AMA #51: Understanding and improving your metabolic health

**Peter Attia** (0:11)
Hey, everyone, welcome to a sneak peek, Ask Me Anything or AMA episode of the Drive podcast. I'm your host, Peter Attia. At the end of this short episode, I'll explain how you can access the AMA episodes in full, along with a ton of other membership benefits we've created. Or you can learn more now by going to peterattiamd.com forward slash subscribe. So without further delay, here's today's sneak peek of the Ask Me Anything episode.
Welcome to Ask Me Anything, episode number 51 I'm once again joined by Nick Stenson. Today's AMA focuses on questions we've gathered around metabolic disease. If you've listened to this podcast or read my book, you're probably familiar with what I call the Four Horsemen, which are the major disease processes of aging. These include cardiovascular disease, cancer, neurodegenerative disease, and metabolic disease, which is really a continuum of conditions.
In today's episode, we really dive into that fourth horseman, these conditions around metabolic disease.
These topics that we explore include questions about how metabolic disease feeds the other three horsemen and why we should be aware of our metabolic health. We talk about the various metrics that I use with my patients to understand their metabolic health. Now this will include some common ones as well as some less common ones. And then of course, we get into the various factors that you can manipulate in which to improve your metabolic health. And they include some of the obvious ones, but also some less obvious ones. So if you're a subscriber and you want to watch the full video of this podcast, you can find it on the show notes page. If you're not a subscriber, you can watch a sneak peek of the video on our YouTube page. So without further delay, I hope you enjoy AMA number 51

**Nick Stenson** (1:57)
Peter, welcome to another AMA. How you doing?

**Peter Attia** (2:00)
Good, thanks for having me.

**Nick Stenson** (2:01)
So today's AMA, we're really gonna focus on metabolic health. I think a lot of people are familiar with this term you call the four horsemen, which are the four major diseases of aging. That includes cardiovascular disease, cancer, neurogenetic disease, and then metabolic disease, which is really a range of conditions, kind of from obesity all the way to type 2 diabetes. And we haven't covered it on recent AMAs that closely. And so what we wanted to do was gather all the questions that have come in on that and then put them into today's AMA. So we're going to hopefully get to as many as we can, but this will include what is metabolic disease and how do you define it, how it feeds the other three main horsemen, and how it can cause problems for people.
And then really look at the metrics that you look at with your patients to understand on an individual level where they're at metabolic wise. And so I think a lot of people will look at metabolic health from simple blood metrics such as HbA1c or things that they can get with a typical annual physical. But I know with you and your patients, you look at a lot of other things, and we're going to get into those details today, which is, what are those things? What do you like to see? And ultimately, what can they tell people about their metabolic health?
And then we'll end the AMA looking at kind of what are the lifestyle interventions that people can use to help improve their metabolic health. And this will look at nutrition, sleep and exercise. So we have a lot to get to. So with all that said, anything you want to add before we get started?

**Peter Attia** (3:34)
No, I mean, I just think we're going to structure this discussion by probably spending a bit of time talking about the nuanced ways in which you could define or identify a person who's not metabolically healthy.
We'll come up with a very high bar for that on what real metabolic health looks like. And then as you said, we'll talk about, okay, what do you do about it if you're in this situation? Because most people listening to this, myself included frankly, will always have an area in which they could improve.

**Nick Stenson** (4:00)
Let's start with a little bit of primer on metabolic disease and how it can feed into the other three horsemen, which is cardiovascular disease, cancer, neurogenetic disease. So to do this, I think we need to kind of define metabolic disease or metabolic syndrome and look at how that feeds those other diseases.

**Peter Attia** (4:19)
I think a bit of historical context is helpful here. There was a very famous, remarkable endocrinologist by the name of Jerry Rieven. Definitely one of the regrets I have is not having interviewed Jerry for the podcast before he passed away because I did know him and I'd met him several times.