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  #1   ^
Old Sat, Apr-16-22, 04:26
JEY100's Avatar
JEY100 JEY100 is offline
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Default Dr Peter Attia, Evolving Nutrition Advice

There are older threads here on Dr Peter Attia, when he was taking ketone esters, and thought extended fasts helpful for "autophagy", and other nutritional hacks.
His latest thoughts very much align with Dr Ted Naiman on the importance of protein and Marty Kendall's work on nutrients and protein, that an "overly compressed eating window". ( aka OMAD!) is not enough to support optimal nutrition.

This is an excellent summary of Dr Attia's latest thoughts, which Marty has summarized as follows:

Quote:
Interesting recent reflections and shifts in thinking from Peter Attia (from 44 mins):

- most of the benefits of time-restricted eating are simply due to caloric restriction,
- overly compressed eating windows compromise protein intake and degrade food quality,
- this leads to loss of muscle mass and increasing body fat % and worsening insulin resistance,
- the RDA for protein is severely underbaked
- it's how much you need to live (not how much you need to thrive),
- your kidneys are not going to be challenged until you hit 3-4 g/kg LBM of protein (which is VERY hard to achieve),
- the most challenging demographic is middle-aged women who are undereating protein, fasting and doing no exercise - this is a recipe for a shorter life and a lower quality life.

https://youtu.be/LkUPHBhM8Ow?t=2642


The post quoted above is from the Optimising Nutrition free community. Not on Facebook.

Last edited by JEY100 : Sat, Apr-16-22 at 06:51.
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  #2   ^
Old Sat, Apr-16-22, 09:40
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thud123 thud123 is offline
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Subscribed to this thread! I <3 Peter's flexible mind on these matters.
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  #3   ^
Old Sat, Apr-16-22, 09:44
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JLx JLx is offline
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Interesting comment from a listener:

As a T2 diabetic I have been practicing time restricted eating for about 1 Ĺ years. I have lost close to 50lbs during that time. The last several weeks I have been going through exactly the symptoms that Peter describes in this podcast. I wear a CGM and observed a dramatic increase in my blood glucose over night reaching an alarming peak of over 200 in the early morning. I did not understand what was happening to me until I listened to this podcast. I was afraid I would soon have to go back on insulin. I increased my protein intake dramatically and observed a 40% lowering of my overnight and morning blood glucose levels. I have also decreased the length of fast particularly on days when I workout hard. It appears to be working.

A lot of people are invested in these ideas such as long fasts and time-restricted eating and it's going to be hard for them to give up unless they see it's personal.

I recall Dr. Naiman saying in one of the podcasts I listened to that Dr. Attia had lost lean tissue over a year's time so I'm glad to see him talking about it. I've wondered how Dr. Naiman gets those 200 gm of protein in within 8 hours.
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  #4   ^
Old Sat, Apr-16-22, 10:12
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JEY100 JEY100 is offline
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If you are on Twitter, Dr Eenfeldt posted his comments only on the Protein part there. Had he also clipped the earlier section of Dr Attia's comments on Fasting like Marty did, he would have to remove all the Fasting guides on the DietDoctor website.

JL, Dr Naiman has described what he eats on many interview podcasts and in his P:E book. Usually coffee for breakfast, first meal of the day is heavy in proteins, along with their natural fats, and the "lower carb carbs" like salad. Second meal has even more protein, living in WA he grills a lot of salmon, plus his allowed carbs (lots of green vegetables, starchy tubers, fruit in his protein ice cream "desserts". He uses some protein powders. Meals are mostly simple grilled meats and veg (see the photos in the P:E book or these plates, https://lowenergydiet.com/HowtoeataLED.html)

The "recipe section" of the P:E book has very few actual recipes, though he has since created a meatloaf and recently a high-protein red lentil pasta dish that is amazing. Since it is not heavy in cheese or cream fats, and it uses lean beef, it does not sit in stomach like a "real" lasagna. There are no fake protein breads or anything that is not real, nutrient dense food.

Like Dr Naiman and Marty Kendall, Dr Attia also recommends 1g protein per pound of ideal body weight. This can be achieved with real, whole, food.

Last edited by JEY100 : Sat, Apr-16-22 at 10:24.
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  #5   ^
Old Sat, Apr-16-22, 12:30
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JLx JLx is offline
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Plan: High protein, lower fat
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Yeah, I've seen his descriptions and heard him talk about all the wild salmon he eats ($13.99/lb here) but it's still 200 gm within 8 hours, which isn't much time between large amounts of protein.

And why is he doing time-restricted eating, anyway? I've heard him say that's what he does but not why. Considering this podcast and Dr. Attia saying its only benefit is reducing calories.

Btw, has he ever said if he eats dressing on those salads?
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  #6   ^
Old Sat, Apr-16-22, 12:47
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teaser teaser is offline
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Some doubts on the benefits of time restricted eating being due to calorie restriction, there's pretty strong evidence I think that calorie restriction is effective because the animals tend to binge when they are fed--and then while they're waiting for their next meal, they're in a fast. A calorie-restricted meal timing protocol. A recent study showed mice benefiting from calorie restriction if they were given all their food in a lump first thing in their waking period--but the same level of calorie restriction did them no good if the food was dribbled to them right through the day.
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  #7   ^
Old Sat, Apr-16-22, 17:31
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JEY100 JEY100 is offline
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JL, There are about 20 pages in the PE book all about TRE, so Dr Naiman has a long list of benefits beyond weight loss by keeping his insulin and glucose low, improves metabolism, immune system, mindful eating, etc. Based on your ideal weight, your goal is "only" 130 g. protein. A medium can of salmon is 43g protein, full of good nutrition.

For dressings, Dr Naiman suggests a splash of an acid, sherry vinegar is his favorite, or lemon juice, or some side dishes show a "drizzle" of olive oil and balsamic vinegar. Not much fat is required as you adjust to leaner proteins and limited added fats. A small amount of Avocado and yogurt make good replacements for mayonnaise.

Teaser, This is a big change from Dr Attia's use of extended fasts not long ago. He and his typical client, already fit and a good weight, add fasting but end up losing 5 pounds of lean mass, not fat. He admitted someone with 100 ponds to lose would still benefit. I havenít followed Dr Attia or Fung for a few years when I realized the benefits to me from two high protein meals a day, a 16 hour daily fast is perfect for me, so stopped reading about fasting

And from my new favorite podcaster:

Quote:
Post by Andrew Huberman, PhD, Huberman Labs

There is nothing inherently better about intermittent fasting vs. caloric restriction except the glaring truth: most people find it easier not to eat for a period of time than to eat small portions. It is all about dopamine. Ignoring the neural side of nutrition is a mistake.

In fact, many people who do intermittent fasting come to enjoy the non-feeding phase & enjoy food more. Again, itís dopaminergic. Do as you wish & is healthiest for you but skip the fasting vs X debates online; they miss that itís not all about nutrients. Itís about adherence.

Last edited by JEY100 : Sun, Apr-17-22 at 11:55.
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  #8   ^
Old Wed, Apr-20-22, 14:50
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GRB5111 GRB5111 is offline
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Quote:
Originally Posted by JEY100
JL, There are about 20 pages in the PE book all about TRE, so Dr Naiman has a long list of benefits beyond weight loss by keeping his insulin and glucose low, improves metabolism, immune system, mindful eating, etc. Based on your ideal weight, your goal is "only" 130 g. protein. A medium can of salmon is 43g protein, full of good nutrition.

Yes, TRE has lots of benefits including achieving autophagy during that 16-18 hour of not consuming food. I follow Dr. Mark Mattson's (recently retired but actively engaged) research on this.

Quote:
Originally Posted by JEY100
I havenít followed Dr Attia or Fung for a few years when I realized the benefits to me from two high protein meals a day, a 16 hour daily fast is perfect for me, so stopped reading about fasting

Ditto, and I stopped testing for ketones.

Quote:
Originally Posted by JEY100
And from my new favorite podcaster:
Quote:
Post by Andrew Huberman, PhD, Huberman Labs

There is nothing inherently better about intermittent fasting vs. caloric restriction except the glaring truth: most people find it easier not to eat for a period of time than to eat small portions. It is all about dopamine. Ignoring the neural side of nutrition is a mistake.

In fact, many people who do intermittent fasting come to enjoy the non-feeding phase & enjoy food more. Again, itís dopaminergic. Do as you wish & is healthiest for you but skip the fasting vs X debates online; they miss that itís not all about nutrients. Itís about adherence.

So true, and this is why Dr. Rob Cywes and others refer to frequent snacking or eating as an addiction with the metabolism getting used to its continual glucose fix. My cravings went away with fasting/TRE. Andrew Huberman sounds like a good source.
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  #9   ^
Old Tue, Apr-19-22, 12:29
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BawdyWench BawdyWench is offline
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I agree with everything that has been said. I can't possibly eat all the protein my body needs in one sitting ... unless I sit at the dining table for 8 hours straight! Two meals a day feels good to me, and I can get all the protein in, maybe with a small protein snack in between.

It's also nice to see a nimble mind that can change when presented with new information. Many experts cling to their old ideas without ever considering new ideas and new scientific finds.
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  #10   ^
Old Thu, Apr-21-22, 06:42
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Quote:
Scientists Find No Benefit to Time-Restricted Eating

In a yearlong study, participants who confined meals to certain hours lost no more weight than those who ate at any time.

https://www.nytimes.com/2022/04/20/...cted-diets.html


That's the headline in the NYT, which I don't subscribe to anymore and apparently, you don't even get one free article! Anyway, I assume it is this study (of a pretty small group of people) they are referring to:

Quote:
CONCLUSIONS
Among patients with obesity, a regimen of time-restricted eating was not more beneficial with regard to reduction in body weight, body fat, or metabolic risk factors than daily calorie restriction.

https://www.nejm.org/doi/full/10.1056/NEJMoa2114833



This jibes with what Dr. Attia said in that podcast.
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  #11   ^
Old Thu, Apr-21-22, 07:11
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GRB5111 GRB5111 is offline
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Quote:
Originally Posted by JLx
That's the headline in the NYT, which I don't subscribe to anymore and apparently, you don't even get one free article! Anyway, I assume it is this study (of a pretty small group of people) they are referring to:

C
Quote:
ONCLUSIONS
Among patients with obesity, a regimen of time-restricted eating was not more beneficial with regard to reduction in body weight, body fat, or metabolic risk factors than daily calorie restriction.

https://www.nejm.org/doi/full/10.1056/NEJMoa2114833


This jibes with what Dr. Attia said in that podcast.

It's fascinating how journalists with no ability other than to form words and summarize a study can unintentionally distort the issues. I know that cutting calories for me is not sustainable, slows my metabolism, and causes cravings that are hard to resist and lead to poor food choices. When I eat healthy whole food that doesn't spike my blood glucose, I can eat in a small window of time without any of the other issues and get the benefits of stable blood glucose and autophagy. It took a bit of time to adapt, but I've been doing it for years with much success. Where can people find that information from the large media sources?
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  #12   ^
Old Thu, Apr-21-22, 11:17
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teaser teaser is offline
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One problem is these studies often show what happens when you ask somebody to do something--as opposed to when they actually do it. This is why there are metabolic chamber studies, you can be more certain of what people are actually up to.

Compliance can be big--and one thing that I think can increase compliance is knowing that something is likely to be effective. Two equally effective interventions, but you believe one will work, and the other won't--suddenly what were otherwise equal interventions, what would give equivalent results in say a mouse or a tube-feeding study, might give very different results.
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  #13   ^
Old Thu, Apr-21-22, 12:50
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JLx JLx is offline
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It's fascinating how journalists with no ability other than to form words and summarize a study can unintentionally distort the issues.

That quote was from the study, not the NYT. Here's what else they said in the link I posted:

Quote:
Changes in weight were not significantly different in the two groups at the 12-month assessment.... Results of analyses of waist circumferences, BMI, body fat, body lean mass, blood pressure, and metabolic risk factors were consistent with the results of the primary outcome.


I know that cutting calories for me is not sustainable, slows my metabolism, and causes cravings that are hard to resist and lead to poor food choices. When I eat healthy whole food that doesn't spike my blood glucose, I can eat in a small window of time without any of the other issues and get the benefits of stable blood glucose and autophagy.

I believe the point being made here is that you are cutting calories by eating in a small window of time. What Peter Attia said recently in this podcast is that...

"3000 calories spread out over the day 12 hrs, versus 6 hrs, versus narrow window of eating Ė no difference."

Now if a person would ordinarily eat 4,000 calories over 12 hours, then eating only 6 hours resulting in 3,000 calories instead is an obvious advantage.
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  #14   ^
Old Fri, Apr-22-22, 11:36
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GRB5111 GRB5111 is offline
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Quote:
Originally Posted by JLx
It's fascinating how journalists with no ability other than to form words and summarize a study can unintentionally distort the issues.

That quote was from the study, not the NYT. Here's what else they said in the link I posted:
Quote:
Changes in weight were not significantly different in the two groups at the 12-month assessment.... Results of analyses of waist circumferences, BMI, body fat, body lean mass, blood pressure, and metabolic risk factors were consistent with the results of the primary outcome.

Since the NYT article is behind a paywall, I can only refer to the short study description as reported by the NEJM. My comment was on articles in general citing nutrition/eating studies that are often misinterpreted or cannot be assessed for quality by the journalist, particularly if the NYT used only the NEJM summary as its source. In addition, I find no statements of rigor in how study subjects controlled, measured or reported accurate calorie consumption, as it's simply a summary of findings.
Quote:
Background The long-term efficacy and safety of time-restricted eating for weight loss are not clear.

At the end of this study, I believe the previous statement is still true.
Quote:
Originally Posted by JLx
I know that cutting calories for me is not sustainable, slows my metabolism, and causes cravings that are hard to resist and lead to poor food choices. When I eat healthy whole food that doesn't spike my blood glucose, I can eat in a small window of time without any of the other issues and get the benefits of stable blood glucose and autophagy.

I believe the point being made here is that you are cutting calories by eating in a small window of time. What Peter Attia said recently in this podcast is that...

"3000 calories spread out over the day 12 hrs, versus 6 hrs, versus narrow window of eating Ė no difference."

Now if a person would ordinarily eat 4,000 calories over 12 hours, then eating only 6 hours resulting in 3,000 calories instead is an obvious advantage.

Yes and that's one of my points, that people who eat in smaller windows may consume fewer calories. The other part of this is that those who eat satiating food during those smaller eating windows including increasing good-quality protein and lower carb vegetables may eat even less and still be satiated without corresponding lean-mass loss. The calorie count may be positively impacted. Yet it doesn't appear that food quality was part of the referenced study, which is very hard to control in human subjects. My observation was purely from my experiences, and my history of eating more frequently over longer periods of time was a failure for me. I don't doubt the study is accurate, but applying it as a "one size fits all" has never worked for me, and I suspect others. Many I know can eat different foods on a different schedule than I, and some do very well. So, it's fine to observe that.

I believe a key in pursuing nutritional health is understanding the added complexity of how we all vary. It's why reading a diet book or article can put some on a good path, but the rest is up to the individual to discover how to fine-tune it based on personal results. This is an important message, as many (the majority?) aren't willing to do the introspective deep dive to make those discoveries.

This conflicts with many other studies; yet, it's refreshing to read about a human study despite how hard it is to have rigorous controls for us. However, there are many who are researching the metabolic benefits of caloric restriction through a variety of methods. Attia, I find I need to take his statements with a grain of salt. Yes, he's focused on longevity, but I believe his references about loss of lean mass were in observation of the times he did longer fasts. It's a good sign to see him adapt and change his views over time, that's science, as good science is never static. Mark Mattson is an extremely knowledgeable person in this field as well. And yes, Walter Longo is not yet out of a job.
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  #15   ^
Old Thu, Apr-21-22, 13:56
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teaser teaser is offline
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https://www.sciencedaily.com/releas...11018112513.htm

Quote:
Over the last few decades, scientists have discovered that long-term calorie restriction provides a wealth of benefits in animals: lower weight, better blood sugar control, even longer lifespans.

Researchers have largely assumed that reduced food intake drove these benefits by reprogramming metabolism. But a new study from University of Wisconsin-Madison researchers finds that reduced calorie intake alone is not enough; fasting is essential for mice to derive full benefit.

The new findings lend support to preliminary evidence that fasting can boost health in people, as trends like intermittent fasting continue to hold sway. These human and animal studies have added to the growing picture of how health is controlled by when and what we eat, not just how much.

The research further emphasizes the complexity of nutrition and metabolism and provides guidance to researchers trying to untangle the true causes of diet-induced health benefits in animals and humans.

The researchers discovered that, combined with eating less, fasting reduces frailty in old age and extends the lifespan of mice. And fasting alone can improve blood sugar and liver metabolism.

Surprisingly, mice that ate fewer calories but never fasted died younger than mice that ate as much as they wanted, suggesting that calorie restriction alone may be harmful.

The research was led by UW School of Medicine and Public Health metabolism researcher Dudley Lamming, his graduate student Heidi Pak and their colleagues at UW-Madison and other institutions. The team published their findings Oct. 18 in Nature Metabolism.

Pak and Lamming were inspired to conduct the study because researchers began to realize that previous studies had unintentionally combined calorie restrictions with long fasts by providing animals with food just once a day. It was difficult, then, to distinguish the effects of one from the other.

"This overlap of treatment -- both reducing calories and imposing a fast -- was something that everybody saw, but it wasn't always obvious that it had biological significance," says Lamming, who has long studied the effect of restricted diets on metabolism. "It's only been in the past few years that people started getting interested in this issue."

To untangle these factors, Lamming's group designed four different diets for mice to follow. One group ate as much as they wanted whenever they wanted. Another group ate a full amount, but in a short period of time -- this gave them a long daily fast without reducing calories.

The other two groups were given about 30% fewer calories either once a day or dispersed over the entire day. That meant that some mice had a long daily fast while others ate the same reduced-calorie diet but never fasted, which differed from most previous studies of calorie restriction.

It turned out that many of the benefits originally ascribed to calorie restriction alone -- better blood sugar control, healthier use of fat for energy, protection from frailty in old age and longer lifespans -- all required fasting as well. Mice who ate fewer calories without fasting didn't see these positive changes.

Fasting on its own, without reducing the amount of food eaten, was just as powerful as calorie restriction with fasting. Fasting alone was enough to improve insulin sensitivity and to reprogram metabolism to focus more on using fats as a source of energy. The livers of fasting mice also showed the hallmarks of healthier metabolism.

The researchers did not study the effect of fasting alone on lifespan or frailty as mice aged, but other studies have suggested that fasting can provide these benefits as well.

While the mice that ate fewer calories without ever fasting did show some improved blood sugar control, they also died younger. Compared with mice who both ate less and fasted, these mice that only ate less died about 8 months earlier on average.

"That was quite surprising," says Lamming, although other studies have also shown some negative effects from restricting calories. The team also measured frailty through metrics like grip strength and coat condition. "In addition to their shorter lifespans, these mice were worse in certain aspects of frailty, but better in others. So, on balance their frailty didn't change much, but they didn't look as healthy."

The primary studies were done in male mice, but Lamming's lab also found similar metabolic effects of fasting in female mice.

The research reveals how difficult diet studies are, even in a laboratory environment. That difficulty is magnified for human studies, which simply can't match the level of control possible in animal models. The new study can provide direction to future work trying to answer whether fasting improves human health.

"We need to know whether this fasting is required for people to see benefits," Lamming says. "If fasting is the main driver of health, we should be studying drugs or diet interventions that mimic fasting rather than those that mimic fewer calories."


I don't think Valter Longo is out of work quite yet.

In mice--calorie restriction where they're given their food in a lump at the beginning of the feeding period and then they just eat ad lib--results in early feeding, followed by fasting by default. So... what happens in humans, if they do successfully restrict calories? Do they end up eating in a restricted window? Might depend on the current fashion.
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