#202 – Peter on nutrition, disease prevention, sleep, and more — looking back on the last 100 episodes

I really think that in 10 years we're going to basically be using designer-based immunotherapies to eradicate most solid organ metastatic cancers.” —Peter Attia

Read Time 37 minutes

In this second edition of the “Strong Convictions, Loosely Held” episode, Peter discusses topics on which his thoughts have evolved as a result of his interviews with podcast guests and other information he’s gained since episode 100. Peter covers topics including cancer therapy and screening, as well as prevention strategies for cardiovascular disease and Alzheimer’s disease. He also describes changes in his perspectives on time-restricted feeding and protein consumption and on the therapeutic use of psychedelics, and he discusses some sleep supplements with remarkable efficacy. He ends with a special discussion on all things Formula 1 racing.


We discuss:

  • The concept of “strong convictions, loosely held” [3:10];
  • Update on Peter’s upcoming book [8:30];
  • Cancer: the promise of immunotherapy [14:15];
  • Cancer: how aggressive screening for gastrointestinal cancers could save lives [24:30];
  • Cardiovascular disease: how early and aggressive lowering of apoB could change the course of ASCVD [31:30];
  • Alzheimer’s disease: genes that modify risk associated with the APOE4 variant [40:15];
  • Time-restricted feeding: where the benefit comes from, and when this practice can be problematic [44:00];
  • The common problem of protein underconsumption [51:45];
  • The tremendous impact of exercise on lifespan and healthspan [54:45];
  • Peter’s shoulder surgery [1:00:15];
  • An uninspiring viewpoint on NAD precursors as a longevity tool [1:06:15];
  • Psychedelics: a powerful therapeutic tool in the right setting [1:09:30];
  • Sleep: updated thoughts on blue light and a remarkable drug for aiding sleep quality [1:13:15];
  • Book recommendation from Peter [1:20:45];
  • Formula 1: the 5 variables that determine the winner [1:22:00];
  • F1: the drivers [1:26:00];
  • F1: the tires [1:27:30];
  • F1: the engine and chassis [1:32:00];
  • F1: rule changes around cars [1:34:15];
  • F1: importance of qualifying races [1:41:15];
  • F1: racing strategy [1:47:30];
  • F1: season outlook and predictions [1:51:00]; and
  • More.


The concept of “strong convictions, loosely held” [3:10]

Previous “strong convictions, loosely held” episode: #103 – Looking back on the first 99 episodes: Strong Convictions, Loosely Held


Explaining the phrase “strong convictions loosely held”

  • Peter is unsure where this phrase came from originally
  • However, Peter first heard it from his friend, John Griffin, who used to run a very successful hedge fund
    • When talking about his investment philosophy, John says that you have to invest based on strong convictions, but they need to be loosely held, and so you have to constantly update your assumptions with new information
    • if you’re more interested in staying with a position as opposed to evolving your position, you’re probably not going to be a very good investor
  • This can be related to our understanding of science and medicine
    • Unfortunately, it’s probably our default setting to dig our heels in on a position
  • Ironically, in politics especially, it’s viewed as a sign of weakness or being wishy-washy when you change your mind
  • For this very reason, Peter has consternation about his upcoming book release which he started writing in 2016 — “I can promise you that there are things that I’m going to have changed my mind on that will be in print.”
    • In contrast, this is why he loves podcasts so much because you can do exactly what we are doing right now which is being able to consolidate all the changes in how he thinks about stuff


Update on Peter’s upcoming book [8:30]

  • The draft was insanely long, but it’s in the process of being cut down
  • The manuscript was close to 200,000 words, but the hope is to get it down to about 120,000 words
  • Peter’s coauthor is Bill Gifford and they are relentlessly pushing each other to figure out how this can be said in fewer words
  • This is the perfect example of “killing your babies”
    • Peter was giving great advice in medical school when writing his first scientific paper
    • “I put so much work into it, and I had all of these figures and all of these tables”
    • One of the guys he was working with in the lab said, “Look, you got to learn to kill your babies. You’re going to do 20 experiments that are not going to make their way into the paper, and that’s going to feel awkward. It’s going to feel like, ‘No, no, I need to show you, as the reader of this paper, everything I’ve done and every experiment and every iteration.”
  • Similarly, with a book, there’s a part of Peter that wants the reader to see how much work has gone into this but, of course, that doesn’t make for a good book
    • So, there’s lots of baby killing going on now. I hope that that will make it better.”
  • The last big stress is over the audiobook version — he’s currently looking for a good reader for the book as Peter doesn’t want to be the voice for the book for various reasons


Cancer: the promise of immunotherapy [14:15]

Peter says there are three disease topics where his thinking today is either more clear or different than it was before: 

  • i) cancer 
  • ii) atherosclerotic cardiovascular disease (ASCVD), and 
  • iii) Alzheimer’s disease

Cancer: the promise of immunotherapy

{end of show notes preview}

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  1. Hopefully in an upcoming podcast you will explain further why you have changed your mind on time-restricted eating. Even Dom D’Agostino in AMA #116 does it occasionally. I tried it while tracking my calories daily like I’ve done for years. (I use MyPlate calorie counter app). I made sure my total calories didn’t drop. At the same time I also reduced my carbs from around 130 grams to 50-70, so not really ketogenic. I eat a lot of almonds now. I lost 4 lbs quickly and it has stayed off. I don’t feel that I lost muscle because I work out, 6’,170. Don’t want to lose any more , so I have breakfast occasionally. My goal was really to become more insulin sensitive in an effort to do all I can to keep my heart healthy. My doctor won’t do an insulin test, but my fasting glucose dropped from 99 to 90.

    • I think what he’s saying is that the majority of the benefit from TR eating is from the caloric restriction and not so much from the “fasting.” There’s nothing bad about it but I think people make it more glamorous than it really is. If it works for you then it works for you. Keep doing it. But Peter’s point (I believe) is that its not doing anything special aside from reducing calories (which has benefits for weight loss if you are in a caloric deficit). If by using TRF you are decreasing your protein consumption and losing lean muscle, then I’d say its doing more harm than good. Even if your number on the scale is staying the same.

      • In my case, I didn’t reduce total calories, nor did I reduce protein. I track everything. I just ate more fat (while trying to watch saturated fat) and reduced carbs like I said. Could be my kidneys shedding excess sodium, from my insulin going down (from what I’ve read). So, probably the main effect was the carb reduction.

      • My calorie intake was the same. I kept the protein the same also. I track accurately daily. Just increased fat (while being mindful of too much saturated fat). Most likely my reduction in weight was from lowering carbs, meaning with lowered insulin the kidneys offloaded some excess sodium (from what I’ve read elsewhere).

  2. Peter, as a family physician, I wish I had 10% of your knowledge. I wait in great anticipation for your book.

  3. Happy to hear you are bringing Layne Norton back. The last time you two were together I was left with a lot of unanswered questions. I am 64, I have competed in karate internationally in -70kg and I was able to move into -75kg without any issues simply by exercising and drinking carbs. Today I have difficulties keeping my 69kg. If I drink carbs post workout they go into my belly muscle. I seem to be able to keep my weight with 25 gr of protein post work and with BCAAs but muscle doesn’t go up even when I use creatine. I am now on my third week implementing rutin. I am wondering about testosterone, and that is where you and Layne come in. Protein synthesis is a major issue at this age. If you have not covered this with down to hearth solutions I would appreciate that you consider this subject on your future AMA.
    I would love to live to 100 but only if my legs can power me up the stairs several floors.
    Thank u for all your great work
    PS:enjoy short sparring clip

  4. Can someone please point me to the study which shows the HR’s for the different percentiles listed for ApoB? The link refers to the Framingham website but I have a hard time finding the data there.

    What I’m really interested in is how much the risk for ASCVD would be reduced going from, say, the 20th percentile to the 5th percentile.

  5. I enjoy both the content and the speaker of this podcast. I am not a great consumer of audio books, but I would enjoy the aforementioned book spoken by you.

  6. If the goal of this podcast was to leave me wanting more, it served its purpose. I am really excited about the Layne Norton podcast and it sounds like he has changed your thinking in a number of ways. I want you two to have it out on fructose. I argued that, at minimum, fructose crowds out better micronutrients and he told me to f off. I think you will have better luck.

    On protein… I have always consumed an inordinate amount of protein. Protein activates MTOR as does strength training. My cousin was on rapamycin, but cycled off of it to add lean body mass. There is a real balancing act here, and it sounds like you are tilted to muscle hypertrophy right now. How does one balance these out long term? David Sinclair tries to minimize protein consumption as an example. I get the feeling there are not a lot of studies on this.

    Also, in a podcast long ago, you asked where the body count was from anabolic steroid use. Body builder Cedric McMillan, 44 died today. Also dead this year: pro-card holders George Peterson and Shawn Rhoden. It sure seems like there is a real danger from anabolic abuse in this (admittedly extreme) sport. They are doing something different than what a basketball or football player is, so I am guessing the dose makes the poison.

    • I like the targeted intermittent fasting protocol from Siim Land detailed in his book ‘Metabolic Autophagy’. Basically drinking a protein shake during workout as first food and later one big meal with sufficient protein.

  7. Can you expand upon using Mefenamic acid for ASCVD prevention in hyper synthesizers?

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