The Drive With Peter Attia: Ask Me Anything Edition

Peter’s Instantly Vital New Podcast is back with an AMA and with excellent results. Enjoy!

Thoughts on Alcohol?

  • Alcohol is a toxin, pretty similar to sugar in the liver, with no clear benefits to the body beyond the buzz
    • * See: Is sugar toxic? by Peter Attia for more on what toxicity means
  • Wine is not good for your heart, Resveratrol is at very very low levels and the “French Paradox” is not really true and certainly not a result of drinking wine alone
  • Favorite drinks?

Best Lab Tests to Request from your Doctor?

1 time tests:

  1. Lp(a) (Lipoprotein A): Phenotype – you want to know Mass and Particle number
  1. APOE Genotype: Risk for Alzheimer’s/greater risk from head injury. People have a mix of 2,3, and 4 (one from each parent)
    • Having 2 ApoE4 alleles can increase risk of AD (Alzheimer’s Disease) by 10-20x Peter argues that this is definitely worth checking as you can in fact prevent Alzheimer’s disease (Rhonda Patrick would agree, for example don’t play sports with high risk of head injury (TBI – Traumatic Brain Injury) – More here in the section on genetic risk factors)
    • APOE also tells you a lot about your CV risk

Things to Test Multiple Times:

  1. LDL-P (or ApoB): Get you the same thing, influenced by amount of cholesterol you synthesize and absorb, amount of triglycerides you carry around and your clearance of the particles
    • Small LDL-P: Want this to be below 20 mg/dl
    • Trigs: Most responsive to diet changes
    • LDL synthesis: The most preset/not variable
    •  Better predictive markers than LDL-C (despite C being the more common test)
    • VLDL Cholesterol: Non-HDL cholesterol and subtract LDL cholesterol à below 15mg/dl
    • Total cholesterol is basically useless, HDL is minimally valuable
  1. OGTT (oral glucose tolerance test): Metabolic health, try to get it with insulin measurements
    • Goals = Fasting glucose below 90, 1 hour post prandial <120-130, 2 hour glucose below 100
    • Keto diet people will have very high levels after a challenge (low before), but this isn’t accurate
    • Fasting glucose: Only directionally interesting. This varies a lot during the day, difference from 90 or 105 is more about your cortisol level than metabolic issues
    • Peter uses a Continuous Glucose Monitor (CGM), he doesn’t like the Abbot Freestyle Libre (not accurate enough), has a test version of to be lanuched Dexcom G6 which is much better, tiny needle, no calibration needed and can connect with your phone
      • A month of CGM data is > an OGTT test to Peter
    • Added sugars drive coronary heart disease via insulin resistance and hyperinsulinaemia: a new paradigm (DiNicolantonio and O’Keefe, 2018
  1. ALT (alanine aminotransferase): Liver health
  • Best test to see if your liver has issues (side note: ALT elevations are a signal that you should stop taking a new medication – many potential new drugs are stopped if they elevate ALT)
  • Reference range is 7-55 U/L, BUT Peter recommends <20
  • Don’t simply accept it if your Dr. tells you your levels are “normal” as those levels have drifted up over time as the average person has gotten less healthy)
  • Fatty Liver/NASH will be the leading driver of liver transplant in the future in US

Honorable mentions: Hcy, hs-CRP, fibrinogen, Lp-PLA2, ADMA, SDMA, Estradiol (E2) – these levels keep going up on average in American men,  and knowing your family history

Family History: More important than doing a whole genome sequence. But behavior matters (e.g. if your grandma smoked and you don’t)

Longevity Markers: Longevity genes include APOE, Lp(a) and then the below

  • Heart Disease: The younger you are, the more blood tests can tell you about your risk of cardiovascular disease, older people need to rely more on scans (e.g. CT angiograms)
  • Inflammation: Fibrinogen, CRP, , oxLDL, and oxPL
  • Endothelial Health: Insulin sensitivity, homosystine, ADMA, SDMA
  • Cancer: Blood gives up the least insight, until liquid biopsy tests become accurate (company like Grail)
    • Most cancers are somatic mutations not germ line mutations so knowing your genotype doesn’t help much with a few exceptions (e.g. BRCA and Lynch)
    • As a result, you can focus on inflammation markers and metabolic health
  • Alzheimer’s Disease: APOE tells you low/medium/high risk and long with risk driven by the same drivers of heart disease, metabolic component, and toxins which we can’t understand/track the least
    • TOMM40: A TOMM40 variable-length polymorphism predicts the age of late-onset Alzheimer’s disease (Roses et al., 2010)

What Wearables Matter:

  1. Are you measuring something that matters?
  2. Is the device measuring to well?
  3. Real-time feedback?
  4. Do I have an ability to fix it?

Peter’s Favorites:

  1. CGM: DexCom 6
  2. Oura Sleep Ring: highly accurate measurements of sleep and Heart rate variability – (use the code “podcastnotes” for $50 off at checkout)

Eating Risks When You Have Kids: Peter is 10 pounds fatter because he has kids. We are most vulnerable in the environment we eat most. His kids eat better than most, but there is still a bunch of crap like Wheat Thins (surprisingly sweet). Hard to be a parent and not eat their leftovers

How to Find a Good Doctor:

  1. Ability
  2. Bedside Manner
  3. Availability
  4. Constantly Learning

Your doctor needs to listen: Speaking and interruptions during primary care office visits (Rhoades et al., 2010)

Exercise: Stages of Competences

  • Unconsciously incompetent
  • Consciously incompetent
  • Consciously competent
  • UnConsciously competent

Swimming Fuel: Hammer Perpetuem…high carb fuel, Maxum (maltodextrin) spiked Cytomax

Peter’s Exercise Regimen:

  • Lift Weights: 3 days a week
    • Rule #1, Don’t get hurt
    • Only pressing with Dumb Bells
  • Riding: 4 days a week on a Pelaton or Wahoo KICKR (Trainer Road)
  • Focus on Regular movement prep: flexibility, mobility, and movement correction for injury prevention

How to Learn: Total Immersion (likely not the most efficient)

  • First, go 80/20: Try to squeeze out an 80% understanding of the topic;
  • Then, go 20/80: Contact the people who can get you closer to 100% on the topic

Serenity Prayer: Accept what cannot be changed and don’t waste your time, spend more time in the present with people that matter to you,

Peter’s Diet:

Race Car Driving:

  • Major Elements: Throttle, Brake, Steering, and Shifting
  • What Makes You Fast: Tires, engine, chasis, driver
  • What Gives You Control: Vison/Lines your take, not under or over steering
    • Fixing and oversteer is very difficult

Future Topics: Statins, Smart Drugs/Supplements, Heat and Cold Therapy, HRT (hormone replacement therapy), Autophagy

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