Dr Peter Attia

Peter Attia is a relentless self-experimenter, obsessed with the idea of a "quantified self." In the presentation he will share two components of his physical transformation as he evolved from "fit but fat and metabolically deranged" to "fit, lean, and metabolically dialed in." In particular, Peter focuses on the possible advantages of a ketogenic diet, and in the process share much of what he's learned implementing it in himself and hundreds of others over the past two years.

Peter was the President and co-founder of the Nutrition Science Initiative (NuSI), a California-based 501(c)(3) until December, 2015. Peter was a former McKinsey & Company consultant, where he was a member of both the corporate risk and health care practices. Prior to his time at McKinsey, Peter spent five years at the Johns Hopkins Hospital as a general surgery resident, where he was the recipient of several prestigious awards and the author of a comprehensive review of general surgery. Peter also spent two years at the National Institutes of Health as a surgical oncology fellow at the National Cancer Institute under Dr. Steve Rosenberg, where his research focused on the role of regulatory T cells in cancer regression and other immune-based therapies for cancer.

Peter is a 2012/2013 recipient of the French-American Foundation Young Leader's Fellowship, which recognizes the most promising leaders under 40. Peter earned his M.D. from Stanford University and holds a B.Sc. in mechanical engineering and applied mathematics from Queen's University in Kingston, Ontario, Canada, where he also taught and helped design the calculus curriculum.

Peter is also a physician and today his medical practise and his continued N=1 self experiments are his point of focus.

Analogy – Day to day driving and Motor racing

I typically use this analogy with my patients. They all know that I'm obsessed with race cars, and of course, they always throw back at me, well, how can that be good for your longevity?

They don't understand that I'm at greater risk driving to the racetrack, than I am being in the race car on the racetrack. The racetrack is much more predictable than the highway.

Let's imagine; we're sitting in an office and looking out over Park Avenue, New York.
I say, "Look out the window. You see all those cars there? Do you think that for any of those cars right now the PSI in each tire is exactly to spec. No, of course not. Are any of those cars using tyres with little tread? What's the chance that some of the cars out there are 400 or 1000 miles past due on their oil change? Lots of them are not well maintained. We can be sure of that. But they're all fine. They're all getting away with it."

"Contrast that with, a Formula One Grand Prix. Do you think one of those cars in a Grand Prix is literally half a PSI out of whack on their tires? Is any car using tyres down on the tread? Is any car running on old oil?"

"So what's the difference? The difference is tolerance the margin between the stress on the vehicle, and the technical limits of it's performance. When you're out there driving, commuting, you're nowhere near the technical specification of the car, and the car is incredibly forgiving.

But when you push any vehicle to its technical limit, the forgiveness goes away in a second.
That's what racing does. I love knowing what it's like to be in a car at its limit.
I like to see if can put myself at my limit.
When motor racing I experience those two things, both on that edge.

Not worrying about when your oil gets changed and not worrying about the PSI in your tires, is a luxury. But there is a cost, in loss of peak performance. This is like an allostatic load, many things are out of balance, but still the vehicle continues to perform. It starts, and you get from A to B, there doesn't appear to be any serious issue.

A Common Story - Retirement

I had lunch with one of my best friends. I asked him how his dad was doing. His dad is pretty young, only 73.

He said, “Yeah, he's just not doing well. I'm kind of worried about him, his balance, his heart, there's a lot of stuff going wrong.”

His dad used to be a successful lawyer, a really big-deal guy.
I said, “When did your dad retire?”

“You know, 10 years ago.”

“But what does he do now?”

He said, “Nothing. He sometimes plays golf.”

We sort of looked at each other, and I didn't need to say any more. It was pretty obvious what the problem is.

There's something to be said, for not retiring from life. We are really happy to talk about hazard ratios of 1.15 when it comes to goofy things like red meat. Yet when you look at the hazard ratios associated with retiring (About 1.37) and not retiring (About 1.04), you can see we worry about the wrong things. The odds against your good health are much greater if you retire.

"Peter Attia on how to live longer and better"

Stem Talk: Published on 5 Apr 2016

(Podcast only - 80 minutes)

Dr Peter Attia

Peters approach to longevity

If the question is when and how will I die? That seems more manageable. We actually have pretty good data on that.

When you look at these people who live to be a hundred or more, there's what I call the depressing hypothesis, which is that they all have genetic gifts. For the rest of us, absent those genetic gifts, we're all doomed.

But in fact, we don't see that. We see the opposite. We see that they die of largely the same types of diseases in largely the same distribution that people who aren't centenarians die of.

We're dying from chronic diseases, and these are, almost without exception, preventable — at the very least, delayable — diseases. They're all diseases of civilization.

I think about the eight levers of longevity, Nutrition, exercise, sleep, stress, social support, sense of purpose, drugs and supplements, and physiological reserve.

How do we die?

You have to draw a line in the sand somewhere, so here are the simplifications I'll take. I'm going to limit this to people over 40, a nonsmoker and not going to commit suicide. Suicide is actually a leading cause of death.

With that simplification of the dataset, 70 to 80 percent of all deaths will be due to four diseases or what I really think of as three disease processes.

The first is atherogenic diseases, which obviously includes heart disease and cerebrovascular disease (strokes). The second is neoplasm, cancer, and the third is neurodegenerative disease of which two particular diseases make it into the top 10—Alzheimer's disease and Parkinson's disease.

None more on the rise than Alzheimer's disease. Heart disease is actually on the decline. Cancer, more or less, flat lined.

Accidental death overall is the fifth leading cause of death, and 80 percent of all accidental deaths are just three types, which are motor vehicle accident, accidental poisoning, and falls.

Eight Levers for Better Health and Longevity

1: Nutrition

I don't like talking about nutrition much. I'm not a big fan of religion and I'm not a big fan of politics, and nutrition is like both of those. I don't really care about diet. None of that stuff interests me. I don't care if you're paleo, and I don't care if you're vegan.

So in somebody like me, who exercises a lot, my diet is about a 20 percent carbohydrate, 20 percent protein, 60 percent fat. I try to eat and exercise and fast, in ways that maximise my muscle mass. I do get into ketosis at least once a week, just generally as a result of a fast that I'm doing. I will just continue to consume very very low amounts of carbohydrates, very modest amounts of protein, and high amounts of fat. The days when, for just months and months, I would not get out of ketosis appear to be long gone. I will say this; I actually felt at my best on a ketogenic diet.

I'm really just interested in the biochemistry of dietary choices; given that different people can tolerate these foods in different fractions.

Carbohydrate

The name of the game if you want to live long, is glucose disposal. Can you maintain a low average level of glucose and a low variance of glucose in the blood. If you can that guarantees a low level of insulin. That challenge is not easy to do. We can't measure insulin in real time. Measuring glucose several times a day, isn't something people like to do.

I've been wearing a continuous glucose monitor for several months now. These are devices that are typically worn by patients with type 1 diabetes, but I think for my interest it's a totally reasonable thing to do.

Protein

There's pretty reasonable evidence when you look at the carnivorous societies, they actually have a preference for offal meats.

I think that IGF protein data is interesting. I still don't know that they're entirely conclusive, but I would say this. You're probably better off with excess fat in your diet than excess protein in your diet.

I'm telling my patients that they only need as much protein as is necessary to preserve muscle mass. That's the goal.

2: Supplements and Drugs

I take vitamin D, I take a baby aspirin, I take methylfolate, I take B-12, I take EPA and DHA Omega 3 fatty acids, and I take berberine. I think that's all I take, and you could argue baby aspirin is not really a supplement, but I count it as one I guess.

What do I not take? I do not take a multivitamin, I do not take vitamin A, I do not take vitamin C. I believe that we should aim to get all the nutriments we need from real food.

3: Stress

Bruce McEwen developed the concept of allostatic load a few years back. It's the metabolic cost of maintaining homeostasis. What is the price we pay for the body having to work to respond to these repeated stressors?

If you fail to maintain your body in good health, your body tries to compensate for your lack of attention. There's a cost, in terms of allostatic load. The body has to focus resources on what's urgent at the moment. Things that can be delayed or put off for a while, don't get done. Therefore, the physiological reserve is reduced, the technical capacity of the body is reduced.

It's not just the price, of wear and tear on the body. Now the performance capability of the body is down. If suddenly by accident of illness, it becomes necessary to survive under a brutal amount of stress, the system might fail. That can happen in an instant. Things were fine and then suddenly there is a cascade of changes, that compound and lead to a life threatening crisis.

Transcendental Meditation

There have been good trials of transcendental meditation. Better trials than we see in human nutrition. Obviously the trials aren't blinded, but they've done pretty good things to actually identify the effect of transcendental meditation versus periods of quiet resting. The effects on blood pressure, on cortisol, on glucose, on metabolic factors are marked. I think those results are real.

I do “prescribe,” for lack of a better word, transcendental meditation to all my patients, especially the phenotype that's sort of like me, that probably needs it the most.

4: Exercise

On exercise, the framework has two objectives: glucose disposal and maintaining muscle mass.

A friend at the gym looks at my gym routine. “Why the hell are you doing that?!” - “Is that really necessary? You bike, you swim, and you run. That's a lot, so why do the gym?”

I said, “It is doing something for me that biking, swimming, and running can't do. Those activities don't activate my IIB muscle fibers, and that's something I'm placing a high premium on.” It's very hard to activate the type IIB fiber, and yet if I can get all of those fibers working—type I, IIA, IIAB, and IIB—I'm going to have a much more glucose-hungry muscle, and I'm going to have much more mitochondrial activity.

We are all born knowing how to squat perfectly.

The moment we start sitting we start to lose the hip flexibility necessary to perfectly squat. The good news is you can get it back. I think squats and deadlifts are the two most important exercises.

At rest we have a cardiac output that's modest. So someone my size might pump three or five liters per minute. Meaning as I sit here, my heart is putting three to five liters per minute of blood throughout my body.

A well-trained athlete could get to 30, even more than 30 liters per minute. And you get part of that increase through an increase in heart rate, but a lot of it comes through an increase in stroke volume, which means that the heart has to expand. That can cause heart damage. It's doubtful if increasing VO2 max, is a sensible target for most people.

5: Sleep

We work on a handful of sleep hygiene things. Keeping the room completely dark, keeping the room really cold, not looking at blue light after a certain period of time. If we do need to look at light, using apps that basically can pull the blue light out.

It turns out sleep is pretty easy to fix once the patient buys into why they need to fix it. That's probably the biggest challenge, people are reluctant to set aside time for sleep.

"An Advantaged Metabolic State: Human Performance, Resilience & Health"

The IHMC: Published on 10 Jun 2013

6: Social support

There's this fascinating study that showed that social support is a better predictor of lifespan than body mass index, air pollution, and even smoking 15 cigarettes a day.

Making changes to build your social network requires a shift in how we relate to ourselves, how we relate to the world around us, and how we act and behave.

7: Sense of Purpose

If you lose purpose, if you don't have something important to do in the morning, you tend to waste away.

You need a plan, it was never intended that we spend our lives sitting on a beach. The plan should challenge your capacity, should force you to be the best you can be. That will increase your physiological capacity, will build a reserve of strength and resilience, that you might need one day.

8: Physiological Reserve

It's like that with our bodies too. If we maintain our bodies like we look after our street cars, there will be loss of technical performance and a decline in resilience in the face of stressors. You can let your metabolism decline for years and get away with it. Your body has enormous built in adaptability and resilience.

Then something happens, accident or illness and in no time, you're in a crisis. There is a cascade of events occurring and you're not in control. Survival might be in question. The final outcome may depend on how much physiological safety margin is left.

Applying the Lessons

I explain to patients is that each of those eight levers, provide tools that make a difference. They need to choose the right action. What's the right intervention? I call that efficacy. But that's not enough, how do you make it stick? The effectiveness of the action depends on how well you do it.

I walk through each option with each patient and say, “Here's, what the experience looks like,” and then we make a plan to manage that change to ensure success.

For example, when it comes to nutrition, both efficacy and effectiveness are hard. I just look at a person and figure out what they should be eating. It actually requires an iteration or two or three, to get something that works.

Then for exercise it's the same sort of thing. Trial and error. Once you get into sleep and stress management, the efficacy is actually very easy. Knowing what to do is quite trivial. Doing it is always hard.