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The personal blog of Peter Attia, M.D.

Welcome to a blog I’d like to read

Welcome to a blog I’d like to read
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On January 8th I’ll be “retiring” this blog and launching a new and improved one which hopes to provide much more content. More on that, below.

What started as a weekly email to a handful of friends grew into a substantially longer list of friends, then friends of friends, and quickly expanded to complete strangers. By late 2011, I decided to start putting my emails into long format and posting them as blogs. I mostly wrote about nutrition, but soon my interest in slightly more esoteric topics—such as lipidology—influenced what I wrote about.

Over the last few years competition for my time and energy have resulted in blogging dropping to the bottom of the priority list, somewhere just above watching reality TV (which I don’t watch) and just below rec league bocce ball (which I don’t play). But as my time for blogging has gone down, my reading and writing has actually gone up, just for a different reason.

In science, unlike politics, there is value in saying, “I don’t know,” or “We don’t really know, but it might be this,” or “Actually, what I believed last year is no longer likely correct.” Once you actually embrace this notion—that you can’t know everything, that facts have a half-life, and that humility is a blessing more than a curse when it comes to trying to understand the natural laws of our universe—you become obsessed with research. But there is an obstacle to consuming research (there are many obstacles, actually, but this one seems particularly troublesome): time. There are 168 hours in a week. Sleep, patient care (“work”), time with family, exercise, all chip away at this magic 168 number.

One of the great joys of practicing medicine is the frequency with which a patient asks you a question you don’t know the answer to. This is learning! Without it, the job could get boring. This happens to me about 5 or 6 times every week. Other times a patient asks a question to which I think I know the answer, but a day later I realize the answer I gave them was based on my last reading of the literature, which on that given topic was circa 2007. Maybe it’s no longer valid? Do PPIs really increase the risk of Alzheimer’s disease? Which fasting protocol is “better,” 5/25 or daily intermittent fasting? If one is only willing to exercise 3 times per week, what should the workouts look like?

The sheer volume of published work in the English language alone is staggering. At last check (based on 2016 publications), every month 98,197 new papers make their way onto PubMed. Yes, every minute that goes by, more than 2 papers are indexed on PubMed.

David Hamilton, writing in Science (1990), noted the following statistics: an estimated 80% percent of papers that are published in academic journals were never cited more than once. (In addition, self-citation accounted for up to 20% of all citations. It may not be a stretch to think that some of those solo citations came from the eponymous author[s].)  On top of that, 10% of the academic journals probably got 90% of the citations.

Let me re-state this: 80 percent of studies that are peer-reviewed and published are (or were), it seems, so utterly useless that no one ever cites them more than once. (In a follow-up study, estimates revealed that in the field of medicine, the percentage of papers without a single citation was about 46%; in the field of arts and humanities, an estimated 98% of papers go uncited.)

OK, so let’s pause for a moment and regroup. First, when I read/hear “thought leaders” (who shall remain nameless) claim to read all of the literature out there, I have to call BS. It’s simply not possible. Second, why would you want to? The above observations lead to the inevitable conclusion that most (by volume) of the published work on PubMed is barely fit to line the bottom of a bird cage.

(For the reader who gets all verklempt hearing that most published research is nonsense, it might be helpful to read this article on the chicanery in the modern scientific publishing world.)

It’s not lost on us that a heavily cited paper can be worse than useless and a thinly-cited one can be invaluable. A keen eye and good mental models can only get one so far. With more and more papers published by the minute, just how much noise is generated in the current landscape? Our conservative calculations show that, “these go to eleven.” To be sure, there’s still a formidable amount of information and knowledge waiting to be plucked from the literature. And a limited amount of time.

The best investment I’ve ever made

In 2015 I came to the realization that I was slipping. My “work” obligations, even with the huge reduction I deliberately made in exercise time, made it too difficult for me to keep up. The list of “To read” papers on my desktop was becoming an eyesore. I actually contemplated spending even more time on airplanes since that seemed to be best time for me to read. Yes, elective flights around the world just to read at 40,000 feet. The solution was obvious. I needed more brains. Literally more brains. So I hired them. Today, my practice employs a team of research analysts who are not just exceptionally bright and voracious consumers of literature, but also people who are so naturally curious (arguably the one skill I can’t really teach) that when you give them a problem, it’s just a matter of time until our collective knowledge on the topic will be increased.

Over the past year the volume of reports we’ve created—both in response to patient questions and our more elaborate proactive research agenda—has been impressive, though largely underused. In many cases, a particular report may only be shared with the one patient who asked for it. In other cases, maybe a dozen patients read it. But this work has largely remained internal. We’ve even created an internal helpdesk to moderate, organize, prioritize, and keep track of our work. (I love sending my requests to an email address that begins with Support@…)

Earlier this year one of my patients expressed his gratitude for the reports we had prepared for him. He suggested we make our work public as part of a subscription service. While we may indeed do this in the future, the other takeaway from his comment was that it was time to re-organize the blog, create a few different types of posts, and most of all, get back to some regularity.

Nerd Safari

Bob Kaplan, our head analyst, is a really amazing guy, and not just because he’s done more pullups than pretty much any one on earth, though that helps. (At a bodyweight of 185 pounds, Bob did a weighted pullup of 195 pounds [i.e., 195 pounds hanging from a chained waist-belt] … just 35 pounds shy of the world record.) Bob immediately had three great ideas when we kicked this idea around:

  1. Don’t worry about trying to figure out what everyone wants to read, write the blog I would want to read and let like-minded people find it.
  2. We should create three different types of posts and regularly put them out:
    1. A personal blog, which is basically what I do now; we’ll aim to put out one new post per month; and one blast from the past (previous post with updates).
    2. Reviews, specifically one “Bob’s book report” per month and one review of a scientific paper (i.e., journal club) we deem illustrative for the purpose of interpreting research papers.
    3. Nerd Safari, a weekly blog that focuses on, well, some of the more nuanced and detailed stuff that people like me (and you, if you’re reading this) have come to love. Bob also gets credit for this name, which I find pure gold. Some of the cognoscenti may have noticed I’m starting to hashtag this… #nerdsafari on Twitter.
  3. At some frequency, and ideally weekly, do a live video session on Facebook, to add commentary and address questions to that week’s Nerd Safari article.

As I get closer to the publication of the book (if I had to guess, Q4 2019), we’ll also start to release some other content related to the book, such as our on-camera interviews with some of the top scientists in the fields related to longevity. Once the book is out, we’ll also publish the “outtakes” (i.e., the stuff the publisher felt was too dense for the book).

And—eventually—what I really hope will come of all this is something that so many of you have been asking of me for years: an online forum where patients and doctors can find each other. Every week I get asked, at least a dozen times, some variant of the following question: “Peter, I live in the city of so-and-so and I really wish I could find a doctor who understands X, Y, Z. Can you point me in the right direction?”  [X, Y, Z can be anything from ketosis to HRT to nutritional approaches to cancer care to lipidology.]  I usually don’t have an answer for them but I’m convinced there is a way to play match.com for like-minded doctors and patients to find each other.

The Upshot

When over 3,000 articles are published daily on PubMed, and when the vast majority of the subsequent reporting on those articles appears dubious (at best), it pains me to even think of computing the signal-to-noise ratio people face when they want the straight dope on any given subject relating to their health.

I want to visit a site that publishes meaningful information that makes me wiser for having read it. This almost always requires me to do some of the lifting. Many of the topics I love so much cannot be summarized in a listicle. If the title of an article starts with “8 Essential Foods for…,” or the like, chances are it’s not worth reading. To really learn something requires contemplation and thinking—even as the reader—and over time this leads to new insights, which is one of the most rewarding experiences I have come to know. It’s the reason why I get so excited when a patient asks me a question I don’t know the answer to. I want to learn more each day, ask better questions, create and connect more dots, and engage my curiosity.

The new site is my attempt to create this environment for you. Buckle up.

Bye, bye Eating Academy…. hello Nerd Safari.

NB: Comments from this post will not move over to the new blog, so Twitter or FB are probably better avenues to comment or ask questions.

(My parting joke and a reference to my formative years…)

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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. Jorge Marcos  November 20, 2017

    Congrats Peter – very excited to see what comes next. Thanks for all the time and effort you’ve put into this, I dare say you’ve changed more than a few lives for the better. Couldn’t be more thrilled to see this project scale. Cheers,

    (reply)
    • Bianca  November 21, 2017

      So excited!!!!! Thank you, Peter

  2. Karen Fahey  November 20, 2017

    Sounds fascinating! I look forward to NerdSafari!

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  3. Peter Cook  November 20, 2017

    Congratulations! Exciting stuff. Thank you for continuing to share all your great work.

    (reply)
  4. Raoul Wiart  November 20, 2017

    I had never realized the volume of material coming through Pub Med. Looking forward to the NerdSafari. Thanks for all you have done and continue to do to get out nutritional information.

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  5. Baird  November 20, 2017

    Wish to subscribe. Thanks

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  6. Jonathan Housman  November 20, 2017

    I am a family medicine physician who discovered this blog in medical school, and I could not be more excited about these changes. Thank you for all of your content and teaching!

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  7. Brad Spencer  November 20, 2017

    Really looking forward to Nerd Safari. Thanks for sharing. I, too, am curious, and I have to rely on the good work of trusted friends. Again, thank you.

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  8. Yensy James Hall  November 20, 2017

    Peter – I’m a huge fan of your work which I’ve been following and disseminating for many years. Needless to say, I’d love to work with you. Is there a way I can help? (I’m an experienced software engineer). All the best to Nerd Safari. Cheers!

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  9. Helle Madsen  November 20, 2017

    How exiting, a nerd safari. I will look forward to the little new one, thanks for this old one, and all your work.

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  10. Alisa Kim  November 20, 2017

    The most jaw-dropping tidbit was not in regards to the number of papers that come out on PubMed but your colleague’s pull-ups. Crazy!

    (reply)
    • Peter Attia  November 20, 2017

      I’m glad at least one person knows what’s really going on!

  11. Gretchen  November 20, 2017

    I empathize. New information comes in faster than I can process the old, and the stacks of unread articles threatens to cause a fatal paper avalanche. Anything you can do to distill the essential information will be greatly appreciated.

    When I wrote a book on diabetes, what I wrote was the book I wished I’d had when I was Dx’d, and it seemed to resonate with a lot of people. So I think your approach of a blog you’d like to read is a good one.

    We’re rooting for you.

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  12. Christopher Grove  November 20, 2017

    Hey Peter… this is cool… Congrats!

    I hope that the subscription price will reflect the people that NEED some of your information for the benefit of recovering from their poor health, which is how I found you in the first place. (That and the fact that I can point to you and say, “He’s a Canuck!”

    Best Wishes!

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  13. Cindy Baird  November 20, 2017

    YES! Cannot wait, this approach sounds great, thanks in advance for the efforts they are sorely needed.

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  14. Christopher Grove  November 20, 2017

    BTW… If you do decide to monetize, one idea that you may wish to consider is “micropayments” for lengthy articles. This way the financially strapped people out there, looking for health info, could pay very modestly for only the articles that they need. I’ve been considering this payment concept for my own blog. Possibly articles would be free for a time, then a micropayment for archived articles. Just a thought.

    https://www.digitaltrends.com/web/google-launches-micropayments-for-web-content/

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  15. John Steen  November 20, 2017

    Can’t wait for this Peter. This is exactly what I’ve been hoping to find online. And with a team and leader that is so rigorous in sorting out the truth in an applicable way, this is going to be game-changing for a lot of people. Thanks.

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  16. Su-Chong Lim  November 20, 2017

    Hey, Fellow Canuck: Tune out — Grey Cup’s on. Seriously, your track record is such that any move that you make towards refined content (in the blogging, I mean, not in food per se) will be voraciously consumed.

    (reply)
    • Su-Chong Lim  November 27, 2017

      Canadiana Grey Cup Update: 2 minutes to go, in a blinding snowstorm, Calgary Stampeders with a comfortable lead take the ball to a couple yard of touchdown, but the icy ball squirts free, is grabbed by Toronto Argonauts, run back the length of the field for a touchdown. Which is converted to a double to tie. Toronto scores field gold to win. Calgary is in mourning.

    • Su-Chong Lim  November 27, 2017

      And I OD’d on chips and dip and am out of ketosis.

  17. celeste kelsey  November 20, 2017

    Thank you for sharing what little time you have after all of your more important activities. Having followed you for more years than I recall, I know you are nothing if not an educator who has a passion for elevating the conversation. I look forward to your “Nerding Out.” When I look back on where I started…I know I would not be as savvy as I am today without smart people like you. Hope the subscription price is not prohibitive to laypeople like me. Look forward to your book and hope it answers some questions you left hanging in your blog (unless I missed it). As a Hashimoto’s sufferer…I remember a promise to discuss the implications of Hypothyroid on Cardiovascular Health and Cholesterol. Something with which I am intimately aware. Peter…the epitomy of “A Rolling Stone Gathers No Moss.” 🙂

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  18. Greg Hill  November 20, 2017

    I would be very interested to read anything you might have to say about William Walsh’s work addressing the physiological underpinnings of different types of “depression,” and his book Nutrient Power.

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  19. Gregory Illes  November 21, 2017

    So when are we going to get the new Nerd Safari URL?

    (reply)
  20. Patty Handrahan  November 21, 2017

    Thanks so much for sharing a great trip down memory lane (“verklempt” and “these go to 11” had me rolling — such good stuff!) I have truly appreciated the Eating Academy blog and look forward to the Nerd Safari. Onward and upward!

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  21. Lynn  November 21, 2017

    Dr. Attia, it has been your blog that helped me learn how to help my husband recapture good health. How do I sign up for your new venture? I am very thankful for your help.

    (reply)
    • Peter Attia  November 21, 2017

      Just check back in after Jan 8.

  22. Susan Richart  November 21, 2017

    Peter,
    I read Consumer Reports on Health and was surprised recently when they finally figured out that low-fat wasn’t that good for many people and they basically said: “Who could have known?” Of course, this is after I’ve read numerous books that looked into real research on the topic for a couple of decades. Instead of articles, how about categories that get updated with new quality research. An example would be how much water should a person drink and what variables affect that amount and then update it as new valid information comes in. Best of luck in whatever path you and your analysts take.

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  23. D  November 21, 2017

    Great news about your new site Peter, I’m looking forward to it.

    With the retirement of this blog, will the currently available content still be available in the future?

    (reply)
    • Peter Attia  November 21, 2017

      It’s all moving over the new site, not to worry.

  24. Scott R  November 21, 2017

    Excellent! Really looking forward to this.

    I’ve always appreciated the economy of your writing. And your allergy to overgeneralizing.

    Now to prepare for a reallocation of reading time – I’m presuming the post lengths will remain…robust.

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  25. Michael Dale  November 21, 2017

    Thanks Peter, I can’t wait to read everything.

    (reply)
  26. Doug Tom  November 21, 2017

    My favorite kind of nerds reference Spinal Tap and SNL skits. Very excite for the new site!

    (reply)
    • Peter Attia  November 22, 2017

      You’re in good, but rare, company.

  27. tony  November 22, 2017

    Strength to your sword arm!

    (reply)
  28. Mads  November 22, 2017

    Looking forward to the new blog! Your work has really had a huge impact on me. I really appreciate everything you do. Just wanted to let you know that.

    I have a small question, that I hope you can find the time to answer. I am currently doing a carb tolerance test (a la Robb Wolf’s 7-day carb test) and have had great blood glucose responses. I ate 50 grams of effective carbs from cold white potatoes with a fasting BG of 91,8 at both the one and two hour mark my BG was 88,2. When i did white rice (again 50 grams of effective carbs) my fasting BG was 99. At the one hour mark my BG was unchanged and at the two hour mark it was 106,2. So here’s my question. Is there any way to estimate my insulin sensitivity based on these tests? I really just want to know if it is a good or bad sign that my blood glucose is nearly unchanged 2 hours post carbs.

    PS. My bodyfat is around 17% and i have trouble getting it lower even on a low carb or even ketogenic hypo-caloric diet. It has been like this the past six months.

    I hope to hear from you, but i completely appreciate the fact, that you might not have time to answer.

    (reply)
  29. Nathan  November 22, 2017

    You had mentioned some time ago a planned blog post on Lp(a). Will that be included in the new blog? I hope so and will be anxiously awaiting. Thanks.

    (reply)
  30. Zaid  November 24, 2017

    Peter,

    Thank you for sharing your experience. This is my first comment here, but I spent countless hours on this blog over the years.

    There is so much more to learn.

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  31. Stephen  November 24, 2017

    Peter, I searched your blog for your mention of an elderly female health practitioner whom you considered to be an expert in the treatment of auto-immune diseases, and was also a sufferer herself, but couldn’t find it.

    I had written it down and gave it to my sister, whose daughter was literally at death’s door last year, but my sister lost it.
    Do you recall the name of the woman I’m thinking of?
    TIA

    (reply)
    • Peter Attia  November 25, 2017

      Terry Wahls

    • Su-Chong Lim  November 29, 2017

      Elderly? She was born in 1955.

  32. Eric  November 29, 2017

    Hello Dr. Attia,

    Looking forward to the new site and more content!
    The best strategies for optimal health/longevity sometimes feel like Churchill’s comment about Russia:

    “It is a riddle, wrapped in a mystery, inside an enigma; but perhaps there is a key.”

    People like you help provide the key.

    For example, you commented on STEM talk about the importance of Type 2b muscle fiber. I did a little research and, at least in one case, unfortunately came up with the opposite:

    https://www.ncbi.nlm.nih.gov/pubmed/11375332
    “GLUT4 is reduced in slow muscle fibers of type 2 diabetic patients: is insulin resistance in type 2 diabetes a slow, type 1 fiber disease?”

    So I take that as a green light to do aerobic, Maffetone level work on the bike and skip squat day – which I hate 🙂 Or is it?

    I’m looking forward to the new content, and especially your book, to provide a key, or keys, with regard to the best nutritional, exercise, and lifestyle strategies to maximize health-span and lifespan.

    Thanks,
    -Eric

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  33. Tracii  December 1, 2017

    Just extremely grateful for ANY tidbit. Thank you.

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  34. Mariela  December 4, 2017

    Peter,
    Cannot wait to see the new blog!
    Thank you !!!

    (reply)

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