March 16, 2016


2016 update

by Peter Attia

Read Time 8 minutes

Yes, I know, I haven’t written a blog post since ‘nam. Unfortunately (for anyone looking to read a new one) I’m not about to start now. But…I do have two things to offer in the place of treatises on cholesterol (yes, I know, I didn’t finish the Straight Dope series), insulin resistance, hypothyroidism, and a dozen other topics (not including “what I eat, circa Q12016”): first, a series of updates (most of you will want to skip this section if you’re only here for the hardcore science talk); second, a few recent podcasts I’ve done.

Update 1: Work, then

I am no longer at NuSI. I left NuSI at the end of 2015 after four great, albeit very challenging, years. The work we started is still going on and in the following years I look forward to seeing the published research as it becomes available to the public (which I am now a part of).

Update 2: Work, now

Today I am working Peter-part-time (30-35 hours/week) on my medical practice, which is located in San Diego and NYC. It’s a very small practice and sort of referral only. It is not a “ketogenic” practice whatever that means (though people seem to ask me that). The focus is longevity and healthspan, for which nutrition is but one of eight components. I love this work more than I can describe, but I have no plans to scale this practice. For now I’m more content to build a few Ferrari’s a year than a thousand Toyota’s. Nothing against scalable, mass-produced reliable cars, but I’m obsessed with perfection, and I can’t perfect much more than a small handful of patients at a time.

The other half of my time is spent working on things I’m not ready to talk about publicly yet, but they are very much related to my interests expressed in the practice.

Lastly, I am (slowly) working on turning my 10,000 word longevity manifesto (circa 2014) into a book. No, I’m not willing to share the manifesto, but I hope it will be worth the wait when/if the book ever comes out.

Update 3: Exercise

Because I get asked a lot on the blog and through social medial…here goes:

I hung up the bike in January 2015 (from a competitive standpoint). I simply could not travel 140 days a year (which I did last year), work 60-80 hours/week, spend time with my family, and be a quasi-serious wannabe time-trialist. And if I could, I don’t think I wanted to. So the past year marks a first, since the age of 13—it’s the first year I have not competed in something. It felt horrible for a few months, but I’m at peace with the fact that I can’t FTP at more than 4 watts/kg and probably never will again (especially since I think it was actually shortening my lifespan, not lengthening it). I will ride socially a couple of times per month, and find the experience fun and humbling simultaneously. I’m swimming Master’s zero to three times per week, depending on my travel (on my two weeks/month in NYC, it’s zero; in SD it’s 2-3). To fill the some of the endorphin void I’ve take up bootcamps—Barry’s in NYC and OTF in San Diego. Lastly, I’ve re-discovered my obsession with heavy squats and deadlifts. So total exercise volume is low-ish by my historical standards varying between 8 and 12 hours/week with nothing constituting “training” except for squats and deadlifts.

Because I know someone will ask, here is my favorite squat/deadlift set: after a thorough warmup of 7-10 sets ascending in weight, the main set is 5 sets of 5 reps, followed by 4 sets of 10 reps, following by 3 sets of 20 reps. Pat Jak introduced me to this set. Another cool variation, which I did yesterday, is ascending sets of 5 reps until failure (i.e., keep increasing the weight until you can’t get 5 reps), then dropping down to a “test” weight (I use 315 on deadlift and 275 on squat) and going to failure. Then, drop to a second, lighter “test” weight (I used 275 on deadlift and 225 on squat) and go to failure once more. Failure occurs when form breaks, not when you fall under the bar and the goal is increase the reps of those test sets each week.

I don’t possess the vocabulary to explain what this does to my glycogen reserves.

Do not—repeat—do not do this if you don’t know how to squat and deadlift perfectly. If you’re looking for an education, I can’t recommend Mark Rippetoe enough. His book, Starting Strength, is a bible for anyone who wants to correctly lift heavy weights. I also plan to take his 3-day course for a little tune up. I’ve been doing these exercises since I was about 15, and was fortunate to be coached by wonderful people, but you can’t be too perfect in these movements.

Update 4: Displacement

People who meet me often assume I’m uber-competitive. Actually, I’m not and I don’t think I ever have been. I’m obsessed with mastery, though, yet I consider that very inward. Swimming and cycling were amazing ways to scratch that itch and so was surgery, mathematics, and virtually everything I’ve ever done. So in another effort to fill that mastery void, now that I’m no longer training hard enough to master anything, I’ve been putting more time into another passion—auto racing.

I could write three or four blogposts about this obsession! Last year I managed 9 full days on the track (Laguna Seca and Buttonwillow, above in spec E30) and this year will probably be the same, but the game-changer is my simulator. Using iracing software and a professional simulator built my Mike Wagner (see pic, below, including my shrine to Ayrton Senna) which is the most realistic sim out there, I can actually spend 60-90 minutes per week in the sim and continue to fine tune every detail of the technique necessary to drive a car at its technical limit. The best part (besides hydraulic pedals)? I can practice with my coach, Thomas Merrill (that hyperlink is to a cool test drive he did in a 458), virtually, for hours on end. I’ve never done anything that requires so much concentration and through which I lose all sense of time. Sometimes I tell my wife I’ll be “simming” for 45 minutes only to have her come out and tell me it’s been almost 2 hours. Another added benefit is that I get to teach my kids about driving while they sit on my lap. Fun for the whole family, really. Except my wife, although she has learned to fly through the corkscrew at Laguna in a Miata. I initially planned to put the sim in our bedroom, but that idea was vetoed in favor of the garage. Better than nothing, but I don’t see why the bedroom was such a bad idea.

On the track, my best blooper so far was an amazing failure of metallurgy going into turn 2 at Buttonwillow. Admittedly I tried to cheat and shift from 4 to 2, instead of 4 to 3 to 2, but still… c’mon…


Update 5: Family

Speaking of family, and since I do get asked (thank you very much), my family is doing great and especially happy to see me under much, much less stress than when I was a full-time fundraiser. And as far as kiddos go, it’s still amazing to think there was a day when I didn’t want them (in the abstract, not my actual kids). So glad I was talked into it. The little guy is, officially, a monster. At his 18 month check-up he was 99th percentile in height and 91st in weight. Probably not going to be a great jockey. Big sis adores him and hasn’t (yet) got sick of him. She plays drums like it’s her job and he dances like it’s his.

Update 6: What I eat (the only update you care about…)

In 2015 I did a 6 month experiment of exactly one meal per day (23 hours of fasting, then ~1 hour of eating at dinner). Very interesting. I’m sure I discuss it in at least one of the podcasts, below. These days I’m eating about as freely as I have in 7 years. I’m still carb-restricted by the standards of most Americans, but nowhere near the ketogenic lines of 2011, 2012, and 2013. I almost always skip breakfast, and lunch is usually a salad (“in a bowl larger than my head,” if possible). Dinner is usually a serving of meat with more salad and veggies. I’m more liberal on fruit and even occasionally rice or potatoes. Also, in moments of weakness I sometimes lean into my kid’s crappy food.

The biggest “news” on my eating front is that I now wear a 24-hour continuous glucose monitor (CGM) 24/7. This was the result of one of the most fortuitous flights of my life. In the fall of 2015 I was flying to NYC and half way through the flight, needing a short break from work, I went to one of my favorite watch sites. The fellow next to me made a comment—clearly he was part of the cognoscenti—and we got ultra-deep into watch idiotness. After a while I asked him what he did only to find out he was the CEO of Dexcom, the company that makes the best CGM device on the market. Fast forward a week and Kevin has introduced me to his amazing team (Christy Pospisil is awesome!) and I’m hooked. CGM is a game-changer and it does warrant more discussion than I can provide now. The insights have been staggering. I’m pretty obsessed with it (shocker, yes) and I aim to keep my 14-day running glucose around 90 mg/dL with spot-check standard deviation less than 10 mg/dL. By keeping average glucose low and glucose variability low, I can reasonably assume my insulin AUC (area under curve) is low.

Below is a printout of my last 14 days. As you can see my measured average glucose was 92 mg/dL, which imputes an A1C of 4.8%. At some point I may write about the dozen insights gleaned from CGM (and I think I mention a few in the podcasts), but here’s one: measured A1C is probably directionally valuable (you know, the difference between, say, 5% and 9%), but that’s about it. If your RBC (red blood cells) live longer than 90 days—mine live much longer since I have beta thal trait—your A1C will artificially reflect a higher average glucose. Conversely, if your RBC are large, the opposite occurs. (For those wondering, MCV, which is part of a standard CBC, shows you RBC size).

My A1C in standard blood tests routinely measures 5.5% to 6.0% (courtesy of my tiny RBCs), which poses a problem when applying for life insurance (prediabetic is defined as 5.7% to 6.4%). But with CGM, which is calibrated 2-3 times daily, my imputed A1C, which is much more reliable, varies from 4.6 to 4.9%. Big difference, huh? As an aside, I can’t talk about my beta-thal without hearing my med school roommate, Matt McCormack referring to them as “shite for blood” in the best Scottish accent ever. As if it’s not bad enough having an artificially high A1C… you gotta have shite for blood.

And that’s the least amazing part of CGM. I’m not sure I’m at liberty to discuss the next generation of CGM. Admittedly, not too many people want to wear the device I wear, but in two years, well, that’s when it will get amazing.

And that’s just the tip of the iceberg when it comes to why this device is adding insights and actionable data at a geometric rate. In two years this device will evolve into something everyone can wear.


And lastly…

Ok, I can’t think of any other updates so with that below are three podcasts I’ve done in the past 3 or 4 months. By some coincidence all of them have gone live in the past week, which is what prompted me to do this post-that-is-not-really-a-post.

Here they are in the order they were recorded.

  1. Rhonda Patrick and I spoke in Fall 2015. Here is the link to the video, which she nicely annotates. I believe this is also available on iTunes.
  2. Ken Ford and I spoke in January of this year. I was honored to be the first speaker in IHMC’s STEM series. Here is the link.
  3. Chris Kresser and I spoke in February of this year. We planned (before the talk) to discuss lipoproteins, but I don’t recall doing so. Here is the link.

I hope these three podcasts—all of which were really fun discussions—keep you occupied for a while. I have not listened to them, but my recollection is that there will be overlap between them, especially the latter two.

I’ve been asked a lot in the past few months to do other podcasts but I’ve politely declined, noting that I’m a bit podcasted out. I’m sure the energy will return next year, assuming I have something to say.

Photo by Jeff Cooper on Unsplash

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