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Dr. Peter Attia: Readdressing Dietary Guidelines

Todd Allen

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In the thread "continuous glucose monitoring the latest" started by Mechanism, https://www.crsociety.org/topic/11648-continuous-glucose-monitoring-the-latest/?hl=%2Bpeter+%2Battia, was a video of an interview with Dr. Peter Attia, a former vegan.

As Dean has pointed out physical appearance matters believing it impacts Aubrey de Grey's public credibility.  So I'm likely biased by Peter Attia's apparently good health and fitness.  I'd love it if my personal physicians were competitive endurance swimmers able to dead lift 500+ lbs.  Which lead me to watch this video:

Dr. Peter Attia:  Readdressing Dietary Guidelines

The beginning of the talk addresses how we got to where we are with government established dietary guidelines that appear to be aggravating the worst public health issues.  Around the 50 minute mark he discusses the following which I believe is important.

Professor Jerry Reaven, an endocrinologist, of Stanford in the mid 80s made the observation that a cluster of metabolic findings seem to be the best predictor of the rate of onset of diabetes and later was shown to also predict heart disease, stroke, cancer and alzheimers.  He called it syndrome X, characterized by having 3 or more of these bio markers:
trunkal obesity, high bp, elevated fasting blood glucose, low HDL and high triglycerides.  Further studies have produced much support and it has come to be known by the term metabolic syndrome.

High carbohydrate intake, especially refined sugars and simple starches, have been shown to contribute to trunkal obesity, high bp and elevated fasting blood glucose probably through a mechanism of elevated insulin response when it leads to decreasing insulin sensitivity / impaired glucose tolerance.  A couple related interesting points, increasing fat intake, especially saturated fat has been shown to increase HDL and lower triglycerides and there is no significant linkage between LDL or cholesterol or dietary cholesterol to metabolic syndrome.

The leading causes of death in adults are these chronic slowly progressing 'diseases' of aging accelerated with metabolic syndrome.  They are leading causes of death for the long lived, even centenarians, who die from these causes in similar proportions, having only slowed the processes but not escaping them.

Important to me, there is likely positive feedback between metabolic syndrome and losing muscle mass.  Insulin is a primary regulatory hormone and a prime driver of anabolic processes with an impact on growth hormone, IGF1 and many other growth factors.  Insulin insensitivity may contribute to the problem of muscle repair and growth not keeping pace with muscle deterioration and loss.  And loss of muscle may aggravate insulin insensitivity as muscle is a primary tissue for taking up and metabolizing glucose.

Another interesting item later in the video, Dr. Christopher Gardener, a professor of medicine at Stanford, also a vegan, conducted a study, the "A to Z trial" in 2007 comparing 4 different popular diets:  Atkins, Zone, LEARN, and Ornish.  After 1 year the Atkins diet, most diametrically opposed to his personal diet, yielded the best result at improving each of the markers monitored which are elements of metabolic syndrome:  weight -4.5 kg, trig -29.3, HDL +4.9 and DBP -4.4.  While the Ornish diet, most similar to the researcher's own diet, performed least best - minimizing the likelihood of personal bias contributing to the result.

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The science may be contentious.  For example, the "Ornish" diet was not the Ornish diet.  That they read a book does not guarantee that they followed the diet.


Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial.
Gardner CD, Kiazand A, Alhassan S, Kim S, Stafford RS, Balise RR, Kraemer HC, King AC.
JAMA. 2007 Mar 7;297(9):969-77. Erratum in: JAMA. 2007 Jul 11;298(2):178.
PMID: 17341711

Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women.
Sears B.[, Etcetera.]
MedGenMed. 2007;9(3):57; author reply 57. No abstract available.
PMID: 18159610

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Compliance is a major issue for all long term human nutrition studies.  The approach here was better than you insinuate.  From the Methods section of the study:


Each diet group attended 1-hour classes led by a registered dietitian once per week for 8 weeks and covered approximately one eighth of their respective books per class. The same dietitian taught all classes to all groups in all 4 cohorts and was rated by participants at the end of the 8-week sessions for enthusiasm and knowledge of the material (rating scale of 1-5, from “strongly disagree” to “strongly agree,” respectively). The LEARN program is intended to be a 16-week program and, therefore, the 8 weeks of guidance through this book reflected an accelerated time frame, which was necessary to match the time frame given for the other 3 diet groups. Efforts to maximize retention in the study included e-mail and telephone reminders for appointments, e-mail or telephone contact from staff between the 2and 6-month and between the 6 and 12 month data collection points, and incentive payments of $25, $50, and $75 for completing the 2-, 6-, and 12 month data collection, respectively.


I think the bigger limitation is that this was a study of overweight middle aged women and it may not speak to other groups such as those of ideal body weight, men, those older or younger, etc.  Also, it was only for a year, perhaps the Atkins diet makes you look healthier by every bio marker in the first year but still manages to killl you 10 or 20 years later.


Still, this study in combination with everything else Dr. Peter Attia presents makes a strong case that the demonization of fats, especially saturated fats deserves careful reconsideration.

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