts!

    (reply)
    • Peter Attia  January 30, 2015

      Ha ha! Am I Beavis or Butthead? Look forward to addressing your questions on follow up.

  90. Matthew  January 26, 2015

    Hey Peter,

    Thanks so much for all your value on the blog and I cannot wait to read the book. I just thought I would try and share something with you as a fellow Feynman enthusiast. Below is a link to a 5 day interview about his whole life, much of which I haven’t seen elsewhere with the American Institute of Physicists. There is one particular anecdote about how his father taught him pattern recognition before he could even talk that I believe you could find most useful with the new son you have.

    http://www.aip.org/history/ohilist/5020_1.html

    There are a few hundred other interviews on the site and I recommend those with Dirac and Bohr because of the occasional nuggets they drop about the process of creating new knowledge and framing problems differently.

    Enjoy

    (reply)
    • Peter Attia  January 30, 2015

      Thanks very much for passing this along. These guys–Feynman, Bohr, Dirac, Gauss–such studs. I had a *huge* picture of Gauss in my bedroom in collage (like this one: http://www.rare-earth-magnets.com/t-johann-carl-friedrich-gauss.aspx).
      Funny thing, the ladies never liked it…they thought I was the weirdest dude, but they didn’t get it. These guys re-wrote the rules of the game.

  91. Lauren  January 26, 2015

    Yesterday, my 5 month old son was diagnosed with Infantile Spasms, a rare form of epilepsy due to hypoxic-ischemia/watershed brain damage. We’re mtg with the team at 2 pm ET today to review treatment options, but they include either a steroid/ACTH (high and low dose options), Vigabitrin (sp? comes with a black box warning) or a ketogenic diet. All options (except for low dose ATCH) seem to offer the same level of efficacy. The diet is the one approach the doctors here (Boston Children’s) have the least data about relative to the drug options; however, they are open to it and concede that it has been as efficacious as the drug options in the limited testing. Have you ever helped someone achieve and maintain ketosis as a way to manage epilepsy? More specifically, could I as a nursing mom achieve ketosis and make ketogenic milk for my son?

    I’d also value your opinion about nursing+drugs vs not nursing/ketogenic diet – is my milk as miraculous when mixed with toxic drugs or is a state of false starvation optimal for his mental recovery and development? I appreciate your opinion and insights, as we urgently establish a treatment plan.

    Btw, your children are adorable.

    (reply)
    • Peter Attia  February 4, 2015

      Lauren, what came of the meeting?

  92. Melinda  January 26, 2015

    Congrats on your baby boy (and lovely daughter)! I have an almost 3-month old son and a 2 1/2 year old daughter too, so I have some happy distractions myself. Which brings me to one of the topics I would love to see more information about: eating low-carb while breastfeeding. I just shifted my diet to low carb one week ago to help get the baby weight off and just be healthier in general, but I haven’t been able to find info on how, if at all, this effects my exclusively breastfed son. I’ve noticed a change in the texture of his poop and there seems to be less of it (more like once/day whereas used to be around 3/day) and he’s had a little bit of gas, but he still is an avid nurser/bottle-taker and seems to be fine (not fussy, etc.). The general advice online is to not start a low-carb diet until at least 8-weeks postpartum (I think to make sure your milk gets established bc it can reduce milk output) and not to go under 50 grams of carbs/day. I don’t know what the last bit is based on, and it would be nice to understand the science of the issue. I did see some research cited online stating that infants are born in and remain in ketosis prior to starting solids, which I find rather fascinating since breastmilk is supposedly somewhere around 50% carbs. Anything you could add on the topic would be great!
    Also, a thought re: part II of the podcast, perhaps you could explore some of the other keys to longevity that you mentioned but did not discuss (in particular, I’m interested in hearing more about the relationship of sleep to longevity). Thanks!

    (reply)
    • Peter Attia  January 30, 2015

      I’d have to defer to my wife (or other women) on that one since I’ve never breastfed. I’m guessing the safest approach (in general, but including BF) is to minimize refined carbs and added sugars. But I’m not sure would make sense to be overly restrictive (e.g., ketogenic) with carbohydrates. That said, I have no idea.

  93. Nate  January 27, 2015

    I look forward to your podcasts and would love to hear your thoughts on a few topics in particular:

    •Omega-6 and omega-3 fatty acids
    •What’s the story on vitamin D?
    •How does low-carb eating apply to women during pregnancy?
    •Stretching and flexibility
    •Gut microbiome
    •The best sushi restaurant in SD county

    Congratulations to you and your family and thanks for all your work!

    (reply)
    • Peter Attia  January 28, 2015

      Here’s the answer to the last question: Sushi Ota in Pacific Beach.
      (other questions can’t be answered as quickly, but possibly as important as the sushi one)

  94. Read  January 28, 2015

    Congratulations on the new King of Pop! He looks like a star.

    Count me among those who would look forward to any book you would write but especially one on longevity. I appreciate the clarity of your thought about science and nutrition and expect you will write a great book. You have picked a massive subject to chew on but the time is right for someone to bring some clarity to a field that is cluttered with all kinds of quackery. Millions of boomers like me are increasingly interested in this subject, and given all of the new science, I am sure your book will be very well received.

    Best wishes to you and your beautiful family Dr. Attia.

    (reply)
    • Peter Attia  January 30, 2015

      Thanks, Read. The “King” just hit 5 months old today. Stay tuned for book, etc. (but don’t hold your breath, it will be a while, unfortunately).

  95. Chip  January 30, 2015

    Peter,

    No questions to answer, I just wanted to second Dr. Milligan’s request on the use of UCAN in more detail. A group of flat-landers from Chicago will be doing LOTOJA this year (Sept), meet you out there if you haven’t already checked it off.

    (reply)
  96. Sam Kovalak  February 2, 2015

    Peter
    Hoping you could give me some advice. I,m 63 years old 160 lbs, in good condition. Been in NK for 15 months. I’ll be doing a long distance thru hike this summer. The John Muir trail. Every day is the same, nine to ten hours burning what I think is around 500 calories every hour. Planning to stay in NK eating only around 4000 calories each day. Typically lose around half pound every day. Wondering what your thoughts might be concerning how I can manage the trail diet and carb consumption to optimize fat utilization. I think consuming a steady low amount of carbs all day then eating a large carb dinner before bed seems like a possible solution. Thank You
    Sam Kovalak

    (reply)
    • Perry  February 6, 2015

      Sam,

      If you are planning to stay in NK (nutritional ketosis) during the hike, is a large carb dinner a good idea? And, why do it? Have you tried it, and taken your ketone meter along to see what happens? Of course everyone is different, that’s why the N=1 experiments are so important.

      I’m not a long distance hiker. I’m 69 and have been in NK for the last couple of years. I hike a fair amount each summer. Typically its four or five trips, which run 7 to 10 days each, 8-12 miles per day, average elevation gain of 2000 ft. per day… definitely not a thru hiker pace.

      For me, eating a little too much in the way of carbs and protein put me in ‘no man’s land’….not enough to fuel my hiking, but enough to put my ketones down in the low to 0.3 range. Energy level at times was pretty bad. Before I took the ketone meter, I thought I was eating low enough crabs and protein to stay in ketosis, but when I took the meter and tested, I found out that I was not. Now, I try to keep fasting ketones above 1.5 all the time.

      It took me awhile to figure out trail food. Now my primary trail fuel is fat, specifically a mix of coconut oil and butter. It can melt during hot days, so a liquid tight container is critical to avoid a mess. For breakfast and dinner, I make my own dehydrated meals at home which are usually ground beef based (with no grains). I put the dehydrated food into zip-lock bags, then on the trail, rehydrate in the bag using hot water…pretty easy. And, then when it’s rehydrated, add a couple of ounces of the coconut oil – butter mixture.

      I have minimal hunger during the day, but will usually have a small snack once or twice a day…minimizing the carbs as much as possible…things like sausage or 85% dark chocolate.

      You may have much more metabolic flexibility than I do, and maybe you can stay well into ketosis with the meal plan you propose; but try it on a multi day trip beforehand, and take the meter.

      I hope this is helpful,
      Perry

  97. Murat  February 2, 2015

    Congrats on your 2nd child, and very beautiful family!

    re: NuSI, has the board considered the optimal marketing mix strategy it will use to release its findings to the public in order for maximum impact in reducing the tolls of obesity? Or, will it leave design and implementation of weight loss programs based on NUSI’s science to people like myself? (I am a PCP in the US and soon to be medical director of a large multi-specialty group)

    I have learned from my experience practicing medicine coupled with a marketing MBA degree that *HOW* medical information is presented to patients/groups/target markets has just (if not more) as much effect on success as *WHAT* (quality) of the data presented, likely due to increased patient compliance with recommendations. Compliance with nutritional advice appears to be more volatile (anecdoctally speaking) than with other topics (such as cancer treatment, completing antibiotics course, etc).

    I hope that NuSI keeps this in mind high quality data is presented in the years to come! I look forward to a day where obesity is no longer the #1 threat to health in America.

    (reply)
    • Peter Attia  February 4, 2015

      Murat, yup a lot of thought goes into how to translate “new” science into behavioral change, which ultimately the necessary step (whatever that behavioral change turns out to be).

  98. Greg  February 4, 2015

    Peter,

    I’ve followed you on and off for years, checking in periodically to see what’s going on. I really enjoyed the back and forth with Tim on the podcast. Like you, I’m a father who also has enjoyed making an endurance sport part of my life (in my case running). I’ve probably been much more sporadic and less dedicated with my training than you and high-level athletes, but nonetheless I’ve had my periods of really hammering out the miles.

    That said, I’m really struggling with finding the right approach to fitness now that I’ve entered my 40s. At worst, am I doing myself some harm? Do the possible negative correlations of heavy endurance training to heart function (and maybe even strokes) outweigh possible positive metabolic benefits. I’ve gotten back into shorter races, lost a bit of weight and feel better than ever. But is the real solution to a healthier mid to older age one of finding a balance between some cardio and more strength training? Could these answers really come down to specific risk factors for individuals as opposed to even taking a stance on this? I’m thinking of some of the recent research with regard to aerobic exercise and mental function. Is there room for something beyond “moderation” or is that really the golden rule we should all follow?

    Tough issues to ponder.

    (reply)
    • Peter Attia  February 4, 2015

      Yup, not easy. Hope to make sense of it.

  99. Matilda  February 4, 2015

    Congratulations Peter!
    I am another one to request a podcast discussion about probiotics. (Overwhelmed by which one to buy and if it’s something I really even “need”).

    (reply)
  100. kellyt  February 5, 2015

    Peter, gratz on the new stinker!!! Pretty cool man.

    Your discussion with Tim was excellent. I think y’all should just sit down and shoot the s#@t every month.. So many great gems in there. Thanks much, for all ya do.

    Also, thanks for the education over the years. I have a T1 Diabetes boy who’s A1C has been “normalized” thanks in large part to the work you and Taubes have done. If I can get this nutrition stuff, anyone can 😉 Your time and effort in explaining these complex issues does make a difference man.. I’m forever in your debt.

    (reply)
    • Peter Attia  February 12, 2015

      Tim asked me to record another one this weekend, which I’ll try to do. There’s a link I re-tweeted that shows where you can post questions. I’ll try to get through 10. Please ask away. Congrats on your son!

  101. Paloma  February 5, 2015

    Congratulations on your new baby. He looks really smart and healthy. Like your daughter. 🙂
    I am happy to know that you are well. Take care.
    I hope you make very interesting discoveries; I will be waiting to read them.

    (reply)
  102. Jeff Pobst  February 5, 2015

    I just listened to the podcast. I guess I’ll stop calling you Peter Atty-uh now that I know (not quite as bad as I used to butcher apolipoprotein). Anyway, thanks for all you do. I’m as impatient as anyone who wants to see more, but I appreciate your priorities (family and Nusi should come before the blog). I’m a week out from finishing my thesis for my physics PhD, so I should sympathize more with science taking a while (especially if you want to do it well), but nonetheless I’m still going to ask. Could NuSI post an estimate of when they expect to release some results from the Energy Balance Consortium Study (the edge of my seat is getting worn)? In any case, keep up the good work, and I’d love to see a podcast from you.

    (reply)
    • Peter Attia  February 12, 2015

      The EBC investigators are analyzing the hell out of the pilot data and I suspect will submit an abstract before a manuscript in the coming months. The real push, of course, is to design the actual “big” study.

  103. Perry  February 6, 2015

    Hello Peter,

    The podcasts sound like a great idea. You have a unique ability to understand the science, great insight, and an ability to communicate very clearly. Just make it easy; and check the perfectionism at the door.

    It seems like you could do them with or without an interviewer. If without an interviewer, perhaps just jot down a topic or two; then consider: what if a friend asked you to explain that topic to them; turn on the mice, talk, and post it. ?

    (reply)
    • Peter Attia  February 12, 2015

      Perry, what I’m going to do (on Tim’s podcast) is basically that–read a question then respond. The questions are being collected now (see link I recently re-tweeted to post your questions or vote on existing questions).

  104. Tom Bunnell  February 7, 2015

    Peter

    Your being a Mark Twain fan you might want to recollect “The Damed Human Race” as it applies to your longevity project.

    Typically, everything you have learned is dead wrong. Not so much a lie, just wrong.

    Native American’s for instance mostly all lived to be over a hundred years old and in perfect health the whole way with something like zero infant mortality and hardly any early childhood death at all.

    None comes close.

    The exact opposite of what we have been taught.

    Perfect people on a perfect land.

    Just like all virgin people on all virgin lands.

    Blacks, Australians, India Indians, everybody before this modern diet and ingestion of stimulants.

    Hybrid plant life.

    Thousands of years now.

    Aztec and Maya got all messed up on hybrid plant life too.

    Egyptians.

    The native diet of mostly fat and meat and fish and birds and natures true plant life had everything to do with this.

    That and water only to drink.

    Clean air and water and everything didn’t hurt.

    This is the big daddy of them all we’re talking about.

    The big kahona!

    Turns everything we have been taught and learned, upside down.

    Everything.

    Best to you.

    Precious kids.

    -Tom Bunnell

    (reply)
  105. Rich  February 7, 2015

    Peter, what are your thought on Coronary Microvascular Disease and how is it different than CHD?? Thanks

    (reply)
  106. Whitney  February 9, 2015

    Hi Peter!
    I have a few loaded questions for you. 🙂

    1.) (a little background first) It is my belief that all of the health challenges I have faced have to do with insulin, and have found the low carb, high quality real food way of life to be best for me. So my question is, do you think your body can get better with time in regards to insulin sensitity? I am kind of intense with my diet, as are you, I only have ketostix to help my measure things, no fancy equipment, though I would totally self experiment if given the tools and knowledge and proper training. Haha

    2.) How do you drink your coffee? I too do not really do breakfast but love warm coffee in the morning. Are you on the bulletproof train? And sorry if you have answered these questions previously.

    3.) How can we help you blog more?

    Thank you so much for your blog and amazing work with NuSI.

    (reply)
    • Peter Attia  February 15, 2015

      Because I’m not in ketosis these days I do not drink BP coffee. Just coffee and cream, though I prefer it whenever the Jura makes it.
      If/when I figure out the answer the #3 I will definitely let you know. The only answer that comes to mind is raising money for NuSI which takes up most of my working hours.

  107. Hakim  February 9, 2015

    Fish Oil:

    I’ve been reading conflicting reviews on Fish oil. Even though convential wisdom is that they are great for health. When I look at the macronutrient label,lab of fish oils, most will have more PUFAs compared to Saturated or Monosatursted fats. I believe in the ketotic literature it is theorized to avoid or minimize consumption of those PUFAs cause they may cause inflammation or other negative things. Just like to know if you think fish oils are good and even in high amounts as Robb Wolf suggests besides there high PUFAs and other damning reviews. . Thanks.

    (reply)
  108. piotr  February 9, 2015

    Hello,
    I have not very related question but I cannot find the answer so maybe you know it sir as you used keto a lot. So the question is “MCT oil has antimicrobial properties, so can it hurt good gut bacteria as side effect?”
    Thank you,
    Piotr

    (reply)
  109. JJ Bell  February 9, 2015

    Hi Peter

    Sorry in advance for self-indulgent question but any training advice for a newbie (road) cyclist? Have zero cardio and looking to build to point where can complete 70 mile charity runs with work colleagues.

    So far your advice on:
    – diet (i.e. experiment)
    – supplements (was prev Vit D deficient)
    – coffee (that amazing chicory, cinnamon, vanilla concoction is incredible!)
    – movement (slow lifting)
    have turned out great.

    Failing any pointers, any links or resources much appreciated.

    (reply)
  110. Matt  February 11, 2015

    Hello Dr. Attia and congrats on the new addition to the family.

    I first heard your name on the Freakonomics podcast and have now read and heard much of your work (and watched your blockbuster TED talk). Color me somewhat skeptical of your nutritional theories, but I commend your unwavering commitment to sound science and rigorous testing. There are only winners when scrupulous science provides reliable, reproducible results.

    What if your ketogenic regimen is the best way antidote for metabolic syndrome and type 2 diabetes, BUT, once a healthy weight and metabolic function are obtained, an Ornish type diet then becomes the best maintenance program for overall long term health and disease prevention. This seems entirely plausible to me, but completely impossible to demonstrate scientifically – both because of the research limitations and because it would seemingly satisfy nobody.

    (reply)
    • Peter Attia  February 12, 2015

      Matt, it seems plausible, for sure. Remember, a KD and an “ornish” diet (call it a well-formulated plant-based diet) have so much in common! I’ve actually tried to point this out to Dean a number of times. What if–and this is my hypothesis–the single most important dietary trigger of metabolic dysregulation is refined carbohydrate and sugar? If this is true, then one could expect some modicum of success with any diet that completely eliminates these agents–something both a KD and PBD do.
      This is a favorite topic of mine and one worth expanding on in a podcast.

    • Boundless  February 12, 2015

      re: What if–and this is my hypothesis–the single most important dietary trigger of metabolic dysregulation is refined carbohydrate and sugar?

      When you are pressing that argument, be sure to emphasize that the carbs don’t have to be very refined. Whole grain wheat beats table sugar at raising BG (evidently due to being 60% glucose vs. the 50% of sucrose, being a branched glucose polymer which humans excel at metabolizing, and being delivered along with adverse proteins that cause gut leakage).

      And the USDA thinks that getting 60% of your calories from this stuff is just peachy (no offense to peaches intended).

    • Perry  February 15, 2015

      Matt,
      An Ornish type diet likely will work well for some people, and not others. I’m one of those who tried hard to do it, and did not have lasting success.

      In March 2001 my doctor talked to me about my weight and recommended reading “Eat More, Weigh Less” by Dean Ornish. The title sounded appealing, so I read it, and seriously tried to follow it, as best I could. I did not get all the way to vegetarian; but cut out red meat, ate low fat as much as possible, really limited sugar and refined carbs, ate quite a bit of vegetables, salad, and fruit. My weight went from 230# in early March, to 201# by late October 2001.

      But it was a real struggle; hunger was a huge, recurring, daily challenge. I could not maintain the diet, and after a couple of years I gradually regained all the weight I’d lost.

      In contract, nutritional ketosis (NK) has been a ‘stroll in the park’. I’ve been weight stable for 2 ½ years at 170#, and expect to be able to maintain for the rest of my life (in NK). And, for me, the health benefits of NK go far beyond the weight loss.

      “…once a healthy weight and metabolic function are obtained, an Ornish type diet then becomes the best maintenance program ..”
      Just my perspective, based on the research I’ve done, but I suspect that many people who’ve eaten SAD for many decades likely have enough cumulative metabolic/cell damage that truly healthy metabolic function / flexibility will never be regained. Thus, for people like myself NK for life is the best / most healthful option. (I’m a senior, so I think age is a significant factor in the equation.)

      We are all human, but we are also all unique individuals, inside and out.

  111. Alan  February 13, 2015

    Hi Peter, Really enjoy watching your videos on youtube and find them really informative.

    I don’t know if you will have an answer for this but whenever I cut out carbs (and increase fat) I develop a nasty rash over my torso (front and back). I fasted whilst this was happening to see what would happen and after 24 hours the rash began to swell quite dramatically so to I ate some carbs. After binging the next day the rash or at least the redness had gone.

    Do you have any research/ideas regarding this?

    Thanks,

    Alan

    (reply)
    • Peter Attia  February 14, 2015

      Wow, that’s interesting. No, unfortunately, I don’t know what caused the rash or the reversal.

    • Bert Prins  February 14, 2015

      The “keto-rash” is called Prurigo Pigmentosa and as I understand it there isn’t much known about it. Could be something else so don’t take this comment as a diagnosis 😉

  112. Sam knutsson  February 14, 2015

    Hi Peter,

    Loved the podcast you did with Tim.
    I just read the first comment and your reply:

    If you don’t want your son to inherit your shortcomings, I have a suggestion:
    *Manifest and flaunt them, to an embarrassing degree.

    I’m an adolescent, so this one I know;
    kids, whenever they see specific flaws in their parents, they almost instinctively avoid developing that in themselves, or at least go out of their way to avoid doing so.
    It’s normally a strong and reliable reaction.

    I may be completely out of place, if so, I apologize.

    Look forward to hearing more from you on the podcast!
    /Samuel

    (reply)
    • Peter Attia  February 15, 2015

      Never out of place, and very sage advice. I see it in myself, actually.

  113. Tom  February 14, 2015

    Congratulations!

    I would love to get your view on Irritable bowel syndrome.

    (reply)
  114. David Jackson  February 16, 2015

    Hello Peter,

    I really enjoy your knowledge that you share with us, May I ask why you are not in ketosis? I hope it’s not for health reasons. Thanks your time.

    P.s, the fat shakes are yummy!

    (reply)
  115. Kelly H.  February 16, 2015

    Perhaps I’m behind the curve on this one, but why aren’t you in ketosis??

    (reply)
    • Peter Attia  February 16, 2015

      Yup, behind the curve I guess. It’s been over a year.

  116. JJ Bell  February 17, 2015

    Hi Peter

    This will seem like a daft question given other life changing matters of greater importance but wondered how or if you have adjusted your ‘sports’ nutrition since departing from ketosis? i.e. can you still go for those long bike rides with little or nothing or do you find you need to carry a little more fuel?

    (reply)
    • Peter Attia  February 17, 2015

      Not like I used to. Not even close, actually. I’m good for about 50 miles, but not even with great consistency. I’m much for fat adapted than I was 5 years ago, but not to the extent I was 2 years ago.

  117. Dan Walker  February 17, 2015

    Hey Peter,

    If you and Tim get an opportunity in the next pod cast could you discuss a little about what both of your opinions are of Alpha Lipoic Acid and possibly Ubiquinol/Ubiquinone? Or maybe a discussion about compounds like these and their use in diseased states versus healthy states. I have been taking ALA off and on for over 8 years now and I know Tim has mentioned it quite a bit in his one book. I switched to exclusively using Geronova’s Na-R-alpha lipoate about 4 years ago and when I combine it with Kaneka QH Ubiquinol in relatively high doses I get a subtle, but noticeable upswing in my energy levels which is quite helpful considering my NIDDM. I guess I’m mostly somewhat concerned with their long term use, not to mention cost (both are on the GRAS list, I believe). On one hand I feel like I am simply supplementing compounds that my body would normally make but because of damage from my condition my physiology just can’t make enough of them (or make them properly), but on the other hand they are exogenous derived “nutraceuticals” that I haven’t been able to find too much really good, unbiased science published about them. Add that to all sorts of things I read about them on the web including the tie in for RALA with ALCAR and needing extra biotin supplementation and it gets a bit exhausting at times trying to tease out what information is worthwhile. At this point I am essentially just going by whether or not I feel better and whether or not the few physiological quantitations I can reasonably make are getting better, worse, or don’t change at all. Also I have heard Dominic mention another CoQ10 derivative called Idebenone but so far I can’t see as to where this would really offer any benefits over the right preparation of Ubiquinol.

    Anyway, if you guys get a chance that would be great.
    Hope all is well.

    Thanks,
    Dan

    (reply)
    • Peter Attia  February 18, 2015

      I think I’m recording part II next week. Tim has a place on his blog for people to add/vote on existing questions. I’ll try to address the top 10 questions or so.

  118. Ian  February 19, 2015

    Hi Peter,

    Love your work mate and thank you for it. I check in every couple of weeks and have a good read. Very much looking forward to your book. I’m going to see my 60th year on this green and pleasant land roll in in the not too dim and distant and I’m panning on many more, so very timely – any release date in the pipeline? Keep it coming. Thanks again.

    (reply)
    • Peter Attia  February 20, 2015

      Look forward to organizing my insights on this obsession I mean topic.

  119. Brian  February 19, 2015

    Hi Peter,

    Congrats on the new addition! I really enjoyed your previous podcast with Tim. As a new father, I would really enjoy hearing more about your ideas on the “fatherhood manifesto” your brother is working on. Keep up the great work!

    Brian

    (reply)
    • Peter Attia  February 20, 2015

      Yes, I hope my brother decides to one day publish his manifesto on being a great dad.

  120. Tom Bunnell  February 20, 2015

    Please tell me why in this digital age of the internet and worldwide global communication computer world that this entire event in South Africa that Gary is participating in is not being broadcast live and in real time for the entire world to see first hand and right now as it’s happening. — The entire planet earth with millions viewing and viewers participating in a worldwide discussion as it’s happening and then everything readily available through social media and youtube and the cloud and whatnot for those that were unable to be available for the live performance.. The answer of course is that nobody did it. Nobody pushed the button.. How come..

    (reply)
  121. Lisa  February 20, 2015

    I just found out about you from hearing your TED talk on diabetes and obesity. My mom is obese and diabetic. She was fist diagnosed 4 years ago and at the time she was perscribed metformin by her doctor. This was a huge wake up call for us and we have radically changed the way we eat. She now maintains a stable blood sugar level in normal ranges without medication, but she has not lost very much weight. At a recent trip to her doctor her doctor berated her for “not trying hard enough to loose weight”. It is not feasable to change doctors at this time (very small town). I am looking for recomendations on material to send to her doctor to change the way she treats my mother. I sent a link to your TED talk, but I think she is going to want more before she changes her mind.

    (reply)
    • Peter Attia  February 20, 2015

      Lisa, it’s hard to change the minds of doctors who aren’t searching for answers. In other words, if a doctor thinks they KNOW the answers, put no energy into trying to change them…instead seek a new doctor and continue to educate yourself. So your primary objective with your doctor should be to determine if she’s in the “I know all the answers” camp. If so, head for the door.

  122. Jeffrey Worst  February 22, 2015

    As some point, could we get your thoughts on the Scientific Report of the 2015 Dietary Guidelines Advisory Committee?

    (reply)
    • Peter Attia  February 22, 2015

      I think NuSI put out a statement the other day that reflects my thinking. Same for recent op-ed by Nina T and piece in NYT by Anahad O.

    • Jeffrey Worst  February 22, 2015

      I didn’t see anything on the nusi.org site so I’ll read the NYT article.

      Thanks!

  123. Svetlana  February 23, 2015

    Good morning,

    If you go to Nusi Facebook page, the article is there to link out.

    (reply)
    • Peter Attia  February 23, 2015

      I’m not sure where it got released. Might have been a press release or statement.

  124. Claudio  February 23, 2015

    Hi Peter- my apologies if this has already been answered but with so many comments, I didn’t want to scroll through them one by one. Outside of use during sports and fitness, does SuperStarch have any benefits for type 1 diabetics who are looking to keep their blood sugar more stable while not exercising? One common issue with type 1’s is the rebound of low blood sugar and I was just wondering if this product could help prevent type 1’s from getting hit with an unexpected drop in blood sugar. And based on your answer to that, any future benefit of using it with type 1 children? Thanks in advance. I just came across your site today! Good minds think alike!

    (reply)
  125. Sam knutsson  February 24, 2015

    Hi again Peter,

    I heard you on Tim’s podcast; he explained your background and degrees in mathematics/engineering, among many other things.
    I have a question related to that:
    I study Biotech engineering, and have some ideas for products I want to develop in that space.
    In my schooling, all the physiology-related stuff comes so easily. It’s really interesting to me, as I can explore these things practically, through self-experimentation, blood tests etc.

    But I’m having problem with the mathematics. It’s not interesting to me. But I know it can be.
    How did you develop an interest in math? What sparked that?
    What could someone in my situation, who loved the physiology part, but isn’t stimulated by the math part, do to facilitate this kind of learning?

    I know you’re short on time, but any form of advice would be greatly appreciated!
    Really looking forward to part 2 on the podcast.

    /Samuel

    (reply)
    • Peter Attia  February 24, 2015

      Sam, read my post on Woody Sparrow…

  126. Grant  February 25, 2015

    Hi all,
    I am a 17 year old soccer player who has been doing some research lately. Will a ketogenic diet negatively impact explosive strength and anaerobic performance? I read that a Norwegian soccer team and a couple of NBA players have succeeded on a LCHF diet, but I don’t understand how they got around LCHF’s perceived weaknesses in terms of highly-intense, short-term activity. Are there any anectodal methods of overcoming this downisde of being a keto-soccer player, or should I just stay on a carb-based diet? A response from anyone who happens to be reading this would be extremely apreciated.
    Thanks!

    (reply)
  127. Adrian  February 25, 2015

    Peter, congratulations to you and your famiy on what looks like is going to be a very, very tall young man! He’ll just have to tell them that it’s human nature (oh, that was bad!).

    My question is one of not quite desperation, but some discouragement (I am trying to lose weight not in ketosis but a general VLC eating approach), and that is the news story going around stating the conviction of several well-known bariatric specialists that once obesity is reached, regardless of efforts no more than 1% of people who have become obese will be able to achieve and/or maintain weight loss. I’m sorry I don’t have a link to the story, but the persons interviewed seemed to be MDs from highly respectable hospitals (though I know on the face of it that fact is meaningless). One good thing, I guess, is that the focus of their message is that the calories/exercise message is “now” regarded as mistaken, and that everyone needs to stop blaming the obese for their problem, but other than that I thought it seemed pretty defeatist and depressing. Any thoughts or insights you have time for much appreciated.

    (reply)
    • Adrian  February 25, 2015

      Sorry, did my research: the article was in The Lancet, and the LA Times story about it is at this link:

      http://www.latimes.com/science/sciencenow/la-sci-sn-eat-less-more-obesity-20150212-story.html

    • Peter Attia  February 25, 2015

      I disagree with the grimness of their prognosis (which reflects the incompetence of a “conventional” approach to weight loss–focus on eating fewer calories than you expend), but I do agree that the long one has been obese, the more challenging it is to lose weight.
      A lot of hormones are fighting the body’s attempt to lose weight–thyroid, androgen–and in women these factors tend to be more complex for reasons I can’t elaborate on in short time.

  128. Adrian  February 25, 2015

    Thank you, Peter, that’s very encouraging and what I’d hoped to hear. Regardless, I know I’m eating well and in a way that weight is slowly coming off–inches lost from waist especially and more muscle tone (I’m 58). I’m going with this for the long haul, and what comes of it in addition to health gains I’ll be thankful for when it happens.
    Best of luck with all that’s going on, and with upcoming endeavors at NuSci

    (reply)
  129. Daniel  February 25, 2015

    Hi Peter,

    I love your blog. I’ve learned so much from reading it. I’d like to give a ketogenic diet a try as there is some compelling evidence for its efficacy in treating certain mood disorders. I’ve heard that it’s best to begin the diet under the supervision of a medical professional as there are certain things such as blood-lipid parameters that need to be monitored. I live in San Diego, and I’m wondering if you might know of anyone in the area who is qualified in administering this diet. The only qualified physicians that I’ve been able to find are those who focus on the treatment of epilepsy.

    I would greatly appreciate any recommendations you could give me. Thanks!

    (reply)
    • Peter Attia  February 27, 2015

      Daniel, you can probably figure it out for yourself using the Volek/Phinney book (Art and science …).

  130. Francis  February 26, 2015

    Peter,
    Thank you for all your very informative work. I attended a meeting with a diabetologist recently and questioned him on ketogenic diets in relation to improving outcomes for diabetics (and non-diabetics).
    He was against low carbohydrate diets stating that they are nephrotoxic to caucasian populations if continued for more than a few weeks. He stated the ketogenic diet was not necessarily damaging to Inuit populations due to their adaptions in the last few thousand years and the fact that they exclusively consumed nearly raw seal meat.
    I would value your opinion regarding his statement.

    (reply)
    • Peter Attia  February 27, 2015

      I disagree. What is the evidence they are nephrotoxic? They are not even high in protein.

  131. David  February 27, 2015

    Hi Peter,
    I really enjoy reading your blog, such great information. I recently started a keto diet after reading “The New Atkins for a New You”. I’m a 54 year old male and have always eaten anything I wanted. I love the healthy stuff and the bad stuff. I’m a little over 5″ 6″ and had gotten up to 175 lbs. My fasting BG had started to rise over the years (into the 90’s – one year it was 101). My cholesterol was always pretty good, with room for improvement on the HDL. My triglycerides were always in the high normal range. My blood pressure had started spiking the last year or so, finding myself pre-hypertensive and sometimes into the hypertensive range. After doing induction for about 4 weeks I lost 15 lbs (last 5 came off slow) and my health risk assessment values are:
    total cholesterol – 260
    HDL – 45
    LDL – 191
    TRI – 122
    ratio – 5.8
    Blood Pressure – 124/86
    Fasting Blood Sugar – 74

    Sorry for the preamble, here are my questions: Obviously, everything looks pretty good except for the LDL will that eventually come down even after remaining on low carb/higher fat diet?

    Also, I’ve kind of stalled at 160 lbs (I’d like to be about 145 – to 150) while still on induction. If I move on to more than 20 grams of carbs daily, won’t that slow me down even further? (The New Atkins book suggests moving on and not staying in the induction phase). The only thing I can think of that may have stalled my progress is I’ve been consuming more fat in homemade shakes consisting of cream, unsweetened coconut milk and some sweet and low. I’ve probably increased a bit more sweetener also in the last couple of weeks. I’m guessing if one consumes too much fat in relation to daily caloric burn you’ll eat enough to fat to fuel daily activity and not burn any body fat?

    Anyone out there have any advice, assessment etc?

    (reply)
  132. Eric  February 27, 2015

    Hi Peter, I’ve been watching many of your Youtube presentations and I really enjoy and agree with your work. I’m looking forward to reading your book; however, the HRT for women being dangerous example that you use always leaves a sour taste in my mouth. Designer progestins are used almost exclusively, which behave very differently than endogenous progesterone. Dr. Mark Gordon wrote a great paper (googleable) on the topic citing ~260 studies detailing the error in calling these progestins progesterone. Proper HRT for women and men is extremely beneficial, most physicians are not taught how to correctly administer and monitor many hormonal imbalances unless dealing with a life or death disturbance. Reference ranges are far too wide and hallmark signs/symptoms are dismissed. I had the testosterone levels of ~80y old man through most of my 20’s and was referred by endos, urologists, and general physicians to a psychiatrist for my problems; i can only assume to boost testicular production through sheer will, lol. Also, Dr. John Crisler has a great powerpoint on optimal male TRT that you can find online. Best of luck with your book, email me if you would like an anecdote or more information.

    (reply)
    • Peter Attia  February 27, 2015

      Eric, you must be misunderstanding something I’ve said. I’m a proponent of HRT in symptomatic estrogen-dominant women. I believe the WHI was flawed for two reasons: oral estrogen and synthetic progestin. Further, other studies using unopposed therapy are misleading. So, yes, I believe many women do benefit from topical estrogen and real progesterone. I have similarly nuanced views of TRT.

  133. Charles  March 1, 2015

    2 young children, a book you’re working on, a growing medical practice, NuSI, a blog, podcasts…all I can say is that your time-management skills must be *exceptional*! Thanks for everything you do, I always enjoy reading your posts and watching your videos. I guess it’s time to listen to your recent podcast as well.

    (reply)
  134. Jennifer Carpenter  March 2, 2015

    Dr. Attia, I am so trilled to have found you. I have been in Ketosis for 2 weeks and feel great. I have listened to your talk about Superstarch, and I currently use it and love it. The problem is keeping it suspended in a bottle on the bike. I would like to try a brand new product called XRCEL. It is a glucose drink that has a time release suspension. I was wondering if you would take a quick look at it and let me know what you think. I will still use SuperStarch on the run, but I would really like something easier for the bike. I am training for my second Ironman and I am really looking forward to not having so many GI issues and not being dependent on Gu’s. http://xrcel.com/index.php?route=information/science_nutrition&information_id=7

    (reply)
  135. Jim  March 4, 2015

    Peter, congratulations on your new addition. I would wager a bet baby enjoys fat. It seems they may have more sense than most of us. Want to thank you for the information you provide on this blog. Still attempting to wrap my head around the Krebs Cycle.

    I do have a question regarding the use of tobacco. For some time now(nearly 4 years), I’ve focused on dietary fat, probiotic food, etc. After beginning to focus on diet, as sort of my own personal control, I chose to reduce exercise and increase the number of those nasty cigarettes I smoke. I did this in 2011. In 2013, I began competing in Masters track events. However, I did not stop smoking cigarettes.

    I’ve noticed you have referenced observational studies showing the negative effects of tobacco use. The question plaguing me is, why do many folks develop terrible ailments directly attributed to smoking, while others seem to actually experience extraordinary benefit?

    I sort of associate it with the consumption of saturated fat, I guess. It is very odd to me. Just find it difficult to believe so many us could be so wrong. My only thought is that we’re not all wrong. Yet we’re not all correct.

    Not my intent to introduce “evidence”, but this booklet does highlight a few of my concerns:
    http://www.demogr.mpg.de/books/drm/007/3-4.pdf

    I just don’t know? Perhaps, my only argument would be our own thoughts getting in the way? I don’t view myself as an advocate for anything(had to eat crow too many times). Just got it my head that cigarettes can’t be as bad as most of us feel they are?

    (reply)
    • Peter Attia  March 4, 2015

      Environmental factors trigger genetic susceptibilities in susceptible individuals.

  136. Darag Rennie  March 4, 2015

    There’s nothing like being a dad, Peter. The most rewarding journey in the world, enjoy:)!!!!

    I wonder if you can help with a question though because I can’t really find any good posts about it anywhere?

    While my experience is that most people who reduce their CHO intake and increase their good fat intake, recently I’ve come across two people (man & woman) who had triglycerides under 1 before they started LCHF that shot up to over 2 when they took they shifted to LCHF.

    Have you come across this or have anything to suggest?

    Many thanks for all that you do,
    Darag

    (reply)
    • Peter Attia  March 5, 2015

      Hard to know without some prodding.

    • Darag Rennie  March 6, 2015

      Thanks Peter, I’ll see what I can dig up.

  137. Robert Sterbal  March 5, 2015

    Why do relatively young people want to live especially long lives? I understand the part about living well, but I’d rather you talk to and tell me about 80 year olds (who are likely to live long) than hear your ideas about how to live a longer life.

    I hope you take this comment as a way to move forward, not a comment on whatever past ideas you have had.

    Perhaps you can post a list of role models from your life of healthy aging and dying?

    (reply)
    • Peter Attia  March 5, 2015

      Interesting thoughts, Robert.

  138. Joyce  March 5, 2015

    Peter,
    BTW: I know some friends of yours: Megan and Dr. Curt Tribble
    I have been reading all your post. I am very interested in weight loss. I have lost 192 pounds. (I know that is a lot) I come from a family of obesity) I have re-gained about 20 pounds and it is as if I have no control over the weight. I still workout and eat very healthy.
    I want to re lose the 20 and lost about 10 more. my body fat has climbed from about 19% to 28 % over the last year which really concerns me because of the healthy way I eat.
    So I have reviewed your info and you say reduce or eliminate sugar consumption in the form of sucrose and high fructose corn syrup.
    What about other form of sugar?
    I eat Sweet Dreams Chocolate Peanut Butter?
    Total fat 13 grams
    carbs 12 grams
    sugars 7 grams
    protein 6 grams
    All yummy natural ingredients (so the label says) the sugar in this product is derived from dried cane syrup
    Can I keep it or di I need to ditch it?
    I will say I have given it up on occasion over the last year for a month or so but it never made a difference in my weight loss?

    (reply)
    • Peter Attia  March 8, 2015

      Curt and Megan are amazing folks, indeed.
      Hard for me to know the answer to your question, but hopefully you can find a doctor who understands endocrinology well enough to check reverse T3 levels and other important hormones that change in response to weight loss. Your body is probably “fighting” the urge to lose/maintain weight.

    • Aladin  March 8, 2015

      Joyce I wonder when the wording ‘eating healthy’ meant anything to do with deficit-ing calorie intake? “Healthy” food carries calorie values.. just as NON healthy foods do.

      Your referencing the label ingredients shows the sugar levels are creeping back in your foods. ONE food isn’t the culprit most likely.. it’s the entire diet calorie value/s per week and monthly… they ADD up to STORING calories.

      Being leaner is a lifestyle change/choice. Many of us creep back into old habits over time. I seriously doubt a thyroid issue.. given your previous weight loss. The body DOES adapt…. surprise it!

      Best of Luck!

      A.

  139. Stephen  March 6, 2015

    I was doing great on the low carb diet for the last three years, but I went off of it during the Holiday season for a few weeks.
    I went back on it in January, but have had a lot of trouble losing the weight I put on.
    Is this a common feature of low carb dieting?
    Once you go off of it, it becomes very difficult to lose weight when you go back on it?
    TIA

    (reply)
    • Peter Attia  March 8, 2015

      Not necessarily, but one way to re-launch is with a fast. My favorite way to kickstart after a CHO-refeed is 3 days or so of only one meal per day, which effectively means 3 back-to-back 23 hour fasts.

  140. Jim  March 7, 2015

    Thank you very much for the answer regarding tobacco use. Thought about it, and perhaps I’m misinterpreting, but interpret it as “I have absolutely no idea”. I believe this is an extremely wise answer.

    Forgive my greed, but I have another not so radical question. I’ll get right to the question. What are your thoughts on cycling between a carbohydrate dominated diet and a ketogenic type diet? I’ve viewed my own diet as a constant progression, trying new things, and learning by listening. It almost seems(at least to me) that our own brain is really the dumbest organ in our body. Just changed my mind. This is a radical question!

    Your illustration of a fuel tanker, relying only on the saddle tanks for fuel(glucose), while the driver forgets the 5k gallons of fuel that may be utilized. made me think of this. I also thought of an individual with a phantom arm experiencing extreme pain in an arm that does not exist. In both cases, it seems to take two weeks of constant training, for the brain to realize it may utilize the greater source of fuel and also to realize it does not need to experience pain from an arm that doesn’t even exist.

    Thank you. I apologize for the additional question.

    (reply)
    • Peter Attia  March 8, 2015

      Not sure I know the answer to that one either, and I suspect the answer is dependent on the individual and a few other factors, such as exercise and glycogen demand.

  141. Max  March 8, 2015

    Great talk (https://www.youtube.com/watch?v=nhzV-J1h0do). But now the important question. Where did you get this jacket from? It looks really good!

    However, I do not agree as much with your talk on health-care cost (https://www.youtube.com/watch?v=xtmMjRfGMu8). In my opinion, there are three basic system each with an advantage and disadvantage:

    – Beveridge-Model i.e. tax-based (England): 2992 $ per capita per year
    > very cost-effective, however slow regarding innovations, long waiting times for patients)

    – Bismarck-Model: insurance companies and health care providers are non-government organizations, but very strictly regulated by the government like in Germany, France: 3588 $ per capita per year
    > somewhere in between

    – Private model: insurance companies and health care providers run like businesses, USA
    7290 $ per capita per year
    > expensive, over treatment (to many MRI-scans), but very innovative, no waiting times …

    My numbers are from the OECD report 2007. I don’t think that any system is better than any of the other systems. However I see in my hospital (in Germany) one major problem:
    – Usually, mistakes, wrong advice, bad surgery does not get punished because it is often impossible for the patients to distinguish between faults and ‘unavoidable’ complications. The hospital sometimes even profits (in terms of money) from complications (nosocomial infections etc.), which it caused. Nevertheless, I do not know how it would be possible to solve the asymmetric information problem.

    (reply)
  142. Dan Walker  March 12, 2015

    Really enjoyed the follow up podcast with T. Ferriss. The format worked well, I thought. What do you specifically look for in a probiotic and along with that do you think there is a value to tailoring a certain probiotic, or combination of them, to a specific need, issue, or possibly certain gut based biomarkers that may available for testing?
    Thanks!

    Dan

    (reply)
    • Peter Attia  March 13, 2015

      Too long an answer for a quick response.

  143. Greg Yeadon  March 14, 2015

    Peter – I listened to your Q&A recording on Tim Ferris’ podcast, and my eyes were immediately opened to so many new aspects of health. My question for you is – what is the best way to find a PPC who is knowledgable about the latest in diagnostic screenings? I have a PPC who’s in the stone age – standard screenings, come back once a year, etc. I just don’t think that model of checkups is going to be effective to prolong health and wellness for me. If there are any resources you have to help this search, I would be so thrilled – thanks!

    (reply)
    • Peter Attia  March 14, 2015

      Greg, this is a million dollar (probably billion, actually) question. If I knew that…

  144. Daniel J ShenSmith  March 14, 2015

    Many congratulations!!

    (reply)
  145. Diane Allen  March 16, 2015

    I lost 70lbs after changing diet and lifestyle using glycemic index and also addressing other issues which I found were related to immune responses with calcium ingestion. I have been working on theory related to the connection of calcium and glucose in the immune response which may give us a better picture of what is being used to fight several or many infections at one time as they are introduced. From Italian family, I ate wrong while growing up and introduced to many infectious disease from poor household and additionally with my nursing profession, additioinally had 4 children in 5 years, took all of my energy. Thought I was healthy too and doing all that I was taught. I congratulate you are your mission as it unfolds, I will try to follow your posts to understand more of what you propose, as I am also working on connecting with those who have like minds. BTW congratulations and I wish your wife wellness as delivery alone takes much energy, and if she is nursing she should be wise with her eating habits and rest. (I don’t agree with your stats on diabetes, numbers are much higher.)

    (reply)
  146. Greg  March 17, 2015

    Peter,

    Loved the podcast with Tim. Count me as a regular blog follower from now on.

    Coincidentally, about a week after listening I was a participant in an EPA research study in which I was wearing a Holter monitor. After observing me for a minute, the nurse grabbed me and ran me in for an EKG. It revealed ‘Atrial rhythm with occasional supraventricular premature complexes.’ At 60 BPM, I showed a series of 1-second intervals b/w beats followed by a ~0.5 sec interval, ~1.5 sec interval, 1, 0.5, 1.5, etc. In the 24 hours since, I’ve monitored my radial pulse and consistently noticed a similar pattern, regardless of BPM, caffeination, time of day, etc.

    Having read your disclaimer above, would you consider this consistent with the right-sided dilatation/AFib you spoke about in regards to endurance cyclists and runners?

    (I’m a 33 y/o male cyclist/runner/climber with over 12 years of consistent 5-6 days/wk of training)

    Thanks!

    (reply)
  147. Matt Laye  March 18, 2015

    I thought the podcast was a format that worked for you (and me). I really enjoyed the 10 tests questions and propose a slight variation. What is the most monetarily effective test? As a postdoc in the Bay Area it is hard to justify spending a lot of money on a single test that really requires other tests for the proper context (as exemplified by your nicely nuanced hormone answer).

    Related, I would be interested in getting some genetic testing, especially with regards to the ApoE genotype. Any SNP platforms you prefer? Wait for exosome sequencing to come down in price?

    (reply)
    • Peter Attia  March 18, 2015

      To your first question, I’d need to think (though most of the tests I noted are pretty cheap, except IGF-1). To your second question, yes.

  148. Svetlana  March 20, 2015

    Dr. Attia,

    Much to say. Big dat for me! Got my cholesterol panel results today and they were great, off the charts great. I have a theory.

    History – Low carb – Atkins really low carb 8-12 years, (except for pregnancies) . NK for last year at least may be a bit more. Female, 41 to make this relavant.

    My husband – opposite – he can have muffins, cake, ice-cream and cereal and not gain much wait. I gain wait just taking about it.

    I think it is genetic!

    Take away point: We have 4 humans in the household = each is different. I can eat SFA and have really good tests. My husband can not do that. Different bodies are so different. I ate beef and bacon for a year and my test results are off the charts great.. My doc keeps retesting me..

    I know its not normal but I think it woks for some..

    I just want to say we are all all different, I would not take my husband off his medicinem just in case it helps him but it does nothing for me with the same total cholesterol numbers. ,

    I think it is genetic. I think (I may be wrong each person processess carbs, fats and proteins so different) each person has default of way to process energy).

    I think they are groups of people that fit each category.

    I wish we had a test to find our WHO is WHO??

    (reply)
  149. TPB MD  March 25, 2015

    As regards fatty replacement of the liver (FRL):

    I’m a radiologist.

    In 20 years I’ve interpreted thousands of CT scans of the abdomen. FRL is gauged by the computer derived attenuation coefficient of the organ’s radiodensity (water is 0 liver should be > 45).

    20 years ago FRL was a relatively uncommon and significant finding on a CT scan. It warranted a full work-up. I estimate 5-10% of scans demonstrated FRL.

    Today, I estimate 80% of the scans show FRL and another 10% are borderline.

    Also, I’ve noticed a similar appearance to the pancreas (not sure anyone follows this) with most of these organs atrophied or replaced by fatty tissue in the majority of images I see.

    (reply)
    • Peter Attia  March 25, 2015

      Same observation from when my surgical training. What’s driving this?

  150. Danny  March 26, 2015

    Hey Peter. Ive commented on your website before. It was a while back.
    Anyways il get straight to the point. After stumbling across your website/findings and studying ketosis I managed to stay in nutritional ketosis for 30 days roughly 4 weeks. After it though I realized it was easier to gain weight. Very easy. I noticed the your experiment that measured muscle glycogen expenditure during excercisr before and after ketosis.

    Basically before doing that. I started working out and got to around 225 x 6-8 squats after a month and a half.

    Did the 30 day ketosis.

    Started working out in Feb of this year, approximately a month and a half. I am currently squatting 365 x 5.

    I am carb back loading and Implementing a 16/8 lean gains style eating window. I usually workout around 4 without having eaten anything all day only drinking tons of water ( I get the leanest during these days) and some days I have a high fat high protein breakfast only, no carbs before workouts.

    Is it because of the 30 day ketosis that I’m gaining this quickly? My body’s ability to utilize glycogen more efficiently?

    (reply)
  151. eric johnson  April 6, 2015

    Hi Peter,

    I greatly enjoyed both of your podcasts with Tim Ferriss. I admire how you are willing to change your mind on topics as new evidence becomes available.

    1) It appears to me that your nutritional philosophy has evolved to a point that, on some issues, somewhat disagrees with the information listed on your site under your personal nutrition journey and FAQ’s.

    Do you have plans to update those sections of the site, such as making a Part 5 of your personal nutrition journey (now that you cycle in an out of ketosis)?

    I think that would be really valuable to your readers.

    2) I think you would benefit and enjoy meeting James Altucher. While he focuses more on personal development and entrepreneurship, he has a really nice podcast and you would be a great guest on it (he’s covered the Paleo diet several times and has an interest in it). The info you presented on Tim’s latest podcast would really tie all of his previous casts together on the topic and it would expose you to an entirely new base of listeners.

    James also has a lot of knowledge on publishing books (esp. ways to self publish successfully) and I bet he’d share excellent tips and connections to help you do it the way you want. The guy is super generous and loves to give people ideas on how to improve their outreach/business/life circumstances. twitter: @jaltucher

    Thanks for everything you do.

    Eric

    (reply)
    • Peter Attia  April 6, 2015

      Eric, I agree it would be useful to keep the blog updated with respect my evolution. However, I simply don’t have the time to do so. Haven’t listened to James, but happy to.

  152. Kurt Miller  April 14, 2015

    Hi Peter, I work with obese children and adolescents. At what age would you recommend starting an obese child on low carb? Would you cycle them off it after desired weight loss occurred? What level of carb restriction would you go down to if you were concerned with children getting enough of the EFA’s or would you even have the concerns with Children say 8-15 years of age on low carb? Thanks

    (reply)
    • Peter Attia  April 15, 2015

      For any obese child, outside of the rare cases, I would initiate sugar reduction, followed by carb reduction. I would not restrict fruits and vegetables, but there is no reason to include sucrose, HFCS, juice, etc., in their diets.

  153. Rob Evans  May 1, 2015

    Hi Peter,
    This is kind of random but I just read both of Gary Taubes’ books and after “Googling” him, your name came up. After reading about you and your endurance swims, it dawned on me that I had met you before! It was in 2005, in a hotel in Long Beach, California and you were just about to swim the Catalina Channel. I don’t expect you to remember because it was almost 10 years ago and we only spoke briefly but I always remembered your name because I read the article about your swim the next week in the LA Times. You are truly an inspiration. After meeting you and reading the article, my love for swimming was awakened and after a challenging road, I am currently a Helicopter Rescue Swimmer in the US Coast Guard and find your blogs to be helpful and fascinating. I am so grateful for the chance to be able to tell how you unknowingly impacted my life, from our brief encounter 10 years ago. Such a small world! Anyway, keep up the good work!

    (reply)
    • Peter Attia  May 1, 2015

      Wow, Rob! How they heck do you remember that? How did we meet? Amazing.

    • Rob Evans  May 3, 2015

      My parents were visiting me while I was in college and staying at your same hotel. We were having breakfast and I was wearing a shirt that said, “Swim to Catalina”, which was a fundraiser we put together while I worked as lifeguard at the YMCA. You came up to me and asked if I ever swam to Catalina, to which I just laughed and said, “No way,” (the longest I had ever swam at one time had only been 7 miles). And then you said, “Oh, well, I’m swimming it tomorrow.” Needless to say, I was impressed. I even told my family.

      But then, about a week later, the LA Times article came out and I was like, “That was the guy from the hotel!” I guess that is how I remembered your name. The funny thing is that I tried to contact you years after when you did the Au’au Channel and back because once again, I was like, “That was the guy from the hotel!” I had joined the Coast Guard by then and was about to start my Rescue Swimmer training so I was pretty inspired. And on top of all your athletic endeavors, you’re an M.D. who actually knows what he’s talking about. It’s funny the similarities; I also prefer training in a fasted state, do Tabata intervals and shave my head, haha.

      So now, after reading Dave Taubes’ books and reading about how you guys started NuSi, and reading up on your blog, you’re still the guy from the hotel! I’m just a big fan and I’m trying to cite your research and articles in my efforts to make the Coast Guard a little healthier. Like I said, keep up the good work. If we’re ever in SoCal at the same time, I need to hook you up with some Rescue Swimmer gear! It’s the least I could do! Anyway, thanks again. I’m stoked I can finally tell you the story.

    • Peter Attia  May 3, 2015

      Yes, I remember exactly now. I will be happy to be forever known as the “guy from the hotel.” I live in San Diego and am actually in SD ~50% of the time. Please ping me if you’re down.

  154. Rob Evans  May 3, 2015

    *Gary Taubes, not Dave.

    (reply)
  155. Tom Bunnell  May 3, 2015

    “For any obese child, outside of the rare cases, I would initiate sugar reduction, followed by carb reduction. I would not restrict fruits and vegetables, but there is no reason to include sucrose, HFCS, juice, etc., in their diets”.

    Why would you include completely unnatural man made hybrid fruits and vegetables?

    (reply)
  156. Jason Whitworth  May 19, 2015

    Love your Tim Ferris Podcasts, would really love to see a podcast here.

    One other question I had for you generally is how to find a doctor (specifically in NYC in my case) who knows more about Nutrition then to “follow the food pyramid” or “cut out salt”.

    Are there any resources available or do you have any personal recommendations?

    (reply)
  157. Tom K  June 15, 2015

    Peter,
    Congratulations on your new boy he’s a looker!
    Thank you for your work it’s great. You have defiantly found your
    legacy this time.
    I think a book on aging and longevity is a very good idea, in the
    meantime as you do your research I would like to see articles and
    podcasts on this subject. A tantalizing way to promote and build
    interest in your book, and the feedback that you inevitably will
    receive will be invaluable in the writing of it.
    I also have been interested in the latest research on Progeria and
    Werner syndrome, I hope you will be looking into both of these areas.
    I feel aging is an area that does not get the proper attention such a
    cancer or heart disease since it is considered a natural event. With
    turtles living 100++ years and trees able to live over a 1000 there is
    a substantial wealth of knowledge waiting to be learnt on this
    un-natural subject.

    (reply)
  158. John  August 18, 2015

    After hearing your podcast with Tim, I have become a big fan of your blog and I have been obsessed with reading all of your posts.

    I was diagnosed with insulin resistance a month ago and immediately started a ketogenic diet. I have struggled to attain ketosis but Im doing well this week with a 2.5 mM blood level this morning.

    I started running and then I relearned that sub-threshold steady state cardio can increase insulin resistance. Would you recommend HIIT, strength training,running or walking as the best option for staying in ketosis and losing weight?

    Thank you for your time and effort.

    (reply)
    • Peter Attia  August 22, 2015

      It depends how much time you have, but I’d certainly stress strength training and other training that intermittently depletes glycogen.

  159. Meraj Dhir  October 14, 2015

    This is all fantastic stuff. I would like to see more content here though. For example, saying you will eventually share the manifesto is not good enough. We need firm information. Also, both you and Tim don’t really understand or “get” meditation whatsoever. I strongly suspect you guys have been practicing “open monitoring” meditation incorrectly. Open monitoring, or “Vipassana” as it’s called in Pali/Sanskrit or Buddhist terminology, is a very misunderstood and often incorrectly taught practice. It is, however, the most direct and efficient form of meditation, especially for enhancing and boosting mental and brain function in ways that enhance creativity, concentration and “mindfulness” (another very misunderstood concept). If you and Tim would like to understand these ideas and how to practice them I’d be happy to speak with you in your next podcast. I think it would really enhance your overall approach to questions about quality of life and longevity. Cheers! And keep up the great work, you’re an inspiration! M.

    (reply)
  160. Tim  November 28, 2015

    Hi Peter,

    it is a bit of a TLDR, but before i get into it, congrats on the kid i’m
    sure he’ll be a terror 🙂

    I came across you after listening to you on the Tim Ferris Show. It was
    a fascinating listen, full of all sorts of great things. So i have some
    questions I’d like to ask (for the podcast?), and suggestions I’d like
    you to think about.

    My comment here is with regards to the topics on the TFS podcast, and
    i’m only looking for your opinions as an expert.

    Context:
    I’m not a bio-chem guy i’m more electronics-IT Systems. Ever since
    chatting to a geneticist about DNA/RNA, I’ve been fascinated by how
    similar (at an abstract systems level) genetics/epi-genetics, and
    biological systems are to programming and control systems. I have been
    tracking the topics as a layman, and so my questions come from that
    angle.

    The questions:
    – Have you listened to Wim Hoff (he was on the Tim Ferris Show an episode
    or so before you) and what is your opinion on his claims that the
    oxygenation technique changes the body PH level.
    Specifically:

    – Does the PH level changes he talks about have the same effect as the
    drug you mentioned that seems to trigger orderly cancerous cell
    shutdown by changing PH levels?

    – I see in a previous comment from Chris, that there is research that
    shows hypoxia may be a cause of cancer. Assuming this is true, does
    the Wim Hoff oxygenation technique increase or decrease the risk of
    cancer?

    – I want to know more about Ketosis. I was on the slow carb diet, and it
    worked, but i need to know the mechanisms behind it, or i cannot
    maintain or tweak it. Also you mentioned on the podcast some things
    that would immediately bring you out of ketosis, and that it takes 2
    days of “fasting” to get back to ketosis.
    Specifically:

    – I want to be able to ‘fail fast’ without having to have bloodwork
    every day. What (cheap/portable!) tools and/or techniques can you
    recommend as the most effective way to ‘measure’ your depth of
    ketosis other than food journeying.

    – I want to build up my vocabulary and layman understanding of the
    systems i am manipulating with when i tweak my diet for
    ketosis. What is the most effective way for a Layman with systems
    experience to get a grip on this. Or are there some formal systems
    descriptions/models (e.g. UML activity diagrams/Flowcharts) that i
    could use to visualize the feedback loops, functional interactions,
    component balances?

    – Its becoming apparent to me that i have to do some strength and
    flexibility training, alongside ketosis to change my body composition
    and general health but i hate the gym. Also you and Tim (and Tim and a
    large amount of his other guests) are full of exercise terms or
    “terms of art”. This lets you discuss the topic with more precision,
    but is opaque to those of us who don’t know exactly what a leg pull is
    or how to do it. This question could go out to some of Tim’s other
    guests too.

    – I’d like to build my effective vocabulary in a way that maps on to
    the concepts i already understand. Are there resources that can help
    the layman map the metabolic systems/processes (preferably in the
    aforementioned UML diagrams or whatever), to specific physical
    actions/exercises? In the Control systems world, you would have an
    isometric drawing or similar of the physical systems you were
    dealing with?

    – Can you recommend a resource that can help me choose non gym
    (preferably fun) effective actives (other than martial arts/yoga)
    to help improve co-ordination and flexibility?

    Whew, finally the humble suggestions, as it might relate to your new
    NuSI Project.

    I’m constantly amazed by the casual conversations you guys had about
    brain chemistry and metabolism because now i know how others feel when i
    have those conversations with my colleagues in my area of expertise, and
    outsiders/managers listen in smiling bewilderment.

    I think language and vocabulary is key to this, as vocabulary defines
    the problem and problem domain. When i think of they words ketogenic
    diet, i want to be able to also remember what is and is not allowed/a
    show stopper.

    Also its about scaling, you guys do not scale. There is only one of each
    of you and the casually distilled information you guys made about what
    does and does not effect ketosis is seems like kind of capability you
    want to enable with your NuSI project.

    Specifically:
    – I use Anki, but i have started using memrise, since Tim mentioned it
    on your show. My suggestion is that you (and Tim) create some course
    material on ketogenesis, ketogenic dieting, exercise etc. Ideally,
    it would be the kind of distilled version of the resources that i am
    already looking for, but it does not have to be. This is the
    dandelion approach to getting it out there. You want to spread the
    seeds of the idea to the wind. Give your training a wide
    distribution, but also a low barrier to entry. I think that building
    a memrise (or anki) deck/course to get people up to speed so they
    can be immediately effective, will be the gateway mechanism into
    learning more. If you make it more accessible and memorable, you
    will not the single points of failure for this.

    Thanks for your patience,

    warm regards,

    Tim.

    (reply)
    • Tim  November 28, 2015

      Sorry about the formatting it seems to have gone south!

  161. Tim  November 28, 2015

    Worse, than crappy formatting, I just realised i mixed you up with Dom D’Agostino. So some of the questions are still appropriate (if you care to answer them!), nut feel free to just moderate them away.

    (reply)
  162. GK  January 4, 2016

    I had NAFLD 7 months ago and so I started keto research. 2 months on a cyclic ketogenic diet (one cheat meal every sunday) completely reversed my NAFLD. The sonography then showed a liver of normal proportions and the liver enzymes came back to normal. Now I am hooked to Keto for life!

    (reply)
  163. Steve Angel  January 31, 2016

    Peter, nothing is more important than God and family. I wish you the best quality time with your family. You look very happy in the pictures above!! I think that more podcasts would be awesome. I just wanted to let you know that you personally changed my life. I was very ill. I was eating what I thought was the right way. Then I read one of your posts about the ketogenic diet. That turned the light on above my head. Then I read, listened to and watched everything I could find, that referred to you on the web. I will say this has taken 9 months so far and I am not done yet, because thankfully you continue to share your knowledge and life with us. Thank you so much!!

    I am down 90+ pounds. I no longer have a fatty liver, metabolic syndrome, breathing problems, hypercholesterolemia. I can walk now and my BMI has dropped from > 42 to about 30. My body fat has dropped from about 45% to about 26%. I love this way of life thank you for the part you had in me making these changes. In my attempt to pay your kindness forward I have started a Facebook group where we openly discuss this way of life. We support all factions of the ketogenic diet and fasting, in a kind and supportive way. Since November this group has grown to over 1600 family members. We also have a sister group that is where we share recipies and discuss nutrition. This group has quickly grown to over 3200 family member. Both groups are administered by the same admin group. We would love it if you would join our groups, but understand if that is not something you are interested in doing! Dr. Fung joined our group and I was discussing inviting you to our group with the admin groups. One on the admis members said “Attia for me would be like having Richard Petty in one of my car groups!!”. I know your time is in high demand. But we would love to have you if you are interest!!!!
    https://www.facebook.com/groups/1482087988763862/ https://www.facebook.com/groups/1482087988763862/

    (reply)
  164. Dillon Zwick  May 17, 2016

    I loved your podcast with Tim and have listened to the 3 other podcasts you posted several times – they are all great.

    First, regarding your discussion with Dr. Ronda Patrick and your 8 levers for longevity. What role do you see inflammation plays in the prevention of chronic disease? She seemed to emphasis the fiber/gut/endotoxin leading to chronic inflammation causing disease, but I didn’t see how you placed the significance of inflammation.

    Second, how would one maintain RDA values on a ketogenic diet without use of a multivitamin? I’ve been in ketosis for about 90 days and have been tracking micronutients via https://cronometer.com/ – and am coming no where close. I’ve been using your post on Ketones and Carbohydrates to eat most of my carbs (large salad) after exercise in the morning, but anything over 30g and my ketones drop to .6mM. What other techniques could I use to increase my carbohydrate intake and maintain ketosis?

    (reply)
  165. Dave  October 26, 2016

    Congrats on your baby! Be happy!

    (reply)
  166. Craig  December 19, 2016

    Peter

    Really appreciate your wealth of knowledge on the subjects of longevity and life extension. One request I do have is recommendations for Dr’s that share your passion and interest on these subjects as I know you’re only on a referral basis only these days. I live in the NYC area.

    Regards,
    C

    (reply)
  167. George Culp  January 15, 2017

    Hi Peter,
    I cn’t begin to tell you how much your work has meant to me and my health. A quickie….have you ever considered hyperbaric oxygen therapy as a useful adjunct to one’s life?
    Thansk for all you do,
    George

    (reply)
  168. Jerry  April 20, 2017

    I just watched your keynote speech on Youtube. In it you mentioned transcendental meditation as your preferred meditation. Can you site some good resources for a newbie? I’m 50 yo paleo crossfitter but my energy is in the dump by 4PM. I’m suspect I have some deep stress that might be causing my lack of energy. I read and practice stoicism as well. I don’t really feel stressed but maybe it’s lurking deep? Thanks and you rock.

    (reply)
    • Peter Attia  April 20, 2017

      Jerry, Dr. Norman Rosenthal has written a couple of helpful books on TM. I also really like Dan Harris’s book “10% happier” as an overall look at the space, though I believe Dan landed on mindfulness as his preferred method.

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