#162

I follow much of what Peter Attia recommends. But this video does highlight a number of controversial and weak points in his recommendations.

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#163

It’s a bit embarrassing when it’s put this way, and Peter does not speak about the Med diet at all. There is uncertainty because of study design, but everything considered, the value is good.

1 Like
#164

I’m sorry, I don’t really follow you. What is embarrassing when put this way?

#165

Peter Attia’s nutritional nihilism is a bit embarrassing when there is a mountain of uncertain evidence. And it might even be logically inconsistent if he believes in VO2Max studies despite them being epidemiology. There isn’t even tribal camps since the Med diet can be omnivorous or vegan - just not carnivore, meaning “Pro-meat” and “Anti-meat” can both use it.

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#166

Gotcha, wasn’t sure if you were referring to me, the guy making the video, or Peter!

#167

Take the best from every expert and learn enough to know what is the best and what isn’t.

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#168

I don’t have Outlive in front of me; if he doesn’t talk about the Med diet there, he’s certainly given it (and specifically PREDIMED) significant airplay and cautious endorsement on The Drive several times.

I think he’s overly skeptical about nutritional epidemiology; I suspect that when talking about diet, he overplays his skepticism in part to counteract the obsessive and uncritical promotion of nutrition epi findings asif they were causal in the pop press and among most people in the healthy lifestyle community, when contrarily we are collectively failing so miserably at things that are unambiguously important (energy balance and protein intake). His core attitude is that it’s so overwhelmingly important and difficult for most people to get the latter two right that any diet that achieves them and a person finds sustainable is good enough; the rest is marginal improvements of uncertain value.

Exercise epi is also imperfect, but VO2max can be objectively measured, versus many nutritional epi studies with a single baseline dietary data point using one of many weakly-correlated instruments. Even when a study has some kind of nutritional biomarker, it’s often weakly correlated to input and can represent short-term intake, whereas high VO2max is usually achieved after long-term training.

3 Likes
#169

A new review of Peter Attia’s book Outlive by Christin Glorioso (a local Longevity Biotech startup founder and leader in the San Francisco longevity community).

I think it can be valuable to review critical commentary by educated and thoughtful people, and Christin definitely has some criticism (but many areas of agreement also) on Peter’s book:

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#170

…educated and thoughtful…

I felt vicariously body shamed, a feeling that wasn’t pleasant to have to continually endure.

Attia’s story was vulnerable and brave, but also so so privileged.

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#171

Well it made me interested in reading it at least. So I will then, except skip the parts that is not relevant to me. I want to read about exercise, protein, statins, etc.

1 Like
#172

Agreed. I think major weakness is that Attia is heavily biased regarding protein intake, and that one day he’ll end up doing some backpedaling when it comes to protein intake recommendations (as he’s had to do with ketogenic diets). I’m hoping for future studies showing a “sweet spot” of protein intake – just enough such that resistance training itself can do most of the work for building/maintaining muscle mass/strength, but low enough to avoid accelerating the aging process.

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#173

Yes, he is probably wrong about protein.

1 Like
#174

From the review

" * Metformin: Attia himself has backpedalled on promoting Metformin for longevity in his blog but basically promotes it in this book. I am against people taking Metformin when they don’t have diabetes. The primary reason for this is multiple clinical trials pointing to a potential increase in risk of Parkinson’s disease in metformin users. "

  • This caught my eve - new to me!
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#175

Here is Christin’s case for this risk: Parkinson's disease - #23 by RapAdmin

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#176

The thing about the metformin health studies is that they have serious flaws in terms of selection bias.

As far as I am concerned I am not taking metformin because I see no good reason to do so. Initially I was looking at metformin, but I decided to take Berberine because metformin is a prescription drug in the UK. Having studied the issue in much more detail Berberine has so many stronger arguments for it and has a longer tradition of use notwithstanding that both are from natural sources originally. To me natural sources is not a particularly strong argument, however, the fact that people have taken something for hundreds of years is.

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#177

I read Christin’s article on metformin and Parkinsons. And also did a quick Google search of metformin and Parkinson’s disease. At a glance, I agree with you that there is nothing concrete in a variety of studies.

I am very cautious though about using such a strong toxic mitochondrial inhibitor like metformin. And particularly in combination with other inhibitors like glucosamine. In combination with certain supplements, negative outcomes would be likely.

I have used metformin only a few times orbiting my 10 days dose of rapamycin. I am dropping it out of caution. It might be safe at lower dosage but I think Berberine a good substitute to blunt a sugar response. I also use a number of other “blunters” like inositol, beta sitosterol

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#178

Berberine is also toxic to the mitochondria, it’s a poor man’s metformin. I would look at other drugs that also have a benefit in the ITP, like Canifaglozin, there is a large thread on this, but I don’t know much about it.

Pharma drugs have much more evidence of safety than supplements.

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#179

There’s toxic and then there’s toxic. A shallow opinion on my part, but Berberine to a lesser degree.

#180

You’ve never heard about it before because it isn’t true :wink:. I disagree with most of Dr. Glorioso’s criticisms of the book, but her discussion of Outlive, metformin, and PD is where I don’t just disagree with her viewpoint, but see a clear departure from the facts and the evidence.

First, there are no “clinical trials pointing to a potential increase in risk of Parkinson’s disease in metformin users.” If there were, it would have been yanked off the market or at least black-boxed years ago: it certainly wouldn’t be the first-line T2D drug in every country on earth. I expect she is misremembering or misunderstanding observational studies such as these, some but not all of which find that metformin use by diabetics is associated with greater risk of PD.

In the Twitter thread reposted by @RapAdmin, she makes an argument from Complex I inhibition, but repeatedly ignores the facts (noted by user HairyBiologist and by geroscientist Jamie Justice) that these studies report Complex I inhibition in the liver, not the brain, and that it is a much weaker inhibitor than rotenone even there. And regardless, that’s a mechanism, not an outcome.

She brings this up in the context of claiming that Attia “has backpedalled on promoting Metformin for longevity in his blog but basically promotes it in this book”. Attia has been saying he doesn’t think metformin is a longevity therapeutic consistently on the blog and in the podcast since at least 2018, and I don’t remember him promoting it in the book. The only entry for metformin in the index is on page 87, which can’t reasonably be said to be ‘promoting’ metformin as a geroprotectant.

Then she says:

  • Centenarians and smoking: this is not exactly a point of disagreement but there is a link between longevity and smoking in super centenarians and I don’t think this is an accident. People die increasingly from neurodegenerative diseases in the oldest ages and smoking is linked to less Parkinson’s disease. That’s not to say that we all should smoke- definitely not- smoking causes lung cancer and heart disease. But in people above a certain age- say 80 years old- we should consider creating nicotine pathway drugs or prescribing nicotine patches- my two cents. I think this has been wildly understudied.

Now, I’m glad she backed away from suggesting that peope should smoke to prevent PD, but this is still all based on false premises and failure to account for absolute risk. First, there is no “link between longevity and smoking in super centenarians”: I’m guessing that she’s jumped to conclusions from the singular case of Jeanne Calment. In Nir Barzilai’s centenarians, 59.6% of centenarians had smoked at least 100 cigarettes during their lives, compared to 74.5% of their contemporaries in NHANES I. In Thomas Perls’ New England Centenarian Study, 11% of centenarians reported having smoked more than 2 pack-years during their entire lives, which is substantially less than the general population today, let alone in the mid-20th century when they lived their lives.

She may be thinking of a report on the Okinawan supercentenarians: ""Approximately half (42%) of the supercentenarians had a history of smoking; however, of those participants who did smoke, most began later in life and tended to smoke < 20 cigarettes per day and/or quit by their 70s (data not shown). " Compare this to the general Japanese population:

In the late 1960s, 74% of men and 13% of women reported that they were current smokers, and 13% of men and 2% of women reported that they were former smokers (table ​2). In later survey periods, the percentages of current smokers decreased in both sexes and the percentages of former smokers increased. Among current and formers smokers, 25% of men (5842 individuals) and 5% of women (357 individuals) reported that they had started smoking before the age of 20." Impact of smoking on mortality and life expectancy in Japanese smokers: a prospective cohort study - PMC

Beyond that, her whole hypothesis here is inconsistent with the absolute risks involved. Smoking greatly reduces life expectancy by increasing the risk of lung, colorectal, kidney, bladder, and other cancers, as well as CVD and COPD. Yes, there is some epidemiological evidence that smoking reduces the risk of PD, and Parkinson’s disease is a terrible disease, but it is relatively rare and even less commonly kills its victims. Even amongst people aged 85+, only 3% of people have PD — and of course, not everyone with PD dies from PD. The idea that people have a better chance of living to 110 by reducing the risk of a rare disease like PD while greatly increasing the risk of the top two killers and several others of the top 10 is a clear case of an “extraordinary claim requiring extraordinary evidence.”

5 Likes
#181

Please cite references to berberine