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mccoy

glucose versus cholesterol optimization

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I recently saw the available clip form this AMA from Peter Attia:

 

And I was impressed by his record from the GCM: almost totally flat, no peaks, low average glucose, very little variability (7:00 minutes).

 

How does he do it? And, above all, how does he control cholesterol? My thoughts as follows:

  1. All right, he eats usually once a day and fasts regularly
  2. But he no more follows a keto diet
  3. He eats a huge salad with salmon
  4. What else does he eat, since he's active and needs about 3500 kCals a day or more?
  5. If he really keeps carbs pretty low, then how he reaches his caloric input, likely with lots of fats.
  6. Since he reiterates in his podcasts that the lower the LDL-c, LDL-P, APOE-B, the better, how does he control his cholesterol? Eating no animal fats at all?
  7. He probably takes statins or other cholesterol-lowering drugs such as PCKS-9 inhibitors (?)
  8. He maybe takes some of the newest glucose-lowering drugs like Liraglutide or similar (?)
  9. HAs anyone a subscription to his AMAs and knows the end of this episode?
  10. Has anyone more clues than I have?

My hunch is that he uses a mix of carbs controls and pharmaceutical drugs to succeed in lowering both glucose and cholesterol at the same time. I assume his cholesterol is low, if he adheres to his optimization strategies.

Maybe in his book he will disclose clearly these aspects (but he continuously delays the publication)

 

 

Edited by mccoy

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I'm finding that my blood glucose homeostasis is drifting toward higher setpoints at the threshold of prediabetes (fasting glucose and HbA1C), so I'm reasoning about some suitable strategy which does not involve extreme restrictions in food variety. I'm not sure about my present cholesterol levels, which I'll have to measure soon. Again, it's easy to control glucose OR cholesterol by dietary interventions, not so easy to control both of them at the same time.

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Criteria defining prediabetes according to the 2021 ADA guidelines.

As we know,  HbA1C may not be a reliable indicator in some conditions (CR, Red globules MCV outside the norm), but ruling those conditions out it may be used as a marker.

 

image.png.2e5dd51db56e6ebca9a92c1643d54fc9.png

 

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Other organizations have less strict markers for impaired glucose tolerance, but the fasting optimum values for healthspan and longevity as we know should be below 90 and always below 100 mg/dL

 

image.png.1d71c80f39e2c548a78f3a7d7e33ee9a.png

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I have yet to see evidence of what constitutes an optimal cholesterol profile for those without metabolic syndrome.   I'm focusing my optimizations on factors for which I have evidence based targets that are relevant to me.

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1 hour ago, Todd Allen said:

I have yet to see evidence of what constitutes an optimal cholesterol profile for those without metabolic syndrome.   I'm focusing my optimizations on factors for which I have evidence based targets that are relevant to me.

Yet, in all his recent podcasts, when cholesterol is discussed, Peter Attia always says that in his practice he wants it to be below pretty strict thresholds. And, like Luigi Fontana, he repeats that 'the lower, the better', without setting a lower threshold of risk.

So again, my question would be, what are the suggestions he gives to his patients, since glucose must be as low as possible, cholesterol as low as possible, but the regime to lower the former often tends to elevate the latter. I'm pretty sure that he doesn't suggest a macrobiotic diet based on cereals, vegetables, legumes and sesame seeds.

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25 minutes ago, mccoy said:

So again, my question would be, what are the suggestions he gives to his patients

He keeps his cholesterol down when very low carb by restricting saturated fat and making EVOO his primary fat source.  He claims that also works for many of his patients.  It worked for me too, my cholesterol was much lower when I used to include significant amounts of EVOO and nuts in my diet.

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I have never had difficulty keeping cholesterol, LDL  cholesterol, and FG all low.  And the same is true for most of the strict calorie restriction practitioners on this Forum. 

Perhaps making one's primary goal to be body building is not consistent with CR.

  --  Saul

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I never look at most guru podcasts.  Printed or text information (or at least hypotheses) is much more useful.

  -- Saul

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37 minutes ago, Saul said:

I have never had difficulty keeping cholesterol, LDL  cholesterol, and FG all low.  And the same is true for most of the strict calorie restriction practitioners on this Forum. 

Perhaps making one's primary goal to be body building is not consistent with CR.

  --  Saul

Saul

You don't have problems probably because your regime is based on vegetables and fish plus caloric restriction. That's another example of strict regime by which it is possible to reach optimization in both glucose and cholesterol homeostasis. I ruled out a priori though all the diets which are too stoic, which would cause food aversion in me, plus personally I don't eat fish.

For example, a keto-vegan diet with only unsaturated fats might do the trick maybe, but in my case it would mean drastic weight loss, muscle tissue included.

By the way, presently I cannot say I'm practicing bodybuilding, since I'm only bench pressing 2-3 times a week , plus cardio exercises. I should update the exercise optimization thread.

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43 minutes ago, Saul said:

Perhaps making one's primary goal to be body building is not consistent with CR.

I agree 100%. My priority is maximizing strength and physical performance.  Maximizing longevity is secondary.  My interest in CR ends where it ceases to be compatible with those goals.

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7 hours ago, mccoy said:

So again, my question would be, what are the suggestions he gives to his patients, since glucose must be as low as possible, cholesterol as low as possible, but the regime to lower the former often tends to elevate the latter. I'm pretty sure that he doesn't suggest a macrobiotic diet based on cereals, vegetables, legumes and sesame seeds

I am not sure that a reasonable balance cannot be achieved without too much effort, barring significant genetic factors.

Cutting all oils out of my home pantry (primarily EVOO) has dropped my cholesterol levels, and keeping them close enough to 1:1 HDL to LDL ratio. This was combined with a further decrease in my already reduced cheese consumption.

My glucose varies between the low 80s and 90s (the last FG test was over 100, but I believe it was an aberration addressed elsewhere). Not great, but given my very heavy carb consumption, it's generally within the optimum range as shown by Michael Lustgarten in his glucose-related video.

I don't test glucose at home because I have an aversion to pricking myself and the optical monitors are not accurate enough for precise measurements -- thus I wouldn't place much stock in Attia's claim of low peaks. The optical CGMs are, however, fine for monitoring general trends and I would buy one when Apple or Samsung implement the tech in their watches, likely next year.

I listened to the video and while I have major issues with Peter Attia's opinions, I still found it informative, thanks. I think he is incorrect in his interpretation of some of the research, and he does cherry-pick to make his points, more so than what I am comfortable with.

Based on what I have read, I believe that low-carb diets have temporary benefits for some specific cases, but in general, are unhealthy. I think there is plenty of evidence that high fat and high animal protein diets may make you lose weight, but are also atherosclerotic and likely to promote various forms of cancer.

One should also at least be aware that Peter Attia gets funding from the Arnold Foundation, which also funds the Nutrition Coalition, and Nina Teicholz, who essentially lobby on behalf of the meat and dairy industries, and the major agricultural interests. 

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9 hours ago, Ron Put said:

One should also at least be aware that Peter Attia gets funding from the Arnold Foundation, which also funds the Nutrition Coalition, and Nina Teicholz, who essentially lobby on behalf of the meat and dairy industries, and the major agricultural interests. 

Ron, Peter Attia a few years ago used to travel in that train, but more recently appears to have got off the wagon. He discloses his affiliations in his drive podcast.

Multiple times, and the latest one in his recent podcast with Tim Ferriss, he says clearly that low concentrations of cholesterol (LDL-C, LDL-P. APOEB) and triglycerides are required to effectively decrease the risk of atherosclerosis. Such concentrations are incompatible with a high fats diet, at least saturated fats, and exactly contrary to the narrative of Nina Teicholz and similar.

So, I find him pretty reliable. He still suggests a low carb diet, mainly because that's what his patients, or most of'em require. But he also suggests low cholesterol, which seems to be contrary to the classic low-carb diet based on saturated fats. Hence the glucose-cholesterol issue in this topic.

By the way, his CGM uses a subcutaneous needle and it's considered pretty reliable, although it needs a couple of calibrations per day. It's the present standard of care for T1D, I know people wearing it and they say it works.

9 hours ago, Ron Put said:

Cutting all oils out of my home pantry (primarily EVOO) has dropped my cholesterol levels, and keeping them close enough to 1:1 HDL to LDL ratio. This was combined with a further decrease in my already reduced cheese consumption.

My glucose varies between the low 80s and 90s (the last FG test was over 100, but I believe it was an aberration addressed elsewhere). Not great, but given my very heavy carb consumption, it's generally within the optimum range as shown by Michael Lustgarten in his glucose-related video.

I might try a lowfat diet and monitor the results. I would discard a priori diets like those proposed by McDougal and the macrobiotics though.

The glycemic range you cite is good (80-90 mg/dL), but I found that in my case, from that range it increased in the latest 3 years (an effect of aging?).

The fact that I practice regular, although moderate cardio exercise and developed some muscular mass was not enough to avoid the increase in fasting glucose and HBA1C, indicating that there are other factors governing, at least in my case.

 

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12 hours ago, Ron Put said:

My glucose varies between the low 80s and 90s (the last FG test was over 100, but I believe it was an aberration addressed elsewhere). Not great, but given my very heavy carb consumption, it's generally within the optimum range as shown by Michael Lustgarten in his glucose-related video.

The data inthe short blog from mike are pretty interesting, above all those related to the accidents occurring with low levels. That's evidently the result of an hypoglycemic condition, which can result in loss of focus and eventually coma.

Many more aspects are at play. FG is important, The average 3-months value or HbA1C when reliable, and the post-prandial spikes, measured after 2 hours as a benchmark.

With a CGM, another world opens up, with the continuous monitoring of AUV values, values of all spikes, including nightly spikes due to an excess of cortisol, the dawn effect due to the counterregulatory hormones and so on.

Edited by mccoy

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1 hour ago, mccoy said:

 I might try a lowfat diet and monitor the results.

Here's my simplistic take:

For most people, not all:  if you eat a WFPB diet, keep your calories low, animal proteins low, saturated fats low,  simple sugars  low, and exercise,  you shouldn't have much trouble achieving healthy cholesterol and glucose levels.   The relative amounts of healthy carbs and fats is probably the least important variable.

Dean Pomerleau (2016):

Quote

[Mechanism:]   would it not be unreasonable, to be conservative, to keep the % calories from oil/fat at or under the percent witnessed by blue zones populations?

[Dean:] Here is a good rule to follow. Keeping protein on the low side until one's elder years, when one should boost protein (and calories) to compensate for absorption issues and prevent sarcopenia. Beyond that, the evidence (including the so-called "Blue Zones") suggests that people can thrive on a wide range of percentages for the other two macronutrients - healthy carbs and healthy fats.

In your case, McCoy,  the first thing I'd suggest would be to reduce your caloric intake, bringing your BMI down to the 20-22 range. 

(Yeah, I know all the contrary bodybuilding arguments...) 

 

Edited by Sibiriak

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9 minutes ago, Sibiriak said:

In your case, McCoy,  the first thing I'd suggest would be reducing your caloric intake, bringing your BMI down to the 20-22 range.  (  Yeah, I know all the contrary bodybuilding arguments...) 

Sibiriak, the hypocaloric solution is sure a valid one, but now I weight about 71 kg with a BMI of 25, going down below 22 would mean to loose at least 9 kg of weight, which I deem too low for me, it will happen only if I get injured or seriously sick...At that bodyweight I look seriously emaciated.

Hence my search for alternative solutions.

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2 minutes ago, mccoy said:

.At that bodyweight I look seriously emaciated

Well, maybe 23 then. 😊  I bet you'd look ripped.

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23 well-ripped (7% adiposity) would be good, but pretty hard to maintain, almost impossible with my present workload, possible after retirement and exercising conspicuosly...

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7 hours ago, mccoy said:

With a CGM, another world opens up, with the continuous monitoring of AUV values, values of all spikes

Based on what I've read, I don't believe the accuracy of the optical glucose monitors is sufficient for precise monitoring, which is why I questioned Attia's claim about spikes. The CGMs appear to have value in establishing less granular trends during the day, which is fine for me, but not compelling enough to jump on the bandwagon yet. I  definitely replace my fitness watch with one that includes CGM when they appear. There were rumors about Samsung bringing one out this year, but now it seems unlikely. There is a more reliable report that Apple will introduce it in 2022.

 

7 hours ago, mccoy said:

I might try a lowfat diet and monitor the results.

If I may suggest simply removing EVOO and dairy from your home pantry? Restaurants, unless a daily event, are OK :) Measure before and then give it three months and see if you get a significant drop.

It worked well for me. I still eat almonds and walnuts daily and avocado a few times a week, but I don't use oil for cooking at home. Apple cider vinegar and spices make anything taste good to me.

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5 hours ago, Sibiriak said:

24? 

That would be pretty good, shedding some adiposity but saving the muscle tissue...

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1 hour ago, Ron Put said:

Based on what I've read, I don't believe the accuracy of the optical glucose monitors is sufficient for precise monitoring, which is why I questioned Attia's claim about spikes. The CGMs appear to have value in establishing less granular trends during the day, which is fine for me, but not compelling enough to jump on the bandwagon yet. I  definitely replace my fitness watch with one that includes CGM when they appear. There were rumors about Samsung bringing one out this year, but now it seems unlikely. There is a more reliable report that Apple will introduce it in 2022.

Ron, are you sure medical CGMs use optical and not electrical devices? That's a needle inserted into the skin, not just a sensor above it...

Edited by mccoy

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39 minutes ago, mccoy said:

Ron, are you sure medical CGMs use optical and not electrical devices? That's a needle inserted into the skin, not just a sensor above it...

No, I was actually completely confused, as I've been reading about the optical tech.... Just ignore me :)

I had seen a 20% accuracy and assumed it was some sort of optical, as it seemed high and that's the subject I had been reading about a couple of days ago. I didn't realize that that's the same accuracy as a regular glucose meter.

Edited by Ron Put

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Sibiriak, that's a pretty good article which summarizes the possible optimization of BG by meals patterns.

The article confirms the known fact that it's better too eat carbs at breakfast, adding that it's also best to eat little at night.

The effect of meal frequency is more confused, since the article cites studies which would tend to confute the thesis that fewer meals per day improve glucose status (although, OMAD is not contemplated in the studies).

From the graph below, an optimization strategy could be eat a little more at breakfast and more carbs, less carbs at lungh and less and very little carbs at dinner, especially if the dinner is a late one. By the way, the fact that lately I switched my dinners to later hours may be the cause for a worse glucose status.

I cannot paste the graph because the system only allows me 61 kb, I don't know if there is a quota in the 24 hours...

 

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