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. I also loved the AMA though will admit to not being able to follow it at times. Yes, you back it up with show notes, but it would be worth trying to make sure you’re defining terms and avoiding jargon as you go through. I’m a physician and have been Keto since 2013 so not new to the topics(s), yet found it confusing at times.
    You have a great deal to teach and ostensibly sharing this knowledge is the purpose of the podcast. The larger the audience which can just follow the podcast the better. I’m not suggesting you dumb it down, just pay a bit more attention to your use of jargon.

  2. Thank you for starting these podcasts. I think they are of great value. Please continue doing them. I have a few follow-up questions based on your first 3 podcasts and this ama. 1) You’ve done a great job describing the 3 components driving atherosclerotic disease, especially clarifying the LDL role. Could you explain how blood pressure is involved as a risk factor / driver of cardiovascular disease? 2) In regards to IGF-1 debate, what is the thought that reconciles Laron syndrome observation of low disease risk with the latest thinking that sustained low IGF-1 is probably not optimal? 3) In your opinion, what are main levers that can get ALT levels down to your aggressive target of <20? For sake of argument, let's assume ALT level starting point is just high normal of reference range. Thank you.

  3. it would be great to hear a discussion/debate with Valter Longo — or, if not that — perhaps a discussion of where your line of thinking aligns and where you part company.

  4. You mentioned in a couple of podcasts that the amount of papers published is enormous and most of the papers are never cited again – by other researchers. I inferred – maybe wrongly – that you concentrate on those papers that are recited and widely accepted by the medical community. Assuming that big companies have an influence on what is researched how you ensure that new/old (alternative) ideas won’t be overlooked? Do you have any concern here? Could you say more about the method your team reviews the papers?

    What do you think about the healthcare system? (I think you picked areas of medicine that has more sense – like ER/research on longevity which may be very similar to real prevention/diagnosing. Were these choices deliberate?

    If I look at pictures that were taken let’s say 30 years ago, I see e.g. that people had more hair and been smaller – for example, I remember 4-5 people could easily get into cars like the VW Beetle or the Citroen 2CV. I think today only 3 would sign up for a ride in those :). Assuming that our environment is quite different and that in turn had an effect on us (e.g. by turning on and off genes etc) then for how long a dietary advice can be true? Doesn’t it entail that such an advice should be moderate (– but moderate by what standard)?

  5. The best version of the “Maybe” story I’ve found is the one in Jon J Muth’s children’s book Zen Shorts. Two pages, captures it perfectly.

  6. Can autoimmune illness be a metabolic illness? Making similar changes to the immune system to those in cancer?

    Why do you and e.g. Don prefer eating dinner/having your eating window in the evening? Isn’t it against circadian rhythm?

  7. Dear Peter,

    what, if any, app or software do you use to aggregate, store and analyse your lab results, devices readings, and other health data that you collect?

  8. So many questions! Not enough answers. Who/where are the docs who looking into situations where a woman is NOT a candidate for estrogen replacement (i.e., women who have estrogen dependent breast cancer or estrogen dependent endometriosis). Its tiresome that HRT/Estrogen is the default treatment for all docs I see who conveniently forget about the very real problems with endometriosis.

  9. Assuming that an upgrade/technical revolution to our health system is coming, is there a point of starting to collect data on ourselves/ our kids? If yes, what data you would start gathering/keeping track of? (There are quite a few smart rings, scales, thermometers etc on the market…)

  10. If you were just starting out in medicine again, maybe halfway through med school or so, how would you approach things? Would you do the same residency again? (on a related note, do you see yourself as an internist for the rest of your career, or is there something that would/could pull you back into the OR?)

  11. A series of questions I’d love answered as part of a cardio/diabetes series if possible (in order!)

    1. For those at higher cardio risk (apoB, lp(a)), how would you rate the quality of the various tests that can be run… i.e. stress test, CIMT, CAC, echo, cardiac MRI I think peter mentioned, or other. I’m not a fan of radiation after several CT scans already so the CAC turns me off.

    2. Could you comment on the pre-diabetic state some more? Are some % of beta cells completely gone at this point? At what point is insulin resistance no longer reversible? Despite years of eating better and working out my A1C hasn’t really moved.

    3. Would like to hear additional commentary as statins for as a first line of defense vs. only post-event. Any successful trials for this at all? Treat high apoB / high lp(a) despite the lack of evidence of first line defense?

    4. Say you run some type of cardio test and see a % blockage. At what % blockage do you start to intervene beyond pharmaceuticals?

    5. What early interventions do you consider useful vs. useless when high % blockages are caught early? (Have heard mixed things about stents, for example). i.e. 70-80% blocked patient with no events yet.

    6. Do any other drugs mimic the anti-inflammatory benefits that statins provide? That is, if you wanted to get the anti-inflammatory benefits rather than just the particle count reduction

    7. What has been your experience in change in LDL-P with the introduction of metformin alone?

    Thanks!

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