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. Dear Peter

    I was so moved by your TED talk.

    From the point of view as a researcher I loved how you and research team has categorised the meta themes and most importantly you are not only asking the scientific/technical question of the relationship between food and metabolism, but what can be done safely and practically and HOW behaviour can be changed. It is so heartening to know that scientific research is being approached in this humane and empathetic way.

    What I was mostly moved about your talk Peter was by your conscious vulnerability. Your willingness to allow what happened to you to openly reflect on how you are as a doctor and a human being towards others, your openness and personal bravery to reveal it to others and your courage and determinism to do something about the insights you have had as a doctor, scientist and human being.

    I have shared your TED talk with many people.

    I would love to know how it has been for you, and other’s reactions, especially from your colleagues in the medical community been as you embarked on this journey of being so open about your insights in to yourself? I ask this because I too am on a journey to be more open and brave in my own life, in my own practice as a leadership coach and management consultant and I am researching ‘conscious vulnerability’ as part of my doctoral studies.

    Thank you for your vulnerability and your compassion to others. I hope you are as compassionate and loving towards yourself too as your progress on this journey.

    Sending you many blessings.

    • Very provocative questions you ask, Mihirini, and they show how insightful you are! It’s been a bit overwhelming, actually, but most of the feedback from my “peers” has been very positive. I may do a post about it at some time down the line, as I’ve been asked by a few folks close to me to do this. Thank you for all you’ve said and shared.

  2. Peter,
    Thanks for all you do.
    Your TED talk was outstanding as was Ric’s and Andrew Solomon’s.

  3. Peter – After hearing (and crying through) your TED Talk ,then revisiting your blog, I’ve started a folder of talks that I want to get “out there.” Yours is definitely at the top. There are no words left to thank you for allowing the world to experience your vulnerability – but thanks anyway (seems entirely inadequate). And thanks for the links to Ric and Zubin (when he says he has no talent, what I want to know is — what’s he smoking these days? sheeeesh!!). Brilliant, all of them.

    I feel a change coming in the world . . . .

  4. Hi Peter, Loved your TED talk but unlike the others, I am interested in the details. I am a follower of Gary Taubes, so I know how much you left out of your talk. By the response you are getting, it was probably the correct decision. One quick question, do you hope to be able to influence the 2015 Dietary Guidelines process which just got started?

    Oh, there was an odd comment left on the TED comments for your talk by a person who claims to be Diane Kress. She is claiming that you talk took material verbatim from her book. In case you did not get the word, here is a link to her TED profile page which links to the two comment she made.


    • I have not heard of Ms. Kress, nor have I have I read her book. I have not read any comments on the TED website, so first I’m hearing of this comment.

  5. Thank you so much for doing the work that you do. Very inspiring and your talk was moving.

    I also want to thank you for exposing me to other great minds through this post.

    Lastly, proud that you are a former Torontonian! (I’m currently living and studying here.)

    • Biniam, is this you!? My long lost friend? If so, I’m delighted you found me and honored to have inspired you. (p.s., if it’s you Biniam, I had lunch with Hamid yesterday…and all we talked about was credit risk modeling!).

  6. Moved and inspired by your Ted Talk, Finally a Dr, who doesn’t just deal with the end result but goes to the root of the issue. Thank you.

    I wanted to know what you thought of Spirulina dietary supplement and green juicing as i’m a diabetic and trying this now? They have classified me as having type 1.5 diabetes, LADA and I’m on insulin and had enough of the side effects of this horrible disease.

    • Thank you, Ash. I know a bit about spirulina, though I have not seen any compelling evidence to suggest it’s a “magic” food or uniquely special protein. I’ve also seen no compelling evidence for juicing, especially for someone with either T1D or T2D.

  7. Thank you Peter for your talk on TED.

    Excuse me for my english, isn’t my first language.

    In fact, I was interested in your site because of that talk on TED. You seem sensitive and logical at the same time, so I will just relate you with some of my interrogations.

    First: About this lady with diabete that you had to amputate, I wonder if her diabete could have been worsen by some anti-cholesterol medication. As I learn form some research I have made through litterature, statins increase the diabete. So, if somebody having diabete or beeing near of it, takes statins, it may become harder to control it. How come a toxin can be a good thing? How come the pharmaceutics came to make us think that a natural thing thar our body produces for his needs (cholesterol), is a bad thing? How come doctors always say that cholesterol is a bad thing when naturaly low cholesterol levels are related with higher risk of death in general and more often from cancer?

    Second: Is there a link between hypothiroidism and obesity and other long term disability. Thyroid hormones give the cells (mitochondia) the power to transform sugar and fat into energy. If that system don’t work well i think that all the others in the body cann’t do ther work well either. Isn’t it?

    Like you, I think I do everything ok for my health. I eat well, according to the Michael Pollan rules, I watch for IG of my food, I try to take good fat and avoid trans fat, I eat legumes, fishes, etc. Only the good stuf. I train 5 to 10 hours a week. I realy enjoy doing sport, bicycle, trekking and X-ski (my favorite).

    A few yaers ago, I met a new doctor, when she saw me, she asked a few questions and told me I might have hypothiroidism. In fact my TSH level was near 5.5. I started to take syntrhoid, and I feel better, though my TSH is still not keeping in the normal range. My former doctor, told me it was OK. For him there’s no need to treat if TSH is not higher than 5. His target is to bring it between 3 and 4. My new doctor wants it around 2. Normal people have TSH between 1 and 2. So how come when doctors treats us, they don’t want to bring us in the normal range of everybody. I’m sure that before the birth of my babies, 30 years ago. my rate was as normal as anybody. At that time, I could eat whatever I wanted, whenever I wanted. Since then, I gain 3 to 4 pound yearly. I’m very frustrate with that. I train like hell and perform like (*&*&). Never again a doctor will tell me my results are OK. I want to read them myself. I’m intelligent enough to understand them or to do some research and learn. For now, all my numbers are in the normal range, except for my TSH and the number on my scale. I”ve lost some pounds with exercice and diet, they all found me back. I think I gather the pounds that people lose on their way. Where and how can I give them back where they belong?

    A friend of mine is struggling with the same patern. Her thyroid had been burned because of a cancer. She now takes synthroid and gain 3-4 poiunds a year despite she cycles for almost 8 000 km/yr and go to the gym on winter. She eats well also. She just takes more “sport drinks” than I do. I just hate this kind of stuff and simply not beleive in it. She’s not fat, but she added 15 pounds in the past years.

    Thank you for your attention. I’ve been longer thant I though.

    • Danie, to your first question, it is possible, though the data suggesting this linkage or generally observational, not RCT. To your second question, no doubt hypothyroidism can contribute not only to obesity, but more importantly, lipoprotein abnormalities.

  8. Peter,
    Just want to say, great Ted talk and that I have sent the link to your talk through-out the public health department I work for. I’ve gotten a few very positive comments back already (just sent it around this morning) and one director is talking about gathering all staff to watch it. This is a big deal in a culture that is essentially directed in all it does through the CDC (funding issues, of course), and that is focused to such a large degree on the obesity crisis.

    I think it was very effective to focus so exclusively on the precise point of cause vs. effect. Very well done.

    Thank you.

  9. Peter – I just watched your talk on TED. Thank you for making me realize that the world is a better place than I thought it was 15:58 minutes ago.

  10. Dr. Attia,

    I just watched your TEDMED talk on YouTube. More sincere, heartfelt, supportive words…well, I’ve never heard them until today. Morbid obesity has been my curse for the last 15 years. I used to be lean and fit until everything changed. I was 23, had just been through my own perfect storm of personal tragic events and with the onset of depression and my own self-esteem dying, my weight more than doubled over a 5 year period.

    I was told it was PCOS although no tests were done. The gynecologist looked at my 311 lb body and assumed. Years later my family doctor tested my hormone levels (specifically testosterone, androgens, etc) to find they were within normal limits for a woman my age. He told me that I was obese by my own doing, that poor dietary choices and lack of exercise were my issue. The diagnosis changed to one of blame and ‘it’s your issue to fix. Just lose weight and you’ll be fine.”

    Today, I’m 38 years old and weigh 340lbs. Regardless of how many doctors explain that although my health indicators (BP, cholesterol, blood sugar, etc) are all within normal ranges, their next statement is always that I’m on the verge of a health crisis. I will develop Type II diabetes, heart disease and likely cancer…one doctor even went so far as to say “You have such a pretty face! It’s so sad that you can’t get your weight under control. Men would chase you!” It’s also been 15 years since I’ve been in a romantic relationship…understandably that last last statement made me cry. The doctor was right…no man could love me this way.

    The pressure does nothing to help motivate lasting success. I’ve always known that the excessive weight I carry is a mere symptom for the true underlying cause. While many people judge me and assume that those underlying issues are recklessness, stupidity and laziness, I know better. I know it’s something more connected to the myriad hormones coursing through my body. I’m not a doctor, but could the biochemical changes tied to depression and anxiety trigger insulin resistance?

    I’ve rambled on long enough! LOL Thank you for sharing your insight, encouragement, compassion and empathy. Your former patient may never see the video, but I did, and it comforted my heart. It takes courage to ask for forgiveness and I’m sure many physicians will learn by your example.

    • Barb, it breaks my heart to hear this, but more to know that I don’t know “the answer.” If I can give you even one ounce of hope, I’d say the following, there is at least one other person today who knows this is not your fault and that your worth as a person has nothing to do with what the scale says.

    • Hi Barb,

      Please go to Jack Kruse’s blog and read his own story and his different protocols for getting to optimal, I truly believe that you can lose the weight and feel better with the right ‘tools’.

      Good luck!

    • Barb,
      I hear you loud and clear. I wish I could give you answers but I can’t. I’ve been on the same treadmill of trying to cure my obesity for a very long time. I did not come to my obesity through a disastrous accident like you did. Rather mine started when I was very young about 6 years old and went downhill (uphill?) from there. I’ve gone the same route of trying to discover why as well as trying to ‘fix’ it to very little success.

      It is difficult when health care practitioners spout the same old theories about losing weight. Even more difficult when you ask them about current studies. I have two doctors that discount anything about insulin and LDL etc. when I ask. They assume incorrectly that I am referring to spurious studies instead of information gleaned from reliable sources. Furthermore, I cannot look for a new doctor. Under the current health plan I am stuck with what I have. It makes it all the more frustrating.

      Unlike you I have moderate high blood pressure and diabetes that is well controlled. What irks me is the blame I receive for my weight for any problem I may have. My weight is responsible for my having an ear infection….really. I had one neurologist discount me immediately the moment I set foot in his office because I was an obese female. He refused to listen to what I had to say instead making comments that my imbalance and nerve loss was due to my weight.

      If you have no other factors for metabolic syndrome then chances are you are not a candidate for trouble down the road. Obesity is a symptom yes but you have to have at least three or maybe it is five of the factors to be said to have metabolic syndrome. And the retort that has been on my lips when people tell me they don’t have a problem because they are of normal weight is that even people of normal size can have metabolic syndrome. Weight is not the only indicator. Dr. Lustig’s book Fat Chance is a must read. I wish I could give it to my health team to read.

      I’ll sum up here for as usual I am long winded. I believe my obesity is due to a hailstorm of hormonal problems exacerbated by addiction problems (I believe I am addicted to sugar. I have withdrawal symptoms that are very unpleasant when I stop sugar. I’ve cut down but …..) and depression (which does not respond to chemical intervention) I have made changes for the better and have lost some weight but not enough for society or the medical establishment which does not seem to want to celebrate even small victories.

      I don’t know if it helps to know you are not alone in your frustration. It is not your fault just as it is not my fault that we are obese but that is hard to remember when individuals feel free to take jabs and deny us the basic right of even being alive. ( I won’t go there. It’s too painful for me to recount ) I’m glad Peter does his blog. There is a host of information here that is very helpful and I’m glad you found it.

  11. Dr. Attia,

    I saw your favorite talk some time before I saw yours. I liked yours better. You were talking about me and many of the people I love. To hear a doctor say it might not be my fault, is life changing for me.
    What you said was not that strange to me as I did Atkins for 2 years. I didn’t have good success with Atkins. I had trouble staying in ketosis. I had no idea protein could cause an insulin response.
    I’ve been back to low carb for a week and have already lost 6 pounds. Thank you so much.


  12. Dear Dr. Attia,

    I watched your TEDMED talk on Upworthy through a Facebook advert. Wow! (I sent it to my sister who is a family practitioner.) I work with frail elders and very disabled adults and more than 50% have Diabetes. I work in Adult Day Health Care and we feed everyone a “nutritionally” balanced meal each day – I put nutritionally in quotes because we get federal funding to supplement the cost to provide the meal and thus use FDA requirements that define balanced. Potatoes are a vegetable accordingly. We carb load diabetics excessively as they must have two servings of bread and then at least 4 oz of potatoes if that is the vegetable of the day. And then we measure their blood glucose levels. It’s insane. But I digress – for them, I thank you. Our agency’s mission is to provide dignity and independence to people with disabilities and other special needs and this is what you spoke to at the end of your presentation. Dignity. Not blame. So we look at each person – whether they have Diabetes or Alzheimer’s disease, as a human being who deserves care.

    I have been on your site now for the better part of two hours and feel inspired and depressed all at the same time. As an executive in the mom and pop nonprofit world, and mother of one biological and two full-time step children, your life will never be mine. I so relate to Barb and her post. I have almost doubled my weight in 5 years. I exercise daily and have tried every diet under the sun from South Beach to Atkins to Suzanne Sommers to organic low fat and I could go on. I have had every test run that I know of and nothing is “wrong” with me. I think it is hormonal – I have never been fat and unhappy in my life until these last few years – I have always had a crappy body image, but never been overweight – and have always been a positive and outgoing person. Now I go to work and do not want to be seen in public. I dread going to meetings where I haven’t seen colleagues for a while and they see me and get that, “Oh my God what happened to her?” expression they try to hide. And while I believe what you write and am inspired, I also look at your lifestyle – between your style of exercise and consumption – as impossible given my reality.

    I write this to agree with you, with your thoughts, and to support you in your devotion to healing over judging. But I also write to tell you I believe that women have hormonal challenges that your study does not address (unless I haven’t read that part – I can’t say I’ve exhausted all you’ve written – so forgive me if I’ve missed this). And until such a time as we fundamentally change what we feed America – we can make marijuana illegal but sell Big Macs by the millions – things won’t change. The wealthy will continue to have access to education and healthy food and the poor will lack the education to know better and the money to eat better.

    So thank you – for your raw presentation – and your work – and I wish you continued growth in a way that looks even more broadly at what is necessary to flip the switch.


    • Debbie, thank you so much for all you’ve shared and for your kind words. There is no doubt in my mind that many (some? I don’t really know, actually) women have additional layers of endocrine complexities that can really complicate insulin resistance, and by extension, diabetes. Fortunately, one of the three studies NuSI will be funding to launch this year will be able to address this issue, and hopefully many more to follow. We have to address this issue and many more.

    • Thank you so much for writing back 🙂 – definitely made me smile! I get 100 plus emails a day and I know I can’t always respond to all – and I imagine you get significantly more and do that crazy exercise routine – so am doubly grateful. I am reading more on diving back into ketosis in a healthier way. Thank you for your inspiration and I promise to check in as I go.

      Additionally, we have a late-stage Alzheimer’s/related dementia program and I am seriously considering foregoing our federal subsidies and seeking a grant to do the ketosis program at work and encourage it with caregivers. Often times, folks in the late stages are hard to even get interested in food – so ice cream is something somehow universal. But I’ve made my own with Stevia and know it can be done.

      At any rate – your response means so much and I look forward to your research results. In the meantime, I will switch to ketosis, give it at least a month, and continue my daily exercise and meditation practice.

  13. Dr. Attia,
    You assembled a cognitively diverse group with each colleague having different backgrounds and ideas whose individual opinions may not be the answer, but whose collective insights may well provide breakthroughs if not cures, and certainly greater understanding. I’d be interested to know if and how intestinal flora may be involved.

    I look forward to following your progress and celebrating your successes. Courage, doubt, and compassion are the key components of your mission.

  14. A friend just linked your TED talk, and I have to say I shed tears watching it. If you ever want to consider a clinical trial or DNA analysis, please keep me in mind. I have lost (and gained) hundreds of pounds in my lifetime. I have lost 130 – 150 pounds three times when I stick to a low carbohydrate regimen. I can even maintain my weight for years at a time through very strict protocols, but I do have an addictive response to sugars that kicks in after about 30 mg of sugars in a 2 hour period and go into an eating spiral. My weight loss is rapid – 130 pounds gone in a matter of months, but the opposite is also true – gaining 3 pounds from one muffin, for example. My friends call it freakish – it just now either makes me angry or I get apathetic. If only the problem were as simple as quitting smoking or drinking alcohol – one can simply walk away, but with food I’m always in a bit of danger every few hours.

    I went to my doctor at 290 pounds with knee pain and begged to see a nutritionist. Finally after long badgering and tears he relented. In the interview with the nutritionist, she told me that my low carbohydrate plan was sound, and after switching my diet, the weight just fell off. Frustratingly, it seems that I am constantly hungry no matter what my weight or current state of intake, although it is less a problem with a low carb diet.

    Thank you so much for making this your life’s work. You have a new follower and I am looking forward to learning more to improve my health. If I have an insight, I’ll be happy to share.

    • I think you’re right, Katherine. Not to minimize the difficulty of overcoming addiction to cigarettes, alcohol, or other drugs, but none of these are essential for life the way food is. It sounds like you’re on a path that is moving you in the right direction for a sustainable dietary strategy.

  15. I just got through watching your TED video. Thank you.

    I would like to tell you my story. I am a PhD student currently in Healthcare Innovation. Also I have been a practicing midwife for 30 years.

    I was diagnosed with PCOS in my teens. I have struggled with weight gain my whole life, but I managed to stay normal weight until my 40’s when I became obese. I was diagnosed with Type II diabetes almost two years ago after 3 years of graduate school. I had been eating a lot of fast food and junk food. I was put on meds but did not tolerate them. I was sent for diabetes dietary education. I knew I couldn’t follow what they were telling me. I dislike diet foods. I had recently read “The Fertility Diet”. I decided to experiment on myself and change my diet. Historically before graduate school I had always tended toward whole foods, organic, etc.. So when I say I changed my diet, I really didn’t change it but returned to what I had eaten in 20’s before I was obese and when I had time to garden and preserve my own food. At about the same time I took a job in a rural community with no access to fast food and only one grocer. Needless to say, I planted a garden and ate what I raised. My diet consists of whole foods in their most natural state, mostly organic. I eat some meat, but mostly farm (small rural family farm) of beef and chicken. But mostly I eat fresh vegetables and fruits. Very little rice or pasta. I eat whole grains. My fats are olive oil, butter, and whole fat diary. My diabetes is gone. I didn’t loose any weight, but I will continue to learn what I can to loose it. In the mean time I will garden and love myself for who I am and what I do.

    Thanks again.

  16. Dr. Attia — I watched your talk this morning (and also Ric Elias’ — wow!). Two things: I’m among the group who are so damned moved by the things you said because of my experiences as an overweight person, struggling with insulin resistance and trying not to tip over into diabetes. You’ve given a gift to so many people in that someone in the medical field “gets it,” and offering compassion and, potentially, help, rather than disgust and scorn. But secondly, I want to comment on your speech itself, your construction of it and your delivery — I’ve already shared the link with a number of colleagues who teach oral or written communication (I’m an English prof), and your TED talk will be appearing in classrooms as soon as they can get it into them (including mine). Your talk was a model of what such a speech should be, a wonderful combination of logos, ethos, and pathos that are perfectly balanced for maximum rhetorical impact. It’s a powerful piece of communication, and I thank you for it. I’m looking forward to exploring your blog and work further.

    • Elise, wow, what a compliment. I have to share the credit, as I’m not sure how much (if any) I deserve. The TEDMED team, a remarkable group of people, all played in hand in helping me shape my story. (If you saw the first version — 3 times longer, way more technical, etc. — you would be delighted you didn’t have to sit through it). In particular, Marcus Webb at TEDMED was simply ‘gifted’ at forcing me to balance the “facts” with the “story.” At some point in the coming months, I will write more about this experience, which may be of interest to you. I’ll also share my 10 favorite TED talks of all time (Ric’s plus the 9-way tie for second).

  17. I just watched your TEDMED talk…..even though you did not directly apologize to me, Dr. Attia, I want you to know that, as an obese woman with Type II diabetes, I forgive you. I hope one day soon that all physicians will have the same compassion for people like me that you have shown in your talk.

  18. Wow,

    I just watched your TED talk twice to let everything soak in and I wish I could give you a warm hug. I am so moved by your humility and honesty.

    I am food geek to the core and have been studying nutrition for the past three years. I currently doing nutrition counseling at two treatment centers and while I don’t work with many patients who are insulin resistant or diabetic, many of my client’s feel powerless over sugar and carbohydrate cravings. People often dismiss poor diet choices or obesity as a lack of personal restraint or laziness. In a feminist theory class I took in college, we explored that notion that prejudice towards people who are fat or overweight is the last “acceptable” form of prejudice. Your speech tore apart this notion and after studying the bodies complex endocrine system, I have great respect for the intricate balance of hormones and how imbalances in the system can overwhelm any human being, no matter their relationship with nutrition and exercise. Thank you for igniting another spark in my passion for health and food. I want to stay connected with your work and look forward to reading new research and your blog.

    • Katie, thank you so much for your kind words. I think I have to agree with the conclusions from your class. I think it speaks to the underlying belief that obesity is a disorder of gluttony and sloth. Unlike, say, race, gender, or sexual orientation, most people still believe that an overweight person is 100% responsible for his or her state, and therefore worthy of no empathy. This fuels the prejudice, of course.

  19. I was diagnosed as having PCOS about two years ago. I was told by a specialist at UCLA that I was also insulin resistant. I have done a good bit of research and most women with PCOS are obese, but at that time I was 23 years old and 140lbs and 5 feet 11 inches tall. I decided to see what would happen to my body if I discontinued the use of oral contraceptives and sprinolatone while maintaining a ridged workout schedule and I even followed the exact same diet you have mentioned in your videos (basically a diabetic diet). Instead of feeling better, I became very anxious, my hair began to thin and I gained 20 pounds. Now that I have been on an oral contraceptive, spirnolactone, and metformin for two years, I feel like a completely new person. I am now 130 pounds and I cannot seem to gain weight. Why is it that you were able to control your insulin resistance through diet and I am not able to stop taking metformin without feeling exhausted all the time? Do hormones play an integrated role when it comes to being insulin resistant? I cannot seem to find information that addresses this issue. Thank you for your time.

    • Aubrey (and anyone else reading this who is interested in PCOS), I really need to do a post on this topic, as it is such a clear example of IR resulting from something other than “eating too much.” I don’t think I yet have the expertise to really do the topic justice, but if you can be patient with me, I’ll get to it in the next year, I hope.

    • Jimmy Moore’s Livin’ La Vida Low Carb Show episode 700 links to an interview he did with an expert on low carb and PCOS. Perhaps there might be information there that can help you.

    • Thank you for your response. I am having trouble finding information on very thin people with PCOS; seems to be a rare occurrence. I look forward to your post!

      Maryann, I will check it out! Thank you for your help!

    • I actually came on here (just watched his TED talk today) to mention PCOS. How my endocrinologist explained it to me, is that having PCOS throws off your hormones. The imbalance between these male and female hormones caused by our thicker uterine wall (and the cysts) effects our metabolic abilities. This can CAUSE insulin resistance. I think this would be an interesting area of research because part of me believes that this epidemic is caused by our hormones being out of balance, something that might not be noticed. I was actually misdiagnosed 3 years before my actual diagnosis of PCOS. They actually believe there may be a male counterpart to PCOS. And a lot of doctors (like my family doctor) don’t know what needs to be seen to diagnose PCOS (they usually do one test, that if positive then yes you have PCOS, if negative, then you may still have it) and then what to do to treat it. There are also many doctors that I have to explain it to. I actually wanted to ask Dr. Attia if he had thought of it and now I’ve see his comment, so he has, and that is good. I think a lot of women have this problem and don’t even realize it.

      As for me, I have found that a low-carb option works for me. I’ve always been incredibly active and eaten pretty darn healthy, but I never lost any weight (this is how I knew there was a problem). I now essentially eat lean proteins and vegetables. I’ve found that the sugar in fruit can set off my BGL, not just high, but mine actually kinda freaks out and gets high, then low, then high, etc. So I’ve chosen to not eat fruit (which I miss dearly). I’ve found this lets me lose the most weight, and as long as I keep my water intake up, it’s pretty great. I exercise often. I HOPE, but I know this isn’t always the case, that someday I’ll be at a point where I don’t need my medicine. But I know there’s a chance that my hormones still will be crap, but hopefully with my diet like this and weighing less will allow my hormones to balance out.

      But because of my experience, I hate when people give larger people a harder time. I’ve always had great cardio; my resting heart rate sits around 55 – 60. Yet people think I’m unhealthy for how I look. They don’t understand how hard it is to lose weight when your hormones and body DO NOT want to cooperate, at all. They just say, eat less, exercise more, but don’t understand that there is so much more to how much somebody weighs, and they do not know what could be wrong with that person. Yes, for some people, they can lose weight easily, but people with hormone imbalances, it can be nearly impossible. Metformin is probably the only reason I lose the little bits I’ve been able to lose so far.

      Sorry for the long post, but thank you Dr. Attia for your talk, outlining how we really shouldn’t judge people by their weight. I also look forward to your post about PCOS. It’s really an interesting syndrome, and I’m glad you’ve thought about it, because I think it directly correlates to your topic.

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