By playing, you agree to uListen's Terms and Privacy Policy and YouTube's Terms of Service.
Peter Attia MDPeter’s historical changes in body composition & evolving nutrition & training [AMA 44 sneak peek]
Summaries, chapters, transcripts, and FAQs on this page are made by uListen, not YouTube.
CHAPTERS
- 0:02 – 2:40
Switching Up the AMA: Walking Through Peter's Own DEXA Data
After some banter about the cold weather, the host explains that this AMA will be a case study built on Peter's labs and DEXA results from the past week. Peter's spreadsheet of DEXAs spanning about 11 years will anchor the discussion of his changes in exercise and nutrition.
- •Banter about cold weather in Minnesota and Canada
- •The AMA is changed to a case study with Peter as the patient
- •A spreadsheet of DEXA scans covers roughly 11 years
- •The data will be tied to changes in exercise and nutrition
- 2:40 – 5:34
From Calipers and Hydrostatic Tests to DEXA
Peter describes how he tracked body composition over the years, from calipers during his boxing days to hydrostatic testing in his 30s. He explains why he moved to DEXA around 2011 and why it is considered the gold standard.
- •Boxing relied on calipers, which depend heavily on the skill of the tester
- •Hydrostatic testing is affected by how much air remains in the lungs
- •DEXA divides tissue into bone, fat, and other
- •He switched to DEXA around 2011
- 5:34 – 9:21
The Four DEXA Metrics That Matter More Than Body Fat
Peter explains what he reviews with patients: body fat, visceral fat, bone mineral density, and muscle mass indices. He uses the bathtub analogy for fat storage capacity and explains ALMI and FFMI.
- •Body fat is the least interesting of the four metrics
- •Visceral fat reflects overflow of the subcutaneous 'bathtub' and is highly inflammatory
- •Bone density is assessed with Z-scores and T-scores
- •ALMI and FFMI measure muscle mass relative to height
- •Patients should aim above the 75th percentile for ALMI and FFMI
- 9:21 – 11:20
Why Tracking Trends Over Time Matters
Peter lays out the three variables that changed over the decade: time, nutrition, and exercise. The host then points out that Peter keeps trend sheets for patients, and Peter agrees that trends matter more than isolated results.
- •Peter has logged DEXA data for nearly 12 years
- •Nutrition ranged from strict diets to fasting to unrestricted eating
- •Exercise changed dramatically over the period
- •Historical labs are gathered to build trend sheets for patients
- •Results are treated in light of their trends
- 11:20 – 15:55
The 2011 Baseline: DEXA vs. Hydrostatic Test
Peter shows his first DEXA from May 2011, taken the same day as a hydrostatic test that had put him at about 16% body fat. The DEXA read 9.3%, which matched how he felt. He walks through the weight, lean mass, fat mass and FFMI from that scan.
- •The hydrostatic test said about 16% while the DEXA said 9.3%
- •Weight was just under 180 pounds with about 156 pounds of lean mass
- •The facility did not provide visceral fat or segmental data
- •FFMI of 23.4 was above the 97th percentile
- •At that time he was swimming, lifting heavily, cycling a bit, and carb-restricted
- 15:55 – 18:06
Early Ketogenic Months and Why ALMI Is Preferred Over FFMI
A few months after starting a ketogenic diet, Peter's weight dropped to about 172.5 pounds, including some lost lean mass. Responding to the host, he explains that ALMI is preferred over FFMI when the two disagree, since limbs contain only muscle, fat, and bone.
- •Weight fell about seven pounds, roughly half lean mass and half fat
- •Body fat dropped to 7.5% and FFMI to about 23
- •A target FFMI for his age would be about 19, the 75th percentile
- •ALMI is preferred because it is a purer measure and has more supporting data
- •His FFMI percentile runs higher than his ALMI, which he attributes to thin arms
- 18:06 – 20:55
DEXA Scans 2012–2014: Cycling on a Ketogenic Diet
Peter describes the period from 2011 to 2014 on a ketogenic diet, when he shifted from swimming to cycling several days a week. His lowest DEXA weight was 167.5 pounds in October 2012, and he explains why he eventually left keto and began fasting in mid-2014.
- •He cycled five days a week, with two very long weekend rides
- •Lean mass fell to about 145 pounds by October 2012
- •FFMI was about 22 and body fat about 9.5% at that point
- •Keto adaptation took three months to get over the hump and about 18 months to feel fully adapted
- •In mid-2014 he stopped keto because it was so restrictive and began experimenting with fasting
- 20:55 – 24:03
Protein Intake on Keto vs. Now
The host asks whether Peter's protein intake during the ketogenic years matched what he eats now, given the drop in lean mass of about 11 pounds. The episode then ends with the sneak-peek membership pitch and disclaimers.
- •The host notes lean mass fell about 11 pounds between May 2011 and a later scan
- •The question is whether protein intake then was comparable to now
- •The full AMA is available to members
