Quotations by Peter Attia

The real art to dietary restriction, Nutrition 3.0-style, is not picking which evil foods we're eliminating. Rather, it's finding the best mix of macronutrients for our patient-coming up with an eating pattern that helps them achieve their goals, in a way that they can sustain. This is a tricky balancing act, and it requires us to forget about labels and viewpoints and drill down into nutritional biochemistry. [2023] - Peter Attia

Now we have a tool to help us understand our own individual carbohydrate tolerance and how we respond to specific foods. This is called continuous glucose monitoring, or CGM. Typically, my healthy patients need to use CGM only for a month or two before they begin to understand what foods are spiking their glucose (and insulin) and how to adjust their eating pattern to obtain a more stable glucose curve. Fructose doesn't get measured by CGM, but because fructose is almost always consumed in combination with glucose, fructose-heavy foods will still likely cause blood-glucose spikes. [2023] - Peter Attia

Rice and oatmeal are surprisingly glycemic (meaning they cause a sharp rise in glucose levels), despite not being particularly refined; more surprising is that brown rise is only slightly less glycemic than long-grain white rice. Nonstarchy veggies such as spinach or broccoli have virtually no impact on blood sugar. Foods high in protein and fat (e.g., eggs, beef short ribs) have virtually no effect on blood sugar (assuming the short ribs are not coated in sweet sauce), but large amounts of lean protein (e.g., chicken breast) will elevate glucose slightly. Protein shakes, especially if low in fat, have a more pronounced effect (particularly if they contain sugar, obviously). [2023] - Peter Attia

In general, aerobic exercise seems most efficacious at removing glucose from circulation, while high-intensity exercise and strength training tend to increase glucose transiently, because the liver is sending more glucose into the circulation to fuel the muscles. Don't be alarmed by glucose spikes when you're exercising. All things equal, it appears that sleeping just 5-6 hours (versus 8 hours) accounts for about 10-20 mg/dL (that's a lot!) jump in peak glucose response, and about 5-10 mg/dL in overall levels. Stress, presumably, via cortisol and other stress hormones, has a surprising impact on blood glucose, even while one is fasting or restricting carbohydrates. The effect is most visible during sleep or periods long after meals. [2023] - Peter Attia

In a study that looked at the effect of strength training in 62 frail seniors, the subjects who did only strength training for 6 months gained no muscle mass. Another group of subjects was given protein supplementation (via a protein shake); those subjects added an average of about 3 pounds of lean mass. The extra protein likely made the difference. Similar results have been found in multiple other studies, although it remains unclear whether protein supplementation helps to improve muscle "strength" as well as muscle mass. We don't store protein in the way we store fat (in fat cells) or glucose (as glycogen). If you consume more protein than you can synthesize into lean mass, you'll simply excrete the excess in your urine as urea. [2023] - Peter Attia

The first thing you need to know about protein is that the standard recommendations for daily consumption are a joke. Right now the US recommended dietary allowance (RDA) for protein is 0.8g/kg of body weight. This may reflect how much protein we need to stay alive, but it's a far cry from what we need to thrive. More than one study has found that elderly people consuming that RDA of protein (0.8g/kg/day) end up losing muscle mass, even in as short a period as 2 weeks. In my patients I typically set 1.6g/kg/day as the minimum, which is twice the RDA. The ideal amount can vary from person to person, but the data suggest that for active people with normal kidney function, one gram per pound of body weight per day (or 2.2g/kg/day) is a good place to start-nearly triple the minimal recommendation. [2023] - Peter Attia

Older people in particular should try to keep track of their lean mass, such as via a body-composition-measuring scale (or better yet, DEXA scan), and adjust their protein intake upwards if lean mass declines. For me and my patients, this works out to 4 servings of protein per day (each at ~0.25g/lb of body weight), with at least one of them being a whey protein shake (Typically, I'll consume a protein shake, a high-protein snack, and two protein meals). The overall quality of protein derived from plants is significantly lower than that from animal products. The same is true of protein supplements. Whey protein isolate (from dairy) is richer in available amino acids than soy protein isolate. [2023] - Peter Attia

We try to boost monounsaturated fatty acids (MUFA) closer to 50-55%, while cutting saturated fatty acids (SFA) down to 15-20% and adjusting total polyunsaturated fatty acids (PUFA) to fill the gap. Putting all these changes into practice typically means eating more extra virgin olive oil (and high-MUFA vegetable oils) and avocados and nuts, cutting back on (but not necessarily eliminating) things like butter and lard, and reducing the omega-6-rich corn, soybean, and sunflower oils-while also looking for ways to increase high-omega-3 marine PUFAs from sources such as salmon and anchovies (or taking EPA and DHA supplements in capsule or oil form). [2023] - Peter Attia

While intermittent fasting and eating "windows" have become popular and even trendy in recent years, I've grown skeptical of their effectiveness. And frequent longer-term fasting has enough negatives attached to it that I'm reluctant to use it in all but the most metabolically sick patients. The jury is still out on the utility of infrequent (e.g. yearly) prolonged fasts. Overall, I've come to believe that fasting-based interventions must be utilized carefully and with precision. [2023] - Peter Attia

Three studies found no weight loss or cardiometabolic benefits on a 16/8 eating pattern (16 hours of fasting, 8 hours to eat). One other study did find that shifting the eating window to early in the day, from 8 am to 2 pm, actually did result in lower 24-hour glucose levels, reduced glucose excursions, and lower insulin levels compared to controls. So perhaps an early-day feeding window could be effective, but in my view 16 hours without food simply isn't long enough to activate autophagy or inhibit chronic mTOR elevation. Another drawback is that you're virtually guaranteed to miss your protein target with this approach. [2023] - Peter Attia

One small but revealing study found that subjects on an alternate-day fasting (ADF) diet did lose weight-but they also lost more lean mass (i.e. muscle) than subjects who simply ate 25% fewer calories every day. This study was limited because of its small size and short duration, but it suggests that fasting might cause some people, especially lean people, to lose too much muscle. On top of this, the ADF group had much lower activity levels during the study, which suggests that they were not feeling very good on the days they were not eating. [2023] - Peter Attia

If there is one type of food that I would eliminate from everyone's diet if I could, it would be fructose-sweetened drinks, including both sodas and fruit juices, which deliver too much fructose, too quickly, to a gut and liver that much prefer to process fructose slowly. Just eat fruit and let nature provide the right amount of fiber and water. [2023] - Peter Attia

Many studies have confirmed what your mother told you: We need to sleep about 7.5 to 8.5 hours a night. Getting significantly less sleep than this, or significantly more, will almost inevitably cause problems in the long run. Even a single night of bad sleep has been found to have deleterious effects on our physical and cognitive performance. Sleep is essential to performance in dangerous tasks, such as driving. [2023] - Peter Attia

Poor or inadequate sleep can help tilt us into metabolic dysfunction. Multiple large meta-analyses of sleep studies have revealed a close relationship between sleep duration and risk of type 2 diabetes and the metabolic syndrome. But it cuts both ways: long sleep is also a sign of problems. People who sleep 11 hours or more nightly have a nearly 50% higher risk of all-cause mortality, likely because long sleep = poor quality sleep, but it may also reflect an underlying illness. Similar risk associations have been found between poor or short sleep and hypertension (17%), cardiovascular disease (16%), coronary heart disease (26%), and obesity (38%). [2023] - Peter Attia

Our ability to obtain deep sleep declines with age, beginning as soon as our late twenties or early thirties, but worsening as we enter middle age. One analysis suggests that the bulk of the changes in adult sleep patterns occur between the ages of 19 and 60 and only minimally decline after that, if one remains in good health (a big if). More research points to the forties and sixties as the decades of life when deep sleep is especially important for the prevention of Alzheimer's disease. People who have slept less during those decades seem to be at higher risk of developing dementia later on. [2023] - Peter Attia

One study found that Ambien (zolpidem) actually decreased slow-wave sleep (deep sleep) without increasing REM, meaning people who take it are basically trading high-quality sleep for low-quality sleep. Older benzodiazepine drugs, such as Valium (diazepam) and Xanax (alprazolam) typically induce unconsciousness without improving sleep quality. Somewhat worryingly, their use has also been associated with cognitive decline, and they're generally not recommended for older adults beyond very short-term time horizons (nor is Ambien). [2023] - Peter Attia

Antagonist inhibitors such as Dayvigo (lemborexant) and Quviviq (daridorexant) have been approved for treating insomnia, and they appear to be promising. They are, however, quite expensive. One drug that we do find helpful for assisting with sleep is trazodone, a fairly old anti-depressant (approved in 1981) that never really took off. At the doses used to treat depression, 200-300 milligrams per day, it had the unwanted side effect of causing users to fall asleep. That side effect is what we want in a sleep medication, especially if it also improves sleep architecture. We have also had good results with the supplement ashwagandha. [2023] - Peter Attia

You should make a longer-term assessment of your sleep quality over the last month. Probably the best-validated sleep questionnaire is the Pittsburgh Sleep Quality Index, a four-page document that asks questions about your sleep patterns over the last month. There's another, even simpler quiz called the Epworth Sleepiness Scale, which asks users to rate how likely they're to fall asleep in certain situations. Yet another helpful screening tool is the Insomnia Severity Index, which provides an opportunity to reflect on and report your experience of sleep problems and their impact on your functioning and well-being. [2023] - Peter Attia

One large-scale survey found that the more interactive devices subjects used during the hour before bedtime, the more difficulties they had falling asleep and staying asleep-whereas passive devices such as TV, electronic music players, and best of all, books were less likely to be associated with poor asleep. Turn off the computer and put away your phone at least an hour before bedtime. [2023] - Peter Attia

This concept of sleep pressure, our need or desire for sleep, is key to many of our sleep tactics. One of the primary techniques that doctors use to treat patients with insomnia is actually sleep restriction, limiting the hours when they're "allowed" to sleep to six, or less. This basically makes them tired enough that they fall asleep more easily at the end of the day, and (hopefully) their normal sleep cycle is restored. Another way to help cultivate sleep pressure is via exercise, particularly sustained endurance exercise (e.g., zone 2), ideally not within 2 or 3 hours of bedtime. Even better is exercise that entails some exposure to sunlight (i.e., outdoors). [2023] - Peter Attia