we at the National Lipid Assn are very proud to have presented BOTH Peter Attia and Tom Dayspring achievement awards at last year s Scientific convention. See us at www.lipid.org.
Like nearly all books that claim to educate on controversial topics, they start with truth and end with speculation, not just in health, but in all other topics like climate, archaeology, psychology (the worst), even sometimes biology.
If we eliminated speculation in books, I think we'd have no non-fiction books left!
The trick here would be for authors to be extremely clear about what is evidence-based, and what is speculative. That would be nice.
It is hard to know where to begin with this. Probably should start with the author's claims about the pathophysiology of atherosclerosis. This is a degenerative disorder that is that is found in practically all long lived animal species including many that have an almost exclusively vegetarian diet (e.g. parrots, chimps, and gorillas). A degenerative disorder is one that comes with age. Best evidence is that atherosclerotic plaques begin with a proliferation of smooth muscle cells in the middle layer of the arterial wall and, as they enlarge, push the thin endothelial layer into the lumen of the artery. If the endothelial layer is broken the blood is exposed to the underlying collagen and a cascade of blood clotting may occur. This can bring about the well known sequelae of atherosclerosis---heart attacks and strokes. The point is that, in this process, nothing is deposited on the inside of endothelial layer as is commonly believed by many---including, unfortunately, many physicians. Nowhere in this process does blood cholesterol or any other biological lipid play any role. The obsession with cholesterol started when chemical analysis of plaques revealed a significant amount of cholesterol; but this will be true of any cluster of cells since most of the cell components are derived from cholesterol and related compounds. The intense focus on cholesterol always reminds me of the famous joke about the drunk at midnight looking around beneath a streetlight for his car keys. A passerby asked him where he dropped his keys and he pointed to a spot some distance away down a dark alley. Then why are you looking here? Because the light is better. I wish Dr. Attia well in his search for the keys to longevity but I doubt he will find any in his drive to lower his cholesterol with multiple medications.
Then there is the issue of longevity. Over the years this has attracted a multitude of scam artists along with some well-intentioned researchers. But that would require extending this comment well beyond a reasonable limit.
When you are as smart as he is, it may be perceived as egotistical. My beef is with the preoccupation with recounting one's own personal health stories during interviews which should be looking at the overall science in a topic rather than anecdotes.
It will be interesting to see Attia’s autopsy one day, of course if he doesn’t look any ours first. In a past 200 years we managed to extend our average life expectancy for few decades so I doubt that any other intervention will have significant impact. Therefore Peter’s, or anyone else’s attempt, will be doomed to failure. I must also note that his efforts reach almost pathological levels. He is spending hours a day in the gym and probably tens of thousands of dollars for special diet and medications. Honestly whatever the benefit of this is it is not a lifestyle achievable by majority of population.
What Attia’s prescription lacks….is data. What he has in spades is biologic plausibility, exuberance, and hubris.
He’s within his rights to do whatever he wants, to himself. But it’s borderline irresponsible to preach this stuff to the masses without outcome evidence.
He’s no doubt a learned individual….with a bit of snake oil salesman mixed in.
This is interesting. What would you say to a 56 year old woman who checks all the ‘correct’ lifestyle boxes, NO family history of sudden death OR heart disease, a cardiac calcium score of zero, excellent HDL and triglycerides, but super high LDL (140 ish) and apo(a) (142)?
Like you, I very much appreciated Attias writing, especially when I first set out on educating myself about longevity. I grew tired of his ego, over time, and found many others who complimented and then replaced his writings for me.
I’m curious your thoughts on the LMHR study that was done recently (I was one of the study participants), indicating that elevated LDL-C is not the bad boy that we’ve been told; at least not on its own and not in the LMHR phenotype.
I enjoy the post and I believe Dr. Attia is a very smart doctor. However, after having practiced nearly 40 years he leaves out some practical points that most of us have learned the hard way.
1. Given the choice of being lucky or Smart in patient care most of us would choose lucky.
2. if the best medical student and the radiologist sees the nodule on the x-ray. It's not there.
Flecainide for post MI PVCs, monoplax an IV dobutamine seem like a good idea at the time.. not so much now
3. I had a screening colonoscopy and then 10 days later five pulmonary emboli as a result of being rear ended stopped next to a school bus- coming back from an outreach clinic no less .
4. There's a lot to be said about enjoying life and not being crazy about trying to extend it an extra day or two.
5. If you have an adult, that is a non-smoker, moderately exercising, has a good social support network, financially stable and laughs a lot- That's probably as good as you are going to get. Get your labs where they need to be , check your blood pressure, your PSA and your colon occasionally. Wear your seatbelt.
And don't cross the bridge at one in the morning. You're on three drugs for LDL and you're filling in a pothole decent honest work and then you're 180 feet dropped into Coldwater.
Enjoy your life don't overthink it
PS my family had other health scares on the same level both of which were no fault of theirs....
Here we go again...keep lowering the thresholds so that more and more people can be put on more and more drugs sooner than ever and for an entire lifetime. This is why I refer the medical community as being the modern stone age medical mafia. Keeping people on drugs forever is NOT real medicine and healing. It's the opposite as the causes for diseases are never fully explored or understood. Why? That would put a gigantic dent in the revenues of the medical establishment.
Is it a coincidence that this article came one day after Dr. Cifu's amusing critique of "celebrity doctors?" I haven't read "Outlive," but I have been listening to "The Drive" from the beginning. I don't consider Attia the "typical" celebrity doctor for several reasons. That's not to say he doesn't have his biases, but you can tell his degree was in engineering, as I've never observed a more logical mind, and he usually remembers to state when he's citing established research vs extrapolating/speculating. One can never know for sure, but I believe he is not doing what he does for ego or money. Anyway, his website and podcasts, especially the one with Thomas Dayspring, is what convinced me to finally get a CAC, and based on that, start a statin. According to Dayspring, "Numerous clinical trials have demonstrated that there is no danger in lowering plasma LDL-C too low. LDL-C is the cholesterol circulating in plasma and is not a measure of tissue cholesterol (all cells synthesize all the cholesterol they need). LDL-C has no relation to brain, adrenal or gonadal cholesterol." (link #1 below). However, he also said this: "Low desmosterol, a biomarker related to cholesterol synthesis & low levels predict AD. When using statins at any dose in patients with AD risk (apoE4, family history) I reduce statin dose when absolute concentrations of desmosterol hits or is < 20th %tile cut point. This is not a common occurrence but bears watching. If needed lower apoB by adding other Rx - No other lipid lowering Rx inhibits brain cholesterol synthesis. This is outside of the box thinking." (link #2) Note he's not saying LDL-C levels can get too low, since he recommends other medications to lower it, and only statins can potentially reduce desmosterol. Patients can test their own desmosterol at home through Empower Dx's cholesterol Dx test (link #3). For now, I doubt many folks will get their cholesterol down to neonatal levels due to the expense of using PCSK9 inhibitors. But CRISPR has already demonstrated effectiveness in primates knocking out PCSK9, and clinical trials in humans will be next. (link #4) Who will volunteer? Probably folks with FH who lost a parent to heart disease in their 40's. And Peter Attia! :)
we at the National Lipid Assn are very proud to have presented BOTH Peter Attia and Tom Dayspring achievement awards at last year s Scientific convention. See us at www.lipid.org.
Like nearly all books that claim to educate on controversial topics, they start with truth and end with speculation, not just in health, but in all other topics like climate, archaeology, psychology (the worst), even sometimes biology.
If we eliminated speculation in books, I think we'd have no non-fiction books left!
The trick here would be for authors to be extremely clear about what is evidence-based, and what is speculative. That would be nice.
Read Dr Cifu's earlier commentary about all of this. His opinions pretty much the same as mine on all of this!
It is hard to know where to begin with this. Probably should start with the author's claims about the pathophysiology of atherosclerosis. This is a degenerative disorder that is that is found in practically all long lived animal species including many that have an almost exclusively vegetarian diet (e.g. parrots, chimps, and gorillas). A degenerative disorder is one that comes with age. Best evidence is that atherosclerotic plaques begin with a proliferation of smooth muscle cells in the middle layer of the arterial wall and, as they enlarge, push the thin endothelial layer into the lumen of the artery. If the endothelial layer is broken the blood is exposed to the underlying collagen and a cascade of blood clotting may occur. This can bring about the well known sequelae of atherosclerosis---heart attacks and strokes. The point is that, in this process, nothing is deposited on the inside of endothelial layer as is commonly believed by many---including, unfortunately, many physicians. Nowhere in this process does blood cholesterol or any other biological lipid play any role. The obsession with cholesterol started when chemical analysis of plaques revealed a significant amount of cholesterol; but this will be true of any cluster of cells since most of the cell components are derived from cholesterol and related compounds. The intense focus on cholesterol always reminds me of the famous joke about the drunk at midnight looking around beneath a streetlight for his car keys. A passerby asked him where he dropped his keys and he pointed to a spot some distance away down a dark alley. Then why are you looking here? Because the light is better. I wish Dr. Attia well in his search for the keys to longevity but I doubt he will find any in his drive to lower his cholesterol with multiple medications.
Then there is the issue of longevity. Over the years this has attracted a multitude of scam artists along with some well-intentioned researchers. But that would require extending this comment well beyond a reasonable limit.
When you are as smart as he is, it may be perceived as egotistical. My beef is with the preoccupation with recounting one's own personal health stories during interviews which should be looking at the overall science in a topic rather than anecdotes.
It will be interesting to see Attia’s autopsy one day, of course if he doesn’t look any ours first. In a past 200 years we managed to extend our average life expectancy for few decades so I doubt that any other intervention will have significant impact. Therefore Peter’s, or anyone else’s attempt, will be doomed to failure. I must also note that his efforts reach almost pathological levels. He is spending hours a day in the gym and probably tens of thousands of dollars for special diet and medications. Honestly whatever the benefit of this is it is not a lifestyle achievable by majority of population.
This article is a fair summary.
What Attia’s prescription lacks….is data. What he has in spades is biologic plausibility, exuberance, and hubris.
He’s within his rights to do whatever he wants, to himself. But it’s borderline irresponsible to preach this stuff to the masses without outcome evidence.
He’s no doubt a learned individual….with a bit of snake oil salesman mixed in.
It's easy to do.
This is interesting. What would you say to a 56 year old woman who checks all the ‘correct’ lifestyle boxes, NO family history of sudden death OR heart disease, a cardiac calcium score of zero, excellent HDL and triglycerides, but super high LDL (140 ish) and apo(a) (142)?
Stopped listening to Attia when he recommended the untested/warp sped covid jabs. Said, The FDA is gold?
Like you, I very much appreciated Attias writing, especially when I first set out on educating myself about longevity. I grew tired of his ego, over time, and found many others who complimented and then replaced his writings for me.
I’m curious your thoughts on the LMHR study that was done recently (I was one of the study participants), indicating that elevated LDL-C is not the bad boy that we’ve been told; at least not on its own and not in the LMHR phenotype.
I enjoy the post and I believe Dr. Attia is a very smart doctor. However, after having practiced nearly 40 years he leaves out some practical points that most of us have learned the hard way.
1. Given the choice of being lucky or Smart in patient care most of us would choose lucky.
2. if the best medical student and the radiologist sees the nodule on the x-ray. It's not there.
Flecainide for post MI PVCs, monoplax an IV dobutamine seem like a good idea at the time.. not so much now
3. I had a screening colonoscopy and then 10 days later five pulmonary emboli as a result of being rear ended stopped next to a school bus- coming back from an outreach clinic no less .
4. There's a lot to be said about enjoying life and not being crazy about trying to extend it an extra day or two.
5. If you have an adult, that is a non-smoker, moderately exercising, has a good social support network, financially stable and laughs a lot- That's probably as good as you are going to get. Get your labs where they need to be , check your blood pressure, your PSA and your colon occasionally. Wear your seatbelt.
And don't cross the bridge at one in the morning. You're on three drugs for LDL and you're filling in a pothole decent honest work and then you're 180 feet dropped into Coldwater.
Enjoy your life don't overthink it
PS my family had other health scares on the same level both of which were no fault of theirs....
Here we go again...keep lowering the thresholds so that more and more people can be put on more and more drugs sooner than ever and for an entire lifetime. This is why I refer the medical community as being the modern stone age medical mafia. Keeping people on drugs forever is NOT real medicine and healing. It's the opposite as the causes for diseases are never fully explored or understood. Why? That would put a gigantic dent in the revenues of the medical establishment.
Is it a coincidence that this article came one day after Dr. Cifu's amusing critique of "celebrity doctors?" I haven't read "Outlive," but I have been listening to "The Drive" from the beginning. I don't consider Attia the "typical" celebrity doctor for several reasons. That's not to say he doesn't have his biases, but you can tell his degree was in engineering, as I've never observed a more logical mind, and he usually remembers to state when he's citing established research vs extrapolating/speculating. One can never know for sure, but I believe he is not doing what he does for ego or money. Anyway, his website and podcasts, especially the one with Thomas Dayspring, is what convinced me to finally get a CAC, and based on that, start a statin. According to Dayspring, "Numerous clinical trials have demonstrated that there is no danger in lowering plasma LDL-C too low. LDL-C is the cholesterol circulating in plasma and is not a measure of tissue cholesterol (all cells synthesize all the cholesterol they need). LDL-C has no relation to brain, adrenal or gonadal cholesterol." (link #1 below). However, he also said this: "Low desmosterol, a biomarker related to cholesterol synthesis & low levels predict AD. When using statins at any dose in patients with AD risk (apoE4, family history) I reduce statin dose when absolute concentrations of desmosterol hits or is < 20th %tile cut point. This is not a common occurrence but bears watching. If needed lower apoB by adding other Rx - No other lipid lowering Rx inhibits brain cholesterol synthesis. This is outside of the box thinking." (link #2) Note he's not saying LDL-C levels can get too low, since he recommends other medications to lower it, and only statins can potentially reduce desmosterol. Patients can test their own desmosterol at home through Empower Dx's cholesterol Dx test (link #3). For now, I doubt many folks will get their cholesterol down to neonatal levels due to the expense of using PCSK9 inhibitors. But CRISPR has already demonstrated effectiveness in primates knocking out PCSK9, and clinical trials in humans will be next. (link #4) Who will volunteer? Probably folks with FH who lost a parent to heart disease in their 40's. And Peter Attia! :)
https://www.linkedin.com/posts/thomas-dayspring-md-facp-fnla-3aaa876_knowfh-activity-7111752996786470913-I0z3/
https://twitter.com/Drlipid/status/1670796947337236482
https://empowerdxlab.com/products/product/cholesterol-dx-test
https://www.nature.com/articles/s41586-021-03534-y
Attia needs a hug. Poor guy.
Just one other point WRT Fructose (and I'm writing from memory)
Fructose is converted to glucose in cells using ATP
There's no feedback mechanism in human cells to slow this down, so paradoxically your cells can get starved of ATP by eating fructose.