April 20, 2013

Mental models

TEDMED 2013…now I get it

Read Time 7 minutes

I just got back from the 2013 TEDMED conference at the Kennedy Center in Washington, DC.  I’ve always enjoyed watching TED talks online, but I’d never been to the actual conference.  I was told the experience is very different.  That was an understatement.  I don’t even know where to begin.  I don’t think anything I can write about this week will come close to actually sharing my experience, but I’ll try.

I was one of 50 speakers/performers, but the conference is about much more than the 50 of us.  There are nearly 2,000 participants and unlike most conferences where people are spread out over different sessions and ‘breakout rooms’ (a term that, to this day, makes me laugh out loud – I keep picturing a room with broken down cardboard boxes on the floor and nylon pants and 80’s hip hop), at this conference we all experience it together.  No parallel processing.  That it also takes place in such an epic building, overlooking the Potomac River, is another story.

To answer the first question you may have, I do not know when my talk will be on line, let alone where.  It could show up on the TED and/or TEDMED websites.  I’m told it will be no sooner than 6-8 weeks, and probably closer to 3 months.

This was not a typical Peter Attia talk. Information density was somewhere between zero and small. When I was preparing for the talk I had the complete privilege of working with the TEDMED editorial team.  Talk about an All-Star team.  These people are too talented for words.  It was simply amazing to be in their presence.  Jay Walker, the curator of TEDMED (and one of the most intuitive people I have ever met) gave me the most valuable advice when I was preparing my talk.  He said,

  1. Leave your “M.D.” and “McKinsey” personas off the stage.  While those are your comfort zones, get out of those zones.
  2. Don’t try to “teach” people a bunch of facts (even though you love facts); don’t try to “prove” how smart you are; don’t even try to “convince” people of anything.
  3. Engage both sides of your listener – their intellect and their emotion.
  4. Be authentic. The audience cares less about what you know, and more that you care at all.

This was really hard for me!  I love to teach, and I love data, and I’m much better at engaging intellect than emotion.  But with that advice, and the amazing help of Marcus Webb (TEDMED’s Chief Storyteller), I gave it a shot.  In a few months, I suppose, you can be the judge.

There were so many moments this week that just shot me back onto my heels – moments when it didn’t seem like “this” could be happening.  I’d love to share a few with you.

Meeting the man who gave my favorite TED talk of all time

Before you read another word, watch the 2011 TED talk given by Ric Elias.  Seriously. STOP READING THIS NOW AND WATCH IT.  I have watched this talk, perhaps, as many times as I’ve watched all other talks combined. Probably every 3 or 4 weeks, actually.  Why? Because, unfortunately, that appears to be the frequency with which I need a little reminder of what matters more than NuSI. A few months ago I mentioned this to Jay.  He said, “Do you want to meet Ric? I’m happy to introduce you.”  That was like asking a 15-year-old girl if she wanted to meet Justin Bieber.  Except I didn’t scream as loud. And Ric is way cooler than Justin.

The day after my talk, I was introduced to Ric and we spent about an hour together. It was a unique experience to understate it.  Too often when we meet people we “feel” like we know (due to their celebrity), we’re often let down because we build them up to be more than they could ever be.  Amazingly, and I don’t say this lightly, the person Ric is far exceeded the image of Ric I had, based on a 5 minute video.  He’s one of the rare few I’ve met (one day I’d like to write a book about this short list of folks) that I could imagine dropping everything I was doing to go and work with and for them.  Every man should aspire to be half the father Ric has become since that flight.

Medical school connection

The day before my talk, I was backstage trying to figure out where everything was, and I looked up and saw Zubin Damania!  You may not know who Zubin is, or even his YouTube alter-ego, ZDoggMD (though you’ll definitely want to check out his video on screening for testicular cancer, among many others).  But here’s the thing…the last time I saw Zubin was 13 years ago when he was my intern on my internal medicine rotation at Stanford.  For 8 straight weeks Zubin had me rolling on the floor laughing (and enjoying every single moment of being in the hospital with him).  Zubin is sui generis.  I remember staying up nights on call with him, asking him, “Are you sure this [medicine] is the best use of your talent?  I mean, you’re too damn funny and talented to do this!”

Well, let’s just say, nothing I saw this week surprised me.  Zubin is a rock star and the world is a better place because of his humor and brilliance, and the way he actually combines them. Zubin’s talk was, without question, the peak of TEDMED 2013 entertainment.

If that wasn’t enough, two days later (the day after my talk), a woman stopped me in the lobby and said, “Peter, I really loved your talk.  Thank you for sharing that story.  I hope other doctors hear this message.” I thanked her and we chatted for a minute, the whole time I’m thinking, “Gee she looks really familiar…,” when it finally hit me.  This woman, Dr. Ramona Doyle, an amazing pulmonologist, taught me respiratory physiology 16 years earlier at Stanford!  What made this so special, though, was hearing what she does today.  In addition to her “day job,” she runs a free clinic for uninsured patients in South San Francisco.  Her stories were amazing.  She seemed happier than ever.

The most moving talk

The last talk of Session 7 (there were 10 sessions, each with 5 speakers, for a total of 50 speakers/performers), was given by author Andrew Solomon.  Since you’ll all be able to watch this for yourselves in 2 months or so, I won’t say much. But, if you think back to Jay’s advice to me, Andrew gave a seminar on how to do this.  Andrew is a very special man, and though I was only able to speak with him for 10 minutes backstage, it was clear that he was cut from a different cloth.  A very special cloth.  When his talk began, I thought I knew where he was going.  And I was looking forward to it.  But where he went instead, well, I can’t describe the emotional rollercoaster.  If you can only watch one talk, and I hope you can watch many more, Andrew’s is the one to watch.

Greatest human spectacle

Charity Tillemann-Dick, a remarkable singer, who has undergone a double lung transplant due to primary pulmonary hypertension, simply lit up the room with her soprano voice.  I just could not imagine for the life of me how this woman could sing with such a beautiful voice not powered by her ‘native’ lungs.  In Charity’s case, there was also a deeply personal reason I was so touched by her story.  It highlights the importance of organ transplantation. As she shared with us, life is neither a marathon, nor a sprint.  It’s a relay.

After her talk (and song), I caught up with her back stage and shared the story of my friends, Jeff and Teena Webster, who lost their son Aaron in September 2009, one day before I swam from Los Angeles to Catalina Island – a swim I dedicated to Aaron.  Aaron’s story is both tragic and glorious, as 13 people now live with a part of Aaron in them, including a man who was probably a week away from death due to liver failure.  Today, that man has a tattoo on his arm that reads: Aaron Webster, my hero. 

Best line of the week

Spoken by a juggernaut of a woman, the amazing America Bracho, who is empowering impoverished communities in Southern California by creating participants out of patients, left an impression on me.  Sounds crazy until you hear her tell you and then watch her show you. Make sure you watch her talk when it’s out.  Like Andrew’s talk, this moved me to tears.

She was asked, essentially, can this model she has deployed work with anyone?  She said, “no, you must choose the right people.”  The clincher: “Recruit the heart. Train the brain.”  As someone obsessed with building a great team, truer words have not been spoken.

Most surreal moment

A team of artists created portraits of each speaker, which hung as banners.  A man named Robert Brinkerhoff, who I had never met until my talk, created the following image of me.  I realize this may sound strange, but this struck me as very touching.  Someone who didn’t know me put that much time into trying to represent me?  Very humbling.  Thank you, Robert.


Closing thoughts

I don’t know if they will ever read this, but if they do, I really want to thank the following people at TEDMED for guiding and encouraging me to share my story, which I was very reluctant to do.  There are so many people behind the scenes whose names I don’t know, but who I owe my gratitude.  I really want to thank Jay Walker, John Benditt (and Gary Taubes, who suggested me as a speaker to John), Lisa Shufro, Lindsay (none-of-my-boys-are-named-Harry) Potter, Pritpal S. Tamber, Jon (the-apple-doesn’t-fall-far-from-the-tree) Ellenthal, Alyssa Picchini Schaeffer, and Marcus Webb, without whom I could not have told my story.  And, Steve Maler.  You gave me the confidence I needed to be so vulnerable, my friend.

I have no idea how I got to be one of the people there this year.  I felt such a responsibility to give back to TEDMED, as I’ve received so much from TED and TEDMED over the past 7 or 8 years.  Though Ric Elias’ talk is my favorite, there is a huge tie for second place (including Virginia Breen, who I just happened to sit beside by random luck during Andrew’s epic talk – once you’ve seen Virginia’s talk and Andrew’s talk, you’ll understand why this juxtaposition was so powerful).  The talks I fall in love with are simply the ones that move me the most.  I spend my whole day learning things.  What I crave is inspiration.

A day after my talk, a woman came up to me in the common area.  She was crying. Just sobbing.  She said she cried through my entire talk.  She couldn’t figure out why.  What was I saying to bring out such emotion, I thought? I apologized. But then she said the most insightful thing that, I think, explains why some of these talks just really move us.  She said, “Peter, it wasn’t what you said, or even how you said it.  You just made me look at myself differently.  These emotions pouring out of me are about me, not you.  You just gave me a different way to think about myself.”

I think that sums up why these talks are so special to me.  It’s about the mirror inside me and everyone else.  I did learn many things this week and met people I want to know better. But for 3 glorious days on the Potomac, I didn’t think about my world or my vision.  I simply got inspired and moved by everyone else’s.

Photo by Mike Wilson on Unsplash

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  1. They claim to use organic ingredients, and the product derives all vitamins from whole foods rather than synthetically producing them, also some C-C bonding which increases absorption. Amazon.com is full of hundreds of rave 5* star reviews, giving the impression of a miracle product with some genuine claims behind it. Some comments even claim a professional in some medical field had suggested it to them.

    However, if you were to suggest backing away from such a product, what advice would you offer on supplement taking in respects to trusting the quality of a product and what supps to consider taking?


  2. OK, apologies if this is boring, but I’m very hesitant about putting any supplements in my body before trusting the brand/quality.

    I read your ‘What I Eat’ posts, and see you’ve made reference to your daily supplementation plan alongside the brands you use. I’m going to follow your advice here and follow this same plan, though being from the UK it’s difficult to obtain some of the listed brands. The ‘NOW’ brand seems to have made it across the pond, so I’m presuming if you promote some of their products I’d imagine their Magnessium Oxide tablets will be of equal quality.

    However, what else I’d like to enquire about is that as a ‘dry-land’ resistance trainer approx. 5 times a week and a recreational runner/swimmer on the weekends, is their other more specific products you would advise to assist me? Obviously whey protein is a cornerstone supplement to any athlete, and I saw in one of your posts a mention to L-glutamine – well which I’ve never used.

    A general supplement plan to assist my exercise routine would be very much appreciated.

  3. Well, it just so happens I am a medical student and was in attendance at TedMed. Your talk was beyond inspiring to me. Just as you experienced the “effect” of TedMed, you were also the “cause.” Considering your talk, I think that’s pretty interesting to think about 🙂

    As a medical student, I’m finding that such prejudices with patients start early. I often feel like we are trained to be narrow-minded in focus, but it’s our job to keep questioning what we have learned as “given.” You can be confident in knowing, that sharing your story has saved at least one medical student from making a similar mistake, so I thank you for giving me the foresight to be a better doctor and human.

    I’ve shared your talk with as many people as possible; from colleagues, to faculty, to my family (of which Diabetes is prevalent.) In fact, my mom just replied saying, “AMAZING HUMAN FOR BEING SO COMPASSIONATE AND HONEST NOT TO MENTION HIS QUESTIONING CONVENTIONAL WISDOM.” (She’s very fond of capital letters.)

    And she’s right! Your talk was even more powerful because you delivered it humbly, with grace, and courage. Thank you again!!

    • Jodi, thanks so much for letting me know this. I’m still reeling in the aftermath of that talk and wondering if being so open was the right thing to do. A note like this makes it seem much more likely that, despite the discomfort, it will be (and has been) worth it. Best of luck in your journey.

  4. Peter: I am brand new here – found my way after watching your moving and thought-provoking presentation at TEDMED last week (I was not there – I found it on the internet). By way of background I have stage IV (metastatic) renal cell carcinoma (mRCC).

    I have not yet had the time to explore your website so please forgive me if this has been covered before or if this is the wrong place to post the following. Yesterday the following press release went out: “Mayo Clinic Finds Experimental Drug Inhibits Growth in All Stages of Common Kidney Cancer” (http://www.mayoclinic.org/news2013-jax/7446.html?rss-feedid=5 ). Actual study is here: “Stearoyl-CoA Desaturase 1 is a Novel Molecular Therapeutic Target for Clear Cell Renal Cell Carcinoma” (http://clincancerres.aacrjournals.org/content/early/2013/04/22/1078-0432.CCR-12-3249.abstract). Why I bring this up is due to this NIH presentation here: “Role of Stearoyl-CoA Desaturase-1 in Metabolism: Implication in Human Diseases” (http://www.youtube.com/watch?v=CmWJ9ZmZv3E). I know you are very busy but I wonder if at some point you would comment on the practical dietary implications of what this all might mean. Thank you so much for what the NuSI is attempting to accomplish on behalf of all of us.

    • Neil, though I trained in oncology, I have been out of the field for several years and am not up to speed on latest advances in RCC, so I really would offer little insight into the efficacy of this treatment. Have you look for experimental protocols at NCI? When last I was there, Dr. James Yang was actively working on RCC from and immune-based approach.

  5. Very interesting Tedtalk….i just found this blog, i like the articles i have read so far, looking forward to reading more….

  6. Peter,
    Congratulations on your journey, your results, your blog and now your growing recognition and reputation. I take my hat off to your many responses after every post! People are starting to starting to listen.

    I’ve been a convert to low carb ever since I read NHI by Rob Fagan in my teens (probably the only one in Scotland at that time). If only I practice what I preach because I’ve been on a carb/no-carb rollercoaster ever since, hovering between two equilibriums. As you’ve said previously, it’s easy to go from 1 treat to 2 then 3 ad infinitum! I have a couple of questions if you don’t mind? One is meal frequency as there is often the debate that small and often is good to continually increase metabolism regardless of metabolic state, do you have a view? Also, with respect to nuts, particularly mixed salted nuts that have net fibre and sodium – would you still recommend consumption in moderation? Being a Brit, I do like some nuts and a cup of tea often during work when Im low-carbing (I can often be at my desk for 8-12 hrs so that a lot of tea and a lot of nuts). Finally, being a bit of a data geek too, what would you recommend that I monitor and the frequency. I’m just of the view that if many practitioners took the same approach from the bottom up and were consistent (perhaps a shareable Google docs file?) it would help change the perception in the scientific community.

    Anyway, keep up the good work

    • The meal frequency issue is, to my mind, not really settled yet, and I’ve experimented a lot, including one meal per day. It may come down to (for me it does) balancing performance metrics. Monitoring questing is too complex and depends on too many variables.

  7. Peter. Many thanks for your response and your suggestion. However, dealing with my situation was not why I brought this up. My point is that the approach that the Mayo Clinic researchers are espousing is to use a new drug to interfere with basic cell metabolism. This drug is used to inhibit SCD1 – a key metabolic protein. “We found it to be incredibly specific to cancer cells … but it is also being investigated for its role in promoting obesity and diabetes.”

    In particular, if you then view the NIH presentation, it goes into detail about certain dietary influences on the expression of SCD1 in humans. In particular, and of direct pertinence to your present interests, a low carbohydrate diet will also inhibit SCD1 – in much the same manor as this experimental drug that the Mayo folks are touting in their PR.

  8. Hi Peter,
    I have been trying to adapt to LCHF lifestyle for at least 3 months now but am still dealing with sleepiness and fatigue during the day. I understand about the importance of salt and add it to my meals and mineral water, but looks like it is not enough to overcome the tiredness. I couldn’t find your comments on this issue apart from salt during the keto adaptation. Can you please suggest what else can be done, as you have mentioned in your interviews similar issues with adaptation? Thanks!

    • I’ve struggled with lchf also but did improve with eating a large amount of spinach each day, possibly potassium an issue? I also took a half teaspoon of epsom salts (magnesium) in a glass of water each day and this seemed to make a difference.

  9. Did I miss something, or is there no link anywhere to the whole of Peter’s talk at Tedmed?

  10. Hello Peter … I have been a lurker on your blog for some time. I have enjoyed immensely your writing style and was super excited to see that you were invited to TED (it’s an addiction!) – can’t wait to see your broadcast. TED is a dream of mine, not to speak (although it was be totally awesome) but just to sit in the audience would be a privilege beyond compare. Thanks so much for sharing your experience, and also, thanks for turning me on to ZDoggMD. I am amazed how the artist captured you in the painting. It’s scary close, wow. Thanks for all you do!

  11. I found Peter’s beautiful talk via this previous comment copied below for you. God bless you Peter, maryann

    Jed Batchelder April 25, 2013

    The presentations are still available on the livestream site. http://new.livestream.com/accounts/3320021/events/2005920
    Your presentation is in session 4 and starts at the 1:15:14 mark.
    I had the privilege of attending TEDMED this year and as a long time reader of your website, I was delighted to hear that you were going to be a presenter.

    Your presentation, and others at TEDMED illuminated the empathy that is already present in healthcare today, but is often trapped in the confines of our current, impersonal healthcare delivery model.
    Thank you!
    Jed Batchelder

  12. Dear Peter,
    this is the first time I have ever commented on a blog, ever. But I just feel the need to say “Thank you for sharing this!”
    Really touched me to realize that there are people out there who feel this way about TED and therefore maybe even about the human spirit in general. I have troubles phrasing this without making it sound cheesy, but I feel truely inspired – thank you so much for sharing your thoughts so honestly!
    I just subscribed 🙂

    Kind regards from Germany,

  13. Peter-

    I have been an avid reader and viewer of your work and have also enjoyed TED for some time. Your post tied the both together in an amazing way. I watched the Ric Elias talk first and was awed by it. After reading your post I watched your talk and was equally moved. I put down my ipad and went to say goodnight to my 15 year-old daughter. I mentioned Ric Elias’ talk only to find that she had watched it it school! I then explained how I found it and described in basic terms (the only way I can express this science!) what you were positing and trying to accomplish. In telling her about your talk I was visibly moved by it, as I explained not just your honesty and sincerity, but the passion you have and the courage to -as you say- bet your career on your beliefs.

    It occurred to me that I was doing what Ric implored us to do: to be the best parent I could be, which to me means guiding, teaching, and supporting my kids in their journey to hopefully being happy and fulfilled. Your post became a great vehicle for reinforcing the the vital messages I have tried to convey to my kids: Follow your passion and don’t be afraid to express it; believe in yourself and your ideals, even when the doubters come, and work hard for what you believe in; but don’t forget to be a good person- trustworthy, humble and willing to admit when you are wrong.

    You are setting a great example as you lead the way and I hope the multi-disciplinary cross-pollination of inspiring thinkers and leaders has an effect that is greater than the sum of its parts. Keep it up!



    • Jeff, your story is very moving and inspiring. Thank you so much for sharing this. Your daughter is very lucky. I will share this comment with Ric, who will be equally moved.

  14. Dear Peter,

    I watched the excerpt video a bit over a week ago, and it made me cry too. You have a very genuine and caring spirit. But I think what made me cry was the apology, from a doctor. In my mind you were my doctor. The one I went to see a bit over 8 years ago, I had lost 25 kg doing the low fat high cardio thing, when my weight lost stopped for months. I went to see my doctor for advice, for help… and he said the old calories in calories out, I must be eating to much. I was at this point still 120 kg, so still obese, and I saw him struggle to believe me when I tried to explain how little I was eating and how much I was exercising…actually I think his eyes glazed over and he stopped listening. I left the surgery in tears… and started eating again. Your apology meant the world to me…its not my fault!

    I found primal / paleo five years ago, but only really dabbled in it, as I needed a long time to get my head around the fact this is how I would now eat for the rest of my life. But I woke up a month ago and started the whole30, I’ve lost 10kg, but more than that I feel great, energetic and positive again. And most important I know I can live like this for keeps.

    Thank you for your great work and kind words.

    • Robyne, I can’t…really can’t…tell you how humbling this is. You deserve a doctor who will care for you the way your friends do. I hope you will find that soon.

  15. Peter,
    I watched your TEDMED lecture, I really enjoyed it.
    As you know I am from the other side of the pond and to be honest from my view we are lagging far behind you in the US.
    Its painful to see.
    I have felt this way for a long time now, I have worked as a junior doctor in the leading cardiology hospital in the country and to be honest I felt I had to leave. I could no longer stand by the advice I was forced to deliver, I could not stand to see younger and younger patients walk through the doors. In the course of 3 months we had 4 20-30 year old men with an MI, no genetic or underlying condition detected, just atherosclerosis.
    This to me is heart-breaking. The level of obesity and insulin resistance/type to diabetes is rocketing, the british diabetic associations guidelines are for lots of slow release (this is an oxymoron surely) carbs such as pasta, bread and rice throughout the day.

    I have given multiple talks now to local authorities, I planned on giving one to the Cardiologists at the Glenfield where I worked, but at the time I feared it would impact on my career. I no longer have those worries!

    I see the work you and Gary Taubes in particular are doing and I want to be part of it, in that I can only do so much on my own over here. I am changing 1 person at a time, my friends and family are now eating far healthier than they were before and enjoying life more.
    My cousin who is a type 2 diabetic, diagnosed at 28 (and very lean to go with it) is now reducing her insulin and is on the right path.
    Let me know what I can do to help, my email should be attached to this.


    • Let me noodle a bit, Tom. Maybe getting you plugged into progressive doctors and cardiologists (specifically) in the U.S. would be a good start? I know several.

  16. It might be only wishful thinking, a fool’s hope or whatever, but I want to believe in what I start to feel stronger everyday: that humankind is on the edge of a “healing” era, an era that is the “prophesied” change of spiritual tides of ancient knowledge and wisdom that took on many forms and shapes, oftentimes disbelieved, ridiculed, finger-pointed for not being rational, logical, scientific, etc. A reconciliation of humility and genuine science, body and spirit, etc. Time will tell …

  17. Peter,
    That sounds fantastic. Anyone I can talk to/help or gain help from is always a good step.
    I feel a little alone over here, frustrated at being able to see all that is going wrong and not only unable to do anything but being beaten down at the smallest suggestion that ‘conventional wisdom’ may be questionable.

    I hope you are right and I think you are. As we move out of this economic crisis (I don’t know how hard you have had it in the states, but we have had it pretty hard over here, especially for the poorer members of society) there is a sense that we cannot control these economic issues, but can we control our own lives in terms of happiness and health?
    People seem to be caring more about the elements of life they CAN control, which is fantastic to see.

    • One idea you may consider is forming a group for doctors and patients. The “forum” could serve at least 2 purposes — let like-minded doctors “chat” about these issues (e.g., share learnings, discuss patient cases) in a private forum for the docs; give patients a resource to identify participating doctors.

  18. You are obviously EXTREMELY busy but did you ever write a follow up to the fantastic comment in July on the Harvard (Ludwig et al) diet study (about cortisol & thyroid hormones?) I’ve scanned other posts but can’t see.

    Also, did you speak with him?????

  19. Thanks Peter I already learnt I was making few mistakes reading your blog and watching interviews to you (and Stephen Phinney).

    But I still have a question I wish you could answer, I love pasta and rice and pizza (I am italian), I always cooked it with raw ingredients; now for the past three weeks I shout them down completely and I am ok with it but I know I can’t go on forever like this because I just love the taste of it.

    Also, you often mention you still eat some rice and pasta, but how much and how often? 100g of pasta contains 40g of carbs, so if I eat 100g I should eat no more carbs in any form for the whole day. Right?

    Is there anything I can do to re-introduce some pasta, some rice, some pizza, at least once a week, at least in small quantities, at least with some limitations?

    Thanks in advance for your time!

    • This is only relevant if one is in ketosis. If not in ketosis, but doing a low carb diet, I think there is room for occasional rice and pasta. It’s more the sugars and highly refined grains one ought to remove. Personally, I don’t consume pasta and the only rice I eat is when it’s wrapping sushi. I always timing a sushi meal right after a glycogen-depleting workout with RQ above 0.85 for sustained periods of time. Amazingly, in such situations, blood glucose actually goes down after consuming rice.

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