July 9, 2018

Podcast

#04 – AMA #1: alcohol, best lab tests, wearables, finding the right doc, racing, and more

"I feel the need...the need for speed." —Maverick and Goose

by Peter Attia

Read Time 15 minutes

In the first “Ask Me Anything” episode, I answer a wide range of questions from podcast listeners and the Twittersphere. Bob Kaplan, my head analyst, playing the role of Mike Wallace, asks, and follows up on, the hard-hitting questions submitted via Twitter.

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* If you have any questions for the next AMA (#2), please submit them to the comments section of this post. *

We discuss:

  • What are my thoughts on alcohol consumption and health? [4:00]
  • What are the best lab tests to request from your PCP, and what are the best markers for longevity? [14:00]
  • What are the best wearables and why, and why do I use a continuous glucose monitor? [35:00]
  • How does one select the right physician as a patient? [47:00]
  • Why do I race cars and what’s the hardest thing to learn as a new driver? [54:30]
  • What is my current exercise regimen and what are my thoughts on exercise for improving lifespan and healthspan? [1:20:15]
  • What is my strategy for learning something deeply? [1:33:00]
  • What is my process for forming my beliefs? [1:53:30]
  • What does my diet look like these days? [1:57:45]
  • And more.

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  1. when fasting, curious how low is too low for glucose. most days i do time restricted eating (or just skip breakfast & lunch), but occasionally i like to do a longer fast (5 days or something like that). it comes very naturally to me, and aside from the first day, i generally feel fantastic. however, the last few times, on day 2 or 3, i’m woken at about 4am feeling wonky. last time, got up, checked glucose and it was 38. figured it was an outlier, but i was getting so woozy that i tested again — this time 34. chugged kombucha and broke the fast, but trying to educate myself on why this might be, and if there’s the potential to safely push through this somehow, without breaking the fast. very few resources out there that offer advice beyond “stop if you feel unwell”. i want more! thanks!

  2. hello peter. i’ve recently discovered your work, and i’m already a big fan.

    here’s my question: for the last year or so, my focus, nutritionally, has been on reaching my micronutrient daily goal for all micronutrients (reaching 100% of rda or above). it’s very easy to track this kind of things using food databases and services that let you log what you eat.

    is this a correct approach to nutrition? is it short-sighted? there are several things that i don’t understand, if this approach is correct; for example, one of the main things is: why does everybody put emphasis on varying foods? there’s a few of selected foods that are largely superior to others, with regard to micronutrient density; e.g. the only fruits and vegetables in my diet are tomato puree, spinach and strawberries/oranges (depending on seasonality), as these are more than enough to provide the micronutrients i need, given their incredible micronutrient density.

    any comments on this would be highly appreciated. keep doing what you do; i’ll be reading/listening.

  3. Question for next AMA – how does one know without doubt whether they have Familial Hypercholesterolemia? Is there a genetic test or specific labs? Does high omega 3 supplementation help FH? Thanks!

  4. Awesome podcast. Thank you so much. I am very interested in continuous glucose monitoring and can’t get a cgm device prescribed as I’m not a diabetic. Yes that’s a good thing! The Abbott Libre device will have real time information on your cell phone, once the app is approved for use in the USA, but the error margin seems high. The device is quite affordable though. Do you think the Libre might still be useful for a non-diabetic, once real time information is available? I’m interested mostly in real time glucose response to different foods.

    Thank you also for the Schelke et al., 2018 paper. I have provided this paper to individuals with APOE 4 positive genetic results, mostly to encourage them to entertain the possibility that Alzheimer’s prevention is possible, especially when faced with APOE4 homozygous results. Finding a Neurologist to entertain this idea is a different matter though. Your thoughts on how to choose a doctor are extremely useful in this context.

    Your website design and functionality is excellent and impressive. I believe Bob is the one to thank for that.

  5. Hi Peter. Thank you so much for podcasting and posting these really complete and helpful transcripts – I am learning so much. I love the AMA format and hope you’ll keep these coming every now and then. A few questions:

    – At what number should an A1C lab result be followed up with an OGTT or other testing to figure out exactly what is going on? For prediabetic values in otherwise healthy/athletic individuals, what is the best science out there on “preventative” uses of metformin or even basal insulin vs. simply going very low carb to get blood sugar numbers back to optimal values?
    – Genetic test results often produce a mix of bad news and good news. Do we know anything about how these various genetic variants interact and influence each other? For instance, I have the FOXO3 variant associated with longevity (great news!), but also am APOE 3/4 (bummer deal, dude), along with many variants associated with Type 1 and 2 diabetes. How does one make sense of this jumbled look into the future?
    – What is the easiest and most accurate way to determine if you are NOT genetically cut out for a ketogenic diet?

    Keep up the great work and thanks again.

  6. Thank you for the great podcast. I believe it is of equally value to the conversations with subject matter experts as your audience has questions that will most likely not come up in the normal course of conversation with a SME. One example (perhaps for a future podcast). You state that measuring ALT is important, but what does an elevated ALT mean? Is it always due to fatty liver disease or are there other causes of the same symptom? How would one identify the cause of an elevated ALT? What strategies do clinicians use to address an elevated ALT?

  7. Great show Peter and Bob. Love the format and the topics. Looking forward to hearing Peter’s thoughts on TRT replacement and autophagy.

    Art DeVany would be a great interview if you can get him to come out of hiding 🙂

    Speaking of finding the right doc, how does one contact Peter to become a patient? I see this asked on Twitter and elsewhere without response, and all phone numbers on the Interwebs are dead. I live in the San Diego area. Thanks!

  8. Peter , perfect timing for your podcasts. I listen to all the cutting edge nutrition/ biochemistry minds out there , and recently felt I needed to hear someone new. You are not new , I’ve been following you for 3-4 yrs , and I’m so happy to hear your thoughts again. Interestingly I have a Lpa over 200 and my PMD who is also a Lipidologist and studied with Tom Dayspring ,was not impressed. I was not happy with, that response. I’m very much excited to hear your podcast on Lpa.
    Thank you
    Joan in GA

  9. Hello Peter and Bob, thank you for the podcast. Super interesting stuff. I’ve been following Peter for a couple of years now, since the Keto days. Learned about Peter through Tim Ferriss’s podcast. Fan from Thailand!

    Quick question for the next podcast,
    Peter seems to be very conscious of his diet and impact on health vs longevity. What are his thoughts on organic food? Worth it? Along similar lines, Monsanto (now Bayer), GMO, monoculture crops?

  10. Peter,

    When I heard about your fasting session I could not fathom it. I can’t go more than 3 hours without eating. Its so bad that I feel faint, dizzy and shaky. I feel I am eating constantly. I try to stay out of the junk. My bloodwork always comes up fine. Doctor says to eat every 2-3 hours. I’ll eat 3 eggs on toast with coffee in the morning, 2-3 hours later, I am starving, not just hungry, starving. Eat again, same thing, 2-3 hours later starving. I turned 50 this year. I drop 30 pounds in the last year, I am down to 270. I am trying to lose more, but I can’t stop eating. They is no way i could do the fast like you do. I found out about your fasting while listening to your interview with Joe Rogan. Does my body not process food properly?? I am told I am not hypoglycemic or diabetic. I can’t stand this, I am at my wits end.

  11. Why does sleep go to all hell for women in prei-menopause/menopause and what can be done about it when typical hacks don’t work?

  12. Hello Peter and Bob. Thanks a lot for AMA. It is very helpful to clarify fundamental doubts for non medico background folks like me. I got to know about Peters work through Tim Ferris and Kevin Rose podcast. One question about HDL and TG. I read few articles in your “Dope on cholesterol” series but not able to understand what are best ways to manage HDL / TG balance? I mean low HDL and high TG scenarios? Any of your article / paper i can go through?

  13. Great show and i’ve always enjoyed your interviews on tim ferris show.
    My question is whether i should be concerned about avoiding breakfast to complete my 16 hour fasting window. Recently someone else important mentioned that the when you cut eliminate breakfast, your existing insulin consumes all the sugar in your blood stream and then you are hyperglycemic state for the rest of the day. Really confused whether i should change something that’s currently working for me.

    Thank you
    a fan from India

  14. A few podcasts earlier, you mentioned the experience with psychedelic medication experience in South America
    How can I have more information about it
    My daughter who is 32 has severe depression bipolar and BPD. We tried all possible treatment and very poor progress. We would like to try psychedelics you tried.
    BTW you are incredible teaching me for last over 2-3 years.
    Thank you so much.

  15. Question for anyone and Peter; If I eat a high fat diet, low protein and low carb (calories around 80:10:10, respectively), and carbs NOT low enough to be in ketosis, is my diet worse off than a standard american diet?? Am I losing the benefit of low carb since I’m not in ketosis burning fat?

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