Who I Am

My name is Peter Attia. While I have a background suggesting I should have known something about nutrition, it’s safe to say it wasn’t until early 2010 that I really began to understand how what I ate impacted my health and performance. You can read about my personal journey here. For the past two years I’ve been obsessively reading everything on the “science” of nutrition (you’ll understand why “science” is in quotation marks as you read on) and seeing how I could apply it to myself. I am a relentless self-experimenter and my own experiences, coupled with the remarkable work of my good friend, Gary Taubes, and others, have completely changed everything I thought I knew about nutrition.

If you are interested in losing weight, reducing your risk of chronic disease (heart disease, cancer, diabetes, Alzheimer’s disease, and many others), and improving your performance (physically and mentally), I think you’ll find my journey interesting and informative, if not outright provocative.

As you can probably guess from the title of my blog, I believe the biggest single culprit in our epidemic of obesity and chronic disease is insulin. The “war on insulin” is one part of my attempt to bring the science of the last 200 years to you.

The Problem

The problem I am trying to fight in the “war on insulin” is dire. Here are some data to put the problem in context:

• 34% of Americans are obese and two thirds are overweight.  This represents more than a 200% increase from 1970.
• Over 8% of Americans are diabetic, and if you include those undiagnosed, an additional 26% of Americans are pre-diabetic.  This represents more than a 400% increase from 1970.
• Every 7 seconds someone in the world dies from a diabetic complication (this is not a typo).
• Diabetes is also the leading cause of stroke, blindness, kidney failure requiring transplantation, all amputations combined, and many other medical problems.
• According to McKinsey & Company, reducing the U.S. obesity rate to 15% (that of 1970) would save approximately $150 billion per year in Medicare spending alone, and close to $500 billion per year in overall U.S. healthcare spending.
• A recent study in Obesity estimates that by 2030, 50% of Americans will be obese and 79% will be overweight.
• The U.S. spends over $2.4 trillion per year on healthcare – nearly 18% of our GDP, and more than any other country.  Even if no other aspect of our spending increases in the next 20 years, the cost of healthcare alone will bankrupt us as a country.

I believe – and I hope to convince you – that the cause of this epidemic is NOT that people don’t care about their health, are too lazy, or eat too much. The root of the problem lies in the fact that people are being given the wrong information by those they look to as authorities.

The bad news: This problem is not going away; in fact, it seems to be getting much worse.

The good news: This problem is entirely solvable.

Why I’m Doing This

For the past 40 years, great confusion around diet and nutrition has been the inescapable norm. This confusion is largely a consequence of erroneous health and nutrition recommendations to the general population driven by flawed science, biased observations, and political obfuscation. In turn, this misinformation has resulted in an unprecedented rise in Western morbidity associated with what is now referred to as metabolic syndrome and its associated disease states including obesity, diabetes, heart disease, and cancer. Perhaps the single greatest misconception is that “calories in” less “calories out” determines weight, without regard for what those calories are. I believe the theory that what you eat matters – less because of the absolute value of the caloric energy of the food you ingest – but more because of the influence the types of those calories exert on your body’s ability to regulate (i.e., store and burn) fat.

This problem is solvable. With the correct science, observations, and messaging, metabolic syndrome can be slowed, reversed, and eventually overcome. People do care about their health, their quality of life, their mental and physical performance, and their fitness. They simply haven’t had the right information to guide their behavior towards success.

I believe the work Gary Taubes has done, specifically in the masterpiece Good Calories, Bad Calories, provides ample substrate to ask the following provocative questions:

• What if much of what we’ve been taught about the interaction of health and nutrition is wrong?
• What if the unprecedented rise Western societies have seen in obesity, diabetes, and heart disease has been caused by compliance with the “best” recommendations regarding nutrition of the government and medical community?
• What if there was fully verified and reviewed scientific information, without observational and political biases, that showed what “correct” nutrition should be?
• What then?

Who I Want to Reach

At the highest levels, elucidation of clear, unambiguous recommendations to reduce morbidity associated with obesity and metabolic syndrome should be targeted to the American Medical Associate (AMA), U.S. Department of Agriculture (USDA), American Diabetic Association (ADA), American Heart Association (AHA), and National Institutes of Health (NIH).  Ultimately, however, with or without support from these organizations and their concomitant formal recommendations, the definitive results of this effort must reach mainstream audiences.  In other words, both a so-called “top-down” and “bottoms-up” approach are necessary to make the world a healthier place tomorrow.

Why This Time is Unique

I believe there is a confluence of events pointing us towards a shift in mainstream thinking. Just as doctors were once ridiculed for suggesting that ulcers were caused by a bacteria (we now take this for granted, and the doctors that demonstrated this were awarded the Nobel Prize in Medicine), we will one day look back at the mainstream medical recommendations and wonder how it could have been the case.

Why do I feel this way?

1. Critical mass of ideas
A tremendous amount of work has been done laying the scientific foundation for what I am proposing. In particular, people like Jeff Volek, Steve Phinney, Gary Taubes, Rob Lustig, and many others have picked up where Peter Cleve left off his research and John Yudkin left off with his prophetic book, Sweet and Dangerous (a book published in 1972 that essentially predicted the impact increasing sugar intake would have on Western society). In the early 1970’s Yudkin, Cleve, and Atkins were essentially voices alone. Much of their work (certainly in the case of Atkins) was based more on correct observation and less on experimental data and rigorous analysis. We are a few critical experiments away from making the debate moot.

2. Broader message to a larger audience
Historically, this “message” was typically one of weight loss. The problem with this approach is that it allowed for great distraction and scientific misinformation to be introduced to the debate (e.g., “Sure, you can lose weight, but you’ll be skinny and die of a heart attack”), and it spoke to only one population (those who cared to lose weight). However, the message today is much broader than it was yesterday: Reducing carbohydrate intake will do the following:

• Improve your current health and reduce your chances of suffering/dying from heart disease, cardiovascular and cerebrovascular disease, cancer, and diabetes
• Reduce your body fat and allow you to look and feel younger
• Eliminate the need to count calories
• Improve your mental performance
• Improve you physical performance

This is a more powerful message that speaks to a larger audience.

3. Better “tools” at our disposal, both scientifically and socially
Experiments that could only have been dreamt of 40 years ago are standard practice today. We have the ability to assess every conceivable subparticle of cholesterol, each incremental glycolated protein, and cell surface receptors that “make fat.” Perhaps more importantly, we have communication tools that did not exist even a decade ago. In the early 1970’s Ancel Keys and colleagues won the debate in front of the U.S. Senate. However, few people outside of that room knew the debate was going on, let alone the arguments. Most people were just given the “conclusion” on the cover of Time magazine. Today we have inexpensive, broad, and deep communication channels to both targeted groups and the global population at large.

4. It’s not just a list of things to eat and not eat
Virtually all “diets” out there fall into the category of pure instruction. People are told what to eat, what not to eat, how much to eat, when to eat. Unfortunately, these rigid systems don’t survive the test of time – they are too prescriptive, too restrictive, and not adaptive enough, which often leads to recidivism. What I’m proposing is different. I want to teach people the evidence that shows why to eat a certain way. I believe that when people actually understand the laws and consequences governing fat storage, they will make the correct choices with what they eat.

Let me reiterate this last point: I believe that when people actually understand the laws governing fat storage (the way we understand the laws governing gravity), they will make the correct choices about what they eat (the way we make the correct choices about how to avoid the “consequences” of gravity).

Bio – Peter Attia

I was born and raised in Toronto, Canada. I studied mechanical engineering and applied mathematics as an undergrad at Queen’s University. Shortly before starting my Ph.D. in aerospace engineering, I had a change of heart following a profound personal experience, and I decided I wanted to become a doctor. I taught calculus for a year while taking the prerequisites and enrolled a year later at Stanford Medical School. I entered med school thinking I would be a pediatric oncologist, but by the time I started my clinical rotations I realized surgery was my passion.

I did my residency in general surgery at Johns Hopkins Hospital in Baltimore, Maryland and while there spent two years at NIH in the National Cancer Institute as a surgical oncology fellow under the very fortunate mentorship of Dr. Steve Rosenberg working on immune-based treatments for cancer.  Much of the passion I bring to this topic is actually inspired by Dr. Rosenberg.  I’ve never met (let alone had the privilege to work closely with) someone who better understood the difference between “good” and “bad” science.  Dr. Rosenberg always forced me to ask the right questions.  Without that, I learned, one could generate all the data in the world – it just wouldn’t have any value.

During the fifth year of my residency I became a bit frustrated with certain aspects of medicine and health care, in general. In particular, I grew tired of the notion that we (doctors) did little to keep patients healthy, and were basically the last line of defense against, well, death, once patients become ill. The concept of “preventative medicine” received some lip service, but didn’t really have any chops as far as I could tell. In addition to this frustration (and others), I really missed quantitative and analytical problem solving.

I left residency to join the consulting firm McKinsey & Company, which was certainly the most stimulating experience of my professional life. During my time at McKinsey I split my time between working on healthcare problems (ranging from problems for health insurance “payers” to those of large hospital systems “providers” to those of medical device companies) and financial system problems (specifically, credit risk modeling and Basel II compliance for large banks).