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Peter Attia MDPeter’s historical changes in body composition & evolving nutrition & training [AMA 44 sneak peek]
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At a glance
WHAT IT’S REALLY ABOUT
Peter Attia Walks Through a Decade of His DEXA Scans
- Peter Attia traces how he measured body composition over time, from calipers in his boxing days to hydrostatic testing in his 30s to DEXA scanning starting in 2011.
- He says the four DEXA results he emphasizes with patients are body fat, visceral fat, bone mineral density, and muscle mass indices (ALMI and FFMI), and he calls body fat the least interesting of the four.
- His first DEXA in May 2011 showed 9.3% body fat and an FFMI of 23.4, while a hydrostatic test the same day had suggested about 16%.
- After starting a ketogenic diet in 2011 and shifting from swimming to heavy cycling, his weight and lean mass fell, with his lowest DEXA weight of 167.5 pounds in October 2012.
- The host stresses the value of tracking trends over time rather than isolated results, and the clip ends as the host asks about protein intake during the keto years.
IDEAS WORTH REMEMBERING
5 ideasDEXA is the gold standard, and other methods can mislead
Attia found calipers depend on the tester's skill and hydrostatic testing depends on how much air is left in the lungs. His same-day tests gave 16% by hydrostatic and 9.3% by DEXA, and he never did hydrostatic testing again.
Body fat percentage is the least interesting DEXA number
Attia tells patients to focus on visceral fat, bone mineral density, and muscle mass indices instead. He asks patients to get a DEXA at least once a year.
Visceral fat reflects overflowing safe storage
Using a bathtub analogy, he says each person has a genetic capacity to store fat subcutaneously. Once it is exceeded, fat spills into the liver, pancreas, kidneys, and heart, where it is highly inflammatory.
ALMI is preferred over FFMI when they disagree
Attia says ALMI has more supporting data and is purer because limbs contain mainly muscle, fat, and bone, whereas FFMI is confounded by organs. His own FFMI places him at a higher percentile than his ALMI.
Trends matter more than single data points
The host notes that the team builds trend sheets of historical labs for patients, and Attia agrees that trends matter. He keeps his own spreadsheet of DEXA data going back to 2011.
WORDS WORTH SAVING
5 quotesOf the four things we're gonna talk about today, the least interesting of these is your body fat.
— Peter Attia
So everybody has sort of a different size bathtub. That's their genetic capacity to store fat in the safe subcutaneous space. The water coming in the bathtub is what you're eating. The water leaving the bathtub through the drain is the energy expenditure.
— Peter Attia
But if you get to the point where you exceed your bathtub's capacity to hold water and you start to spill over, really bad things happen.
— Peter Attia
It takes a while to adapt. I want to be really clear. It took, it took three months to just even get over the, the, the cliff of, uh, maybe get over the hump, I should say, of feeling kind of miserable when I exercised, and I would say it took me 18 months to get to the point where I couldn't distinguish between being on and off carbohydrates.
— Peter Attia
Um, but yes, I mean, I think, you know, trends matter. Um, you're treating what you see, but you're, you're, you're mindful of the trends.
— Peter Attia
High quality AI-generated summary created from speaker-labeled transcript.
