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

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