Outlive: The Science and Art of Longevity by Doctor Peter Attia

[curious_george]

So...anyone else read this book?

Thoughts? Opinions?

I'm not looking for any specific sort of feedback this time. Just your general thoughts if you are familiar with this book or this author.

Thanks!

[Metalcat]

Peter Attia says a lot of stuff, a lot of it reasonable, some of it not, and it's very hard to tell the difference. He's definitely the darling of the tech-bro-medicine world, which is generally a bit of a clusterfuck, and he's promoted some serious quacks in that space.

He's extremely convincing, which should make people side-eye what he's saying. He tends to colour within the lines more than a lot of the bro-science quacks he has to associate with to stay famous, but I generally just tune him out.

Let's just say he's very, very good at being famous.

[curious_george]

Peter Attia says a lot of stuff, a lot of it reasonable, some of it not, and it's very hard to tell the difference. He's definitely the darling of the tech-bro-medicine world, which is generally a bit of a clusterfuck, and he's promoted some serious quacks in that space.

He's extremely convincing, which should make people side-eye what he's saying. He tends to colour within the lines more than a lot of the bro-science quacks he has to associate with to stay famous, but I generally just tune him out.

Let's just say he's very, very good at being famous.

Do you have any sort of recommendation for learning about the science of longevity research?

[Metalcat]

Peter Attia says a lot of stuff, a lot of it reasonable, some of it not, and it's very hard to tell the difference. He's definitely the darling of the tech-bro-medicine world, which is generally a bit of a clusterfuck, and he's promoted some serious quacks in that space.

He's extremely convincing, which should make people side-eye what he's saying. He tends to colour within the lines more than a lot of the bro-science quacks he has to associate with to stay famous, but I generally just tune him out.

Let's just say he's very, very good at being famous.

Do you have any sort of recommendation for learning about the science of longevity research?

Not really. A lot of it is kind of pie-in-the-sky interpretations of reasonable science that doesn't provide a lot of practical applications for the individual. It's an interesting area of development, but most of it at this point is "suuuuure, maybe...that sounds plausible I guess."

I don't doubt that some interesting stuff will come out of that movement eventually, but it's a whole lot more about cashing in on the tech-bro culture (and money) than anything else at this point.

[Metalcat]

It's also worth observing that fixation on longevity science is a remarkably male thing.

I've read about the few MDs in the US willing to prescribe rapamycin for longevity and they all indicate that it's overwhelmingly men coming to see them.

I'm fascinated by this. Is it just because these "gurus" are operating in the tech-bro space and marketing themselves to men, or is there some causal reason why men in particular are so willing to take unproven, and potentially very dangerous drugs for unproven reasons?

I remember when this happened with metformin years ago. Suddenly non diabetic men in droves were asking for metformin believing that it was a miracle longevity drug.

What is it about longevity tech/science that appeals to much specifically to men?

As for my thoughts on rapamycin, my take is this: the science is ridiculously unclear and limited. However, the one thing we do know about the human body is that it tends to adjust to whatever you put in it.

Pump a dude full of steroids and at first he'll look more masculine, but then the body will adjust and eventually he'll grow breasts. Take T4 to lose weight and at first you will drop weight like crazy, but eventually your body will adjust and blow out your thyroid to compensate. Take a 5HT supplement and for a brief period you might feel a lot happier, but over time the endogenous serotonin system might downregulate. Opioids work great for awhile and then you need elephant doses just to get through the day.

The body adjusts to whatever you give it. We have no clue how it adjusts to lower doses of rapamycin, but no one can conclude from the existing research that the long-term effects will be beneficial.

It also anecdotally has about a 5% serious infection rate according to one doctor who has been prescribing it for anti-aging for a few years. But how many serious infections does that mean for an individual over their lifetime, and what will the drug have done to their immune system over those years?

Will it have boosted the immune system as the longevity bros claim or will it suppress the immune system? Or will it temporarily boost it and then through regulation suppress it? Or will it boost it temporarily, then level off, then plummet if you stop taking rapamycin?

Who knows?

Could rapamycin turn out to be the miracle anti aging drug that metformin wasn't? Maybe, we'll see. But we don't even know yet what causes aging, not really, so we certainly don't have enough evidence for me to feel at all enthusiastic about taking a med long term and just expecting my body not to do something fucking stupid after long-term use.

I don't even like taking meds that are prescribed for my particular conditions because even well researched pharmaceuticals with known mechanism are a bit of a crap shoot.

If I was in my late 70s and despite my best efforts things were going downhill, I would probably be willing to try it. But if I were a healthy, middle aged person, I would focus more on living an optimally healthy lifestyle.

I would have a particular focus on optimizing my mental health, because we actually know that chronic psychological stress will age the fuck out of you.

[Kris]

It's also worth observing that fixation on longevity science is a remarkably male thing.

I've read about the few MDs in the US willing to prescribe rapamycin for longevity and they all indicate that it's overwhelmingly men coming to see them.

I'm fascinated by this. Is it just because these "gurus" are operating in the tech-bro space and marketing themselves to men, or is there some causal reason why men in particular are so willing to take unproven, and potentially very dangerous drugs for unproven reasons?

I remember when this happened with metformin years ago. Suddenly non diabetic men in droves were asking for metformin believing that it was a miracle longevity drug.

What is it about longevity tech/science that appeals to much specifically to men?

As for my thoughts on rapamycin, my take is this: the science is ridiculously unclear and limited. However, the one thing we do know about the human body is that it tends to adjust to whatever you put in it.

Pump a dude full of steroids and at first he'll look more masculine, but then the body will adjust and eventually he'll grow breasts. Take T4 to lose weight and at first you will drop weight like crazy, but eventually your body will adjust and blow out your thyroid to compensate. Take a 5HT supplement and for a brief period you might feel a lot happier, but over time the endogenous serotonin system might downregulate. Opioids work great for awhile and then you need elephant doses just to get through the day.

The body adjusts to whatever you give it. We have no clue how it adjusts to lower doses of rapamycin, but no one can conclude from the existing research that the long-term effects will be beneficial.

It also anecdotally has about a 5% serious infection rate according to one doctor who has been prescribing it for anti-aging for a few years. But how many serious infections does that mean for an individual over their lifetime, and what will the drug have done to their immune system over those years?

Will it have boosted the immune system as the longevity bros claim or will it suppress the immune system? Or will it temporarily boost it and then through regulation suppress it? Or will it boost it temporarily, then level off, then plummet if you stop taking rapamycin?

Who knows?

Could rapamycin turn out to be the miracle anti aging drug that metformin wasn't? Maybe, we'll see. But we don't even know yet what causes aging, not really, so we certainly don't have enough evidence for me to feel at all enthusiastic about taking a med long term and just expecting my body not to do something fucking stupid after long-term use.

I don't even like taking meds that are prescribed for my particular conditions because even well researched pharmaceuticals with known mechanism are a bit of a crap shoot.

If I was in my late 70s and despite my best efforts things were going downhill, I would probably be willing to try it. But if I were a healthy, middle aged person, I would focus more on living an optimally healthy lifestyle.

I would have a particular focus on optimizing my mental health, because we actually know that chronic psychological stress will age the fuck out of you.

Thank you for this. I have noticed the same thing, but without being able to comment intelligently on the bioengineering part.

[curious_george]

Edit: This probably isn't the place for me to delve into my personal history.

[Metalcat]

That's why I say that Attia says a alot of stuff, some of it good, some if it bull, the problem is telling the difference.

He criticizes over generalizations of research when it suits his narrative, but then does the exact same thing to promote his particular version of reality.

This is the same nonsense with every fucking pop science book I see, the criticisms are usually spot on, which is how they build their credibility, and then they go all sideways on their "explanations" and specific recommendations.

I see the same pattern over and over and over again.

Also, your particular anecdotes don't explain why men, in particular, are so drawn to longevity pop science. Plenty of women have lost their parents, I've spent my whole life watching my mom and her sister be very sick with MS. Women also tend to do more caregiving for sick and dying parents.

Also, woman have been taking highly questionable drugs for decades for the sake of health and weight-loss.

Literally all of your points could apply to women, especially the part about seeing health as a problem to solve. In my experience, women are MUCH more focused on solving their health problems than men are.

Women in general are more of a target for "health" literature and products, there's just something particular about branding it as "longevity" as opposed to "health" that seems to resonate with men. It makes it more like a futuristic thing and less of a "managing the inevitable decay" thing.

As a medical professional, my take is that making health a techy/longevity thing makes it more palatable to men. I've spent years trying to get men to care about basic health shit and they seem to have a cultural block against it. I've met countless men who take pride in never seeing doctors.

I cannot tell you how many men I've had to raised-voice fight with to care that they have dangerously high blood pressure. They take it as a personal insult. It's fucking crazy.

Caring about their health I think means recognizing some kind of weakness? Maybe? Whatever the case, I can see a lot of these stubborn as fuck men being attracted to a bro-science branding of "health" as not so much being about caring about basic personal maintenance and more about defying death.

When really, they're being sold the exact same thing as the women reading about health and supplements, but it seems to be packaged in more of a "you will get closer to invincibility" kind of branding.

If that branding gets men to eat vegetables, go to doctors, and care about their health, then awesome. But if it's mostly getting dudes to ask for rapamycin prescriptions, then SMH.

[curious_george]

That's why I say that Attia says a alot of stuff, some of it good, some if it bull, the problem is telling the difference.

He criticizes over generalizations of research when it suits his narrative, but then does the exact same thing to promote his particular version of reality.

This is the same nonsense with every fucking pop science book I see, the criticisms are usually spot on, which is how they build their credibility, and then they go all sideways on their "explanations" and specific recommendations.

I see the same pattern over and over and over again.

Also, your particular anecdotes don't explain why men, in particular, are so drawn to longevity pop science. Plenty of women have lost their parents, I've spent my whole life watching my mom and her sister be very sick with MS. Women also tend to do more caregiving for sick and dying parents.

Also, woman have been taking highly questionable drugs for decades for the sake of health and weight-loss.

Literally all of your points could apply to women, especially the part about seeing health as a problem to solve. In my experience, women are MUCH more focused on solving their health problems than men are.

Women in general are more of a target for "health" literature and products, there's just something particular about branding it as "longevity" as opposed to "health" that seems to resonate with men. It makes it more like a futuristic thing and less of a "managing the inevitable decay" thing.

As a medical professional, my take is that making health a techy/longevity thing makes it more palatable to men. I've spent years trying to get men to care about basic health shit and they seem to have a cultural block against it. I've met countless men who take pride in never seeing doctors.

I cannot tell you how many men I've had to raised-voice fight with to care that they have dangerously high blood pressure. They take it as a personal insult. It's fucking crazy.

Caring about their health I think means recognizing some kind of weakness? Maybe? Whatever the case, I can see a lot of these stubborn as fuck men being attracted to a bro-science branding of "health" as not so much being about caring about basic personal maintenance and more about defying death.

When really, they're being sold the exact same thing as the women reading about health and supplements, but it seems to be packaged in more of a "you will get closer to invincibility" kind of branding.

If that branding gets men to eat vegetables, go to doctors, and care about their health, then awesome. But if it's mostly getting dudes to ask for rapamycin prescriptions, then SMH.

lol - all excellent points.

I can explain why *I* am interested in it.

I can't really explain the sex difference because I don't understand either.

Maybe men are just less likely to submit to authority and show weakness in general, as you say. So health has to be described as a way to be superior in some way for men to pay attention to it.

[Morning Glory]

We are already pretty good at keeping older folks alive longer. I know that pure research is great but as a society we really should be putting more effort into reducing maternal/infant/child mortality. I have not read any Peter Attia but it sounds like he is missing the point entirely:

https://www.npr.org/sections/health-shots/2023/03/25/1164819944/live-free-and-die-the-sad-state-of-u-s-life-expectancy

"There are some things Americans get right, according to the "Shorter Lives" report: "The United States has higher survival after age 75 than do peer countries, and it has higher rates of cancer screening and survival, better control of blood pressure and cholesterol levels, lower stroke mortality, lower rates of current smoking, and higher average household income." But those achievements, it's clear, aren't enough to offset the other problems that befall many Americans at younger ages."

Tree, in reply to something you said way upthread, but not related to the rest of this post: if you have good health insurance and think you may have a family history of a neurodegenerative disease (e.g. Huntington's), you may be able to get genetic testing covered. Of course you will have to think about whether you really want to know or not, but it may be useful down the road for your children to have that information when making family planning decisions and whatnot. I also do not know if ltc insurers are able to discriminate based on that data but I know that health insurers are no longer allowed to, thanks to ACA rules.

[curious_george]

For the sake of anyone actually considering reading this book - I will point out the actual recommendations that he has and a brief summary.

Listed in order of importance, as pointed out in the book:

1. Exercise. With descriptions of various exercise routines, scientific studies about why exercise is important and the various effects, following proper form, etc.
2. Nutrition (or nutritional biochemistry) With various studies, advice, and his personal experience tracking biometrics of various people on different diets.
3. Sleep. Studies on sleep, why sleep is important, and how to optimize sleep.
4. Emotional health. The importance of therapy, positive relationships. and his own experience in therapy.
5. And finally the least important - Exogenus molecules. Mostly drugs related to lowering cholesterol, blood pressure, and helping to control type 2 diabetes.

Just want to give anyone reading this a brief overview of what the book is actually about, so they don't get an incorrect impression.

[Metalcat]

Yes, he mostly talks about reasonable common sense stuff that everyone already knows:

Eat well, sleep well, manage your stress, and get regular checkups and take what medications you need to.

And maybe those things need to be framed a certain way to get recalcitrant men to actually do them. God knows a lot of the standard advice doesn't work with a certain subset of men (not all men, I know, but enough that we stress about them, I say this from a place of frustrated concern, not hateful judgement).

But that's not what his fanbase is buying into. They're rushing to find MDs who will give them rapamycin. I seriously doubt the masses who are frothing at the mouth for that drug have already done the hard work of cleaning up their diets, working on their sleep hygiene, seeking therapy for their mental health, etc, etc.

Basic preventive health advice doesn't sell. These celeb-MDs always need some kind of really convincing hook to tag onto their otherwise rather generic advice.

Whether it's rapamycin or CGM or selling a bullshit tea (lookin at you Fung) or countless other supplements (that's you Axe), there's always some kind of special hook to distinguish themselves, get famous, and make a fuck tonne of money.

Simply put, these MDs don't have access to special information. They're not the first people to analyze these studies, nor are they even remotely the most qualified to.

If the research was as clear and tidy as they make it out to be, then that's how the science would be interpreted within the world of science.

I read research papers literally every single day and I have never once seen a conclusion that wasn't messy and complicated. It's always "well here are our findings and here's what they might mean, but here are also fifty seven reasons why you can't jump to too many conclusions and why more research is necessary."

That's why real interpretations of real science generally won't make anyone famous or rich.

Why do you think actual scientists don't make that much money?? Because facts, as they are, especially facts about how the human body works, are very, very, VERY hard to translate into profits, unless you throw a bit of bullshit and good marketing in.

Pharmaceutical companies are perpetually risking bankruptcy because of just how fucking hard it is to use science to come up with anything new in terms of improving human function.

So when some MD (not scientists) come out claiming they understand science in a way that the entire mega-science industry doesn't, and they have some "special" approach that will substantially change people's lives?? It doesn't sit well.

As I said though, people like Attia package basic common sense, scientists the fuck out of it to make it sound more sophisticated, and market that plus some special "hook" and make themselves far more powerful and wealthy than they could ever do just being normal clinicians and staying in their lane of knowledge and competence.

The issue of influencer doctors is a MASSIVE concern right now.

Conflicts of interest, dual relationships, it's just an ethical cluster fuck. The celebrity MD has always been an ethically conflicted role, especially for those are more on the celebrity side and have little to no checks and balances through governance of their conduct.

Med schools, nursing schools, and hospitals are all trying to develop clear policy guidelines for medical professionals and influencing. It's very, very complex.

That said, I've stipulated many times that even the biggest bullshitters can have a positive impact on people. My example I use all the time is Wheatbelly, which is a whole pile of nonsense, but it convinced a fuck tonne of people to stop eating shit all the time. He saved way more lives writing that book than he ever would have being a clinician.

But at what cost? The more these "hooks" make it into the public sphere of knowledge, the more confused people get and the less faith they have in science, because science is being misinterpreted for them.

Most people actually believe that science contradicts itself. They literally believe that different researchers find totally opposing findings, and they lose faith in science.

Why? Because a whole bunch of bullshit artists looking for a hook sold them books and blogs and teas and powders citing scientific findings as if they were more conclusive than they are.

Study findings are not facts, but the general public has been trained to interpret them that way. Study findings are puzzle pieces in 10,000 piece puzzles where you don't even know what the big picture is until you're about 6000 pieces in.

These doctors know this, which is why they pay lip service to the limitations of research so that they have plausible deniability when confronted, but there's no question that they wilfully bend the interpretations of the existing research to suit their particular hook.

If Attia encourages men to eat better, sleep better, seek mental healthcare, and get more regular, preventive medical care, then that's great for those individuals. I won't argue against that.

But as a former scientist, current licensed clinician, and current grad student who reviews MASSIVE amounts of literature each week, I am very, very bothered by the contribution of these so-called medical professionals towards the erosion of public faith in science and medicine, which is a HUGE fucking problem.

So I don't doubt that any given individual can benefit from these pop-science health books, but society as a whole is suffering so that a bunch of MDs can make a lot more money than they would by actually respecting the science they claim to be promoting.

[curious_george]

@Metalcat  - Jesus you type fast, lol. Thank you for your perspective.

I understand your concern, but in my social circle of blue working class barely graduated high school idiots, they get what little advice about health from random meme posts on facebook.

People who want advice will get it from somewhere.

Would you rather them get that advice from a practicing Medical Doctor, Harvard Professor, etc who wrote a pop-sci book...

or would you rather them get advice from silly memes on facebook?

I associate with people who barely graduated high school and have never read a book since high school.

Where do you want them to turn to for nutrition and exercise and health advice?

Because telling them everything is bull shit means they will fill that void with nonsense on facebook.

[Metalcat]

@Metalcat  - Jesus you type fast, lol. Thank you for your perspective.

I understand your concern, but in my social circle of blue working class barely graduated high school idiots, they get what little advice about health from random meme posts on facebook.

People who want advice will get it from somewhere.

Would you rather them get that advice from a practicing Medical Doctor, Harvard Professor, etc who wrote a pop-sci book...

or would you rather them get advice from silly memes on facebook?

I associate with people who barely graduated high school and have never read a book since high school.

Where do you want them to turn to for nutrition and exercise and health advice?

Because telling them everything is bull shit means they will fill that void with nonsense on facebook.

I literally already stipulated this benefit in my post.

Something can simultaneously be good in one context and horrific in another. That was my *entire* point, but obviously it wasn't clear enough.

[curious_george]

@Metalcat  - Jesus you type fast, lol. Thank you for your perspective.

I understand your concern, but in my social circle of blue working class barely graduated high school idiots, they get what little advice about health from random meme posts on facebook.

People who want advice will get it from somewhere.

Would you rather them get that advice from a practicing Medical Doctor, Harvard Professor, etc who wrote a pop-sci book...

or would you rather them get advice from silly memes on facebook?

I associate with people who barely graduated high school and have never read a book since high school.

Where do you want them to turn to for nutrition and exercise and health advice?

Because telling them everything is bull shit means they will fill that void with nonsense on facebook.

I literally already stipulated this benefit in my post.

Something can simultaneously be good in one context and horrific in another. That was my *entire* point, but obviously it wasn't clear enough.

*I* understand your stipulation.

Some friends of mine will read your post (and maybe some people on this forum) may read part of your post and conclude this doctor is completely full of shit.

Then they will turn somewhere else for advice - which could be even lower quality information.

That is my point. Your message, when talking to someone who is not educated, may be interpreted incorrectly and lead to even worse health outcomes for the masses.

Facebook memes are FAR more popular than these pop-sci books...

[curious_george]

Sorry - I will rephrase using your terminology.

You have attacked the professional credibility of various Medical Doctors on this forum and some professors just because they wrote a fucking book.

As someone who has personally benefitted from these works, and watched the transformation in other people, this makes me angry, which is a feeling you normally do not cause in me.
 

[Metalcat]

Sorry - I will rephrase using your terminology.

You have attacked the professional credibility of various Medical Doctors on this forum and some professors just because they wrote a fucking book.

As someone who has personally benefitted from these works, and watched the transformation in other people, this makes me angry, which is a feeling you normally do not cause in me.

I find this reaction odd, but I'll think about it. I'll also stop replying to your posts about pop science books because I don't want to unnecessarily upset you.

ETA: I'm not criticizing them as doctors, I'm criticizing them as influencers. The distinction is *very* important.

[curious_george]

Sorry - I will rephrase using your terminology.

You have attacked the professional credibility of various Medical Doctors on this forum and some professors just because they wrote a fucking book.

As someone who has personally benefitted from these works, and watched the transformation in other people, this makes me angry, which is a feeling you normally do not cause in me.

I find this reaction odd, but I'll think about it. I'll also stop replying to your posts about pop science books because I don't want to unnecessarily upset you.

ETA: I'm not criticizing them as doctors, I'm criticizing them as influencers. The distinction is *very* important.

Thank you.

Please continue to reply to the pop science books.

Your feedback is very valuable to me.

I am just being honest about how it makes me feel.

Most likely I am just misinterpreting your post on some emotional level, I think.

[Metalcat]

Sorry - I will rephrase using your terminology.

You have attacked the professional credibility of various Medical Doctors on this forum and some professors just because they wrote a fucking book.

As someone who has personally benefitted from these works, and watched the transformation in other people, this makes me angry, which is a feeling you normally do not cause in me.

I find this reaction odd, but I'll think about it. I'll also stop replying to your posts about pop science books because I don't want to unnecessarily upset you.

ETA: I'm not criticizing them as doctors, I'm criticizing them as influencers. The distinction is *very* important.

Thank you.

Please continue to reply to the pop science books.

Your feedback is very valuable to me.

I am just being honest about how it makes me feel.

Most likely I am just misinterpreting your post on some emotional level, I think.

I think you are feeling protective of a resource that you see as valuable to a vulnerable population who could use the help. You don't see my critiques as helpful to them, but really, they are the *exact* population I am most concerned about being affected by the erosion of faith in science and medicine.

Every time a clinician decides to become famous and rich by claiming they somehow have "special" access or understanding of science that many scientists understand better than they do, they erode public faith in science in general.

For clinicians, it can be fucking exhausting.

Attia is nowhere near the worst, not by a long shot. But he's also not exempt from the fundamental issue that responsible and faithful interpretation of science generally just doesn't make people famous and rich.

[curious_george]

Sorry - I will rephrase using your terminology.

You have attacked the professional credibility of various Medical Doctors on this forum and some professors just because they wrote a fucking book.

As someone who has personally benefitted from these works, and watched the transformation in other people, this makes me angry, which is a feeling you normally do not cause in me.

I find this reaction odd, but I'll think about it. I'll also stop replying to your posts about pop science books because I don't want to unnecessarily upset you.

ETA: I'm not criticizing them as doctors, I'm criticizing them as influencers. The distinction is *very* important.

Thank you.

Please continue to reply to the pop science books.

Your feedback is very valuable to me.

I am just being honest about how it makes me feel.

Most likely I am just misinterpreting your post on some emotional level, I think.

I think you are feeling protective of a resource that you see as valuable to a vulnerable population who could use the help. You don't see my critiques as helpful to them, but really, they are the *exact* population I am most concerned about being affected by the erosion of faith in science and medicine.

Every time a clinician decides to become famous and rich by claiming they somehow have "special" access or understanding of science that many scientists understand better than they do, they erode public faith in science in general.

For clinicians, it can be fucking exhausting.

Attia is nowhere near the worst, not by a long shot. But he's also not exempt from the fundamental issue that responsible and faithful interpretation of science generally just doesn't make people famous and rich.

I think you are right.

Because of my upbringing in poverty I have strong feelings associated with protecting and promoting poor people.

Sometimes I feel sad just walking into a restaurant, because I used to work in restaurants as a teenager trying to help my foster dad, and I remember the life struggles of the people working there (including myself at the time...).

Note that I do not intellectually disagree with your posts here, based on my experience reading many of these books. I agree the authors often stretch the truth of what the science says, and are basically instilling a sense of confidence in people that the science does not back up for financial benefit.

The anger is gone after I expressed it here.

Jesus therapy is going to be fucking emotionally challenging for me when I go.

No offense, but I might be screaming your name at my therapist at one point for sending me there. Emotionally processing things is WAY more challenging for me than intellectually processing things, and my emotional self is basically completely messed up.

I'm sure I will feel better after I can sort out my emotional self, instead of just repressing it all like I have done for years.

ETA: Note I am joking about screaming at my therapist. My point is just that it will be challenging for me.

ETA2: I'm also wondering if there are any books you would recommend for physical health and wellness and disease prevention?

When you were a teenager, or twenty something year old, what book, resource, website, or college course did you turn to to learn how to properly take care of your body?

Or do you only read published research reports on Pubmed?

Where would you suggest I turn to for information?

[Metalcat]

I read A LOT of dumbfuck pop science in my late teens and believed some really nonsense shit because of it, like that I had to eat according to my blood type.

I also did body building in my late teens and can't even begin to explain the bullshit that I absorbed from that nonsense world.

[curious_george]

I read A LOT of dumbfuck pop science in my late teens and believed some really nonsense shit because of it, like that I had to eat according to my blood type.

I also did body building in my late teens and can't even begin to explain the bullshit that I absorbed from that nonsense world.

I see.

What would you recommend I read?

I mean - I totally see your point about pop science books.

But where should I get my information from?

Or should I just go to medical school?

[Metalcat]

I read A LOT of dumbfuck pop science in my late teens and believed some really nonsense shit because of it, like that I had to eat according to my blood type.

I also did body building in my late teens and can't even begin to explain the bullshit that I absorbed from that nonsense world.

I see.

What would you recommend I read?

I mean - I totally see your point about pop science books.

But where should I get my information from?

Or should I just go to medical school?

N'ah, go ahead and read books, just go in with your eyes open that they're flexing a lot of "facts" and trying to sell you something.

If they're peddling largely common sense, then, okay cool, although you already have that, so I'm not sure what you're looking to gain from it.

You don't have to go to med school, but you can absolutely start reading textbooks, which are generally much better curated collections of research than pop science because absolutely no one is getting rich off of textbooks, lol. You enjoyed the intro neuroscience book I recommended for you. You can just read more of that.

You can also find one or two year old editions of textbooks for free online. Intro textbooks are written for a highschool level education, so they're very easy for most people to understand. From there you can read more and more advanced texts if you want to.

If you haven't already, then start with intro chem and bio, then read organic chem and biochem. This will give you a foundational level of knowledge that will allow you to better understand literally anything and everything you read about health.

Also consider a course like this, I was an arts student when I started school and this was literally the first course I ever attended, it was a chemistry course for non-science students. I loved it so much I taught myself highschool science and physics in order to take other core science classes. I didn't have highschool science and math, so I picked up textbooks for those and taught myself enough to ace my university science courses.

https://carleton.ca/chemistry/current-students/undergraduate/courses/chem-1003-the-chemistry-of-food-health-and-drugs/

You could also email the prof and find out what the textbook is for that course. I remember it being really enjoyable to read.

So basically, yeah, my answer is to read textbooks. They aren't perfect, the further you study the more you will see flaws in them.as well, but at least they're generally very well respected in the science world as a fair representation of the current science.

[curious_george]

Ok - this sounds like excellent advice.

I generally learn less and less from every pop sci book I read, and I did love the biopsychology book way more. I prefer the dry fact filled books with references, lol.

Thank you for the advice!

[DK]

So...anyone else read this book?

Thoughts? Opinions?

I'm not looking for any specific sort of feedback this time. Just your general thoughts if you are familiar with this book or this author.

Thanks!

Bought it but haven't read it yet. Heard some interviews on it so have part of the gist...am a subscriber to his podcast and have followed him a few years so probably have an idea of what will be in it. Heard it's a bit more high level than his in depth podcasts but it allows for a wider audience to get a grasp of the concepts. As far as himself, i'm a fan. Better than a lot of the more salesy podcast/influencers and like his engineer/math/doctor brain he uses. Check out his podcast or other writing if you enjoy his book.

[curious_george]

So...anyone else read this book?

Thoughts? Opinions?

I'm not looking for any specific sort of feedback this time. Just your general thoughts if you are familiar with this book or this author.

Thanks!

Bought it but haven't read it yet. Heard some interviews on it so have part of the gist...am a subscriber to his podcast and have followed him a few years so probably have an idea of what will be in it. Heard it's a bit more high level than his in depth podcasts but it allows for a wider audience to get a grasp of the concepts. As far as himself, i'm a fan. Better than a lot of the more salesy podcast/influencers and like his engineer/math/doctor brain he uses. Check out his podcast or other writing if you enjoy his book.

Oh - I did not even realize he had a podcast and followers. This helps to put Metalcats posts into perspective better.

I just bought the book because he is a Medical Doctor and Huberman and a guy I work with endorsed the book. I buy books all the time without thinking much about it, lol.

With that said - I found the book to be pretty excellent in general. Especially the high level advice.

I'm a little perplexed by his protein recommendation of 1 gram /lb of body weight or something iirc. That seems absurdly high to me and different from what other longevity influencers recommend. That was the only part where I was sort of questioning his advice.

There seems to be some dispute among the different longevity influencers if it is better to aim for high protein (150 grams /lb of body weight) to ensure higher lean muscle mass, because various physical abilities, Vo2 max, grip strength, are correlated so tightly with longevity.

Some other influencers argue it is better to keep protein around 50 grams per pound of body weight per day, because blue zones diets + protein causes insulin release, which encourages cell growth and division.

I'm too ignorant about the science here to figure out who is correct, lol.

[Metalcat]

No one knows, that's my entire point.

[curious_george]

No one knows, that's my entire point.

Yeah - I mean - you're not wrong, and you have excellent points.

We just need a billion dollars, to clone 10,000 men and 10,000 women. We will then separate them at birth into two groups, monitor 24/7 and force one group to eat 1 gram of protein / lb of body weight, and the other group 0.33 grams /lb of body weight. We will keep all other aspects of the diet the same.

Then we will monitor them 24/7 for 120 years and see which ones die first (j/k)

I mean - I'm not even sure how to design a good study for some of the longevity research because ideal studies would require forcing human beings en masse to eat and do certain things for decades.

[Metalcat]

No one knows, that's my entire point.

Yeah - I mean - you're not wrong, and you have excellent points.

We just need a billion dollars, to clone 10,000 men and 10,000 women. We will then separate them at birth into two groups, monitor 24/7 and force one group to eat 1 gram of protein / lb of body weight, and the other group 0.33 grams /lb of body weight. We will keep all other aspects of the diet the same.

Then we will monitor them 24/7 for 120 years and see which ones die first (j/k)

I mean - I'm not even sure how to design a good study for some of the longevity research because ideal studies would require forcing human beings en masse to eat and do certain things for decades.

No, you nailed it. The kind of studies we need for really good information are impossible.

I've mentioned this book many times, but you should really read "Unsavory Truth" by Marion Nestle if you want a good understanding of the nutrition science industry.

Rat and mouse models are great for a lot of things, but they have major limitations when studying long term effects of anything, because they only live for 2 years!

In some ways, that helps when studying longevity because we can do quickly see the lifespan impact on them, but on the flip side, it means we have zero clue what happens long term. An animal that only lives for 2 years is, by definition, experiencing aging very, very differently from a human.

Rats have absolutely astronomical metabolisms and insanely high heart rates, like 500bpm, their parts just aren't designed to last.

You can imagine how vastly differently two types of bodies would evolve in terms of aging when one species is designed to burn out while many of the other species are still just being weaned.

I've personally killed...oh god...so many rats for the sake of trying to understand things and to be able to generalize them to humans and there's just a knowledge gap there that can't be traversed because although we still allow truly horrific shit to be done to rats, we don't tolerate it anymore with primates, good luck even getting approval to experiment on a cat! My former lab went through so many cats back in the day before we had to switch to rats. Really we wanted gerbils and bars because of their particular brain structure, not because they were similar to humans, but just because the parts of the brain we were doing shit to were bigger.

I then ran an entire animal research facility and was on the ethics committee. I've seen so, so many experiments that have eventually failed to be generalizable to humans. Some work out beautifully, in fact, many do, but something like longevity, which we don't even understand?? Like, at all???

Trying to navigate that science is like walking around the woods blindfolded.

Human longevity is the most complex issue of an incredibly complex organism that we barely, and I mean *barely* understand.

My surgeon can't even tell me which of my rotated bones to fix, and that's a clear mechanical problem that should be solveable, but it isn't because no one will ever be allowed to break.a bunch of people's femurs and tibias in a bunch of different places and then force them to walk or run for hours on end to figure out how the hip ligaments tear.

Want to know the most fun part? My surgeon doesn't even know for certain if the pain I have is even from the torn ligaments, because in a lot of cases, torn labrums don't hurt.

This is one of the top researchers in the whole world with access to every speck of science that exists, and believe me, a fuck tonne of it exists, and he has decades of experience *just* doing this kind of surgery. And even then, science and an astounding amount of medical expertise can't help this guy figure out which bone to break to stop mechanical overload of a joint.

This is simple fucking physics and acute surgical solutions and science is useless and hopeless for providing answers.

So how the hell is anyone supposed to know how the fuck to control a process that involves every single part of the body and that as of yet absolutely no one has come close to understand in any species, much less one of the longest living ones.

That's why I'm skeptical of anyone who claims to have answers that somehow the rest of the scientific community doesn't seem to recognize.

The hubris of it is truly astounding.

We know the basics:
-eat nutrient dense foods, not too much
-exercise
-sleep well
-manage stress/mental health
-don't avoid doctors

Maybe keto is the secret to longevity, maybe intermittent fasting is, maybe intermittent fasting combined with keto is, maybe rapamycin is, maybe THC is, maybe the purring of cats is, maybe diet that focuses on colourful plants is, maybe a diet that avoids colourful plants is, maybe serrapeptase is, maybe cryotherapy is, maybe heat therapy is, maybe heat therapy AND cryotherapy is.

These are all things I've seen individual studies suggest. The key word is "suggest." Because absolutely no one fucking knows.

We still don't know how Tylenol works FFS.

[Experimental_FIRE]

@Metalcat your posts are always so robust that I enjoy reading them. I completely agree with you that a lot of men will not take care of their bodies. And they take great pride in not seeing doctors. This makes absolutely no sense to me. I'm on the opposite end of that spectrum. I get a physical every year and get my blood work done religiously. I am in my late 40's and I started this path when I turned 40.

That's probably why I find Attia and Huberman interesting. I would never take the drug they are promoting and as I recall it's a study done on mice. Who knows what it would do to human long term.

I get the nuance as you pointed out. If 'followers' could take the little bits that push them to better health it's all good. But for the ultra rich who want to do nothing and pop a pill it's probably bad.

I'd disagree with you on one point. I don't think that their standard advice to practice good sleep hygiene and exercise etc. is common sense. It's common sense to you, like it's common sense to people here to invest their money rather than waste it. Mainstream culture used to say 'you can sleep when you are dead.' The focus on sleep is finally getting through to people but it's a long ways from common sense.   

I'm curious what your thoughts are on following a whole food plant based diet. I have been mostly eating this way for 5 years. I didn't come to it out of dire health but instead to enhance my health. I personally found that my energy levels shot up and generally find that it's simpler to maintain a healthy bodyweight. My experience is an n of 1.

In this area specifically, like every diet area, there are influencers. And yes, generally they were medical doctors who dove into the research. I'm sure there are holes in the research like every diet. And I understand that eating a diet like this one is a modern possibility.

I'm not convinced that if I eat only vegetables that I'll never get dementia, but I think I have a extremely good chance of avoiding weight related issues, type 2 diabetes, heart disease etc.

[Metalcat]

I think there's a cultural ethos to take pride in being "hardcore" enough to not sleep. There's a lot of bragging about how little sleep people get and how much coffee they drink.

But I still think it's common sense that they all know that they should be sleeping well. I mean, every moron out there knows about the 7-8hrs/night recommendation (whether that's accurate or not, TreeLeaf has read the textbook that explained the research bias behind that).

I think people disregard it the same way they casually disregard the common wisdom that they should floss daily, eat 5-10 servings of vegetables, exercise daily, minimize alcohol, not smoke, etc.

As for my opinion on diet? I only have personal anecdotes because there is no clear science.

We know what nutrients we need, we know what foods have those nutrients, that's about all we know. Seriously, that's what the analysis of a med school course I took on nutrition was. The conclusion was that you can't as a doctor ethically make a lot of specific diet recommendations because there is no good evidence to support most of it.

Basically the old adage "eat food, not too much, mostly plants" is about as definitive as we have, and even then the carnivore people would argue against it and cite a whole bunch of science.

You can find evidence for just about any diet because the evidence isn't at all conclusive. So all of that seemingly "conflicting" evidence isn't actually conflicting at all, it's just very, very small puzzle pieces of a very, very large puzzle.

Once you wrap your mind around the fact that ALL nutrition, health, and longevity research is actually entire compatible and no findings ever contradict other findings, then you can really grasp how little of the big picture is actually known.

There's no such thing as science that contradicts other science. There's only interpretations of science that conflict with other interpretations and the more tenuous the interpretations or the more biased the research design, the easier it is to have those conclusions challenged.

But what the science *actually* shows can never conflict with what other science actually shows. It's literally impossible.

So the carnivore evidence coexists with the vegan evidence and both are valid in some way that we just can't yet reconcile.

What I do know from experience is that different people respond differently to the same way of eating, the same way different people respond VERY differently to the same medication.

Bodies are just fucking complex and the assholes fucking change over time!

Let's not forget also that all rat and mouse studies are done only on male animals because the impact of estrus is so profound that it would fuck with the outcome of any study.

Think about that. A totally normal part of function for half of all rats is so unpredictable and so confounding that HALF of all rats need to be systematically excluded from research.

I repeat: BODIES ARE FUCKING COMPLEX.

[Experimental_FIRE]

That was a good read, thank you. I understand what you are saying about commonsense. It's often thrown out in the pursuit of other things.

One thing I find frustrating about modern medicine is that it is generally sick care. And that works when you are sick. I'm sure glad it was then when I fractured my jaw in 3 places.

But if you want to be proactive with your health most doctors are unwilling to 'work with you'. I asked for a PSA test so that I could have a benchmark for prostate cancer. My doctor said I was too young to worry about it much but I persisted. I guess technically he worked with me because he gave me the script and I had the test. But then he told me that the test itself is not that accurate and if you make a decision to have you prostate removed proactively (based on a high result) that can lead to all kinds of other problems. He explained his point so I left confused.

I hear what you are saying about how complicated bodies are and how it is to get conclusive evidence. I think for the lay person, myself included, this is where it gets so confusing. There is so much conflicting information, as you pointed out either by influencers or mainstream media. And much of that information is influenced by studies funded by companies or associations with a vested interested in a positive result. Butter is back! When people hear 'good news about their bad habits' they throw their hands up and keep following the same patterns.

I think there's a cultural ethos to take pride in being "hardcore" enough to not sleep. There's a lot of bragging about how little sleep people get and how much coffee they drink.

But I still think it's common sense that they all know that they should be sleeping well. I mean, every moron out there knows about the 7-8hrs/night recommendation (whether that's accurate or not, TreeLeaf has read the textbook that explained the research bias behind that).

I think people disregard it the same way they casually disregard the common wisdom that they should floss daily, eat 5-10 servings of vegetables, exercise daily, minimize alcohol, not smoke, etc.

As for my opinion on diet? I only have personal anecdotes because there is no clear science.

We know what nutrients we need, we know what foods have those nutrients, that's about all we know. Seriously, that's what the analysis of a med school course I took on nutrition was. The conclusion was that you can't as a doctor ethically make a lot of specific diet recommendations because there is no good evidence to support most of it.

Basically the old adage "eat food, not too much, mostly plants" is about as definitive as we have, and even then the carnivore people would argue against it and cite a whole bunch of science.

You can find evidence for just about any diet because the evidence isn't at all conclusive. So all of that seemingly "conflicting" evidence isn't actually conflicting at all, it's just very, very small puzzle pieces of a very, very large puzzle.

Once you wrap your mind around the fact that ALL nutrition, health, and longevity research is actually entire compatible and no findings ever contradict other findings, then you can really grasp how little of the big picture is actually known.

There's no such thing as science that contradicts other science. There's only interpretations of science that conflict with other interpretations and the more tenuous the interpretations or the more biased the research design, the easier it is to have those conclusions challenged.

But what the science *actually* shows can never conflict with what other science actually shows. It's literally impossible.

So the carnivore evidence coexists with the vegan evidence and both are valid in some way that we just can't yet reconcile.

What I do know from experience is that different people respond differently to the same way of eating, the same way different people respond VERY differently to the same medication.

Bodies are just fucking complex and the assholes fucking change over time!

Let's not forget also that all rat and mouse studies are done only on male animals because the impact of estrus is so profound that it would fuck with the outcome of any study.

Think about that. A totally normal part of function for half of all rats is so unpredictable and so confounding that HALF of all rats need to be systematically excluded from research.

I repeat: BODIES ARE FUCKING COMPLEX.

[curious_george]

Just to add to @Metalcat 's excellent advice. Yeah - sleep hours is highly disputed. Sleep needs vary from individual to individual, depending on age, health status, genetics, etc.

I have basically concluded that good sleep is not a specific number of hours but a focus on optimal sleeping conditions. If you have optimal sleeping conditions, and you sleep, you will probably sleep as long as your body needs, whatever that number is.

What does good sleep hygeine look like?
Basically:
-Consistent sleep schedule
-Setting aside enough time for sleep. If you wake up in the morning and feel like you could go back to sleep, then you probably did not set enough time for sleep
-Sleep in a cool but not cold, dark room.
-Having sunlight or bright light exposure during the day.
-Stay healthy in other ways (mental health, diet, exercise)
-Being psychologically prepared for sleep (be relaxed mentally before sleep)
-Don't stare at lights and screens right before bed or in the middle of the night(I type this as I'm staring at a screen before bed, lol)

The actual number of hours are highly disputed by the studies because - they vary from individual to individual.

This is my best advice, after reading several books and studies about sleep, and I'm not even that confident in this advice, because this isn't my area of expertise, lol.

ETA: Basically, it's complicated. 7-8 hours is a good average number, but this is misleading because there are some people who can sleep for 5 hours a night for decades with no apparent ill effects, and others who need 10 hours, etc.

The more you read the studies, the more you realize how little we actually know about how much sleep we need, and how not confident we are in what data we have. The effect sizes are not large enough to draw any firm conclusions about the hours needed for any particular individual.

For example - there are studies showing that people who are sleeping more than 9-10 hours per night is strongly correlated with early mortality in a dose dependent manner...so some very smart people concluded too much sleep must be killing people.

Further studies showed that these people are sleeping too long because they have an underlying health condition, which is causing them to die prematurely, and not because of the extended sleep duration. So then some very smart people concluded people who sleep too much have some other underlying medical conditions.

Further studies showed that some people, for completely unknown reasons, seem to require 10+ hours of sleep per night but still seem completely healthy and have average mortality rates.

There are similar studies purposely temporarily depriving healthy people of sleep down to around 5 hours, and various cognitive testing scores show no apparent ill cognitive effects after the brain has adapted for a few days to this schedule.

Some very smart college neuroscience professors then concluded that this means the general population only needs 5 hours of sleep (with the implicit assumption that this sort of deliberate sleep deprivation can be maintained for years and decades with no ill effects - an assumption that the science does NOT prove. Considering the function of sleep is related to immune system health. cardiovascular health, and even shit like how well we can control blood sugar levels during the day, this is straight up dangerous advice - but some college professors PUT THIS INTO A FUCKING ACADEMIC TEXTBOOK! Because various cognitive test and imaging show that the brain has an adaptive ability to adapt to sleep deprivation...but we have no long term health studies and few studies on how sleep deprivation even impacts other aspects of our health like how, exactly it impacts our immune system (we know it does, but the interpretation of if the impact and if it is positive or negative is debated, because we also don't know how exactly the immune system even fucking works)

To further complicate matters - there are enough other studies showing how dangerous deliberate sleep deprivation is on your health, that some scientists argue that deliberate sleep deprivation in healthy humans is not ethical and these sorts of studies should be banned....so we may never actually have an answer.

An influencer will take one of these individual studies that show some small, statistically insignificant correlation, claim they know the underlying cause, then provide a recommendation with full confidence that it will improve some aspect of your health, then sell you some product to do this, all while they get rich and you get poor, when really we have no real fucking idea and might actually be taking something or doing something that we believe makes us healthier but actually harms our health.

So this is really fucking horrible and makes the whole health and science field look bad for the average person and makes people lose confidence in modern medicine and the scientific community as a whole, and do stupid things as a result, all while they get poor and the infuencers get rich.

Which I think is @Metalcat entire point here...

My counter point is that several influencers are actually legit practicing Medical Doctors and professors these days, and some if them (like Huberman....) literally became an influencer to try and combat some of this bullshit and they realize the whole reason the bullshit exists to begin with is because there is a void of health and medical information for the common Joe.

So their high level advice is basically sound, even while they are selling snake oil and bullshit on the side to pay for their lambo and mansion. They get average Joe's interested in health, and enough of them start doing the high level healthy things that the overall societal effect is positive, even while they sow chaos and confusion and doubt about science in the process.

So - they get more people interested doing generally healthy things, even if they are making money and selling people snake oil on the side, so the OVERALL effect is positive for society even if there is tons of bullshit involved.

I view religion in a similar manner - complete bullshit, tons of negativity, but the OVERALL effect for the AVERAGE joe of simply being in a room full of your community members every week in a positive atmosphere and having some hope for the future is positive on people's mental and emotional health.

I also view Santa Clause the same way as well, if anyone is keeping score.

[curious_george]

That was a good read, thank you. I understand what you are saying about commonsense. It's often thrown out in the pursuit of other things.

One thing I find frustrating about modern medicine is that it is generally sick care. And that works when you are sick. I'm sure glad it was then when I fractured my jaw in 3 places.

But if you want to be proactive with your health most doctors are unwilling to 'work with you'. I asked for a PSA test so that I could have a benchmark for prostate cancer. My doctor said I was too young to worry about it much but I persisted. I guess technically he worked with me because he gave me the script and I had the test. But then he told me that the test itself is not that accurate and if you make a decision to have you prostate removed proactively (based on a high result) that can lead to all kinds of other problems. He explained his point so I left confused.

I hear what you are saying about how complicated bodies are and how it is to get conclusive evidence. I think for the lay person, myself included, this is where it gets so confusing. There is so much conflicting information, as you pointed out either by influencers or mainstream media. And much of that information is influenced by studies funded by companies or associations with a vested interested in a positive result. Butter is back! When people hear 'good news about their bad habits' they throw their hands up and keep following the same patterns.

I think there's a cultural ethos to take pride in being "hardcore" enough to not sleep. There's a lot of bragging about how little sleep people get and how much coffee they drink.

But I still think it's common sense that they all know that they should be sleeping well. I mean, every moron out there knows about the 7-8hrs/night recommendation (whether that's accurate or not, TreeLeaf has read the textbook that explained the research bias behind that).

I think people disregard it the same way they casually disregard the common wisdom that they should floss daily, eat 5-10 servings of vegetables, exercise daily, minimize alcohol, not smoke, etc.

As for my opinion on diet? I only have personal anecdotes because there is no clear science.

We know what nutrients we need, we know what foods have those nutrients, that's about all we know. Seriously, that's what the analysis of a med school course I took on nutrition was. The conclusion was that you can't as a doctor ethically make a lot of specific diet recommendations because there is no good evidence to support most of it.

Basically the old adage "eat food, not too much, mostly plants" is about as definitive as we have, and even then the carnivore people would argue against it and cite a whole bunch of science.

You can find evidence for just about any diet because the evidence isn't at all conclusive. So all of that seemingly "conflicting" evidence isn't actually conflicting at all, it's just very, very small puzzle pieces of a very, very large puzzle.

Once you wrap your mind around the fact that ALL nutrition, health, and longevity research is actually entire compatible and no findings ever contradict other findings, then you can really grasp how little of the big picture is actually known.

There's no such thing as science that contradicts other science. There's only interpretations of science that conflict with other interpretations and the more tenuous the interpretations or the more biased the research design, the easier it is to have those conclusions challenged.

But what the science *actually* shows can never conflict with what other science actually shows. It's literally impossible.

So the carnivore evidence coexists with the vegan evidence and both are valid in some way that we just can't yet reconcile.

What I do know from experience is that different people respond differently to the same way of eating, the same way different people respond VERY differently to the same medication.

Bodies are just fucking complex and the assholes fucking change over time!

Let's not forget also that all rat and mouse studies are done only on male animals because the impact of estrus is so profound that it would fuck with the outcome of any study.

Think about that. A totally normal part of function for half of all rats is so unpredictable and so confounding that HALF of all rats need to be systematically excluded from research.

I repeat: BODIES ARE FUCKING COMPLEX.

Just wanted to mention this - a lot of tests (especially blood tests, ultrasounds, etc) can be purchased online these days.

See here, for example: https://www.ultalabtests.com/

Doctors these days try not to run unneeded tests on people. They then have to argue with insurance companies and justify medically why the test was ran, and you often can't justify a test unless someone has a medical problem to begin with.

Or at least that is how my doctor explained to me why he refused to run a basic A1C test, even though I said I was willing to bypass insurance and pay cash.

Of course - DIY'ing your own health an be even worse than trying to diy other things, because if you're wrong about something it could mean your own death.

So - imo - understanding what you DO know about something healthwise is just as important as understanding and admitting when you DON'T know something.

On the flip side you can run personal experiments and then run your own bloodwork to see how they impact things like your ApoB score, A1C score, CRP test, etc, which can give you important insights into your overall state of health and what changes to make to try and improve things.

But - yeah - it can be dangerous...But - given how often well-educated and well trained medical doctors misdiagnose things, and make medical mistakes, that can also be dangerous.

My approach to medics care is to generally DIY my own preventative care, but if I develop an actual medical problem that I can't handle I will hand it over to the medical doctors to treat.

[Metalcat]

More testing is not necessarily better, that's also why I take such issue with the CGM folks.

Understanding what test results mean requires a lot of contextual knowledge. The public have an image of medical testing as some kind of clear indicator of what's going on in the body, when that's rarely the case.

Testing is an incredibly nuanced and complicated thing.

An absolute hallmark of quack doctors is that they do sooooo many tests in the name of being "thorough" and having "superior" standard of care.

In my practice pretty much every week some salesperson was peddling the latest in diagnostic technology and these were the smarmiest fucks in the industry.

Diagnostics is as much of an art as it is a science. And tests are a hell of a lot less clear than lay people think they are.

What tests *actually* measure is constantly being debated, the "normal ranges" for results are hotly contested, the interpretations of results are, well, kind of terrifyingly vague a lot of the time.

As I always said to patients: "x-rays are literally shades of grey."

I've personally been tested upsidedown and backwards. I'm probably in the top .01% of people in terms of the amount of testing I've been through. Literal liters of blood have been tested, every single body structure has been MRI'd, CT'd, x-ray'd, or ultrasounded, most of them have been subjected to multiple of the above.

I've had more biopsies than I can count, multiple exploratory surgeries, coooountless diagnostic treatments, and so, so many assessments. I've seen dozens of specialists.

Because my condition affects every organ and every joint, literally EVERYTHING has been tested, and not a single result has ever been very clear or given a clear path forward.

Medicine is seriously as much of an art as it is a science.

I'm not saying self testing doesn't have value. Just that testing is so much more nuanced and complicated than it appears on the surface, and when doctors don't test, it isn't just about insurance, it's usually about best practices.

I tested A LOT less than my colleagues.

I was the second opinion for a nearby colleague who tested people up to their eyeballs and then convinced them based on the results that they needed to remortgage their houses for 70K worth of treatment or else the health consequences would be dire.

Damn, her testing was convincing.

I literally didn't even look at the results when offering a second opinion because her tests, although convincing, were actually worthless. They showed *something* but the proper interpretation was so fuzzy that they couldn't actually guide treatment. They could tell the patient a TON about themselves, but what it actually meant in terms of outcomes wasn't nearly as clear as she made it out to be.

I did a 3 minute assessment and recommended a $500 treatment with a shrug and a "maybe this will help, but there are no tests that can predict whether it will or not, but mechanically it does the exact same thing as her massive suite of procedures and she can't predict if her much more invasive treatment will work either."

So after a lifetime of testing and a career of dealing with test-happy quacks, I'm pretty conservative when it comes to testing, especially in terms of vague goals like "health" and "longevity."

This is not to say that I don't value testing. I couldn't do my job without appropriate testing. I'm just saying that testing isn't the panacea it's made out to be.

[curious_george]

@Metalcat

Ok - I have to ask - as someone who has fasting blood sugar levels consistently in the pre-diabetic range (this seemed to surprise my doctor given my BMI is 21 and I have an athletic build and I'm physically active and workout everyday and have 1-2" of fat on my abdomen...)

What are the dangers of someone like myself having a CGM?

I would really love to know what they are all the time for a few weeks to see if my blood sugar levels look ok after different meals, etc. It's very strange to me (and my doctor...) that I'm pre-diabetic. The doctor says not to worry about it though.

I have thought several times about buying one.

Reading between the lines, it seems like you are saying I should not buy one for some reason.

I'm just curious why? Should I just not worry about being pre-diabetic?

[Metalcat]

I can't give you personal medical advice.

You should be under the care of an MD, and yes, being prediabetic is serious. If your MD recommends CGM, then you should get CGM.

[curious_george]

I can't give you personal medical advice.

You should be under the care of an MD, and yes, being prediabetic is serious. If your MD recommends CGM, then you should get CGM.

I am under the care of an MD. He told me - and I'm quoting here "It's impossible for someone with your body type to be diabetic." Which is nonsense. Literally anyone can become diabetic. Someone with my body type is just way less likely to develop diabetes.

He told me having fasting blood sugar levels consistently in the pre-diabetic range is not something to be concerned about. Which is also nonsense and contrary to every medical study I have read about pre-diabetes.

When I brought up the medical studies he told me I "should not use Google, should not trust the studies, and should ONLY rely on him for medical information".

I assume you have read some of the same studies on the long term effects of pre-diabetes.

But the average person has no idea.

You see the problem?

Like - this is my health. At the end of the day *I* a responsible for it, because *I* am the one who literally experiences the effects.

My doctor is a legit licensed Medical Doctor in the USA. And he seems to be an idiot.

I have to look out for my own ass - which has always been the case in my life.

[Metalcat]

Can you not find a better doctor?

It is important to be under the care of medical professionals you trust. If you don't trust your provider, don't see them. Assuming you have a option to find another one.

The response to having a bad MD shouldn't be "I guess I'll DIY this then" it should be to find a competent, trustworthy MD.

ETA: that's not to say that people should blindly follow MDs and not be proactive in their own care, but there's a difference between being a proactive, knowledgeable patient and just not getting competent medical care.

[curious_george]

Can you not find a better doctor?

It is important to be under the care of medical professionals you trust. If you don't trust your provider, don't see them. Assuming you have a option to find another one.

The response to having a bad MD shouldn't be "I guess I'll DIY this then" it should be to find a competent, trustworthy MD.

ETA: that's not to say that people should blindly follow MDs and not be proactive in their own care, but there's a difference between being a proactive, knowledgeable patient and just not getting competent medical care.

Yeah - I am looking for a new doctor....

The experience was just infuriating for me.

Meanwhile my 34 year old wife, with no medical problems had an elevated white blood cell count once.

He immediately referred her out to have ultrasounds done and $5,000 dollars worth of diagnostics tests for a variety of cancers. Which of course turned up nothing.

But he literally told her she could have cancer. Because the white blood cell count was elevated one time, and sent her out for these precautionary tests. He had no other explanation. White blood cell counts can be elevated for lots of reasons besides cancer...auto-immune diseases, sickness, allergies, the list goes on.

Like - I just wanted a $30 dollar A1C test to investigate why my fasting blood sugar level was 105 mg/dl. I had to order my own A1C test.

The A1c test was 4.7, so not an issue with my average blood sugar levels. But the results seem perplexing to me and make me think I should buy a cgm device to further investigate further.

So I'm trying to understand if this is a good decision or not, or what the risks of CGM devices are that you seem to know about but I do not.

Why the dislike of CGM's? Just a waste of money?

[Metalcat]

I have no dislike of CGMs, I have dislike of the unfounded claim made by influencers about the interpretation of CGM data for folks who don't have diabetes.

Again, I really can't give you medical advice, but if you are prediabetic you absolutely should have competent primary medical care.

I've had plenty of shit doctors try to main/kill me, I know full well what bad medicine can be like. It just makes me more picky, which is a lot harder in Canada.

[curious_george]

I have no dislike of CGMs, I have dislike of the unfounded claim made by influencers about the interpretation of CGM data for folks who don't have diabetes.

Again, I really can't give you medical advice, but if you are prediabetic you absolutely should have competent primary medical care.

I've had plenty of shit doctors try to main/kill me, I know full well what bad medicine can be like. It just makes me more picky, which is a lot harder in Canada.

Ok - this is what I thought you would say. For people without any sort of blood sugar control issues they are largely pointless, but they are being pushed by influencers to make money, basically. So there doesn't seem to be any risk in buying one, just the money that is now gone.

In America though it is around $1,000 dollars for me to see a doctor and have blood work done through them.

I can order the same labs myself, go to the exact same diagnostics place here, and have the same labwork done  foe around $150 dollars.

So yes - doctors are everywhere here, but they cost an arm and a leg to see - and that's assuming you have no medical problems.

Like - I asked to simply come in and talk to a doctor once, just to evaluate if he would be a good doctor or not, and they charged me $150 dollars for me to talk to him to see if he would be a good fit or not. Absolutely nothing was done - I just talked to him for a few minutes to get a feel for who he is.

[Mariposa]

If your HA1c is 4.7, you do not have pre-diabetes. There are many reasons for a fasting blood sugar of 105; you could have had an extra surge of cortisol that morning, from being stressed. If you've never seen a blood sugar >200, there's no need for CGM. HA1c would have been the next logical test for your doc. If he puts it under the ICD code for elevated glucose, insurance will cover it.

Competent primary care in the community, I hear, can be hard to find.

Is it really $1000 for you to see a primary care doc and get labs done? I think I pay around $25 for some lab co-pays. I'm also in the US.

[curious_george]

If your HA1c is 4.7, you do not have pre-diabetes. There are many reasons for a fasting blood sugar of 105; you could have had an extra surge of cortisol that morning, from being stressed. If you've never seen a blood sugar >200, there's no need for CGM. HA1c would have been the next logical test for your doc. If he puts it under the ICD code for elevated glucose, insurance will cover it.

Competent primary care in the community, I hear, can be hard to find.

Is it really $1000 for you to see a primary care doc and get labs done? I think I pay around $25 for some lab co-pays. I'm also in the US.

Yes. It was just under $1,000 for the doctor visit plus bloodwork out of pocket.

I thought it should have been covered under preventative care, but the insurance paid nothing since I did not hit my deductible. So I'm not sure why insurance did not pay - it was my only time seeing the doctor that whole year.

Difference insurances are VERY different.

The fasting blood sugar is CONSISTENTLY 105 both at the lab and self testing at home.

If it was just a fluke I would not be bothered at all.

ETA: I do realize this means I could just ALWAYS have cortisol spikes...

ETA2. It is always around 105 in the morning after fasting. If I fast for 18 hours or so it does go down into the 70s. But it takes 18 hours of fasting to get there.

[Metta]

My husband and I both read Outlive and came away with slightly differing conclusions, which illustrates that you get out of books what you take into them. I barely even noticed the discussion on Rapamycin, probably because the idea of taking a drug every day was such a terrible idea to my mind that I kept waiting for his conclusion of, "and this is how you achieve that effect without drugs" discussion.

My husband, who has had to take daily drugs for severe asthma since he was a small child, thought the discussion of the drugs was interesting but not proven well enough for him to take them. Also he thought it sounded a bit scammy.

We were both struck mostly by two things that we already should have known but hadn't sunk in:

1) Exercise to prevent muscle atrophy as we age is critical. Our takeaway was that we should get a pull-up/dip tower and that we should increase our weight workouts and workouts in general. I loved his video on how to get up off the floor without using hands. My husband can rise gracefully from a kneeling position. I envy that ability. Having a way to start working toward that was great! In general his exercise chapter was very good.

2) We need to work harder to ensure that our cholesterol and blood pressure are in normal ranges because there is a cumulative effect on our blood vessels. We intellectually knew this was the case, but reading the book caused us to be a lot more concerned about it. As a result we are more careful with salt and junk food. We have for a long time been just barely outside the range for blood pressure and cholesterol. We've been complacent because we knew that if we adjusted our diet we would be ok. Attia's book made us less complacent.

We mostly discounted his advice on diet, because no one knows all that much except that eating whole plant foods seems to be good for one and that one shouldn't overeat. Also we are ethical vegetarians, so any discussion of requiring meat is off the table for us. That's our bias. We are not telling anyone else how to live. I'm just pointing out that we approach any discussion of diet with the question, "Can this be veganized?"

We thought the best thing about the book was his concept of training to be a healthy centenarian, listing the "events" you wanted to be able to do when you were quite old. It changed our thinking a bit. We are both watching our mothers age. I watched my father decline and finally die of renal disease. It's sobering. Having a focus (Attia's "Centenarian Decathlon") was truly helpful to us.

My husband found the chapter on mental health moving and enlightening. As a result he has started a journal to work through his emotions and started to meditate with me. So that's a big win in my book.

[Metalcat]

I have no dislike of CGMs, I have dislike of the unfounded claim made by influencers about the interpretation of CGM data for folks who don't have diabetes.

Again, I really can't give you medical advice, but if you are prediabetic you absolutely should have competent primary medical care.

I've had plenty of shit doctors try to main/kill me, I know full well what bad medicine can be like. It just makes me more picky, which is a lot harder in Canada.

Ok - this is what I thought you would say. For people without any sort of blood sugar control issues they are largely pointless, but they are being pushed by influencers to make money, basically. So there doesn't seem to be any risk in buying one, just the money that is now gone.

In America though it is around $1,000 dollars for me to see a doctor and have blood work done through them.

I can order the same labs myself, go to the exact same diagnostics place here, and have the same labwork done  foe around $150 dollars.

So yes - doctors are everywhere here, but they cost an arm and a leg to see - and that's assuming you have no medical problems.

Like - I asked to simply come in and talk to a doctor once, just to evaluate if he would be a good doctor or not, and they charged me $150 dollars for me to talk to him to see if he would be a good fit or not. Absolutely nothing was done - I just talked to him for a few minutes to get a feel for who he is.

Whoa there, I didn't say pointless, I said there's no clear evidence that what influencers claim about the readings is true.

A lack of evidence does not equal a lack of effect, it just means no one has been able to support a theory sufficiently with evidence and in human lifestyle stuff, it's very hard to acquire sufficient evidence.

Might CGM use help individuals? Maybe, I have no idea, and neither does anyone else.

I've seen individuals claim it's been massively helpful for them. Cool, that's great, but I still wouldn't jump to recommending it for average folks without an indication of a clear understanding of the benefits.

There's no solid evidence that intermittent fasting does anything other than calorie restriction. For me, that has been objectively untrue. My body responds to it spectacularly well.

I still think a lot of what Fung says is nonsense.

This is where the nuance is. He's onto something, he just packages it with way more certainty and nonsense than he has any right to.

What he has is excellent clinical knowledge, which is what most medicine is. It's just the clinical experience of the doctor backed up by as solid information as exists.

That's cool. That's the art of medicine. If we depended on scientific evidence for everything we do we wouldn't be able to do anything. I have ZERO problem with doctors recommending shit based on virtually no scientific evidence. That is A-OK in my books.

The problem is when MDs have clinical experience, then cherry pick rather inconclusive science and try to claim that their clinical opinions are actually scientific opinions.

I would respect Fung to the moon and back if he just focused on his legitimate *clinical* expertise and stuck more with a "I'm not exactly sure why, but this shit works."

The problem is the public doesn't think medicine works that way, so it sells better when you cite a bazillion studies and claim that as special knowledge.

Fung *does* have special knowledge, he has years of experience prescribing intermittent fasting to patients. Almost no other doctor in the world has that experience. That clinical knowledge is HUGELY valuable. But he unnecessarily "scientizes" it to make it more marketable an to sell bullshit tea.

(Note: the reason influencers sell so much tea, powders, and oils is because they're less perishable, not because they have special properties).

Anyhoo, down the line perhaps everyone will wear a CGM every single day, and if someone wants to run an experiment of N=1 with a CGM, then that's cool, have at it. But chances are that person read some bullshit extrapolation of the existing science and doesn't have the judgement to really grasp the readouts they're getting.

Based on the current science, the readouts from CGM may be invaluable or they may be as useful as a mood ring.

I have no idea. I don't know *anything* about science that the larger scientific community doesn't already know.

The only special knowledge any of us clinicians have is our clinical experience, which is incredibly valuable, it's what makes some of us truly stand out from the rest, but it's not scientific evidence.

I've been a scientist and I've been a clinician and those are two wildly different experiences and perspectives, except for the rare folks like my surgeon who are world leaders in both.

And that dude is about the humblest person on the planet and the very, very first person to say he has no idea what's going on and that  both his scientific and clinical knowledge are too limited a lot of the time.

I was the top expert in my region in my particular area of expertise and most of the time my answer to questions was "I have no fucking clue."

[Mariposa]

If your HA1c is 4.7, you do not have pre-diabetes. There are many reasons for a fasting blood sugar of 105; you could have had an extra surge of cortisol that morning, from being stressed. If you've never seen a blood sugar >200, there's no need for CGM. HA1c would have been the next logical test for your doc. If he puts it under the ICD code for elevated glucose, insurance will cover it.

Competent primary care in the community, I hear, can be hard to find.

Is it really $1000 for you to see a primary care doc and get labs done? I think I pay around $25 for some lab co-pays. I'm also in the US.

Yes. It was just under $1,000 for the doctor visit plus bloodwork out of pocket.

I thought it should have been covered under preventative care, but the insurance paid nothing since I did not hit my deductible. So I'm not sure why insurance did not pay - it was my only time seeing the doctor that whole year.

Difference insurances are VERY different.

The fasting blood sugar is CONSISTENTLY 105 both at the lab and self testing at home.

If it was just a fluke I would not be bothered at all.

ETA: I do realize this means I could just ALWAYS have cortisol spikes...

People have hormonal differences; maybe you tend to have elevated cortisol that time of the day, or when you're hungry, so your fasting blood glucose is higher than the average. I wouldn't worry about it with a HA1c of 4.7 AND if your blood glucose has never been >200. You are not pre-diabetic.

Insurances are very different, but after the ACA, preventative care should be covered, regardless of your deductible. Maybe you should look into how things were billed and processed.

At this point, because of my family's particular needs, I've spent many, many hours studying our insurance coverage and talking to them on the phone. I got a letter of denial for my Vitamin D 25OH recently, for example, and it was because my doctor coded it under health screening. I wrote a brief appeal saying it should have been coded under vitamin D deficiency and sent them my prior lab work to prove it. The lab billed insurance about $600 for the test, but I know they would have eventually sent me a bill for around $35 if insurance didn't cover anything. I appealed just because I kind of understand the system, and I could.

[DadJokes]

@Metalcat reading through most of your responses here, it seems like you're ranting about a completely different thing than Peter Attia. You even acknowledge from someone else's post that he ranks pharmacology very low in importance, then continue to rail against him for being a "darling of the tech-bro-medicine world." At least his book wasn't filled with personal attacks, which can't be said about your posts in this thread.

And who cares if men, for whatever reason, want longevity more than women? Why is that some soapbox to get on? Personally, I don't care about living a long time, but I do care about living well in my later years, which was a very big part of his book. Maybe it's because I'm a man with some need for independence. Oh well.

[curious_george]

If your HA1c is 4.7, you do not have pre-diabetes. There are many reasons for a fasting blood sugar of 105; you could have had an extra surge of cortisol that morning, from being stressed. If you've never seen a blood sugar >200, there's no need for CGM. HA1c would have been the next logical test for your doc. If he puts it under the ICD code for elevated glucose, insurance will cover it.

Competent primary care in the community, I hear, can be hard to find.

Is it really $1000 for you to see a primary care doc and get labs done? I think I pay around $25 for some lab co-pays. I'm also in the US.

Yes. It was just under $1,000 for the doctor visit plus bloodwork out of pocket.

I thought it should have been covered under preventative care, but the insurance paid nothing since I did not hit my deductible. So I'm not sure why insurance did not pay - it was my only time seeing the doctor that whole year.

Difference insurances are VERY different.

The fasting blood sugar is CONSISTENTLY 105 both at the lab and self testing at home.

If it was just a fluke I would not be bothered at all.

ETA: I do realize this means I could just ALWAYS have cortisol spikes...

People have hormonal differences; maybe you tend to have elevated cortisol that time of the day, or when you're hungry, so your fasting blood glucose is higher than the average. I wouldn't worry about it with a HA1c of 4.7 AND if your blood glucose has never been >200. You are not pre-diabetic.

Insurances are very different, but after the ACA, preventative care should be covered, regardless of your deductible. Maybe you should look into how things were billed and processed.

At this point, because of my family's particular needs, I've spent many, many hours studying our insurance coverage and talking to them on the phone. I got a letter of denial for my Vitamin D 25OH recently, for example, and it was because my doctor coded it under health screening. I wrote a brief appeal saying it should have been coded under vitamin D deficiency and sent them my prior lab work to prove it. The lab billed insurance about $600 for the test, but I know they would have eventually sent me a bill for around $35 if insurance didn't cover anything. I appealed just because I kind of understand the system, and I could.

This is good to know - thank you!

In retrospect I bet it was not billed correctly.

This makes me feel more comfortable about going back to see a different doctor.

I mean - I think the doctor WAS correct in his assessment to not be worried, but he did NOT have an a1c score at the time, so I feel like with consistent readings of 105 fasting over the years he should have at least addressed and explained my concerns better.

I will find a new doctor.

Thanks!

ETA: I mean - you just explained things better than my doctor did in a finance forum.

[Metalcat]

@Metalcat reading through most of your responses here, it seems like you're ranting about a completely different thing than Peter Attia. You even acknowledge from someone else's post that he ranks pharmacology very low in importance, then continue to rail against him for being a "darling of the tech-bro-medicine world." At least his book wasn't filled with personal attacks, which can't be said about your posts in this thread.

And who cares if men, for whatever reason, want longevity more than women? Why is that some soapbox to get on? Personally, I don't care about living a long time, but I do care about living well in my later years, which was a very big part of his book. Maybe it's because I'm a man with some need for independence. Oh well.

That wasn't a soap box or a criticism, it was an observation that I thought was interesting.

Also, I've said multiple times that a lot of what he says is good. I've made more general comments about health influencer doctors in general because this is an ongoing discussion between myself and OP over multiple threads and PMs