Ask Me Anything

If you have a question for Peter that you want answered on one of his AMA podcasts, this is the place to ask it.

Hi Peter, I wanted to get your thoughts on whether the consumption of black coffee in the am breaks one’s fast. Effectively, this is another way of asking whether the consumption of black coffee in the am raises insulin levels? I ask this, because there seems to be some contradictory advice on the internet regarding this topic and curious your take. Thank you

September 21, 2018

How do you become a patient at Attia Medical or with one of your medical groups?

September 21, 2018

What’s your take on thyroid nodules and cancers in young, healthy adults?

September 21, 2018

I’m thinking about taking Metformin for longevity. What considerations should I think about before doing so? Thanks!

September 21, 2018

Children

September 21, 2018

Like you Peter i’m the father of young children (3). This has many interesting health implication for us parent and the children. Could you do a podcast or AMA section on children? Like how do you manage a keto diet with young children? Can children be fed a keto diet? I give my kids fat…

Children (part II)

September 21, 2018

When we think children, we think sleep deprivation. Thoughts and opinion? tips?

Children (part III)

September 21, 2018

Children and ADHD or similar issues and drugs (Ritalin etc…) and short and long term effects.

Microbiome Deep Dive, AI for longevity

September 21, 2018

Would you consider doing a podcast on microbiome health, monitoring, and the potential use of AI to help solve health related problems and increase longevity? Seems there is a lot of fascinating research in both spaces that overlap to some degree.

I appreciate your podcast series. Many of them dwell on Lp(a), ApoB etc. but I haven’t heard much about Coronary Artery Calcium (CAC) Scanning, that is a quick affordable screening test with less debate about what to do after you get the results compared with NMR data. What do you think of CAC as a diagnostic tool versus NMR ?

September 21, 2018

After listening to your podcasts, and reading the literature you referenced, I brought the topic up with my PCP during my annual medical. I asked if I could have an NMR test vs the traditional bloodwork I had done in previous years. He quoted that NMR results are considered controversial based on some studies and…

What can we learn from centenarians (e.g. Blue Zone descriptions)Some of the interpretations seem to be overgeneralizations.

September 21, 2018

How would you design an informative centenarian study? What are best questions to ask? What metrics? What metabolites? How to identify efficient mitochondria? Epigenetics?

Why, during your KFK (aka “nothing burger”) weeks, would your trigs and uric acid levels have increased so much given that you were consuming no fructose?

September 21, 2018

You have mentioned a couple of times that you have your own set of reference ranges for many biomarkers. For example, you recently spoke about wanting uric acid below 5 and ALT below 25. What are some other markers where you differ substantially on your reference ranges?

September 21, 2018

Do you know anything about PEMF therapy and whether or not it is beneficial?

September 21, 2018

Berberine vs. Metformin – Some studies show Berberine as being as effective as Metformin. Thoughts on this?

September 21, 2018

Are there any known benefits to “cycling” in and out of ketosis?

September 21, 2018

People on the internet (like Mercola) suggest going in and out of ketosis benefits the mitochondria, although Mercola has a habit of using no little data to back up his claims. https://fitness.mercola.com/sites/fitness/archive/2018/01/19/fasting-ketogenic.aspx

How to screen for chronic hyperinsulinemia? In your podcast with Robert Lustig, you stated that you felt that we should treat a patient with “normal” A1C but chronic hyperinsulinemia with the same urgency as a T2 diabetic. Absent a direct measurement, how would the patient become aware of that chronic hyperinsulinemia?

September 21, 2018

In your podcast with Robert Lustig, you stated that you felt that we should treat a patient with “normal” A1C but chronic hyperinsulinemia with the same urgency as a T2 diabetic. Absent a direct measurement, how would the patient become aware of that chronic hyperinsulinemia?

Can you compile a list of medical professionals across the country who you would recommend

September 21, 2018

Do you partake on any non-western practices for longevity?

September 21, 2018

I understand you’re have strong position on quantification and use of scientific principles in everything that you do. But do you practice any type of other so-called “alternative medicine” to your practice that you think can promote longevity?

After listening to the podcast with Dr. Robert Lustig, I wonder what Peter thinks of the FODMAP diet.

September 21, 2018

That is e.g. does Peter think that the other sugars in the FODMAP diet are similarly metabolized and therefore ‘bad’ for us? How much fructose can be still considered healthy – assuming you eat it as a whole food, and it is not a high glycemic food/fruit. FODMAP on wiki: FODMAPs are short chain carbohydrates…

What advice would you give to the 25 year old Peter. You often allude to wishing that you previously prioritized sleep, but what additional advice would you give on health and mental wellbeing

September 21, 2018

This is more of a request. Can you provide the introduction music of podcast as a seperate download. I can’t think of a better alarm clock tune.

September 21, 2018

What are the diseases that kill monks? Have you done any research into the possible connection of longevity and religion? Since religion provides community, a sense of purpose, and connection, one would think this would ultimately help lead to better mental health, and a longer, healthier life

September 21, 2018

Your discussions about mental health are very eye opening, so thank you! It seems as though the mind body connection is stronger than seems possible, and the quest to find meaning and happiness in life is a key factor in longevity.

Do you take a multivitamin, is so which one?

September 21, 2018

I currently don’t take any, but have been doing a lot of research and Ultra Preventive® X, from Douglas Labs seem to be a good candidate. What are your thoughts?

What blood tests and reference ranges would you recommend for a male focusing on healthy lifespan/longevity?

September 21, 2018

Autoimmune diseases – reversible? Are diet/lifestyle interventions enough, or are drug interventions necessary? Long-term safety of new biologic meds? Effects of autoimmune diseases on longevity?

September 21, 2018

As someone who has suffered for a long time with psoriasis, I often wonder whether it’s better to take on the risk of immune-suppressing medications to treat, or not. I also have family history of heart disease, not sure how much my autoimmunity effects heart attack/stroke risks. Your podcast and website are fantastic. Please do…

I’ve been a Type-1 diabetic for 20 years (reasonably well-controlled with a HbA1c of 6, but would like to get it lower). Following a LCHF diet has vastly improved my blood glucose control and reduced my insulin requirement by half. My wife is a Mayo-educated primary care physician who basically dismisses this approach as ‘quackery’. She has numerous diabetic patients with off-the-charts HbA1c numbers. Any suggestion for convincing her of the legitimacy of this approach (LCHF) versus the standard treatment?

September 21, 2018

Creatine supplementation Y/N? Why?

September 21, 2018

I searched site and didn’t see any substantive comments about creatine.

Should someone who is at risk for Alzheimers disease (I have 2 APOE4 alleles) try psychedelics?

September 21, 2018

You’ve mentioned the benefits of psychedelics in previous podcasts but I am not sure if they would do more harm than good to me in the long term.

Why does my mountain bike performance decline so precipitously when its hot and especially humid.

September 21, 2018

I’m 53 (m) and a sub-elite rider in the Don river valley. Think Toronto summer humidity!

Have you heard of the Blue Zone? Do you think there are aspects you could draw from in the pursuit for a longer health-span? https://en.wikipedia.org/wiki/Blue_Zone

September 21, 2018

Using fake name on purpose, don’t think that changes the merit of the question. Thanks for a great blog+podcast with an insane amount of information.

What are your thoughts on an optimal weightlifting routines for longevity?

September 21, 2018

Should the focus be more so on pure strength opposed to hyper trophy, or vice versa? How many days a week per muscle group? Etc.

Lower Back Longevity

September 21, 2018

You wrote a blog post about your lower back problems and surgery while in medical school but talk in your podcast about your deadlifting routine involving some heavy weights. Could you talk about how you rebuilt your back and how you maintain a healthy spine?

You have referenced the “estrogenation” of man as one of the most important get largey uncovered trends. What is this, what causes it, and what can be done to fix it?

September 21, 2018

Can a low-carb diet cause panic attacks?

September 21, 2018

I have always been nervous about public speaking. However, I started having panic attacks whenever speaking in front of a group of people back in June. This is also around the same time I started cutting out carbs for (successful) fat loss. I get up in front of 100+ people about twice a month, but…

What do you think about the uptick in mainstream news articles about the “dangers” of low carb/keto diets and what impact these type of gross generalizations may have on the public?

September 21, 2018

Specifically referring to articles such as this: https://www.thisisinsider.com/is-the-keto-diet-healthy-studies-suggest-carbs-are-linked-to-long-life-2018-9

I am curious about Peter’s opinion regarding mixing carbs/fats in the same meal. Robert Lustig (and a couple others) have left me with the impression that there may be something especially is insidious about combining fats/carbs since foods in nature are either one or the other.

September 21, 2018

Wondering if you can discuss your thoughts on the usefulness of the running a PULS, (protein unstable lesion signature) test, and how it compares at elucidating/ evaluation someones overall cardiovascular risk profile, (I am a doctor). signature) Cardiac test

September 21, 2018

Hi peter, I heard you say you fixed a woman’s thyroid in a recent podcast. What do you mean you fixed her thyroid. I have hypothyroidism is there something I can do besides just taking synthroid?

September 21, 2018

Thank you. You are an inspiration.

What are your thoughts on sugar alternatives (sucralose, sugar alcohols, etc.)?

September 21, 2018

Not sure if there is anyone out there doing this research… but could you do a podcast with a neuroscientist focused on the prevention/reversal of brain aging? Specifically are there foods, exercise modalities, other protocols to maximize brain performance and long term health?

September 7, 2018

I guess this question rests on the assumption the brain can be specifically targeted by interventions that aren’t just systemic…

You wrote on Twitter that you are considering different avenues to monetize the podcast in order to make it sustainable: what do you think is the best way to do it?

September 7, 2018

I’ll try this again. :) I’m curious about you opinion of detox protocols- I.e. Dr Yu’s type of detox- a high Niacin to cardio to sauna to charcoal to cold shower type of protocol to detox your system from toxins, hormones being released from fat during high weight loss

September 6, 2018

Have you traveled to Europe, what did you particularly like about it?

September 6, 2018

How to reverse sleep deterioration in middle age and beyond.

September 6, 2018

Many middle aged people suffer poor sleep time/patterns. Peter has alluded to the evidence on the importance of good sleep to general health. A review article on evidence based ways to improve sleep length/quality would be very useful to many readers and followers.

What are these 8-12 genes that increase longevity that you always talk about?

September 6, 2018

What do you think is the role of sugar in obesity?

September 6, 2018

To detect lactose intolerance or inflammation you once recommended cutting dairy products. If cheese and cream are very low lactose products, why should one cut them? Is there another molecule in dairy products that can produce inflammation?

September 6, 2018

What dose of metformin do you take?

September 6, 2018

In your fasting podcast you mention you take metformin, I was wondering the dose. Strength/formulation/times per day, i.e. metformin 500mgER twice daily. It comes in 750 and 1000, some ER and some plain. Not asking to mimic your regimen but I am a health care professional and was curious to your approach. Thanks.

As a former fat but fit athlete, if you were nutritionist for elite (Olympic level) athletes, what would be one dietary recommendation you’d give them, regardless of sport?

September 6, 2018

Systemic inflammation and osteoarthritis

September 6, 2018

In an interview you gave (I think it was with Jocko), you mentioned that inflammation may be one of the highest contributing factors of life threatening diseases (CVD, Cancer, Dementia). Does having osteoarthritis (which I’ve seen classified as noninflammatory arthritis) raise or contribute to systemic inflammation in say the same or similar way that rheumatoid…

Guillain-Barre, is a very interesting syndrome. This is a vague question, but would there be applicable information of diet/fasting, or mTOR. Currently it appears that only periodical immunoglobulin injections are the only therapy at the moment. Thank you

September 6, 2018

I’m currently in Ketosis to reduce my weight – and it’s eorking well- 11 weeks in and I’ve dropped 12kg. I live in the UK. Are there any labs you recommend for blood testing here. Is it worth having a genetic analysis? Is there value in having a DEXA scan?

September 6, 2018

what is the future of health care and what direction would you advise young like minded people to head in?

September 6, 2018

With the rise of AI and medical tech there is going to come a time in the near future where drs are superseded by diagnosis algorithms etc, what do you predict the health care landscape to look like in 10,20,30 years time. For an aspiring dr is it worth the investment in medical school for…

metformin

September 6, 2018

I understand you take Metformin. Is your goal to increase insulin sensitivity or anti-cancer? Does the correlation to AD/Dementia concern you? What is your daily dose

Do you order omega 3/lipids index blood tests to your patients ? I mean an analysis of the RBC membrane

September 6, 2018

Best protocol for raising testosterone levels

September 6, 2018

I’m 53 with a BMI of 44 and type 2 diabetes. In the month of August, I lost 26 lbs by eating a ketogenic diet and upping my daily dose of Victoza (from 1.8mg to 3.0mg). My hunger has been about a 2-3 most days. FBG is around 100-110. It’s been great. I can’t wait…

Losing weight without excess skin – Is fasting the proven method for losing weight AND avoiding excess skin?

September 6, 2018

Just read Dr. Fung’s post about Dolly’s results. She lost over 100 lbs and has no excess skin like most people who lose over 100 lbs. Her diet regimen was 3 days of fasting per week followed with a low carb, ketogenic diet. As Dr. Fung mentions, there is no research on this yet but…

Why are you taking Acrabose before “cheat meals”? Is this something everyone should be doing?

September 6, 2018

Can you help explain why fasting will increase serum cholesterol?

September 6, 2018

I am carnivorous, a-la Shawn Baker, which helps my Crohn’s and overall health but my LDL-C has. I am requesting an LDL-P test but it is not yet done. I’ve also been listening to David Feldman.

Huge fan of the podcast! What are your thoughts on omega 3 fatty acids for reducing inflammation? What are your thoughts on the theory that our diets, which were once to be far more balanced in omega 6’s:omega 3, are now grossly imbalanced to more pro-inflammatory omega 6’s?

September 6, 2018

How do you face the longevity optimization process with the possibility of a collapse of our civilization in the next 50 years ?

September 6, 2018

It is a constant paradox in my mind. I am both the grasshoper and the ant in Jean de La Fontaines’ Fable (https://www.mamalisa.com/blog/the-grasshopper-and-the-ant-jean-de-la-fontaine-fable-in-french-and-english/) There are multiple indicators (population growth, global warming, reduction of biodiversity, peak oil) pointing toward a possible collaspe of our civilization. So what’s the point in trying to tweak our über complex…

If most of our cholesterol is endogenous, how does diet affect it? What other mechanisms besides absorption..

September 6, 2018

Is it ok to cheat on keto once in a while? Would one cheat day a month hurt? What is a good time between cheats

September 6, 2018

Is there a case for psychedelics as potential remedial agents for those inflicting abuse on others?

September 6, 2018

On your podcast with Tim Ferris, you both described what I interpreted as zapping your mind into a momentary state of enlightenment that helped dissipate causes of anxiety, depression, and addiction. Following your podcast with Corey McCarthy, it was angering to hear about repeated acute and sometimes instant experiences that can have long-lasting damaging effects…

Biomarkers to assess when eating a modified Atkins diet

September 6, 2018

I am a doctor. I am frustrated with how little time I have to give patients. I would love to start another practice with concierge type care so I can provide closer advice and longer time with patients. Do you do this? any recomendations?

September 6, 2018

I’d really like to hear more about Metformin supplementation for longevity. Thanks!

September 6, 2018

There seems to be a trend of new articles saying low carb diets are unhealthy. Looks like it finally surfaced in time magazine. Could you please shed some light on this? Thanks!

September 6, 2018

http://time.com/5381570/low-carb-diets-longevity/

Trying again. I am writing with a scary situation.

September 6, 2018

I am 52 years old, used to be extremely athletic, healthy, and active. I eat what I think you would say is in a very wise way. Now I am barely 100 pounds, 6’1, have lost all my energy, can barely move, have bad nerve damage, my feet are blown up, and nobody can figure…

What are your thought on the effectiveness of foods with added plant sterols, as an alternative to statins?

September 6, 2018

for example – https://www.sanitarium.com.au/products/weet-bix/weet-bix-cholesterol-lowering/cholesterol-lowering?gclid=CjwKCAjwq57cBRBYEiwAdpx0vXX2E0K21CYK0zchGYMQOfPzrCqKYJd-HSnoNMXihLdn3yoiFkf1JRoCPgMQAvD_BwE

Any theories on what was happening with your thyroid during your fast?

September 6, 2018

Is Horvath’s epigenetic clock for aging (and Zymo’s commercial test of it) valuable for an individual?

September 6, 2018

Do you find it valuable and/or use it with your patients? Your thoughts on this would be greatly valued. Thank you, keep up the awesome podcast!

Protocol to establish understanding of personal blood glucose levels/insulin response?

September 6, 2018

What foods/times would be ideal to gather a good understanding of insulin response/blood glucose without finger-sticking non-stop?

Is there anything one can do to help regrow (regenerate) cartilage?

September 6, 2018

About 5 yr ago I’ve started experiencing pain in my knee and after getting 4 MRIs in one year and visiting three different surgeons, they all unanimously said that I should have surgery. Although between the three doctors I was given an option of 4 distinctly different types of procedures. I ignored them, modified my…

How sugar and simple carbs may trigger a low level anxiety or depression 2-3 hours after consumption?

September 6, 2018

I am 57 yo woman and according to standard lab tests, not even close to diabetic. When I cut sugar, had to add sodium, to fight hyponatrimia. And doctor recommended magnesium for leg cramps. Since I found out that I have one copy of e4 allele, I started to research methabolism-brain topics and noticed this…

Could Peter talk about what he has in his living will?

September 6, 2018

For those of us who aren’t doctors, it’s more difficult to know what issues could be overcome near the end, which are extraordinarily painful, etc. This is obviously a very personal decision, but some insight from someone who has seen many people in their final months probably has a better grapple on when to buy…

What are your thoughts on Fasting mimicking diets for the prevention and treatment of autoimmune diseases?

September 6, 2018

Do you think that the workouts outlined in Body by Science is the most effective way to hit the fast twitch mucsle fibers.

September 6, 2018

I was recently in an ALF, and a high % of food served to the tenants were carbs/sugar. Do you think a dietary change (ie, eliminating ice cream/cakes for dessert) would improve healthspan for these folks? Not keto, but lowering sugar intake.

September 6, 2018

In the Nothingburger episode, you mentioned training during a 5 day fast. How do muscles repair without ingesting protein?

September 6, 2018

Information regarding the best way to deal with shift work (Police officer). Usually 2 days/3 nights. 5 off then 3 days/2 nights. Etc. Nutrition best time to eat/hydrate. Best way to recover to take full advantage of rest days. Thanks.

September 6, 2018

police in Ontario (OPP) anyway carry narcan with them at all times. ( I was listening to one of your podcasts and you wondered about that.

Hey, Peter – I don’t want longevity if I am deaf and blind. Macular degeneration runs in my family, along with precipitous hearing loss in later years (late 80’s). Please fix. Thanks.

September 6, 2018

Bob & Peter, you two are awesome and I’m learning a to from the AMA so thanks. Tell us more about the latest and best on APOE4

September 6, 2018

Top Gun High Five. Seriously you two are the best, TY

Could you please talk about the mitochondria, the circandian rhythm and Deteurium?

September 6, 2018

I very appreciate the way you interview your guests. So i was wondering if you could interview Lazlo Boros MD from https://labiomed.org/laszlo-boros-md and Bill Lagakos from http://caloriesproper.com/ and author of the book “The poor, misunderstood calorie”. Thank you so much and congrats for your excellent podcast. Al

First do no harm–I see you as fantastic role model and physician, however, I worry about your off-label use of Metformin, M,W,F use of Lipitor for primary prevention of vascular disease, and your slant towards at least considering the intermittent use of Rapamycin. Beyond perfecting your diet, activity, sleep, stress, and social, please explain to us why you think these three pharmaceuticals will enhance our lives even further.

September 6, 2018

Peter, Thank you for re-shaping the landscape for physicians and patients. The Drive is great, as is your willingness to be on the edge of self-experimentation to help guide the masses towards good health. You and many of your colleagues within the podcast world have provided me an enlightened pathway to help my patients progress…

Can you do an episode on the immune system? I’d like to learn how/why it can be overactivated, why allergies form, why autoimmunity occurs, any links to lymes and EBV, immunity and cancer, immune activation and fatigue, as well as therapies or supplements that are appropriate for different scenarios (including rapamycin for optimizing it).

September 6, 2018

Endocrine, Thyroid, Hashimoto, HRT suggestion for podcast.

September 6, 2018

The subject of endocrine, thyroid, and labs has been broached in prior podcasts. I struggle with hypo/Hashimoto and am interested in the background of endocrine disorders, nature of causes, labs / bloodwork, understanding labs and reference ranges, understanding effective treatments, identifing qualified Dx, and the cutting edge of treatment. Seems to me the run of…

In your 9 part series on cholesterol you make the point that it is LDL-P, and not particle size, that is important in predicting and causing heart disease. However I recently listened to a podcast with Rhonda Patrick and Ron Krauss where he discusses the importance of small dense LDL particles and their importance in atherogenic dislipidemia. Do you stand by your assertion that LDL size is of little to no importance and only LDL-P matters?

September 6, 2018

Is Gary Taubes in your guest list for your podcast?

September 6, 2018

Best time to drink a soft drink if you have a gun to your head

September 6, 2018

I was given two glass bottle mexican cokes for my birthday – I don’t eat/drink refined sugar anymore, but am going to drink these at some point. At which point is my body best able to deal with the extra sugar, I was thinking just after a 10k run? or would before be bettr

What values would you be interested in monitoring continuously, if the tech existed? (beyond blood glucose, HR, …)

September 6, 2018

What are your thoughts on Sodium? Many “classical” thinkers on nutrition describe it as the devil, but I’ve never heard you say anything.

September 6, 2018

How do Day2 and the associated findings affect your thinking on nutrition?

September 6, 2018

Effect of fasting on Gynecomastia

September 6, 2018

I have suffered from gynecomastia since I was a teenager. I have been doing time restricted eating for a few months, and then recently progressed to a few 24 fasts. I noticed a significant improvement in the gynecomastia, although it returned as soon as regular eating resumed. Assuming it wasn’t imagined, why would that be?…

Supplements – is it recommended to cycle onoff? Generally? Specific types? How to do this?

September 6, 2018

For a young person who never built muscle mass and is only interested in it for the long term longevity benefits – suggestions on goals, and how to go about doing this?

September 6, 2018

What is the threshold of carbohydrate restriction that people should start paying attention to adding more salt to their diet? 100 grams? 75 grams?

September 6, 2018

If you’re doing low carb, is it true that there is a type of fueling grey area between 50 and 150 grams of carbs where the carbs aren’t quite low enough to stimulate fat burning to fuel your organs and simultaneously there isn’t enough carbs to actually fuel organs either? If this is true one should either simply to their carbs to fuel things properly or lower them to appropriate levels to allow for fat burning, no?

September 6, 2018

Thoughts on food sensitivities? Thoughts on diet for Crohn’s disease?

September 6, 2018

How does dietary fiber factor into a ketogenic diet? Is it total carbs that should be kept low, or is it “net” carbs that should be kept low?

September 6, 2018

Regarding Alzheimer’s, would you recommend doing a “Cognoscopy” per Dale Bredesen?

September 6, 2018

More specifically, for a 53 year old fit, healthy male who has a history of Alz / Parkinson’s and CAD in the family? Love the pod. Thank you!

Alcohol’s effect on ketosis + mitigation tricks: Would vigorous exercise / weightlifting hours prior to drinking reduce the impact? A high fat meal right before? Certain drinks you’ve noticed having a minimal effect on a state of ketosis?

September 6, 2018

You have mentioned a few times on your podcast that you are currently working on writing a book. What will the book be about and what is the expected release date?

September 6, 2018

I’m a 38 year old male, diagnosed at any early age with Thalassemia minor. When I was a teenager, my GP suggested iron supplementation which had no effect. I never let this diagnosis and seemingly chronic fatigue stop me from exercise and endurance sports which I enjoy. However, my fatigue is sometimes with me 24/7 and no amount of sleep and rest seems to help. My question is there any type of diet, foods or supplementation which may help with fatigue?

September 6, 2018

Thank you very much for your consideration. I admire your willingness and drive to share your time and expertise with the world.

As of today (or whatever day you answer the question) what does the literature actually tell us about which diet correlates most strongly with longevity?

September 6, 2018

I was listening to vegan cardiologist claim in an interview that, “no one should eat a ketogenic diet. A study done in 2007 told us that all cause mortality increases 53% in those who eat ketogenically.” My friends are concerned about me. I discovered I can’t rebut the doctor’s claims – he’s a vegan former…

Any good, scientifically validated tips for ball-shaving?

August 30, 2018

Are the positive effects of meditation related to hypnotic susceptibility?

August 29, 2018

Herbert Benson, an early researcher of meditation, wrote that meditation creates a prehypnotic state, similar to hibernation without the decrease in body temperature. People can be rated on a scale of hypnotic susceptibility.

I recently read a medical hypothesis article suggesting that a ketogenic diet may help anorexic patients during refeeding and recovery, as the state of nutritional ketosis could mimic starvation-induced ketosis sought out or experienced during the illness. Do you have any thoughts on the matter?

August 29, 2018

What are your thoughts on fasting and ketosis for females?

August 29, 2018

Let’s say in the case of NO calorie restriction just the state of ketosis itself. If ketosis mimics the physiological state of fasting in many ways, do you think this could negatively effect reproduction? I’m confused by the signals my body may be getting in ketosis but do you think this could be offset by…

Do you see any reason for a 25 year old, 155 pound man to avoid long-term ketosis?

August 29, 2018

optimizing health in our kids

August 29, 2018

as a parent yourself, are there things you do for your kids (diet, supplements, screen-time, exercise etc) that the average parent probably would not know about? i truly value your scientific rigor and question some popular biohackers…eg i have a friend who gives her 9yo a bullet-proof coffee before school…thanks!

What is the best current treatment for elevated LP (a)? Have you put any credence to Dr. Mathias Rath’s research into Vit C…I realize it is a little marginalized, but it is logically compelling.

August 29, 2018

I have found in my patient population that the Carotid Int/Med thickness to be the best Surrogate marker for state of progression of the disease. It appears that the process is occurring in this layer of the arteries

what made you change career paths completely from subspecialty trained surgeon to longevity specialist that doesn’t operate?

August 29, 2018

Like you and so many people that I know who went into medicine, I feel like you come out of this cattle shoot and your day to day job is not what you envisioned leading to burnout and depression. I’m now thinking of making a similar career switch and wanted to know your thought process…

What supplements are you currently taking and why?

August 29, 2018

Thoughts about different testosterone therapies for men? Potential negative side effects?

August 29, 2018

More specifically, pellet therapy (i.e. BioTe). I’ve had two doctors differ on what’s “normal” in terms of testosterone levels needed.

What is the typical response in the hormone panel to the ketogenic diet? Specifically testosterone, free/total, fsh, lh, estradiol, shbg.

August 29, 2018

What are your thoughts on the MAF method as a case for aerobic training over anaerobic overtraining?

August 29, 2018

This refers to dr. Phil maffetone and his coaching method. Would love to see you bring him on the show. It’s hard to argue with his success (e.g. Mark Allen) but I’d love to see you take a serious critique of data behind his approach.

Out of curiosity, why are you on statins?

August 29, 2018

Aren’t they bad for health?

Can you please discuss HRT for post-menopausal women as previously stated?

August 29, 2018

Do you think Extended Release Niacin can be helpful in lowering LIpoprotein (a) when you take Rosuvastatin, Ezetimibe? My LPA is high.

August 29, 2018

What is your opinion on the functional medicine line that a lot depends on leaky gut syndrome and what you eat is very important. Gluten. Dairy – inflammatory. Autoimmune disease. Lectins.

August 29, 2018

How to measure autophagy

August 29, 2018

You mentioned in a recent podcast that it was hard to measure autophagy. If that’s the case then how do we know it is sped up by fasting?

Why did you previously leave medicine to work in management consulting? In a similar vein, what advice would you give to a mid-career professional (i.e. financial consultant, lawyer, teacher, etc.) interested in pivoting to a high impact career in healthcare, excluding medical school?

August 29, 2018

This is really a two-part question addressing: (1) how you view career fulfillment and (2) where you see the biggest impact and/or need in the healthcare space. For example, what are 2-3 areas that you see a lot of opportunity in and how would one go about being trained?

Fasting leg fatigue

August 29, 2018

I experience the same thing you described where you have gym strength and otherwise felt okay, but walking felt like an effort. I’m putting keto on hold for a few months for the same reason. After 8 months I still haven’t found that uphill gear I had when running steep trails at Mission Trails in…

What if I’m eating a fat heavy, low carb diet, but not in ketosis? Will I get fatter than if I’m eating a carb heavy, low fat diet? How do I think about this?

August 29, 2018

I’ve heard “fat doesn’t make you fat” recently, and I know there are healthy types of fat. Please explain.

Kevin Rose mentioned you have a protocol for what to eat while on a fast mimicing diet. Would you please share? Thank you.

August 29, 2018

I read the Longevity Diet and am convinced of benefits of FMD. I have been listening to you for years and trust your advice on foods to consume during, e.g., nuts, greens, etc. Also, may l have a couple of espresso per day? Thank you.

Are eat-anything “cheat days” once per week detrimental to health and longevity?

August 29, 2018

Thank you! You have re-invigorated my passion for science and learning with the nerd safari and podcasts!

How do you manage your time?

August 29, 2018

HRT for people with Apo and MTHFR genes

August 29, 2018

This may be too specific a question. I have both the ApoE4 and the MTHFR C677T polymorphism. I need your brain on this – The book, Better Brain Function By Steven Masley, recommends HRT for ApoE4s. But, a paper, “MTHFR C677T polymorphism modifies the effect of HRT on metabolic parameters in postmenopausal women” (I’m Greek),…

Who should take a daily baby asprin?

August 29, 2018

If CVD by and large is related to “area under the curve” (i.e. total cumulative exposure to LDL-P), then why are we not treating patients at a much younger age (please disregard cost/QALY info with regards to this question)?

August 29, 2018

Very much enjoy your podcast – thank you. Just listened to your episode with Ron Krauss, and have asked myself this many times:

If TSH Levels improve (decrease) but Free T3 levels decrease and fT3/rT3 ratio worsen on a ketogenic/lowcarb diet, would this suggest improved sensitivity to thyroid hormones?

August 29, 2018

Stephen Phinney believes this phenomena may indicate better thyroid sensitivity. And he also points to studies where it has shown the same phenomena where T4 and T3 levels decrease but TSH also improves or decreases.

Your thoughts on olive oil vs flax oil?

August 29, 2018

Have you heard and what do you thinks of Dr. Michael Eades’ hypothesis that saturated fat protects against obesity by causing electron chain reversal in the mithocondria and inducing insulin resistance in the fat cell inducing?

August 29, 2018

In this talk (https://youtu.be/pIRurLnQ8oo) Dr. Eades puts forward this hypothesis as to why saturated fat protects against obesity by causing electron chain reversal in the fat cell unlike PUFAs which impeade electron chain reversal and allow the fat cell to keep growing and growing.

Cholesterol and the Brain ? What is there to know?

August 29, 2018

Sorry it is so vague. I am currently reading your articles on Cholesterol (currently at part 4) and I am finding the material a little hard to digest. I don’t have a strong science background. I would like to get a better understanding of the role cholesterol has on brain functions. I would also better…

Thoughts on 24-hr ambulatory blood pressure monitoring (who should get it, how often)? For my own curiosity, what do you listen to while working out?

August 29, 2018

Advice for physicians wanting to learn more and practice like you do and/or just incorporate more sound nutritional/lifestyle recommendations into daily primary careful practice?

August 29, 2018

I honestly feel like you could do a whole series of podcasts on this but I’m always curious -listening as an interested person – how I could revamp my practice to better incorporate the level of lipidology, genetic testing, and personalized medicine you discuss and practice into my daily primary care work. I’m a direct…

Is Vivelle considered a bioidentical HRT? If not, where can the average woman find biodentical HRT? I listened to you about 2 years ago on a podcast wherein you discussed triple therapy and what you would want your wife to take (see additional comments, please)

August 29, 2018

ugh, sorry… Estrogen: mostly E3 (estriol) at 80%, and E2 at 20% as well as oral bioidentical progresterone and testosterone. I spoke to my GYN and she prescribed Vivelle, stating its ‘bioidentical’. I seem to think this is not. Can you offer some ideas on how the average woman in menopause can get bioidentical HRT….

What lifestyle changes (diet, type of food and the amount of food) should be made to keep IGF1 level as low as possible to reduce the risk of cancer?

August 29, 2018

About 10 days after diet change and urine strip confirmed Ketosis I developed severe nocturnal calf cramps (and general pain/discomfort/lack of endurance in lower extremities). Cramps resolved with increased Mg, K, Na intake. I cannot find any literature on definitive etiology. Do you have an opinion or any references on this phenomena?

August 29, 2018

Nutritional Ketosis and athletic performance in the two anaerobic metabolic pathways

August 29, 2018

I am a physician myself, a CrossFitter, and a low carb (for 10 years) turned 90% nutritional ketosis eater. Could you please explore the topic of athletic performance while in nutritional ketosis in the two anaerobic metabolic patheways: phosphogen, glycolytic? With the emphasis on the claims of many that, while it may be better for…

What are the most important lab tests, that people with higher risk of CVD should routinely do?

August 29, 2018

Prescription Meds

August 29, 2018

So why do you take Metformin, Atorvastatin, and Ezetimibe?

Have you researched or experienced patients with reactions to the HPV vaccine? Could it be mitochondrial concern when healthy young women suddenly have extreme neuromuscular fatigue and impaired immune system following the vaccine?

August 29, 2018

Thanks!

Diet after cholecystectomy: do you have any experience with or wisdom for those whose can no longer rely on a gall bladder to regulate bile in the digestive tract.

August 29, 2018

I had my gallbladder removed in my late teens because of hereditary hemolytic anemia. At the time, my doctor prudently gave me no dietary advice beyond: “you’ll learn to adjust.” For this I am glad, because the advise I hear others getting would have been worse. After struggling to maintain weight through college, and finally…

The Free Radical Theory of aging seems to be in tatters given recent studies indicating that the principle of hormesis applies to oxidative damage, wherein such “stress” evokes the body’s own antioxidant response. Trying to mitigagte ROS via antioxidant supplementation, the studies indicate, will eventually negate the body’s capacity to respond to ROS. Your thoughts?

August 29, 2018

I wrote about this here: https://www.garmaonhealth.com/free-radical-theory-of-aging-is-dead/

What do you do, or tell your patients to do, in case of a cold?

August 29, 2018

how can mitochondrial genesis be maximized/optimized via exercise?

August 29, 2018

What modality, volume, frequency?

I saw that you take Lipitor and Zetia. When do you think a cholesterol lowering drug is absolutely necessary?

August 29, 2018

My BF has been told by his GP that he should start taking a statin. But after listening to Dr Diamond’s interview on STEM Talks, Dr Tommy Woods analysis of the Liberty Mutual statistics on NBT podcast and several other researchers on the topic, it seems like they may do more harm than good. My…

How to use plant sterol testing in risk stratification of CAD risk

August 29, 2018

I enjoy you work Peter. It is very pertinent to my new practice. I am an ER physician by training who’s purpose has taken a different path from physician leader in sick care to preventive and optimization medicine of a few clients with an enlarging on line tribe. I am on my journey from Dr…

Are lifting and eating to “gain mass” and eating in a manner to prolong longevity and health span mutually exclusive? I feel like this is a dilemma for many of your listeners. Should I feel guilty about my almond milk protein shakes and large but still unprocessed “healthy” meals? Thank you!

August 29, 2018

What supplements do you take? Are you on Rapamycin and, if so, what is your dose?

August 29, 2018

Why do some people struggle to get ketone values into ‘therapeutic range’?

August 29, 2018

I have always struggled to get to ketone values over 1.0 regardless of fast length (days) despite losing 35 lbs and 12% body fat (by dexa). I recently took HMVN ketones and found my ketones only to get to 1.3 mmol. The Virta study showed average ketosis values below 1.0. Any ideas on the mechanism?…

Labs

August 29, 2018

Which do you prefer for lipids NMR or Quest Cardio IQ? Thanks

Wouldn’t the increase in Tryglycerides you noted during your NothingBurger experiment be attributable to the bodies attempt to. Fuel muscle with Tryglycerides and spare sugars via Cori Cycle.

August 29, 2018

My apologies if my question is poorly thought through.

What heart risks are cumulative and which ones point to the same thing. Many lipid measurements have an associated risk as do various ratios. When do they point to separate mechanisms and when are they overlapping. Are there times when values cancel each other out. For instance your LDL-P is elevated, while your small LDL-P is less than 200. Does the “good” small LDL number negate the “bad” overall LDL number. How do you combine these values to get an overall risk.

August 29, 2018

I have tried to evaluate my risk

re CFS, I am still trying to understand if autophogy and forms of intermitent fasting are beneficial if adrenals are functionig at low readings? IE low cortisol in the mornings. When I attepmt keto diet for 2 days I experience heart palpatations and anxiety before sleep – struggle entering deep sleep quite often

August 29, 2018

Why does Peter believe that keeping insulin low is so important for even healthy non-obese individuals? The insulin hypotheses is pretty much debunked.

August 29, 2018

To piggy back off another question related to your career – if you were 20 and in college starting again what would you do the same and what would you do differently? How do you see artificial intelligence/technology playing a role in healthcare in the next 20-30 years? Do you think we could make a bigger impact on healthcare by going into computing/starting a business vs. becoming MDs?

August 29, 2018

What would you recommend as a life style to reduce the delta between life expectancy of 72 years vs life disease free years of 63.3 years

August 29, 2018

Hi Peter, Thank you for your work and sharing your information on health. Very valuable. WHO reports that the global life expediency in 2016 is 72.0 years, but the live disease free span is only 63.3 years. This means that the last 9 years of life is of poor quality of life. I am 53…

Would you consider an AMA running through typical blood tests, what they measure and why it’s important? Like, for an average person to understand.

August 29, 2018

I listened to AMA and understood more about BUN and the thyroid panel just by hearing Peter’s results. That was very helpful. Many doctors don’t “simplify” enough for you to really understand your own blood work and more importantly the things one can do (typically) to shift / improve them.

RE: MCT oil supplementation—if MCT is prioritized over all other macros as energy source, does it delay/prevent the utilization of carbs for energy thus raising BG.

August 29, 2018

Looking forward to your response as I have not come across any relevant discussion. Thank you.

Would love your thoughts on exercise induced autophagy, especially for endurance/ultra-endurance athletes. Does endurance exercise replicate fasting effects to encourage autophagy?

August 29, 2018

Thoughts on carnivore diet, both short and long term? Are you concerned with EMF and 5G? What would be your concussion protocol? What would you do if your child suffered a concussion? Sideline treatment?

August 29, 2018

Any chance you would interview Dr Jack Kruse? What are your thoughts on his approach to health and wellness?

Regarding your exercise regimen, you’ve said that you typically use a cycling trainer (Wahoo Kickr, Peloton) and only rarely cycle outdoors on the roads. Is this due to time/convenience, safety concerns (avoiding injury also rightly seems to be a priority for your physical exercise regimen), or something else?

August 29, 2018

What happened to NUSI?

August 29, 2018

Would you be willing to share your keto FMD protocol that Kevin Rose has talked about with Tim Ferriss?

August 29, 2018

What are the benefits of Metformin or berberine in non diabetics?

August 29, 2018

What advice would you give otherwise healthy people who are looking for more energy and already take care of the basics (sleep 8 hours, exercise, try to avoid added sugar).

August 29, 2018

How do I know if going to med school is for me?

August 29, 2018

Do you see any benefit to molecular hydrogen or is it just another fad?

August 29, 2018

Also, curious if you’re open to student shadows at this time at your NYC office, thanks!

What are your thoughts about effectiveness of slow lifting for health benefits?

August 29, 2018

Diagnostic criteria and treatment recommendations for hypothyroidism and hormone replacement therapy

August 29, 2018

If one were to hypothetically take rapamycin for longevity benefits, how should the determine dosage, frequency and cycling? What should they expect from it in terms of benefits and side effects, and are there blood labs or anything else they should be keeping track of? Would metformin’s benefit be nominal by comparison?

August 29, 2018

Your thoughts on BHRT for women ages 45+

August 29, 2018

Could you please explain your use of Atorvastatin M/W/F and Ezetimibe Tu/Thu/Sa (as mentioned in your AMA #2)? Is this strictly for additional preventative reasons or did lifestyle interventions not adequately address certain lipid markers? Thank you!

August 29, 2018

Do you consider bio-identical hormone replacement therapy to be safe for post menopausal women and if so, for how long?

August 29, 2018

How do you interpret iron panels and how do the different markers relate to each other? (ie: TIBC, iron sat, ferritin, iron) What is your ferritin cut off for concern?

August 29, 2018

I am a clinician and run CRP with all labs. I don’t often see it elevated in instances where I would expect it to be. What’s going on this case? Are they truly not very inflamed or is there something else going on?

August 29, 2018

The reference for the lab available to me in Canada is <2.9 is the low end of measurable. I don’t often see it about this reference range. (ie: above <2.9)

What are your thoughts on sugar alcohols? Are they a better way to satisfy cravings than artificial sweeteners?

August 29, 2018

What can be done to combat brain fog?

August 29, 2018

I’m often plagued by a feeling of heavy-headedness, where my brain feels like it’s operating at a low wattage. When I’m feeling this way, I’m unmotivated and my thought processes feel slow and clouded. The image that comes to mind is that of my head being filled with molasses instead of gray matter. I’m curious…

What does the research show in regards to HGH, IGF-1 and longevity, especially in the post-30 year old demographic? As an extension, how solid is the research, efficacy, and likely safety of HGH peotides, like ipamorelin?

August 29, 2018

I have Addison’s disease. Inflammation is a constant concern. Longevity is also a concern. Does inflammation play a major role in longevity? BTW, I’m 52 years old, 5’6”, weigh 118lbs, and ride my bicycle 5000 miles a year. Jackie

August 29, 2018

Can metformin help regulate BG for Type 1 diabetics? If so, under what circumstances? And can a “healthy” type 1 diabetic benefit from metformin?

August 29, 2018

Over the past few years, my A1C has been between 6.2-6.8. Current goal is to break 6.0. Any other suggestions you may have would also be appreciated!

Hey Peter… The Netflix documentary “explained” just released an episode about longevity. Have you seen it? If so what did you think? What did they get right and what did they leave out?

August 29, 2018

Hi Peter I’m a huge fan of your podcast. I have been wondering if the healthiest diet is as low carb diet why is it that for the most part the healthiest people in the World with longest health span have a diet which includes Carbohydrates ur Okinawans? Thanks Steve

August 29, 2018

What panel tests/Dx do you run on your first-time patients who are healthy, non-overweight, asymptomatic, middle-aged makes concerned about cardiovascular/metabolic health?

August 29, 2018

Is it recommendable and also is it beneficial for a person having familial hypercholesterolemia and fibromyalgia, to take Exogenous ketones? Thank you

August 29, 2018

Does being in ketosis affect the the effectiveness of blood thinners such as Warfarin?

August 29, 2018

What nutrients promote blood vessel selfhealing afyer injuries?

August 29, 2018

I’ve been experimenting with an oral CBD tinture, which jupst became legal in my state, and have noticed a significantly positive impact on my sleep. It also seems to reduce my inflammation after a more strenuous workout. Is this something that you have experimented with? Any thoughts on using it as a tool for controlling inflammation and improving sleep?

August 29, 2018

What are your thoughts on stem cell therapy for treating not only knees, but actual disease states?

August 29, 2018

I am particularly curious if it is worth having stem cell therapy (adipose tissue, bone marrow or amniotic fluid) on my knees which are damaged pretty much since my mid 20s (I’m a 57 year old female), probably due to chronic inflammation issues and too much low fat/chronic cardio nonsense in my past. My second…

if you were to start a medical school, what is one course that you would add that isn’t really conventional in most med school programs?

August 29, 2018

Are there any adverse effects in using melatonin mostly everyday?

August 29, 2018

What food allows you to absorb calcium?

August 29, 2018

Perhaps this question is not as “hot” as many others that you might received, but I have osteoporosis and no treatment is working so far. I’ve tried Forteo and almost a year ago I began with semestral injections. The latter is not working either and I’m deeply concerned. Perhaps you can guide me to the…

Can Peter describe his TRF protocol, how many hours of eating, composition of a typical meal, benefits of TRF, etc.

August 29, 2018

How do I find/select a primary care physician who cares about my overall health and who will help me without just prescribing pills to “fix” things? All doctors I’ve been to for many years just want to prescribe meds and stick to the same outdated information regarding diet and medication.

August 29, 2018

how / where do i get to give thumbs up or down on an AMA question. I’m logged in, and cant find anyway to “vote”

August 29, 2018

You mentioned that you experienced some of the best sleep you’ve ever had while you were on your water fast. Keven Rose, however, who I believe is one of your patients, stated on Tim Ferris’s podcast #333 (the Random Show), that he had a difficult time sleeping when water fasting, due to rapid heartbeat. How would you explain the discrepancy in sleep quality between the two of you, and is there any way to mitigate rapid heartbeat / trouble sleeping on a water fast?

August 29, 2018

I am a perimenopausal woman, and would really love for you to do the HRT episode you have alluded to. It would be so beneficial for me and for the rest of your female audience. We may be in the minority of your listenership, but knowledge about menopause and HRT is critical for both genders….

Are you supplementing with berberine as well as metformin?

August 29, 2018

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