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#276 ‒ Special episode: Peter answers questions on longevity, supplements, protein, fasting, apoB, statins, and more

The Peter Attia Drive

Sun Oct 22 2023



Nutrition Research Challenges:

  • Studying nutrition in humans is challenging due to the complexity of the organism and intervention.
  • Controlled experiments have limitations as they cannot provide long-term health outcomes.
  • Long-term studies require observing individuals outside of a hospital, making it difficult to control their diet for extended periods.
  • Historical exceptions, like the Minnesota coronary study, were conducted in nursing homes with complete control over patients' diets.
  • Epidemiology is often used to study nutrition in humans, looking for patterns without randomization.

Managing Nutrition:

  • Energy balance is crucial for metabolic health. Excess intake leads to poor metabolic health regardless of the "best" diet.
  • Patients with insulin resistance may respond better to carbohydrate restriction as a means of reducing total intake.
  • Sustainability and adherence are key factors. A 7 out of 10 diet that can be maintained indefinitely is more beneficial than a perfect diet followed for only a few months.

Longevity and Diet:

  • Associating longevity solely with diet in specific populations can be misleading due to numerous contributing factors.

Longevity and Supplements:

  • The viability of living beyond 120 years is uncertain due to our limited understanding of aging processes.
  • Geroprotective drugs and supplements are being explored but their effectiveness in reversing aging processes is still unknown.
  • Personalized protocols for drug and supplement regimens are necessary as individual responses may vary.

Lowering ApoB and Statin Use:

  • Lowering ApoB can be achieved through pharmacological intervention or dietary changes.
  • Exercise does not significantly impact lipoprotein-related ASCVD risk factors.
  • Nutrition plays a role in lowering ApoB by reducing carbohydrates or saturated fat intake.
  • Pharmacological interventions such as PCSK9 inhibitors, combination drugs like Nexlozet, and statins effectively lower ApoB levels.
  • Concerns about long-term use of statins should be weighed against alternative risks and benefits for each patient.

LP Little a Medications:

  • Antisense oligonucleotide drugs targeting LP little a synthesis show promise in phase two trials.
  • Phase three trials will determine if these medications reduce clinical events related to LP little a levels.
  • Approval for secondary prevention is more likely initially before expanding to primary prevention indications.

Challenges in Nutrition Research:

  • Studying nutrition in humans is complex due to the multifaceted nature of human physiology and eating habits.
  • Controlled experiments with complete control over diet are difficult to conduct on humans outside of research settings.
  • Epidemiology is often relied upon for studying nutrition patterns without randomization or controlled conditions.

Managing Patients' Nutrition:

  • Energy balance is crucial for metabolic health regardless of specific diets. Excess intake leads to poor outcomes.
  • Individual patients may respond differently to different dietary approaches based on factors like insulin resistance.

General Principles for Longevity:

  • Okinawan adopt a more Western lifestyle, including diet, and lose the benefits they once had.
  • Other factors that contribute to longevity include activity level, exercise, sleep, stress management, social connections, and absence of toxic elements in the environment.
  • Different populations with diverse diets have shown pockets of longevity, suggesting that there is no one perfect diet.
  • The human body can adapt to various dietary conditions as long as energy balance is met and metabolic health is maintained.

Reasons for not doing longer fasts:

  • Logistical reasons: No longer traveling frequently where it was easier to fast.
  • Lack of clear benefit: Uncertainty about whether a prolonged fast has meaningful effects on negative processes in the body.

Importance of Protein:

  • Importance depends on muscle mass. Overnourished individuals with sufficient muscle mass may tolerate a slight protein deficit while in caloric deficit.
  • Individuals who are overnourished but under-muscled need to maintain high protein intake to build muscle while losing fat.
  • Data does not support increased mortality in people below 50 with high protein intake. Any increase in relative amount of protein is likely due to poor health or caloric excess.
  • Peter targets between 150 and 180 grams of protein per day.
  • He consumes venison jerky sticks from Maui Nui, which provide around 10 grams of protein each.
  • He also includes other high-quality sources like whey protein shakes when necessary.

Favorite Wearable - Morpheus:

  • Morpheus is a wearable device that measures heart rate, respiratory rate, heart rate variability (HRV), and provides training zones based on these metrics.
  • Peter uses Morpheus primarily for zone two or VO2 max training and compares predicted heart rates from Morpheus with lactate levels measured during exercise.

Continuous Glucose Monitors (CGMs):

  • CGMs are valuable tools for both diabetics and non-diabetics.
  • Average blood glucose is the most important metric to track, as it correlates with all-cause mortality.
  • Other metrics include standard deviation of blood glucose levels and spike sizes.

Continuous Blood Pressure Monitors:

  • Actia device from Europe is a bracelet that optically measures blood pressure in the wrist and provides average readings throughout the day.
  • The device is not yet FDA approved but shows promise in accuracy compared to automated cuffs.
  • Continuous blood pressure monitoring would be beneficial for managing health conditions and optimizing training.

Desired Wearable - Continuous Lactate Monitor:

  • Peter would like to see continuous lactate monitoring during exercise, particularly for zone two training.
  • It would provide accurate insights into metabolic changes and fatigue during workouts.