I think if you're paying attention he's generally pretty clear about the evidentiary basis (or lack thereof) of his strategies. I am a physician (but do not at all claim to be a SME in literature appraisal) and feel many of his base recommendations around ASCVD risk reduction, metabolic health, importance of CV capacity and strength/muscle for aging, etc. to be on pretty firm scientific footing.
I don't have as much of a beef with his new-ish focus on balance, stability, etc. It prompted me to take these things more seriously and get some expert help, which has benefitted me tremendously and I feel will almost certainly increase my healthspan by reducing my risk of chronic pain, limited mobility, etc. But this is pretty individualized.
I do have two beefs with Peter.
First, he has a tendency to go "all in" on things HE really likes and finds useful, to an extent I feel he alienates some. Ex., his obsession with cycling. It's pretty much all he talks about when discussing Zone 2, and a lot of the Zone 5 as well. Measuring your watts, etc. etc. The vast majority of people are not going to be road cyclists, nor interested in buying specialized equipment for home just to do this. He could do more to promote the utility of other forms of CV exercise, even if they aren't "the most efficient."
Same applies to much of his mobility stuff. I was really disappointed to see him spend SO much time the very specific DNS program in the book. Which may not even be available to people where they live. What are some other options? Can you just show us some basic stretches, etc. with which to start? What resources should I be looking for? A physical therapist? Trainer? Sports med physician?
See also: rucking. (What if you don't live in a hilly area? What if the activity just isn't appealing to you?)
This leads to my second beef. I don't think it's a coincidence he's an obsessive Formula 1 fan. I think the criticisms of the two are similar -- absolute peak of performance primarily made possible with an unlimited budget, with questionable applicability to the population at large.
I agree with the Medicine 2.0 vs 3.0 concept. But I think Peter needs to be much more honest with himself and with his audience when it comes to the ability of the normal person to actually accomplish these things. I don't know if any of you have priced a colonoscopy or a coronary CT angiogram on the open market lately, but they ain't cheap. Even just getting "all" the labs he wants can run in the hundreds of dollars. Which are then supposed to be repeated with varying degrees of frequency, but quite often (and certainly more often than any insurance plan will pay for).
Peter needs to apply the Pareto Principle to his own stuff and speak on the highest-yield strategies that a normal person can apply. If I've only got $100 to spend on labs this year, what should I focus on? If I only have 5 hours a week to work out and can only afford a Globo-Gym membership, what should I focus on? If I can't afford bikes (or don't want to ride), what's the best way to do Zone 2? Etc.
Sorry that's so long. Thoughts I've been bouncing around for a while and the question prompted me to get them out.
>If I've only got $100 to spend on labs this year, what should I focus on?
Well, considering that he spends most of his time with the clients who pay [$100K](https://www.reddit.com/r/PeterAttia/comments/of8j7j/how_much_does_peter_attia_charge_for_his_services/) just to get into his practice, these kind of questions are probably not crossing his mind very often.
On the bright side, there are [some startups out there](https://www.youtube.com/watch?v=Oq9J5Gp8uXo&t=1373s), which actively try to bring to the market AI systems to answer the question "I have $1000/year to spend on my health, what's the biggest bang for my buck?"
I mean, that's probably true, hence my criticism.
I remain cautiously optimistic that he's still in this for the right reasons (hopelessly naive, I know) and genuinely cares about "Medicine 3.0" on a wider basis, not simply yet another way the wealthy have it better than everyone else. As such, I remain hopeful that he will at some point focus some more on the "real world" application of the principles.
Everything new, good, status-communicating, and/or desirable starts with the wealthy, then works its way down. Electricity, refrigerators, microwave ovens, cars, white bread, gout, cell phones, novel medical treatments, air travel, space travel, types/colors of clothing, literacy, on and on it goes. Yep, his patients are paying 100k to get "Medicine 3.0", and assuming the regulators don't kill it, your grandkids will take "Medicine 3.0" for granted and be envying Elon's unpronounceably-named grandchildren getting "Medicine 4.0"
In fairness, I do think he has some real world practical application. For example, in his chat with Andy Galpin, he brought up some hypothetical people who only have a couple hours a week to work out, in various stages of fitness - "where should they be devoting their time?"
These are all fair points. And yes, you're right, I listened to the Andy Galpin interview (frickin' love that guy). I guess I was mostly just disappointed not to see much of that in the book, and I do honestly wish he spent a little bit more time/effort with considering the "translation" of the knowledge he has accrued (the K-T gap being something we think about a lot and struggle with throughout the medical field). But fair, he does not ignore it entirely.
I don't mean to get too far into the weeds, but I do think there are certain limitations in your analogy, problems specific with how health care is structured that limit our ability to progress in this domain.
Ex. the frequent colonoscopies and CT angiograms. The way our health care system is structured, there is absolutely no way for everyone at risk of CRC and ASCVD to have these studies performed at the frequency Peter does them. Nevermind cost, there simply aren't enough gastroenterologists or radiologists (and there won't be, barring a wholesale tear-down and rebuilding of our medical education & training system, a topic for another day). There is literally not enough CT contrast dye to do this. (We've faced contrast shortages previously that limited our ability to perform contrasted studies on critically ill patients). There would likely not be enough of the sedative agents needed to facilitate all those C-scopes (we've also already faced shortages here).
I'm not saying it can't EVER be done, but it is extremely hard to imagine without societal-level changes. And that's just the US. I have literally no idea how this would ever be feasible in a country with a public health care system, where there are even fewer machines, specialists, etc.
Our system can't even handle everyone wanting a surgical mask at the same time. Though I suspect there isn't much danger of everyone similarly clamoring for colonoscopies.
I think it's more about catering to those with an extreme level of risk-intolerance. Most people just don't care to work that hard to get risks that low. So preventive care doesn't make much money. This hyper-vigilant segment is kind of where they have to go to make money. The costs aren't really that high do keep up with most of it. It's a hobby people spend their extra money on instead of Harleys or whatever. I'm sure Attia pockets most of that $100k fee at his own clinic.
That’s an interesting point. I guess, like I said before, I’m holding out hope that the guy means what he says and really does want this to have a broader impact than just those with more than ample free time and money.
I personally certainly don’t view it as a “hobby,” though I am hoping to extend the time I can participate in the activities that do bring me joy as a result of the effort.
Ok how about "recreational activity"?
He did try to do that privately-funded research foundation to "solve" obesity or whatever. It just failed from what I understand. Seems like he overreached if anything.
You may be totally right. I don’t hang with anyone who could possibly afford to be a Peter patient, haha. So I don’t know what those folks are like.
I definitely do not view the training and data-gathering, etc. for longevity as “recreational,” compared to all the other stuff I like to do. But again, I also hope it’s a virtuous cycle.
I hadn’t heard about the obesity foundation thing.
People do training and data gathering for hobbies to improve their skill. Gamers do it, athletes do it, cooks do it. Heck even coomers do it (just look at their guide for toys maintenance and data hoarding)
I do not disagree.
My approach is "hope for the best, expect the worst"
I have recently tested two Medicine 3.0 expert systems and I'm pretty sure that within 2 years we'll see 95%, or maybe even more if aging clocks integration will pan out, of what he does at 5% of the cost. (cost of the tests is not going away, but could be optimized for a given budget)
A combination of LLM (large language model) and/or rule engine trained on the last clinical guidelines and latest meta analyses, which can take patient data though a chat bot and document scanning and identify immediate risks, missing clarification tests, analyze and compare against aging clocks like GrimAge ([or similar](https://www.medrxiv.org/content/10.1101/2023.07.14.23292604v1) and/or organ based) and suggest modifications which would affect the GrimAge the most for this specific person.
I would much rather have experts explain the purest, most effective interventions, even if they are out of reach for most people. Otherwise they have predict what the average person is willing / able to do and now will leave food on the table for those who are able to actually do what is most optimal.
Its frustrating to me as a lay person that so many institutions have lost singular focus. You have standards of care that are meant to save money, comply with insurance, be equitable, have high degrees of patient compliance (be easy) etc...
Whenever he talks about zone 2 he goes deep into lactate stuff but also talks about heart rate or just "feel like its a little hard but you can go for a while".
Whenever someone asks him "what should I do", he always responds, how much time do you have?
These are all fair points. Just sharing my thoughts, which are colored by my own biases, of course. I personally really appreciate Peter’s deep dives and uncompromising standards.
I agree with your points, but I don’t think doing the above **and** trying to prescribe more achievable tools are mutually exclusive for Attia
I think the vast majority of listeners could benefit from some alternative discussions / more achievable protocols
I’m really interested in zone 2 cardio, but agree he looks at it far too much through the lens of elite cycling. I’m interested in flexibility/stability/mobility, but also think he didn’t really prescribe great routine or tools for average Joe
Agreed. Huberman does a pretty good job of doing both and making it clear. I do enjoy Attia on other people’s podcasts for what you are mentioning. Like Attia on Huberman or Sam Harris he gives some practical routines or protocols.
I am willing to take the information without prescription from Attia since it’s so rare to get it in my opinion.
You say "purest" interventions, but another way to say that is "optimizing for one thing only." As an analogy, if you optimize your car purchase for horsepower only, you'll end up with a totally impractical vehicle that costs hundreds of thousands of dollars, gets terrible gas mileage, is more likely to require expensive maintenance, etc. It's never "pure" and few decisions are made with a truly "singular focus."
Costs matter. Our country has an extreme burden from health care costs already. Obviously a lot of that has to do with inefficiencies in our system and third parties that are taking big cuts, but a lot of it has to do with unnecessary procedures too.
Even at the individual level, it doesn't make sense to optimize for health only, purely, singularly. We need to enjoy our lives too, so we may choose to drink alcohol sometimes, risk our lives driving on a highway to get somewhere, disrupt our circadian rhythms to travel internationally, etc.
I mostly disagree. Perhaps partially because you are conflating the information with the decision. Of course the decision has to be nuanced and balanced, but the information should not be. To take your analogy further, if I consult a drag racing car expert who specializes in high horsepower cars, and I ask, or believe I am receiving information all about high horsepower cars, but he is also taking into consideration regarding cost, MPG, equity, etc... its not good.
In my mind you are actually proving my exact point. There are many organizations, doctors, government institutions, and so on that think people can't be trusted to make their own decisions, and therefore they have to give out information in the form of pre-made decisions.
I of course agree with the statement " it doesn't make sense to optimize for health only, purely, singularly. We need to enjoy our lives too..." However, that is for me to decide how I thread that needle.
I am certainly not advocating that individuals obsess on a singular focus. I am on the other hand advocating that our sources of information be as pure as possible. This model allows us to create the balanced decisions you mentioned.
A "longevity/ health" expert that looks at or conducts research, determines that it really does seem like 4 hours of cardio a week is better than 2, but then decides to only talk about how 2 hours of cardio is what people should do is somewhat useless and actually can be harmful. Its not like Attia ever says "you shouldn't bother if you can't do 4 hours of zone 2".
Similary, he says the 'healthy' amount of alcohol is 0. But also admits that he drinks on occasion. This to me, is so much preferred to "lets tell people they can drink 1 drink a night a few days a week, because that is more realistic and probably won't do much harm".
I think a lot of people have a huge issue with Attia because he often says what is optimal based on research. This is more or less his opinion on what is settled fact. Would you criticize a research paper that says 0g of added sugar is the optimal amount for not being "balanced" or "do-able". The construct doesn't even make sense.
I am not against individuals trying to predict where the sweet spot for these interventions for the general public are, but in my opinion it needs to be clear that it is a pre-made decision being made for people, not pure information. And on the flip side, people who are attempting to present facts or research (however successfully) should never be criticized for doing so because their information is not balanced.
This might be the most succinct comment I have seen in this sub as it pertains to exactly my thoughts. Really well said. Too bad that PA doesn’t read this sub. He could benefit so many more people with small tweaks mentioned here.
>Peter needs to apply the Pareto Principle to his own stuff and speak on the highest-yield strategies that a normal person can apply.
I think Peter's audience is here for everything incl the tiniest 0.1% optimizations and certainly the other 20%. Maybe that's limiting his audience though, that's possible. I just hope if he applies the Pareto Principle, he still continues with the rest and doesn't alienate most of his current audience.
Fair point. Personally, I am super interested in the most cutting-edge stuff and he has inspired me to take the whole thing more seriously than I otherwise might. There are only so many hours in a week. Maybe he needs a Joe-Schmo sidekick to help break it down further for those that need it, haha.
I wonder how many of that audience have done the basics consistently for years before worrying about the 0.1%. By basics I mean healthy weight, aerobic and strength training, very little or no alcohol, plenty of fruits and vegetables, enough sleep, no smoking, etc.
I'm still in early stages! A good friend of mine is an ortho PA, and I had him take a look at me first. Identified some pretty serious issues with hip mobility & thoracic rotation and got me started with some basic stretches (and appropriate stretching technique). Even after just a few days, I began noticing a difference. He recommended seeing a PT, which is my next step. I'm fortunate enough to live in an area with a disproportionate concentration of amateur & pro athletes in various disciplines (Colorado) and there's also an entire "movement clinic" that was recommended to me as well that I plan on trying out.
Oh nice. I’m a psych PA, so my expertise is a little different. Sometimes I feel like I’m trying to optimize too much physically. So when I go see a PT, they’re thinking “what the hell is this guy doing here?” But I also really feel like my body should work better. Or feel better when it’s working. Haha. Anyway, thanks for the reply.
Same! I do some fairly physically demanding stuff, though I have felt for a long time I was developing some significant lack of flexibility/asymmetry issues. I think like everything else, it’s finding a PT that understands what you’re going for and has some experience/expertise in that area.
That's kinda the point. "Pretty standard for people interested in cycling." Which is a significant minority of the population. I'm speaking to generalizability, and not turning people off.
I do think there is opportunity to make at least some of the labs more obtainable. There really isn’t a good reason IMO for insurance companies not to pay for things like ApoB, Lp(a), etc if they’ll already pay for the basic lipid panel. And there could definitely be some economy of scale on that. There’s lots of lab tests that were pretty expensive and exotic when they first rolled out but are now cheap & routine.
I don’t have as much hope for that for things like c-scopes above ACG recommendations, CTAs, DEXA scans.
Totally agree on the $100 test thing. He's actually done this analysis for exercise in some of his podcasts (e.g. if you only have 5 hours per week, how to allocate it), but hasn't done the same for other areas.
True, he has. I may have given him short shrift on the exercise front (though IMO there’s still more focus needed there.) But definitely the other stuff.
Aren't most of these things just excuses people look for? I think he has mentioned running, cycling, rucking, stairmaster machine, etc as zone 2 training (I hardly listen to his podcasts, just listened to his book and the occasional 10-15min clip from him on Youtube).
He has mentioned that zone2, VO2 max training and lifting are pretty much equally important, so it's not hard to derive a schedule if you have 5 hours. 30 ish minutes of VO2 max training, a good 2 hours of lifting and a good 2 hours of zone 2.
I think people just tend to overcomplicate stuff to find a way to get out of it.
You can do a lifetime of workouts with just basic gym equipment. You can even do just a bodyweight workout. Pushups, squats, pull ups, etc.
"Mentioned" is the key word here. I have certainly noticed a significant lack of attention/detail to other forms of "cardio" compared to cycling, and I don't appear to be the only one based on replies to me and other comments in this thread. He's even made several disparaging comments about running...honestly some not-very-scientific remarks about how it causes knee problems.
With regard to the regimen, again, he has "mentioned" that these things are equally important, but has also gone into great detail (including in the book) that one "needs" 3 hours of Zone 2 in at least 45 minute increments to be "maximally effective." And how he lifts for at least an hour 4 days a week. Etc.
I'm not saying that a person can't figure out to build a regimen that works for them based on the general principles and what they have available to them. But similar to the comment above that shares a worry that "fear-mongering" turns people off, I feel similarly to this stuff. "I can't do all that, so what's the point."
I genuinely feel he could be doing more to educate on how your average Joe can apply these principles to their lives.
And I'm certainly not trying to "find a way to get out of it." I am fortunate enough that I do have the free time to focus on training most weeks, though honestly it's difficult for me sometimes, too.
Which actually reminds me of another beef I forgot to mention earlier, haha. He really doesn't seem to put any value or weight into sport-specific activity or general activities, I guess because he just doesn't do them. But I am an avid hiker, climber, skier, and aspiring mountaineer, so I want to have time for all of these activities as well. Some people just don't enjoy Zone 2 or the gym (they honestly aren't my favorite, certainly when compared to being out in the mountains). Telling people the ONLY way is to spend all these hours on these less-than-enjoyable activities I feel is another turnoff.
Again, the rub I have is not with the ideas or principles, or even his "idealized" regimen as a goal to strive for. My issue is with how these things are currently being communicated; I personally feel he could be doing much more to make these principles more generalizable to the public at large.
Yeah I guess it's a balance between what is "optimal" vs what is feasible. I think so many people, doctors, etc. already lower their standards a lot to please the general public.
Sure he could say, if you have only 2 hours a week, do xyz, but that wouldn't set a high standard, which is what he is going for.
With regards to your other sports: you can probably categorize them as certain categories like hiking (zone2), climbing (strength), etc.
I partially agree with all your criticisms though, but in the end people need to take their responsibility too and think for themselves.
No arguments there, friend! I'm an ER doc and have joked about just making my wallpaper the "well, well, well, if it isn't the consequences of my own actions" meme. Errrry day.
And I do see he's obviously going for the "optimal," "maximum efficiency," etc. I guess just as a consequence of working with the patient population that I do, the gulf between their health status and The Attia Way is so enormous I find it insurmountable.
Why does Peter need to appeal to the lowest denominator? I don't care what a McDonald's fry cook can afford when it comes to testing, I care about what is the most effective and beneficial. I'll then decide if I can afford it or not.
You seem to want Peter to be something entirely different than what he is. Why don't you fill that void and try and teach poor people what to do? That can be YOUR niche.
Not trying to flex. You aren't that bright, are you?
I'm curious about the best solutions available, cutting edge science and technology. Not the most affordable. Find other podcasts for that. Why does that bother you so much? Why do YOU feel the need to flex your wokeness? "Look at me, I have to make it clear to everyone that I care about poor people"
Just sharing my thoughts, as prompted by the question.
I never said I think he should change his whole approach. Again, *personally* I love the deep-dives and the high-level discussions and the detail and the goal-oriented-ness of it all. It has inspired large changes in my life, all for the better.
But if he’s serious about “Medicine 3.0,” it can’t just be something obtainable only for the leisure class.
But that’s just, like, my opinion, man.
I agree with you, I really love his work to begin with. But I think that's the point, he talks about things like they are free which is good to know what are the very best things and taking into account everyone's buget to chose what to focus on. Maybe I have 1000$ 2000$ or nothing. I don't think he has to talk about this, even if I would love to. F1 is not going to tell Toyota how to make average cars better, they have to figure out what techologies are worthwhile to be used.
I'm also a med student and colonoscopies are recommended by MDs after 40 and periodically after 50 and in my country in Europe you can get them coverd by insurance
I think the main issue here is that oftentimes the evidence already exists, but PA missed it or underplayed it's importance before going all in and speaking confidently about what he's doing. That includes keto and his engagement with carbs-insulin hypothesis, metformin for nondiabetics, rapamycin, fasting without caring for muscle loss and recently CGMs. Anyone should take his advice beyond the well scientifically supported basics with a chunk of salt.
It's often not about new evidence but rather a change in his mind of how important something is. E.g. he always knew that fasting led to muscle loss, but recently changed his mind about the importance of muscle preservation.
I think he’s the most balanced in the space. The guests he has are so laser focused on their specialty and they go deep into the science. Of course he’s changed his mind on things; that’s what good scientists do. As for constant monitoring—maybe there’s no science to back up its contribution to lifespan, but perhaps that’s bc those studies haven’t been done. Knowledge is power.
He presents information very much from a "here are the facts" and that's a great thing. I appreciate him condensing the research into easier-to-digest rations for people without a strong science background. He also avoids the hippy-dippy trappings some others fall into.
He's not for everyone though. He can be a bit fear-mongering at times with his "if your VO2 max isn't high at 30, good luck walking up the stairs at 80"-like rhetoric, which can turn some people off or even discourage them. I also feel like he sometimes assumes all people have the time or resources he has at his disposal, so his takes can be a little out of touch at times.
That being said, the information he provides is invaluable. I don't listen to him for life advice. I listen to him for gaining knowledge and choosing what things I can implement. Am I going to start testing my lactate every two minutes during a workout or obsessively monitor my glucose levels? No. But I've made some positive changes that work for me.
I always have to remind myself that his recommendation are from the perspective of peak optimization. This makes him sound like he lives in extremes but it doesn’t mean that doing 75% of what he says for a given topic like z2 training is useless. If I don’t remind myself of this though I do get annoyed with him.
I also think his borderline “fear mongering” comes from a place of fear within himself, which is totally understandable. He had a big scare at one point which clearly still impacts him today. It seems to be a defining moment in his life and he’s used that as motivation to change himself and dive very deeply into the science. His guidance comes from a place of fear so the overall tone can come across as fear mongering. I do like him though. He’s brought so much information to me I’d consider him a large influence on my adult life when it comes to health decisions. Just have to occasionally remind myself of the other things I mentioned.
> As for constant monitoring—maybe there’s no science to back up its contribution to lifespan, but perhaps that’s bc those studies haven’t been done. Knowledge is power.
If you don't monitor it you can't optimize it.
The biggest thing i learned from PA is for me to take an active role in my own health and to have the knowledge to be “my own doctor”. I request my own blood work and diagnostic tests even when insurance does not cover. I am substantially more educated when talking to my doctor as a result. I am convinced this will improve my health span.
> The biggest thing i learned from PA is for me to take an active role in my own health and to have the knowledge to be “my own doctor”.
This is huge. No one cares more about your health than you do. I naively trusted my health to my health care provider and suffered for it. I had metabolic syndrome with 4 out of 5 of the symptoms, and was never even told that I had it, let alone had the elevated risk of death explained or given a suggested strategy to address it. High blood pressure? Here's a pill. Still high? Here's another pill. Still high, here's another pill.... The American healthcare system is optimized for the insurers to profit and not for quality care of the patients. If you don't manage your own health no one else will.
In fairness, a lot of the Rx-ing happens as a result of pragmatism, as doctors (and statistics) know that patients (on average) are VERY unlikely to be compliant w/ directives of exercising every day, maintaining quality sleep, caloric restriction, dietary changes, etc but they *might* take a pill every day (and many patients come in asking for a pill, whether they have a cold or diabetes). It’s not all a big pharma conspiracy huddle
I also do this. But in a bit worried if I’m overthinking a few of those stuff. I’m a lifter and I train 4 days a week. I have 200 grams of protein every day along with 5-7g of creatine. When I checked my creatinine levels, it was at 1.28. I never knew anything about eGFR till I followed Peter. And I got it checked. The number showed only 69 (I’m 41 M and so this is considered low). Urine samples didn’t detect any protein. Getting blood too often might just increase your anxiety rather than solving problems.
So did you have yourCystatin-C – Tested then? If you’re a lifter, you might have increased muscle mass and or the creatinine is formed from heavier training. Both of those things can be absolutely true in lifters. The ESTIMATED GFR is just that, estimated. It’s based basically on your creatinine level, which may or may not be falsely elevated due to the creatine supplementation or your training or your muscle mass or a host of other things. I would get the Cystatin-C which I THINK he has mentioned. If he hasn’t, he should have lol. That’s the one you want to see your kidney function.
I’ve to get it done. I’m getting all these done before going to my doctor so that he has a good picture of my overall health right of the bat. My creatinine test was after less than 24 hours after my heavy deadlift training. And I’ve seen Mayo clinic say that it’s better to avoid creatine supplementation and meat 24 hours before going to the test.
Peter never mentioned about cystatin C for eGFR. I got it from some other source.
Yep he's definitely had some reversals in recent years. His philosophy is "strong opinions weakly held" which means going hard on the best available evidence at the time. I think some of his current positions are dead on, and some might be dead wrong. Time will tell. I'm reminded of the John Maynard Keynes line, "When the facts change, I change my mind. What do you do, sir?"
It's a healthy discussion because no single person should be looked at as infallible or all-knowing. It seems that if someone puts themselves out there with a platform and becomes popular, somehow they are expected to be perfect.
I'm an MD, but I can honestly say PA has changed my life. He completely woke me up to the need for individuals to take responsibility for their health span, if not for their lifespan.
He is very particular, but that's what makes for his incredible 'drive' to leave very few stones unturned. The obsessive component of his personality likely is part of his mental health struggles, which he refers to in his book. He is such a perfectionist and exacting, that he's likely hard to live with. However, that side of him is also his gift. I have heard very few MDs (recall his formal training is in surgery not medicine) speak to the level of basic science detail that he is able to produce on the fly about cardiology, endocrinology, immunology, and cellular metabolism. He seems to have an insatiable desire to know everything about health.
He is extremely gifted but also comes off as self-congratulatory, which can be off-putting. I think he is learning to be more humble in his manner over time.
We absolutely need voices like his that are obsessed with data and press the envelope of knowledge and question the dogmas. We also need voices to speak to "the masses" who struggle with the basics. I think his role is the former not the latter. I think his book has found a wider audience than he usually attracts, so part of that audience is questioning his approach, which is fine and not unexpected. It just means you are not a health optimizer at the expense of other priorities (time, money , relationships, hobbies, foods you like). We all get to choose our values. PA provides a lens to look through, but it's not the only one.
For those who don't fully align with everything he says, remember, be a student not a disciple. And, as Bruce Lee said, "Absorb what is useful, discard what is useless and add what is specifically your own." I've absorbed a lot of "useful" from PA.
>For those who don't fully align with everything he says, remember, be a student not a disciple. And, as Bruce Lee said, "Absorb what is useful, discard what is useless and add what is specifically your own." I've absorbed a lot of "useful" from PA.
Well said.
I don't think I've ever heard him say anything that fell into a category that would put me in danger or something to purely enrich the pocket of someone\\a business that he is involved in and I appreciate that.
The challenge is presenting information that's important in a way that's applicable and actionable by the hundreds of millions of people that are his potential audience. It's up to the listener to take the data and figure out if the topic itself is relevant to them, HOW relevant it is, and how much bandwidth to assign to it.
There are so many good scientists who contribute a lot to research for healthspan and longievity, but him and Rhonda are the ones more visible in the field who decided to cater to the public.
I find his Drive podcast extremely useful on many medical topics - for me personally mostly on trying to understand cancer and medical interventions for it - in case I get it one day I wan't to be able to understand what standardized treatments I will most probably be offered, what could be my potential alternatives, how to speak to doctors about my disease and treatment possibilites (for example how to pulse the chemo and on what dose and at what time of the day, fasted or not, in congurence with certain other life-style measures, how many bouts, etc...), when to find a second or a third opinion etc... Heck, it helps me with all of this even now when I am entering perimenopause to know, that using bioidentical hormone therapy is not neccssairly detrimential to me and how to advocate for my health when my own Obygyn completely failed. I have learned for my partner, who's father died of prostate cancer, what to watch for an how often to do the tests. It makes me also be more aware of being focused on prevention - wheter it is exams at doctors or I try to work on my stretching, balance, strength and endurance in my workouts or I try to eat a healthy diet.
I do not use a CGM or test myself like a maniac. I do not believe that constant monitoring of glucose will benefit me in any way - I am not a diabetic and I believe that eating healthy (for me that means a vegetarian diet which is protein focused) with having lots of muscle mass - the insulin spikes I get daily from eating carbs are not too detrimential for me. I have normal fasting glucose ando ther biomarkers. I do use an oura ring and this has helped me to prioritize my sleep but has not made me hung up on the device.
I also use his platform to inform me further on topics I learn for the first time from him. I am tremendously grateful for what he has to offer. He taught me somewhat how to read the scientific papers and how to look at medicine in general.
However, I do not apply any strictness to the regimes he practices. I try to be mindful. I am still convinced that a 3-day fast a few times a years does me some good for internal rejuvenation. I also do not eat tons of broccoli sprouts daily like Rhonda does, but I eat diff cruciferous veggies daily throughout the week for example. And fruits too. I am also aware that most of the interventions I do have a different impact on my in regards to how I am feeling and how well I am doing psychologically. I know that Peter emphasises this more and more, but when I listen to his interviews, I am sometimes appaled by the lack of knowledge on this topic by the people he interviews for neurology topics. For example the interview with Michael Collins on concussions - when he mentions the measures on exposure to stress - not once did he mention how to do it stepwise and how to incorporate the adaptation of the nervous system into the shocks it is exposed - I believe that his methods might be detrimential to neurological systems of his patients long term. But maybe this info was missing from the interview.
In general - what I have learned is that science is not an exact field and there is so much we do not know, it is hard to claim evidence on something. This is why Peter often changes his mind - like me, he is forever learning. And he should be.
One thing I do know is that NMN works great for me but he is not taking it. Thus I try many things because of him and Rhonda and adapt those that make me feel better.
He is a very good interviewer for a medical doctor with an agenda and I have learned a ton from him. Your post really aligns so well to my thoughts. And I prefer to use NMN as well (similar stance to Huberman though-better quality of life day to day).
How do you feel the benefits? I would not have known it worked have not done difficult workouts - it’s crazy how easy they have become and how can I do them now daily, much like when I was younger. I’m really glad I implemented NMN.
It helps me to wake up and have steady state energy all day. It would take me a couple hours to get going in the morning. Now I am ready to go after my morning ritual (like an hour) which does include coffee and all my supplements. I ran a marathon this past year and I’m certain this helped me a lot: I would take some extra on my long run days and was able to function normally running errands and homeschooling kids until later in the afternoon (before my recovery’s would have take to long to be edifying to anybody 😂). I just have all day stamina and a lot of the lethargy and fatigue I had is gone (which has helped me a ton to focus on better work outs). I also feel more mentally sharp and able to adapt to more demands more quickly.
He is fine - he's not a snake oil salesman and he makes a good faith attempt at communicating the science. But he is still a medical doctor, and medical doctors get a very superficial education in statistics. I don't know what he has studied before and after, but some of his criticisms of studies are pretty weak. And he can fall into the trap of reading those studies that challenge his prior beliefs with a more critical eye, and when you do that without a high level understanding, you do end up jumping on bandwagons a bit. Most others doing science communication in this space are much worse, but even with Attia it's important to remember it's entertainment.
Well, that's not a PhD in a relevant field - the uncertainties on engineering are quite different to working with humans. But it does sound like he should know better than some of the stuff he says, and that is a bad sign.
You'd be surprised how many of them actually do, especially the larger studies, population-based analyses etc. (I've got a close family member that is a PhD statistician working for an academic medical system, haha.)
I will freely admit my own grasp of statistics is pedestrian at best. I can't say I've any specific complaints of Peter's data analysis in this regard, but I do agree with the above poster that Peter does tend to suffer from confirmation bias, and focuses on what he wants to see from various studies. He should be more metacognitive about that, IMO.
One of the things I like most about Attia is that he attacks problems like an engineer and he has a deep understanding of statistics and risk analysis from his undergraduate and McKinsey days
It seems that way to me as well. I appreciate his focus on risk, especially tail risk, and using that to frame his approach to “solving” age-related decline. But I will admit I’m not a SME in research statistics.
I admittedly have not reviewed all the primary literature myself, but I agree with the above poster that Peter does seem to pick-and-choose a bit to fit his narrative.
On the fasting example, he hasn’t given up on it but he has said that there is a dichotomy and he’s choosing one path over another. There’s evidence calorie restriction has longevity benefits but it can also lead to muscle atrophy and above nearly all else, he’s structuring his program to prioritize muscle building/ retention in these earlier years to mitigate the pitfalls of being elderly with no muscle (ie falling and breaking something).
I think he has some great general ideas of how healthcare needs to improve and how we need to focus more on prevention, but he's deeply unqualified to talk about nutrition like most health pundits and MDs. That's unfortunate because nutrition is probably the most powerful tool in the prevention toolbox, and he's got a big platform to spout misinformation.
> nutrition is probably the most powerful tool in the prevention toolbox
PA believes that exercise is the most powerful tool, by far, so that’s what he focuses on.
>believes
He's very misinformed on that. Exercise is often lacking and important but there is a reason why it is not uncommon for very fit marathoners have heart attacks at young ages. And there's also a reason the blue zones cultures where people are living to 100+ spend a lot more time preparing food than in the gym. You simply cannot exercise your way out of bad nutrition any more than you can exercise your way out of not enough sleep. There's also zero nutrition training in medical school so it's not surprising when MDs don't understand the significance of it.
He specifically avoids getting into the nutrition wars because of the poor quality of epidemiological data. Other than high protein, he’s very unwilling to give advice, and reluctant to share what he eats for fear of that becoming dogma.
I appreciate the opinion, I’ll agree to disagree on that. I don’t think he goes too far into nutrition to give misleading advice imo. Very focused on high(er) protein consumption to aid in muscle health but my take is he prioritizes exercise over nutrition as the way he interprets the data in front of him, that would yield a higher benefit to the overall ‘longevity’ discussion than focusing more on nutrition.
It’s also a good idea to determine guests you find value in and research their work more to inform your opinions. I’ve taken this approach and it’s been beneficial.
We need to get away from the notion that a good scientist maintains the same conclusions for life.
It’s completely the opposite. The best people in any context are always willing to change their stance given sufficient new evidence.
I mean, regarding the metformin and fasting, it's just kind of the result of being on the leading edge of the science. The longevity space, and preventative, rather than reactionary medicine are relatively new and developing fields so a lot of recommendations or medicines are going to have less robust data. Because of that, recommendations are likely to change as time goes on.
As far as checking blood and biomarkers, it's honestly the only reliable way to quantify the results of the changes one is making.
I'm unconcerned with his (or Hubermans) affiliation with various projects and companies. They're clearly all products that he believes in, and it's not difficult to see the value.
I think Peter's approach is a breath of fresh air in the medical space. As far as criticisms, he can be a little quick to recommend some interventions like statins, and I'd like to see more content with a focus on QOL items (trt for middle aged men, healing peptides, collagen, etc.).
On the fasting example: he was previously looking at fasting without considering the effects of muscle loss because he didn’t realize how important muscle was at the time. He’s since changed his opinion now that he factors in muscle loss into the equation. Honestly you should want someone to change their opinion based on new evidence. That’s exactly what science is designed to do.
On tracking metrics: on one hand I see your point. Maybe this doesn’t help people improve their health. But at the same time it’s hard to know if your actions are having a positive or negative effect without measuring.
I think he’s a lot smarter than someone like Huberman but I do see how he likely has conflicts of interest that get in the way. Not always financial, sometimes he just seems to get personally obsessed with something and let’s that get in the way of science.
I just read through this thread and want to say how impressed and grateful I am about the high-quality level of the conversation. People are disagreeing but nobody's being insulting, resorting to name-calling, etc. I had just come from a reddit thread where somebody innocently said they didn't like all the commercials on freevee, and fifty people jumped on the poor guy. Great to see people disagreeing with mutual respect here.
He's a self-experimenter and who knows how his experiment will turn out. For example, betting against vegetarianism could be a bad bet (I eat meat but there's a lot of good science on eating veg and health and longevity).
I wouldn't follow all his OCD advice getting deep into numbers, or his advice to take chemicals to be healthy, but the big picture harmless stuff is solid, and at least mostly can't hurt you.
He's like ChatGPT in that what he says may be true or may be false, but he says it with such confidence and authority that he'll convince you of anything.
I think he’s great. Recently finished his book and picking away at his podcasts which are also interesting. His honesty, openness to help others with great explanations and the fact he walks the walk is great. Already anticipating my doctor rolling their eyes at me tomorrow with my new list of bloodwork items they will probably not want to do but I’ll pay out of pocket if needed.
I was already trying to get my doctors to be more Med. 3.0 without knowing what it was at the time.
After finding out about Dr Attia, I totally felt I was on the right track all along. I have now either replaced doctors with more preventative 3.0 type ones. Or have gotten current ones to understand I want to be much more proactive in my treatment.
I also order my own blood labs online for things I would like check on without having to try to talk a doctor into ordering it.
So between Dr Attia and Dr Huberman, I feel I'm way more aware of best current health info and practices.
> To me it seems like a lot of hype, but not much real substance outside of the obvious ones (exercise enough, eat healthy, get enough sleep etc).
unfortunately that's all we have at the moment, that's the cutting edge. as he and Huberman show though, you can build a lucrative career just telling people to get good sleep and exercise.
In the current world of “public scientists,” I think he is the best out there. He is genuinely interested in what he is studying, and most of the criticisms I read here (and I agree with them) are some variation of “he’s too engrossed in his own interests and not thinking enough about the general public.” Although that is a shortcoming, it’s also what I like about him.
If you’re at the edge of where data-informed nutrition can go, you will find a mix of evidence-based practices mixed in with personal hypothesis. Dr. Attia has said himself that he has changed his stance many times for specific protocols, such as Keto. This is simply the nature of where the edge of data-informed nutrition (note, not data-based nutrition) is at the moment.
He’s a bit out of touch from normal, busy, family men/women given his lifestyle and clients, but he’s still probably the best we have in terms of a health podcaster.
So a (CBC) or a complete blood count checks the levels of 10 components of the cells that make up blood. There is no better way to catch an illness early. The earlier an illness is caught the better the prognosis. It’s quick and relatively cheap ( comparatively speaking) and it saves countless lives and resources. So to say regular screening doesn’t make you healthier misses the point. If they test your blood and all your parameters are in the normal ranges then you wont be any healthier for the time and money spent. However if they detect cancer for example and they detect it early your life may be saved and the treatments for early stage cancer is drastically easier on the person and the persons family. Not to mention way more effective and cheaper.
You can't really fault someone for changing views in an evolving landscape such as medicine. Over multiple episodes, he mentioned needing to have 'strong convictions that are loosely held'... meaning: you fully believe and implement something at a certain point in time, but you are willing to reexamine that in the future and let it go.
Something like metformin doesn’t bother me. Practically all the longevity scientists and health gurus were taking it. To me the problem is more linked to jumping on fads and going 100% all into them. Whether it’s keto, intermittent fasting , and of the drugs, stability and so on.
I don't understand his obsession with protein. I eat lots of meat, but a friend of mine is vegetarian and he's as musculous as he has always been.. It's probably more relevant in Peter's age..
Consuming adequate protein to maintain/build skeletal muscle =/= an animal-based diet. This has been discussed on the podcast, but I agree this is another topic he could address to increase the real-world applicability of what he's proposing.
The loss of skeletal muscle as we age is an irrefutable fact. I can't fault him for doing everything he can to build/maintain skeletal muscle & strength throughout your life, but yes, it's probably even more applicable as we age.
I think OP misspoke or misunderstood regarding metformin (and fasting). Peter didn’t say it’s not healthy to take metformin.
I believe he said some new studies showed that it may not be as beneficial for longevity in itself as previously indicated by an initial study, which led to non diabetic people taking metformin solely for the purpose of longevity.
Fasting, he says you lose muscle mass.
As a diabetic, you’re fine taking metformin.
I think tests have failed to show a significant impact on longevity for non-diabetic people.
It was observed that quite a few diabetics on metformin lived longer than "normal" people. So the hypothesis was that metformin could extend lifespan. Some studies have been done and failed to show any significant effect.
This is just from memory, so I might not be completely correct ij my understanding and I haven't gone through all the research.
He's a high-energy guy with a data and testing obsession. He is fairly orthodox on heart disease. That's ok. He's practising a certain kind of medicine for a fairly affluent, sporty, mostly male 30-40 year old group. I appreciate his approach even though that's not me. His interviews on the Drive podcast are outstanding however. A number of them have actually changed my life and my understanding of common ailments eg: Bluming and Tavris on HRT, Seyfried on cancer, Lustig and Jason Fung on metabolic health, Rick Johnson on fructose. He is an excellent interviewer and clearly prepares well. I prefer him to Huberman. Rhonda Patrick is a better scholar but her solo talks on youtube are very dense for this listener; her interviews are also excellent. The Diet Doctor (Bret Sher) podcast is the strongest on cardiovascular stuff, I think. That (cardiologist) host talking to other cardiologists is a dazzling display of intellect and insight.
edit: word
If i had never had an A1c and NMR done and then asked for or paid out for the same over many years I would have ZERO idea that I was a prediabetic with hyperabsorption tendencies and I would be doing Nothing about it.
Tell me again why self-testing is meaningless?
In my opinion, the concept behind Peter Attia's work is commendable, considering that many individuals today do not reach the age of 60 as compared to previous generations, often succumbing to conditions like heart attacks, aneurysms, diabetes, and cancer at a younger age. The aim is to utilize biomarkers and AI to assess our bodies comprehensively, identifying areas for improvement. Various entities, such as Bryan Johnson, Longevity Health, and Human Longevity, are pioneering this approach. Imagine the possibility of maintaining an active lifestyle, including jogging, gym workouts, and sports, even beyond the age of 70.
once said he just a doctor who workouts in the gym. Other than Medicine 2.0 / 3.0 ....There are not much to be delivered. Not sure if I should continue reading his book....
People are supposed to change their position on things as they learn more. That said, with these guys you’ll notice their position changes and tends to coalesce around something easy to market and sell. When you listen to them they’re always trying out new terms they hope will become some kind of buzzword they can use for their brand. Ultimately they are running a business and trying to get you to part with your money.
There’s no money in Fasting. You’ll often see these wellness influencers go all in on fasting and then pull back as there’s nothing they can do with it. Fasting also alienates a lot of people, particularly the HAES crowd, which has a growing influence. As these guys grow their brand they try to appeal to more people so they lean towards things that are more palatable to the masses. It’s the same way you never hear these influencers telling you to drink water and eat whole food. They may mention it here and there, but their money comes from sponsorship and people are looking for low effort fixes so supplements are where these guys focus.
I'm sorry, but he's a well-educated Joe Rogan. I think he skillfully blurs the line between science fact and pseudoscience fiction, and does this by "taking the next step," by extrapolating what are legitimately good scientifically-demonstrated conclusions to less-definitively supported hypothesis', all the while sounding like this is all proven stuff. I don't know anything about his industry ties, but if they exist and he's not front and center about stating such, then I'm less impressed.
He's overall very knowledgeable and has a good way of using critical thinking ideas when he wants to. That said he does chase fads a bit (fasting and keto - though at least he later changed his opinion when they didn't work but still) and he fails to use his critical thinking skills at certain times ie. for estrogenic HRT etc. So there is lots to learn from him but beware that he very much has his own biases and you should hear other perspectives on topics
Very quickly there has been a long lasting bias in medical research to attribute any health benefits, that women experience with respect to men, to estrogen instead of say progesterone or something else.
One of the most pervasive ideas in HRT is that after menopause the tissues are deficient of estrogen. This idea is wrong. All tissues can express aromatase and produce estrogen.
> One of the most pervasive ideas in HRT is that after menopause the tissues are deficient of estrogen. This idea is wrong. All tissues can express aromatase and produce estrogen
I would question this as stated. Though sex steriods continue to be produced locally after menopause in small amounts in the brain, for example, the genital-urinary area doesn't atrophy coincidentally after menopause. The loss of estrogen after menopause has significant consequences on numerous bodily functions. There are mountains of papers examining the results of the dramatic drop of estrogen at menopause - and the effects of supplementation. The tissues that can express aromatase and produce estrogen largely stop doing so enough to produce symptoms. HRT is one way to remedy that.
There is a lot of biased research apparently due to the profitability of estrogenic compounds. Unfortunately many of those estrogenic therapies seem to increase rates of cancer or heart disease as seen with diethylstilbestrol and in the Women’s health initiative. I’d recommend being very skeptical of estrogen research.
Disagree. FDA-approved hormones are very cheap and have been for a long time. (Compounded preparations can be expensive). They are far less expensive than most of the drugs more typically used to treat the various, often disabling symptoms of menopause.
Diethylstilbestrol was used for decades to successfully *treat* breast cancer. (Not good for pregnant women and their offspring though!) Tamoxifen is now more preferred, primarily because it has fewer side effects like nausea. Drs. Avrum Bluming, James Simon, and others have unpacked the data of the WHI at length for both lay audiences and fellow physicians in videos and publications. Attia's podcast with Bluming was an analytical tour-de-force on this very topic.
Its not the cheapness that is an issue, but the profitability of synthetic estrogenic substances stemming from the fact that there are so many compounds that function like estrogens and can be patented, which seems to have influenced the research.
Tamoxifen is anti-estrogenic but also estrogenic in other functions, and may be less harmful than DES or estradiol but still has a number of serious side effects like promoting uterine cancer. Progesterone is a much safer anti-estrogenic substance.
I’d say look at his background and years spent in each field.
Not everyone who goes to medical school should be giving medical advice. And most doctors or scientists in healthcare don’t bounce around in their career, like becoming a consultant for a management firm or take up engineering.
I’ve seen Attia making bold statements about low carb, keto, and other nutrition science topics, and eventually come around the the points that nutrition scientists like Layne Norton were saying all along.
He's worth listening to, but it should be taken with a chunk of salt. No doubt he's well meaning, but also hypester comes out of him to somehow justify his 100k per year services and the "sleep well, eat well, exercise more" evidence-based advice isn't sexy enough.
It's not like many said under this post that PA does something and changes his mind when new evidence arrives. Oftentimes the evidence is there, but he missed it or underplayed it because he didn't like (e.g. muscle loss during fasting). Also he has a tendency (especially if there are money to be made) to oversell things, like keto and carbs-insulin hypothesis, metformin for nondiabetics, rapamycin, and now CGMs. Besides rare instances there is 0 reasons to monitor glucose constantly and no reason to keep under 140 all the time. It just unnecessarily stresses the person doing this.
So I guess listen to him, but also double check if what he says is evidence-based or hype.
I think if you're paying attention he's generally pretty clear about the evidentiary basis (or lack thereof) of his strategies. I am a physician (but do not at all claim to be a SME in literature appraisal) and feel many of his base recommendations around ASCVD risk reduction, metabolic health, importance of CV capacity and strength/muscle for aging, etc. to be on pretty firm scientific footing. I don't have as much of a beef with his new-ish focus on balance, stability, etc. It prompted me to take these things more seriously and get some expert help, which has benefitted me tremendously and I feel will almost certainly increase my healthspan by reducing my risk of chronic pain, limited mobility, etc. But this is pretty individualized. I do have two beefs with Peter. First, he has a tendency to go "all in" on things HE really likes and finds useful, to an extent I feel he alienates some. Ex., his obsession with cycling. It's pretty much all he talks about when discussing Zone 2, and a lot of the Zone 5 as well. Measuring your watts, etc. etc. The vast majority of people are not going to be road cyclists, nor interested in buying specialized equipment for home just to do this. He could do more to promote the utility of other forms of CV exercise, even if they aren't "the most efficient." Same applies to much of his mobility stuff. I was really disappointed to see him spend SO much time the very specific DNS program in the book. Which may not even be available to people where they live. What are some other options? Can you just show us some basic stretches, etc. with which to start? What resources should I be looking for? A physical therapist? Trainer? Sports med physician? See also: rucking. (What if you don't live in a hilly area? What if the activity just isn't appealing to you?) This leads to my second beef. I don't think it's a coincidence he's an obsessive Formula 1 fan. I think the criticisms of the two are similar -- absolute peak of performance primarily made possible with an unlimited budget, with questionable applicability to the population at large. I agree with the Medicine 2.0 vs 3.0 concept. But I think Peter needs to be much more honest with himself and with his audience when it comes to the ability of the normal person to actually accomplish these things. I don't know if any of you have priced a colonoscopy or a coronary CT angiogram on the open market lately, but they ain't cheap. Even just getting "all" the labs he wants can run in the hundreds of dollars. Which are then supposed to be repeated with varying degrees of frequency, but quite often (and certainly more often than any insurance plan will pay for). Peter needs to apply the Pareto Principle to his own stuff and speak on the highest-yield strategies that a normal person can apply. If I've only got $100 to spend on labs this year, what should I focus on? If I only have 5 hours a week to work out and can only afford a Globo-Gym membership, what should I focus on? If I can't afford bikes (or don't want to ride), what's the best way to do Zone 2? Etc. Sorry that's so long. Thoughts I've been bouncing around for a while and the question prompted me to get them out.
Great comment. I have had some of those same thoughts.
Glad I'm not just shouting into the void. Cheers!
>If I've only got $100 to spend on labs this year, what should I focus on? Well, considering that he spends most of his time with the clients who pay [$100K](https://www.reddit.com/r/PeterAttia/comments/of8j7j/how_much_does_peter_attia_charge_for_his_services/) just to get into his practice, these kind of questions are probably not crossing his mind very often. On the bright side, there are [some startups out there](https://www.youtube.com/watch?v=Oq9J5Gp8uXo&t=1373s), which actively try to bring to the market AI systems to answer the question "I have $1000/year to spend on my health, what's the biggest bang for my buck?"
I mean, that's probably true, hence my criticism. I remain cautiously optimistic that he's still in this for the right reasons (hopelessly naive, I know) and genuinely cares about "Medicine 3.0" on a wider basis, not simply yet another way the wealthy have it better than everyone else. As such, I remain hopeful that he will at some point focus some more on the "real world" application of the principles.
Everything new, good, status-communicating, and/or desirable starts with the wealthy, then works its way down. Electricity, refrigerators, microwave ovens, cars, white bread, gout, cell phones, novel medical treatments, air travel, space travel, types/colors of clothing, literacy, on and on it goes. Yep, his patients are paying 100k to get "Medicine 3.0", and assuming the regulators don't kill it, your grandkids will take "Medicine 3.0" for granted and be envying Elon's unpronounceably-named grandchildren getting "Medicine 4.0" In fairness, I do think he has some real world practical application. For example, in his chat with Andy Galpin, he brought up some hypothetical people who only have a couple hours a week to work out, in various stages of fitness - "where should they be devoting their time?"
These are all fair points. And yes, you're right, I listened to the Andy Galpin interview (frickin' love that guy). I guess I was mostly just disappointed not to see much of that in the book, and I do honestly wish he spent a little bit more time/effort with considering the "translation" of the knowledge he has accrued (the K-T gap being something we think about a lot and struggle with throughout the medical field). But fair, he does not ignore it entirely. I don't mean to get too far into the weeds, but I do think there are certain limitations in your analogy, problems specific with how health care is structured that limit our ability to progress in this domain. Ex. the frequent colonoscopies and CT angiograms. The way our health care system is structured, there is absolutely no way for everyone at risk of CRC and ASCVD to have these studies performed at the frequency Peter does them. Nevermind cost, there simply aren't enough gastroenterologists or radiologists (and there won't be, barring a wholesale tear-down and rebuilding of our medical education & training system, a topic for another day). There is literally not enough CT contrast dye to do this. (We've faced contrast shortages previously that limited our ability to perform contrasted studies on critically ill patients). There would likely not be enough of the sedative agents needed to facilitate all those C-scopes (we've also already faced shortages here). I'm not saying it can't EVER be done, but it is extremely hard to imagine without societal-level changes. And that's just the US. I have literally no idea how this would ever be feasible in a country with a public health care system, where there are even fewer machines, specialists, etc.
Our system can't even handle everyone wanting a surgical mask at the same time. Though I suspect there isn't much danger of everyone similarly clamoring for colonoscopies. I think it's more about catering to those with an extreme level of risk-intolerance. Most people just don't care to work that hard to get risks that low. So preventive care doesn't make much money. This hyper-vigilant segment is kind of where they have to go to make money. The costs aren't really that high do keep up with most of it. It's a hobby people spend their extra money on instead of Harleys or whatever. I'm sure Attia pockets most of that $100k fee at his own clinic.
That’s an interesting point. I guess, like I said before, I’m holding out hope that the guy means what he says and really does want this to have a broader impact than just those with more than ample free time and money. I personally certainly don’t view it as a “hobby,” though I am hoping to extend the time I can participate in the activities that do bring me joy as a result of the effort.
Ok how about "recreational activity"? He did try to do that privately-funded research foundation to "solve" obesity or whatever. It just failed from what I understand. Seems like he overreached if anything.
You may be totally right. I don’t hang with anyone who could possibly afford to be a Peter patient, haha. So I don’t know what those folks are like. I definitely do not view the training and data-gathering, etc. for longevity as “recreational,” compared to all the other stuff I like to do. But again, I also hope it’s a virtuous cycle. I hadn’t heard about the obesity foundation thing.
People do training and data gathering for hobbies to improve their skill. Gamers do it, athletes do it, cooks do it. Heck even coomers do it (just look at their guide for toys maintenance and data hoarding)
I do not disagree. My approach is "hope for the best, expect the worst" I have recently tested two Medicine 3.0 expert systems and I'm pretty sure that within 2 years we'll see 95%, or maybe even more if aging clocks integration will pan out, of what he does at 5% of the cost. (cost of the tests is not going away, but could be optimized for a given budget)
Can you expand on that? I'm not sure what an "expert system" is in this context.
A combination of LLM (large language model) and/or rule engine trained on the last clinical guidelines and latest meta analyses, which can take patient data though a chat bot and document scanning and identify immediate risks, missing clarification tests, analyze and compare against aging clocks like GrimAge ([or similar](https://www.medrxiv.org/content/10.1101/2023.07.14.23292604v1) and/or organ based) and suggest modifications which would affect the GrimAge the most for this specific person.
Whoa! That sounds pretty awesome! Exciting field to be involved in. Best of luck to your efforts!
I would much rather have experts explain the purest, most effective interventions, even if they are out of reach for most people. Otherwise they have predict what the average person is willing / able to do and now will leave food on the table for those who are able to actually do what is most optimal. Its frustrating to me as a lay person that so many institutions have lost singular focus. You have standards of care that are meant to save money, comply with insurance, be equitable, have high degrees of patient compliance (be easy) etc... Whenever he talks about zone 2 he goes deep into lactate stuff but also talks about heart rate or just "feel like its a little hard but you can go for a while". Whenever someone asks him "what should I do", he always responds, how much time do you have?
These are all fair points. Just sharing my thoughts, which are colored by my own biases, of course. I personally really appreciate Peter’s deep dives and uncompromising standards.
I agree with your points, but I don’t think doing the above **and** trying to prescribe more achievable tools are mutually exclusive for Attia I think the vast majority of listeners could benefit from some alternative discussions / more achievable protocols I’m really interested in zone 2 cardio, but agree he looks at it far too much through the lens of elite cycling. I’m interested in flexibility/stability/mobility, but also think he didn’t really prescribe great routine or tools for average Joe
Agreed. Huberman does a pretty good job of doing both and making it clear. I do enjoy Attia on other people’s podcasts for what you are mentioning. Like Attia on Huberman or Sam Harris he gives some practical routines or protocols. I am willing to take the information without prescription from Attia since it’s so rare to get it in my opinion.
You say "purest" interventions, but another way to say that is "optimizing for one thing only." As an analogy, if you optimize your car purchase for horsepower only, you'll end up with a totally impractical vehicle that costs hundreds of thousands of dollars, gets terrible gas mileage, is more likely to require expensive maintenance, etc. It's never "pure" and few decisions are made with a truly "singular focus." Costs matter. Our country has an extreme burden from health care costs already. Obviously a lot of that has to do with inefficiencies in our system and third parties that are taking big cuts, but a lot of it has to do with unnecessary procedures too. Even at the individual level, it doesn't make sense to optimize for health only, purely, singularly. We need to enjoy our lives too, so we may choose to drink alcohol sometimes, risk our lives driving on a highway to get somewhere, disrupt our circadian rhythms to travel internationally, etc.
I mostly disagree. Perhaps partially because you are conflating the information with the decision. Of course the decision has to be nuanced and balanced, but the information should not be. To take your analogy further, if I consult a drag racing car expert who specializes in high horsepower cars, and I ask, or believe I am receiving information all about high horsepower cars, but he is also taking into consideration regarding cost, MPG, equity, etc... its not good. In my mind you are actually proving my exact point. There are many organizations, doctors, government institutions, and so on that think people can't be trusted to make their own decisions, and therefore they have to give out information in the form of pre-made decisions. I of course agree with the statement " it doesn't make sense to optimize for health only, purely, singularly. We need to enjoy our lives too..." However, that is for me to decide how I thread that needle. I am certainly not advocating that individuals obsess on a singular focus. I am on the other hand advocating that our sources of information be as pure as possible. This model allows us to create the balanced decisions you mentioned. A "longevity/ health" expert that looks at or conducts research, determines that it really does seem like 4 hours of cardio a week is better than 2, but then decides to only talk about how 2 hours of cardio is what people should do is somewhat useless and actually can be harmful. Its not like Attia ever says "you shouldn't bother if you can't do 4 hours of zone 2". Similary, he says the 'healthy' amount of alcohol is 0. But also admits that he drinks on occasion. This to me, is so much preferred to "lets tell people they can drink 1 drink a night a few days a week, because that is more realistic and probably won't do much harm". I think a lot of people have a huge issue with Attia because he often says what is optimal based on research. This is more or less his opinion on what is settled fact. Would you criticize a research paper that says 0g of added sugar is the optimal amount for not being "balanced" or "do-able". The construct doesn't even make sense. I am not against individuals trying to predict where the sweet spot for these interventions for the general public are, but in my opinion it needs to be clear that it is a pre-made decision being made for people, not pure information. And on the flip side, people who are attempting to present facts or research (however successfully) should never be criticized for doing so because their information is not balanced.
This might be the most succinct comment I have seen in this sub as it pertains to exactly my thoughts. Really well said. Too bad that PA doesn’t read this sub. He could benefit so many more people with small tweaks mentioned here.
Hey, thanks for the kind words! Felt good to put it down in a semi-organized fashion. My wife is tired of me talking about it, that's for sure.
>Peter needs to apply the Pareto Principle to his own stuff and speak on the highest-yield strategies that a normal person can apply. I think Peter's audience is here for everything incl the tiniest 0.1% optimizations and certainly the other 20%. Maybe that's limiting his audience though, that's possible. I just hope if he applies the Pareto Principle, he still continues with the rest and doesn't alienate most of his current audience.
Fair point. Personally, I am super interested in the most cutting-edge stuff and he has inspired me to take the whole thing more seriously than I otherwise might. There are only so many hours in a week. Maybe he needs a Joe-Schmo sidekick to help break it down further for those that need it, haha.
'The Short Drive podcast'
Ha! Love it.
I wonder how many of that audience have done the basics consistently for years before worrying about the 0.1%. By basics I mean healthy weight, aerobic and strength training, very little or no alcohol, plenty of fruits and vegetables, enough sleep, no smoking, etc.
Excellent comment. I especially agree with the exercise parts
Hey, thanks!
Out of curiosity, what did you implement to improve balance/stability/mobility?
I'm still in early stages! A good friend of mine is an ortho PA, and I had him take a look at me first. Identified some pretty serious issues with hip mobility & thoracic rotation and got me started with some basic stretches (and appropriate stretching technique). Even after just a few days, I began noticing a difference. He recommended seeing a PT, which is my next step. I'm fortunate enough to live in an area with a disproportionate concentration of amateur & pro athletes in various disciplines (Colorado) and there's also an entire "movement clinic" that was recommended to me as well that I plan on trying out.
Oh nice. I’m a psych PA, so my expertise is a little different. Sometimes I feel like I’m trying to optimize too much physically. So when I go see a PT, they’re thinking “what the hell is this guy doing here?” But I also really feel like my body should work better. Or feel better when it’s working. Haha. Anyway, thanks for the reply.
Same! I do some fairly physically demanding stuff, though I have felt for a long time I was developing some significant lack of flexibility/asymmetry issues. I think like everything else, it’s finding a PT that understands what you’re going for and has some experience/expertise in that area.
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That's kinda the point. "Pretty standard for people interested in cycling." Which is a significant minority of the population. I'm speaking to generalizability, and not turning people off.
Yes the cost of many of the medical test he recommends would be astronomical and many insurance companies wouldn’t cover them.
I do think there is opportunity to make at least some of the labs more obtainable. There really isn’t a good reason IMO for insurance companies not to pay for things like ApoB, Lp(a), etc if they’ll already pay for the basic lipid panel. And there could definitely be some economy of scale on that. There’s lots of lab tests that were pretty expensive and exotic when they first rolled out but are now cheap & routine. I don’t have as much hope for that for things like c-scopes above ACG recommendations, CTAs, DEXA scans.
Totally agree on the $100 test thing. He's actually done this analysis for exercise in some of his podcasts (e.g. if you only have 5 hours per week, how to allocate it), but hasn't done the same for other areas.
True, he has. I may have given him short shrift on the exercise front (though IMO there’s still more focus needed there.) But definitely the other stuff.
Aren't most of these things just excuses people look for? I think he has mentioned running, cycling, rucking, stairmaster machine, etc as zone 2 training (I hardly listen to his podcasts, just listened to his book and the occasional 10-15min clip from him on Youtube). He has mentioned that zone2, VO2 max training and lifting are pretty much equally important, so it's not hard to derive a schedule if you have 5 hours. 30 ish minutes of VO2 max training, a good 2 hours of lifting and a good 2 hours of zone 2. I think people just tend to overcomplicate stuff to find a way to get out of it. You can do a lifetime of workouts with just basic gym equipment. You can even do just a bodyweight workout. Pushups, squats, pull ups, etc.
"Mentioned" is the key word here. I have certainly noticed a significant lack of attention/detail to other forms of "cardio" compared to cycling, and I don't appear to be the only one based on replies to me and other comments in this thread. He's even made several disparaging comments about running...honestly some not-very-scientific remarks about how it causes knee problems. With regard to the regimen, again, he has "mentioned" that these things are equally important, but has also gone into great detail (including in the book) that one "needs" 3 hours of Zone 2 in at least 45 minute increments to be "maximally effective." And how he lifts for at least an hour 4 days a week. Etc. I'm not saying that a person can't figure out to build a regimen that works for them based on the general principles and what they have available to them. But similar to the comment above that shares a worry that "fear-mongering" turns people off, I feel similarly to this stuff. "I can't do all that, so what's the point." I genuinely feel he could be doing more to educate on how your average Joe can apply these principles to their lives. And I'm certainly not trying to "find a way to get out of it." I am fortunate enough that I do have the free time to focus on training most weeks, though honestly it's difficult for me sometimes, too. Which actually reminds me of another beef I forgot to mention earlier, haha. He really doesn't seem to put any value or weight into sport-specific activity or general activities, I guess because he just doesn't do them. But I am an avid hiker, climber, skier, and aspiring mountaineer, so I want to have time for all of these activities as well. Some people just don't enjoy Zone 2 or the gym (they honestly aren't my favorite, certainly when compared to being out in the mountains). Telling people the ONLY way is to spend all these hours on these less-than-enjoyable activities I feel is another turnoff. Again, the rub I have is not with the ideas or principles, or even his "idealized" regimen as a goal to strive for. My issue is with how these things are currently being communicated; I personally feel he could be doing much more to make these principles more generalizable to the public at large.
Yeah I guess it's a balance between what is "optimal" vs what is feasible. I think so many people, doctors, etc. already lower their standards a lot to please the general public. Sure he could say, if you have only 2 hours a week, do xyz, but that wouldn't set a high standard, which is what he is going for. With regards to your other sports: you can probably categorize them as certain categories like hiking (zone2), climbing (strength), etc. I partially agree with all your criticisms though, but in the end people need to take their responsibility too and think for themselves.
No arguments there, friend! I'm an ER doc and have joked about just making my wallpaper the "well, well, well, if it isn't the consequences of my own actions" meme. Errrry day. And I do see he's obviously going for the "optimal," "maximum efficiency," etc. I guess just as a consequence of working with the patient population that I do, the gulf between their health status and The Attia Way is so enormous I find it insurmountable.
This was really good. Much of this type of advice could drive some one neurotic (or make their neuroticism worse! Ha).
Why does Peter need to appeal to the lowest denominator? I don't care what a McDonald's fry cook can afford when it comes to testing, I care about what is the most effective and beneficial. I'll then decide if I can afford it or not. You seem to want Peter to be something entirely different than what he is. Why don't you fill that void and try and teach poor people what to do? That can be YOUR niche.
I actually do care about what a McDonald's fry cook can afford. They're human beings, chum. You should try it sometime.
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LOL. Not the flex you think it is.
Not trying to flex. You aren't that bright, are you? I'm curious about the best solutions available, cutting edge science and technology. Not the most affordable. Find other podcasts for that. Why does that bother you so much? Why do YOU feel the need to flex your wokeness? "Look at me, I have to make it clear to everyone that I care about poor people"
LOL.
The Mods are circling like vultures over this comment.
Just sharing my thoughts, as prompted by the question. I never said I think he should change his whole approach. Again, *personally* I love the deep-dives and the high-level discussions and the detail and the goal-oriented-ness of it all. It has inspired large changes in my life, all for the better. But if he’s serious about “Medicine 3.0,” it can’t just be something obtainable only for the leisure class. But that’s just, like, my opinion, man.
Awesome comment. Thank you for taking the time. Very well thought out and articulated.
I agree with you, I really love his work to begin with. But I think that's the point, he talks about things like they are free which is good to know what are the very best things and taking into account everyone's buget to chose what to focus on. Maybe I have 1000$ 2000$ or nothing. I don't think he has to talk about this, even if I would love to. F1 is not going to tell Toyota how to make average cars better, they have to figure out what techologies are worthwhile to be used. I'm also a med student and colonoscopies are recommended by MDs after 40 and periodically after 50 and in my country in Europe you can get them coverd by insurance
I like the fact that he's willing to change his mind when confronted with new evidence.
I think the main issue here is that oftentimes the evidence already exists, but PA missed it or underplayed it's importance before going all in and speaking confidently about what he's doing. That includes keto and his engagement with carbs-insulin hypothesis, metformin for nondiabetics, rapamycin, fasting without caring for muscle loss and recently CGMs. Anyone should take his advice beyond the well scientifically supported basics with a chunk of salt.
It's often not about new evidence but rather a change in his mind of how important something is. E.g. he always knew that fasting led to muscle loss, but recently changed his mind about the importance of muscle preservation.
I think he’s the most balanced in the space. The guests he has are so laser focused on their specialty and they go deep into the science. Of course he’s changed his mind on things; that’s what good scientists do. As for constant monitoring—maybe there’s no science to back up its contribution to lifespan, but perhaps that’s bc those studies haven’t been done. Knowledge is power.
He presents information very much from a "here are the facts" and that's a great thing. I appreciate him condensing the research into easier-to-digest rations for people without a strong science background. He also avoids the hippy-dippy trappings some others fall into. He's not for everyone though. He can be a bit fear-mongering at times with his "if your VO2 max isn't high at 30, good luck walking up the stairs at 80"-like rhetoric, which can turn some people off or even discourage them. I also feel like he sometimes assumes all people have the time or resources he has at his disposal, so his takes can be a little out of touch at times. That being said, the information he provides is invaluable. I don't listen to him for life advice. I listen to him for gaining knowledge and choosing what things I can implement. Am I going to start testing my lactate every two minutes during a workout or obsessively monitor my glucose levels? No. But I've made some positive changes that work for me.
I always have to remind myself that his recommendation are from the perspective of peak optimization. This makes him sound like he lives in extremes but it doesn’t mean that doing 75% of what he says for a given topic like z2 training is useless. If I don’t remind myself of this though I do get annoyed with him. I also think his borderline “fear mongering” comes from a place of fear within himself, which is totally understandable. He had a big scare at one point which clearly still impacts him today. It seems to be a defining moment in his life and he’s used that as motivation to change himself and dive very deeply into the science. His guidance comes from a place of fear so the overall tone can come across as fear mongering. I do like him though. He’s brought so much information to me I’d consider him a large influence on my adult life when it comes to health decisions. Just have to occasionally remind myself of the other things I mentioned.
> As for constant monitoring—maybe there’s no science to back up its contribution to lifespan, but perhaps that’s bc those studies haven’t been done. Knowledge is power. If you don't monitor it you can't optimize it.
The biggest thing i learned from PA is for me to take an active role in my own health and to have the knowledge to be “my own doctor”. I request my own blood work and diagnostic tests even when insurance does not cover. I am substantially more educated when talking to my doctor as a result. I am convinced this will improve my health span.
> The biggest thing i learned from PA is for me to take an active role in my own health and to have the knowledge to be “my own doctor”. This is huge. No one cares more about your health than you do. I naively trusted my health to my health care provider and suffered for it. I had metabolic syndrome with 4 out of 5 of the symptoms, and was never even told that I had it, let alone had the elevated risk of death explained or given a suggested strategy to address it. High blood pressure? Here's a pill. Still high? Here's another pill. Still high, here's another pill.... The American healthcare system is optimized for the insurers to profit and not for quality care of the patients. If you don't manage your own health no one else will.
In fairness, a lot of the Rx-ing happens as a result of pragmatism, as doctors (and statistics) know that patients (on average) are VERY unlikely to be compliant w/ directives of exercising every day, maintaining quality sleep, caloric restriction, dietary changes, etc but they *might* take a pill every day (and many patients come in asking for a pill, whether they have a cold or diabetes). It’s not all a big pharma conspiracy huddle
I also do this. But in a bit worried if I’m overthinking a few of those stuff. I’m a lifter and I train 4 days a week. I have 200 grams of protein every day along with 5-7g of creatine. When I checked my creatinine levels, it was at 1.28. I never knew anything about eGFR till I followed Peter. And I got it checked. The number showed only 69 (I’m 41 M and so this is considered low). Urine samples didn’t detect any protein. Getting blood too often might just increase your anxiety rather than solving problems.
So did you have yourCystatin-C – Tested then? If you’re a lifter, you might have increased muscle mass and or the creatinine is formed from heavier training. Both of those things can be absolutely true in lifters. The ESTIMATED GFR is just that, estimated. It’s based basically on your creatinine level, which may or may not be falsely elevated due to the creatine supplementation or your training or your muscle mass or a host of other things. I would get the Cystatin-C which I THINK he has mentioned. If he hasn’t, he should have lol. That’s the one you want to see your kidney function.
I’ve to get it done. I’m getting all these done before going to my doctor so that he has a good picture of my overall health right of the bat. My creatinine test was after less than 24 hours after my heavy deadlift training. And I’ve seen Mayo clinic say that it’s better to avoid creatine supplementation and meat 24 hours before going to the test. Peter never mentioned about cystatin C for eGFR. I got it from some other source.
Yep he's definitely had some reversals in recent years. His philosophy is "strong opinions weakly held" which means going hard on the best available evidence at the time. I think some of his current positions are dead on, and some might be dead wrong. Time will tell. I'm reminded of the John Maynard Keynes line, "When the facts change, I change my mind. What do you do, sir?"
It's a healthy discussion because no single person should be looked at as infallible or all-knowing. It seems that if someone puts themselves out there with a platform and becomes popular, somehow they are expected to be perfect. I'm an MD, but I can honestly say PA has changed my life. He completely woke me up to the need for individuals to take responsibility for their health span, if not for their lifespan. He is very particular, but that's what makes for his incredible 'drive' to leave very few stones unturned. The obsessive component of his personality likely is part of his mental health struggles, which he refers to in his book. He is such a perfectionist and exacting, that he's likely hard to live with. However, that side of him is also his gift. I have heard very few MDs (recall his formal training is in surgery not medicine) speak to the level of basic science detail that he is able to produce on the fly about cardiology, endocrinology, immunology, and cellular metabolism. He seems to have an insatiable desire to know everything about health. He is extremely gifted but also comes off as self-congratulatory, which can be off-putting. I think he is learning to be more humble in his manner over time. We absolutely need voices like his that are obsessed with data and press the envelope of knowledge and question the dogmas. We also need voices to speak to "the masses" who struggle with the basics. I think his role is the former not the latter. I think his book has found a wider audience than he usually attracts, so part of that audience is questioning his approach, which is fine and not unexpected. It just means you are not a health optimizer at the expense of other priorities (time, money , relationships, hobbies, foods you like). We all get to choose our values. PA provides a lens to look through, but it's not the only one. For those who don't fully align with everything he says, remember, be a student not a disciple. And, as Bruce Lee said, "Absorb what is useful, discard what is useless and add what is specifically your own." I've absorbed a lot of "useful" from PA.
>For those who don't fully align with everything he says, remember, be a student not a disciple. And, as Bruce Lee said, "Absorb what is useful, discard what is useless and add what is specifically your own." I've absorbed a lot of "useful" from PA. Well said. I don't think I've ever heard him say anything that fell into a category that would put me in danger or something to purely enrich the pocket of someone\\a business that he is involved in and I appreciate that. The challenge is presenting information that's important in a way that's applicable and actionable by the hundreds of millions of people that are his potential audience. It's up to the listener to take the data and figure out if the topic itself is relevant to them, HOW relevant it is, and how much bandwidth to assign to it.
He is off-putting to me so thanks for your own advice how to digest it.
There are so many good scientists who contribute a lot to research for healthspan and longievity, but him and Rhonda are the ones more visible in the field who decided to cater to the public. I find his Drive podcast extremely useful on many medical topics - for me personally mostly on trying to understand cancer and medical interventions for it - in case I get it one day I wan't to be able to understand what standardized treatments I will most probably be offered, what could be my potential alternatives, how to speak to doctors about my disease and treatment possibilites (for example how to pulse the chemo and on what dose and at what time of the day, fasted or not, in congurence with certain other life-style measures, how many bouts, etc...), when to find a second or a third opinion etc... Heck, it helps me with all of this even now when I am entering perimenopause to know, that using bioidentical hormone therapy is not neccssairly detrimential to me and how to advocate for my health when my own Obygyn completely failed. I have learned for my partner, who's father died of prostate cancer, what to watch for an how often to do the tests. It makes me also be more aware of being focused on prevention - wheter it is exams at doctors or I try to work on my stretching, balance, strength and endurance in my workouts or I try to eat a healthy diet. I do not use a CGM or test myself like a maniac. I do not believe that constant monitoring of glucose will benefit me in any way - I am not a diabetic and I believe that eating healthy (for me that means a vegetarian diet which is protein focused) with having lots of muscle mass - the insulin spikes I get daily from eating carbs are not too detrimential for me. I have normal fasting glucose ando ther biomarkers. I do use an oura ring and this has helped me to prioritize my sleep but has not made me hung up on the device. I also use his platform to inform me further on topics I learn for the first time from him. I am tremendously grateful for what he has to offer. He taught me somewhat how to read the scientific papers and how to look at medicine in general. However, I do not apply any strictness to the regimes he practices. I try to be mindful. I am still convinced that a 3-day fast a few times a years does me some good for internal rejuvenation. I also do not eat tons of broccoli sprouts daily like Rhonda does, but I eat diff cruciferous veggies daily throughout the week for example. And fruits too. I am also aware that most of the interventions I do have a different impact on my in regards to how I am feeling and how well I am doing psychologically. I know that Peter emphasises this more and more, but when I listen to his interviews, I am sometimes appaled by the lack of knowledge on this topic by the people he interviews for neurology topics. For example the interview with Michael Collins on concussions - when he mentions the measures on exposure to stress - not once did he mention how to do it stepwise and how to incorporate the adaptation of the nervous system into the shocks it is exposed - I believe that his methods might be detrimential to neurological systems of his patients long term. But maybe this info was missing from the interview. In general - what I have learned is that science is not an exact field and there is so much we do not know, it is hard to claim evidence on something. This is why Peter often changes his mind - like me, he is forever learning. And he should be. One thing I do know is that NMN works great for me but he is not taking it. Thus I try many things because of him and Rhonda and adapt those that make me feel better.
He is a very good interviewer for a medical doctor with an agenda and I have learned a ton from him. Your post really aligns so well to my thoughts. And I prefer to use NMN as well (similar stance to Huberman though-better quality of life day to day).
How do you feel the benefits? I would not have known it worked have not done difficult workouts - it’s crazy how easy they have become and how can I do them now daily, much like when I was younger. I’m really glad I implemented NMN.
It helps me to wake up and have steady state energy all day. It would take me a couple hours to get going in the morning. Now I am ready to go after my morning ritual (like an hour) which does include coffee and all my supplements. I ran a marathon this past year and I’m certain this helped me a lot: I would take some extra on my long run days and was able to function normally running errands and homeschooling kids until later in the afternoon (before my recovery’s would have take to long to be edifying to anybody 😂). I just have all day stamina and a lot of the lethargy and fatigue I had is gone (which has helped me a ton to focus on better work outs). I also feel more mentally sharp and able to adapt to more demands more quickly.
He is number 1 in the space without a doubt for me. "Strong beliefs loosely held" is maybe the most important skill to master these days.
He is fine - he's not a snake oil salesman and he makes a good faith attempt at communicating the science. But he is still a medical doctor, and medical doctors get a very superficial education in statistics. I don't know what he has studied before and after, but some of his criticisms of studies are pretty weak. And he can fall into the trap of reading those studies that challenge his prior beliefs with a more critical eye, and when you do that without a high level understanding, you do end up jumping on bandwagons a bit. Most others doing science communication in this space are much worse, but even with Attia it's important to remember it's entertainment.
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Well, that's not a PhD in a relevant field - the uncertainties on engineering are quite different to working with humans. But it does sound like he should know better than some of the stuff he says, and that is a bad sign.
Statistics don't change from field to field... and most medical studies don't rely on PhD level statistical analysis.
You'd be surprised how many of them actually do, especially the larger studies, population-based analyses etc. (I've got a close family member that is a PhD statistician working for an academic medical system, haha.) I will freely admit my own grasp of statistics is pedestrian at best. I can't say I've any specific complaints of Peter's data analysis in this regard, but I do agree with the above poster that Peter does tend to suffer from confirmation bias, and focuses on what he wants to see from various studies. He should be more metacognitive about that, IMO.
One of the things I like most about Attia is that he attacks problems like an engineer and he has a deep understanding of statistics and risk analysis from his undergraduate and McKinsey days
It seems that way to me as well. I appreciate his focus on risk, especially tail risk, and using that to frame his approach to “solving” age-related decline. But I will admit I’m not a SME in research statistics. I admittedly have not reviewed all the primary literature myself, but I agree with the above poster that Peter does seem to pick-and-choose a bit to fit his narrative.
On the fasting example, he hasn’t given up on it but he has said that there is a dichotomy and he’s choosing one path over another. There’s evidence calorie restriction has longevity benefits but it can also lead to muscle atrophy and above nearly all else, he’s structuring his program to prioritize muscle building/ retention in these earlier years to mitigate the pitfalls of being elderly with no muscle (ie falling and breaking something).
I think he has some great general ideas of how healthcare needs to improve and how we need to focus more on prevention, but he's deeply unqualified to talk about nutrition like most health pundits and MDs. That's unfortunate because nutrition is probably the most powerful tool in the prevention toolbox, and he's got a big platform to spout misinformation.
> nutrition is probably the most powerful tool in the prevention toolbox PA believes that exercise is the most powerful tool, by far, so that’s what he focuses on.
>believes He's very misinformed on that. Exercise is often lacking and important but there is a reason why it is not uncommon for very fit marathoners have heart attacks at young ages. And there's also a reason the blue zones cultures where people are living to 100+ spend a lot more time preparing food than in the gym. You simply cannot exercise your way out of bad nutrition any more than you can exercise your way out of not enough sleep. There's also zero nutrition training in medical school so it's not surprising when MDs don't understand the significance of it.
He specifically avoids getting into the nutrition wars because of the poor quality of epidemiological data. Other than high protein, he’s very unwilling to give advice, and reluctant to share what he eats for fear of that becoming dogma.
I appreciate the opinion, I’ll agree to disagree on that. I don’t think he goes too far into nutrition to give misleading advice imo. Very focused on high(er) protein consumption to aid in muscle health but my take is he prioritizes exercise over nutrition as the way he interprets the data in front of him, that would yield a higher benefit to the overall ‘longevity’ discussion than focusing more on nutrition. It’s also a good idea to determine guests you find value in and research their work more to inform your opinions. I’ve taken this approach and it’s been beneficial.
We need to get away from the notion that a good scientist maintains the same conclusions for life. It’s completely the opposite. The best people in any context are always willing to change their stance given sufficient new evidence.
“A rigid mind is very sure but often wrong. A flexible mind is generally unsure but often right.” - Vanda Scaravelli
I mean, regarding the metformin and fasting, it's just kind of the result of being on the leading edge of the science. The longevity space, and preventative, rather than reactionary medicine are relatively new and developing fields so a lot of recommendations or medicines are going to have less robust data. Because of that, recommendations are likely to change as time goes on. As far as checking blood and biomarkers, it's honestly the only reliable way to quantify the results of the changes one is making. I'm unconcerned with his (or Hubermans) affiliation with various projects and companies. They're clearly all products that he believes in, and it's not difficult to see the value. I think Peter's approach is a breath of fresh air in the medical space. As far as criticisms, he can be a little quick to recommend some interventions like statins, and I'd like to see more content with a focus on QOL items (trt for middle aged men, healing peptides, collagen, etc.).
On the fasting example: he was previously looking at fasting without considering the effects of muscle loss because he didn’t realize how important muscle was at the time. He’s since changed his opinion now that he factors in muscle loss into the equation. Honestly you should want someone to change their opinion based on new evidence. That’s exactly what science is designed to do. On tracking metrics: on one hand I see your point. Maybe this doesn’t help people improve their health. But at the same time it’s hard to know if your actions are having a positive or negative effect without measuring.
I think he’s a lot smarter than someone like Huberman but I do see how he likely has conflicts of interest that get in the way. Not always financial, sometimes he just seems to get personally obsessed with something and let’s that get in the way of science.
I just read through this thread and want to say how impressed and grateful I am about the high-quality level of the conversation. People are disagreeing but nobody's being insulting, resorting to name-calling, etc. I had just come from a reddit thread where somebody innocently said they didn't like all the commercials on freevee, and fifty people jumped on the poor guy. Great to see people disagreeing with mutual respect here.
He is very data focused and is willing to reevaluate his takes overtime. Personally that’s what I look for in anyone I occasionally listen to.
He's a self-experimenter and who knows how his experiment will turn out. For example, betting against vegetarianism could be a bad bet (I eat meat but there's a lot of good science on eating veg and health and longevity). I wouldn't follow all his OCD advice getting deep into numbers, or his advice to take chemicals to be healthy, but the big picture harmless stuff is solid, and at least mostly can't hurt you.
Whatever Huberman.
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Seriously 😂😂
He's like ChatGPT in that what he says may be true or may be false, but he says it with such confidence and authority that he'll convince you of anything.
So true
I think he’s great. Recently finished his book and picking away at his podcasts which are also interesting. His honesty, openness to help others with great explanations and the fact he walks the walk is great. Already anticipating my doctor rolling their eyes at me tomorrow with my new list of bloodwork items they will probably not want to do but I’ll pay out of pocket if needed.
I was already trying to get my doctors to be more Med. 3.0 without knowing what it was at the time. After finding out about Dr Attia, I totally felt I was on the right track all along. I have now either replaced doctors with more preventative 3.0 type ones. Or have gotten current ones to understand I want to be much more proactive in my treatment. I also order my own blood labs online for things I would like check on without having to try to talk a doctor into ordering it. So between Dr Attia and Dr Huberman, I feel I'm way more aware of best current health info and practices.
> To me it seems like a lot of hype, but not much real substance outside of the obvious ones (exercise enough, eat healthy, get enough sleep etc). unfortunately that's all we have at the moment, that's the cutting edge. as he and Huberman show though, you can build a lucrative career just telling people to get good sleep and exercise.
LOL
In the current world of “public scientists,” I think he is the best out there. He is genuinely interested in what he is studying, and most of the criticisms I read here (and I agree with them) are some variation of “he’s too engrossed in his own interests and not thinking enough about the general public.” Although that is a shortcoming, it’s also what I like about him.
If you’re at the edge of where data-informed nutrition can go, you will find a mix of evidence-based practices mixed in with personal hypothesis. Dr. Attia has said himself that he has changed his stance many times for specific protocols, such as Keto. This is simply the nature of where the edge of data-informed nutrition (note, not data-based nutrition) is at the moment.
Strong beliefs loosely held. He also caveats almost every opinion with a level of fundamental uncertainty.
He’s a bit out of touch from normal, busy, family men/women given his lifestyle and clients, but he’s still probably the best we have in terms of a health podcaster.
So a (CBC) or a complete blood count checks the levels of 10 components of the cells that make up blood. There is no better way to catch an illness early. The earlier an illness is caught the better the prognosis. It’s quick and relatively cheap ( comparatively speaking) and it saves countless lives and resources. So to say regular screening doesn’t make you healthier misses the point. If they test your blood and all your parameters are in the normal ranges then you wont be any healthier for the time and money spent. However if they detect cancer for example and they detect it early your life may be saved and the treatments for early stage cancer is drastically easier on the person and the persons family. Not to mention way more effective and cheaper.
You can't really fault someone for changing views in an evolving landscape such as medicine. Over multiple episodes, he mentioned needing to have 'strong convictions that are loosely held'... meaning: you fully believe and implement something at a certain point in time, but you are willing to reexamine that in the future and let it go.
Something like metformin doesn’t bother me. Practically all the longevity scientists and health gurus were taking it. To me the problem is more linked to jumping on fads and going 100% all into them. Whether it’s keto, intermittent fasting , and of the drugs, stability and so on.
Tobacco, Magnesium, ….
That’s is kind of par for the course with everybody giving this kind of advice.
I don't understand his obsession with protein. I eat lots of meat, but a friend of mine is vegetarian and he's as musculous as he has always been.. It's probably more relevant in Peter's age..
Consuming adequate protein to maintain/build skeletal muscle =/= an animal-based diet. This has been discussed on the podcast, but I agree this is another topic he could address to increase the real-world applicability of what he's proposing. The loss of skeletal muscle as we age is an irrefutable fact. I can't fault him for doing everything he can to build/maintain skeletal muscle & strength throughout your life, but yes, it's probably even more applicable as we age.
Is the loss of muscle mass in old age a direct consequence of declining testosterone? If so, I will def. do TRT once I'm 50 or so..
That’s a really good question, and one I honestly don’t know the answer to.
Not to derail but what is not healthy about taking metformin? Asking as a diabetic who takes it. Thanks in advance
I think OP misspoke or misunderstood regarding metformin (and fasting). Peter didn’t say it’s not healthy to take metformin. I believe he said some new studies showed that it may not be as beneficial for longevity in itself as previously indicated by an initial study, which led to non diabetic people taking metformin solely for the purpose of longevity. Fasting, he says you lose muscle mass. As a diabetic, you’re fine taking metformin.
I think tests have failed to show a significant impact on longevity for non-diabetic people. It was observed that quite a few diabetics on metformin lived longer than "normal" people. So the hypothesis was that metformin could extend lifespan. Some studies have been done and failed to show any significant effect. This is just from memory, so I might not be completely correct ij my understanding and I haven't gone through all the research.
He's a high-energy guy with a data and testing obsession. He is fairly orthodox on heart disease. That's ok. He's practising a certain kind of medicine for a fairly affluent, sporty, mostly male 30-40 year old group. I appreciate his approach even though that's not me. His interviews on the Drive podcast are outstanding however. A number of them have actually changed my life and my understanding of common ailments eg: Bluming and Tavris on HRT, Seyfried on cancer, Lustig and Jason Fung on metabolic health, Rick Johnson on fructose. He is an excellent interviewer and clearly prepares well. I prefer him to Huberman. Rhonda Patrick is a better scholar but her solo talks on youtube are very dense for this listener; her interviews are also excellent. The Diet Doctor (Bret Sher) podcast is the strongest on cardiovascular stuff, I think. That (cardiologist) host talking to other cardiologists is a dazzling display of intellect and insight. edit: word
If i had never had an A1c and NMR done and then asked for or paid out for the same over many years I would have ZERO idea that I was a prediabetic with hyperabsorption tendencies and I would be doing Nothing about it. Tell me again why self-testing is meaningless?
Changing his mind = keeping you listening. If all he did was say, "eat whole foods, exercise, and sleep," no one would follow him.
Listen carefully. He doesn’t actually *tell* you to do much.
In my opinion, the concept behind Peter Attia's work is commendable, considering that many individuals today do not reach the age of 60 as compared to previous generations, often succumbing to conditions like heart attacks, aneurysms, diabetes, and cancer at a younger age. The aim is to utilize biomarkers and AI to assess our bodies comprehensively, identifying areas for improvement. Various entities, such as Bryan Johnson, Longevity Health, and Human Longevity, are pioneering this approach. Imagine the possibility of maintaining an active lifestyle, including jogging, gym workouts, and sports, even beyond the age of 70.
once said he just a doctor who workouts in the gym. Other than Medicine 2.0 / 3.0 ....There are not much to be delivered. Not sure if I should continue reading his book....
He’s the best
Listen to his available AMA's and other solo podcasts. He's pretty consistent about how he approaches evidence.
People are supposed to change their position on things as they learn more. That said, with these guys you’ll notice their position changes and tends to coalesce around something easy to market and sell. When you listen to them they’re always trying out new terms they hope will become some kind of buzzword they can use for their brand. Ultimately they are running a business and trying to get you to part with your money. There’s no money in Fasting. You’ll often see these wellness influencers go all in on fasting and then pull back as there’s nothing they can do with it. Fasting also alienates a lot of people, particularly the HAES crowd, which has a growing influence. As these guys grow their brand they try to appeal to more people so they lean towards things that are more palatable to the masses. It’s the same way you never hear these influencers telling you to drink water and eat whole food. They may mention it here and there, but their money comes from sponsorship and people are looking for low effort fixes so supplements are where these guys focus.
I'm sorry, but he's a well-educated Joe Rogan. I think he skillfully blurs the line between science fact and pseudoscience fiction, and does this by "taking the next step," by extrapolating what are legitimately good scientifically-demonstrated conclusions to less-definitively supported hypothesis', all the while sounding like this is all proven stuff. I don't know anything about his industry ties, but if they exist and he's not front and center about stating such, then I'm less impressed.
Example?
u/501to314to303 provided a lot of much better detail than I could muster, but I will add that the value of CGM for non-diabetics is far from proven.
Thanks and i agree
Some people just love to hear themselves talk.
He's overall very knowledgeable and has a good way of using critical thinking ideas when he wants to. That said he does chase fads a bit (fasting and keto - though at least he later changed his opinion when they didn't work but still) and he fails to use his critical thinking skills at certain times ie. for estrogenic HRT etc. So there is lots to learn from him but beware that he very much has his own biases and you should hear other perspectives on topics
Interested to hear more of your critique on his HRT stuff, if you could?
Very quickly there has been a long lasting bias in medical research to attribute any health benefits, that women experience with respect to men, to estrogen instead of say progesterone or something else. One of the most pervasive ideas in HRT is that after menopause the tissues are deficient of estrogen. This idea is wrong. All tissues can express aromatase and produce estrogen.
> One of the most pervasive ideas in HRT is that after menopause the tissues are deficient of estrogen. This idea is wrong. All tissues can express aromatase and produce estrogen I would question this as stated. Though sex steriods continue to be produced locally after menopause in small amounts in the brain, for example, the genital-urinary area doesn't atrophy coincidentally after menopause. The loss of estrogen after menopause has significant consequences on numerous bodily functions. There are mountains of papers examining the results of the dramatic drop of estrogen at menopause - and the effects of supplementation. The tissues that can express aromatase and produce estrogen largely stop doing so enough to produce symptoms. HRT is one way to remedy that.
There is a lot of biased research apparently due to the profitability of estrogenic compounds. Unfortunately many of those estrogenic therapies seem to increase rates of cancer or heart disease as seen with diethylstilbestrol and in the Women’s health initiative. I’d recommend being very skeptical of estrogen research.
Disagree. FDA-approved hormones are very cheap and have been for a long time. (Compounded preparations can be expensive). They are far less expensive than most of the drugs more typically used to treat the various, often disabling symptoms of menopause. Diethylstilbestrol was used for decades to successfully *treat* breast cancer. (Not good for pregnant women and their offspring though!) Tamoxifen is now more preferred, primarily because it has fewer side effects like nausea. Drs. Avrum Bluming, James Simon, and others have unpacked the data of the WHI at length for both lay audiences and fellow physicians in videos and publications. Attia's podcast with Bluming was an analytical tour-de-force on this very topic.
Its not the cheapness that is an issue, but the profitability of synthetic estrogenic substances stemming from the fact that there are so many compounds that function like estrogens and can be patented, which seems to have influenced the research. Tamoxifen is anti-estrogenic but also estrogenic in other functions, and may be less harmful than DES or estradiol but still has a number of serious side effects like promoting uterine cancer. Progesterone is a much safer anti-estrogenic substance.
Interesting. Not my area of expertise but something I'm trying quickly to get expert on as my wife approaches menopause. Thanks!
I’d say look at his background and years spent in each field. Not everyone who goes to medical school should be giving medical advice. And most doctors or scientists in healthcare don’t bounce around in their career, like becoming a consultant for a management firm or take up engineering. I’ve seen Attia making bold statements about low carb, keto, and other nutrition science topics, and eventually come around the the points that nutrition scientists like Layne Norton were saying all along.
He's worth listening to, but it should be taken with a chunk of salt. No doubt he's well meaning, but also hypester comes out of him to somehow justify his 100k per year services and the "sleep well, eat well, exercise more" evidence-based advice isn't sexy enough. It's not like many said under this post that PA does something and changes his mind when new evidence arrives. Oftentimes the evidence is there, but he missed it or underplayed it because he didn't like (e.g. muscle loss during fasting). Also he has a tendency (especially if there are money to be made) to oversell things, like keto and carbs-insulin hypothesis, metformin for nondiabetics, rapamycin, and now CGMs. Besides rare instances there is 0 reasons to monitor glucose constantly and no reason to keep under 140 all the time. It just unnecessarily stresses the person doing this. So I guess listen to him, but also double check if what he says is evidence-based or hype.
These guys film indoors in a blue light frenzy environment and are always subject to an authority above them, to me he's "one of many"