Dr. Peter Attia and NuSI (Nutritions Science Initiative)

Since I put up my first post about NuSi (Nutrition Science Initiative), I've had various correspondence with co-founder Peter Attia, MD (co-founder with Gary Taubes, author of Good Calories Bad Calories and Why We Get Fat) by phone and email.

Yesterday, I had the opportunity to head up to Menlo Park to meet him for dinner at Left Bank. I assure you that the 3-hour conversation that ensued was far more interesting in every way than anything I heard on the drive up on the radio, between the two guys vying for the position of second-in-command to rule your life.

While I outline some of my reservations and hopes in that last post, I did want to emphasize that I'm enthusiastic and supportive. Really, how could you fault more science being done? Even when science is done badly, there still remains something of knowledge—and if nothing else, an example of how not to do science, or better spend money doing research. I think they are committed to doing gold standard science and research. I'm sure of it.

But yea, it all comes down to money. Research is expensive. Peter presented a pretty clear picture along these lines. It's like a reverse triangle.

Incidence vs Cost
Incidence vs. Money Spent on Research

In essence, take adverse health incidence on the left, bottom up from lowest to highest, and while not perfect, what you find is somewhat of an inverse relationship with money spent on research (to the right), where some of the lowest occurring problems (breast cancer, HIV, for example) get the most funds (by incidence and I believe, in absolute terms in some cases).

The rate of obesity is about 30% in the US. By far and away the largest single health problem facing America. Spending, as I recall Peter telling me, is on the order of $4 per person; whereas, other conditions with far fewer afflicted are researched on the order of $40-50 per (again, not sure if this was by individual afflicted, or per American). This was a conversation over the course of dinner and that figure above was sketched out on the white paper table covering. My purpose is not to lay out concrete numbers and make a huge distinction, but simply to illustrate that obesity research could use more bucks, they wish to do it privately, and if lots of people pitch in at small amounts some things could really get looked at that haven't before.

Alas, I have it as a side project to begin looking into specific numbers for disease and obesity vs. research funding. I'd also like to break that down into public vs. private funding. Seems to me that private funding for breast cancer research might be a model to look at. I've heard for years, for example, that prostrate cancer in men is nearly as prevalent but receives a pittance of funding comparatively. I've never looked into those numbers myself. I think I'm going to spend some time on all of that.

Another thing. As much as I hate to see all the football players wearing pink on an entire Sunday, I must admit that private funding is better than coerced public funding via tax dollars where the majority is almost certainly squandered. Private funding engenders accountability and I'm sure that a lot of private donors are satisfied with something on the order of 80% going to the actual research (10% administrative, 10% rolled back in for fund raising). I'm just guessing at those numbers, having just begun to think about everything required to raise funds privately (i.e., citizens: not industry; not government)

...I got an intro into the research path, which is complex—research feeding more research. As I recall, about three studies should be up and running in months.

Over the course of this conversation Peter said that one of the things that makes obesity research hard to fund is the general notion that they are seen as gluttonous and slothful (...no, that's only the small minority who go get themselves scooters to ride around on when they don't need to, exacerbating their condition).

OK, but my immediate objection was: then what about HIV research that gets tons of money? By and large, those afflicted engage in well known risk behavior, two kinds of which—IV drug use with used needles and unprotected anal sex—people find disagreeable by various degree. The simple answer is that fat people aren't organizing and agitating for funds. What else could it be?

For me? The best way to get sympathy and get pockets opening for dollars to do research is to focus on childhood obesity, diabetes and NAFLD. No one can argue that they are wholly innocent—and who know now much of the eventual sypathy for HIV wasn't over children being born with it!

So what's really the point of doing the research? I can't speak for NuSI of course, but I have an idea. They're not looking for new drug therapies. Research isn't going to be funded by FD[A] companies (get it?).

In perhaps the most right-before-your-eyes realization during our conversation, Peter asked me to consider the HIV infection rates in places like Botswana, Swaziland, Lesotho. About 25%. 1 in 4! How about the US? About one-half of one percent. 1 in 200. What accounts for the difference? Is HIV genetically different over there? Does it act on them differently? (Answer: no)

Now, consider that the obesity rate in the US is 34%. But then take a look at a list of countries under 5%.

Less than 5 Obesity
Less than 5% Obesity

I ask you again: does food metabolize differently over there? Are they genetically different to such an extent that their genes change when they immigrate to America and many get fat?

So I think that the purpose of NuSI is to conduct the research that can finally, authoritatively give solid insight into the causes of obesity so that people can generally follow it. And a potential bright side too, is that boxed, bagged and canned food companies will want to make a buck off that; and while their wares will never be even the better choice, it will be better than the cheap grain and sugar, engineered stuff they're selling now.

...HIV infection is low in America because people have no doubt that it's transmitted by blood-to-blood contact and they know how to avoid it. This is not the case in Africa with all their tribal myths and the "great work" of the Catholic Church to dissuade condom use—and whatever else the hell is going on there. Conversely, Americans are fat because they eat too much, and they eat too much because they eat the kinds of engineered foods that tend to be both psychologically addictive and dysregulating of appetite and fat storage and mobilization hormones (i.e., both Taubes and Guyenet are right).

NuSI has been initially funded but it's going to take more. I'm going to be thinking about how to help them in raising funds going forward, but here's the donate page. I stepped up to the plate today. Won't you? I've asked that they consider adding a monthly subscription option so that you can just set up for your once per month equivalent of a Venti, sugar-free, non-fat, vanilla soy, double shot, decaf, no foam, extra hot, Peppermint White Chocolate Mocha with light whip and extra syrup...and be done with it.

Comments

  1. Gordon Shannon says:

    I read about NuSI today on your recommendation in comments. What strikes me as particularly valuable about their work is their *explicitly adopted* rational methodology. There is significant value in supporting such an endeavor, even if one disagrees with their focus on obesity rather than other forms of ill-health (I’m not saying that *I* disagree with this focus, but I could understand someone else’s disagreement). So I sent a small donation their way, rather than spending it on a shitty snack at the store. (In fact, my wife just realized she has a significant gluten intolerance, so no snacks for us anyway – dammit).

    • Thank you, Gordon. I’m really going to pressure them to get up a monthly auto or subscription option so people can fire 5,10,15,20 (like an NPR fundraiser) monthly and forget. They’ll never miss it and getting hundreds or thousands to do that means real money.

  2. They also smoke twice as much as we do.

    48.23% Vietnamese males
    41% Laotian males
    23.5% USA males

    • Or maybe they don’t consume 100 pounds of sugar a year like Americans do (especially in the form of soda, etc.).

  3. Yea Charles, but without longevity integrated its kinda….well not meaningless but a bit incomplete, wouldn’t you say?

    After all, everyone dies of something, eventually. Frankly, a coronary in your sleep in your 80s might not be a bad way out.

    Of course, there’s also the issue of accuracy of reporting. We’re taling pretty 3rd world ish here. At least with obesity, pretty observable at a glance.

    • Quality of life is important, and we seem actively determined to make other people determine that for us (whether the people who sell us the “food products” we eat, or the doctors we sue when they cannot clean up the resulting mess).

  4. ladysadie1 says:

    “…give solid insight into the causes of obesity…”

    Finally, someone who is looking at what causes something rather than overblown hype about finding a “cure”!

  5. David McC says:

    Of course what gave HIV massive funding in the 80s was enormous scaremongering by the scientists, politicians and media. There was a genuine fear that a crisis would turn into an epidemic and the world would come to an end if heterosexuals didn’t engage in safe sex. You could argue that the scaremongering had the desired effect and the general population (in the first world anyway) modified their behaviour and that the scaremongering exaggerated the problem, but one way or another a pandemic was avoided in the first world.

    Perhaps the other problem is that obesity per se is not an illness. It may lead to illnesses and there’s certainly cause and effect, but there’s plenty of funding for diabetes research which of course is an illness. Obesity leads to so many potential illnesses that it becomes confusing and as soon as it becomes confusing there’s an excuse not to fund it.

    It’ll be great to see this project get off the ground, but there are many hurdles to overcome.

  6. johnnyvento says:

    You seem to be against public funding for medical research even though you almost certainly know nothing about it. The NIH is responsible for most of the research that advances treatments for disease. NIH also paid for the human genome project which would never have gotten private funding. Private investors want a marketable product before they invest which means they are very reluctant to invest at the seed stage. The public good is served best by funding like this from the NIH. Accountability is measured by productivity- not by the production of a marketable item.

    • “You seem to be against public funding for medical research even though you almost certainly know nothing about it.”

      What, like stealing from people by force is “complicated.”

      Laf. You must not be a regular reader.

      • I personally find the ‘stealing’ verb pretty out there, Richard. But the truth is that one way or another, you will pay for medical research.

        This is what medical research looks like when it’s “free”:

        http://blog.ted.com/2012/09/27/5-prescription-drugs-doctors-had-no-idea-could-hurt-their-patients/

      • johnnyvento says:

        I find your libertarian-invoking response rather odd and misguided. I just told you in my previous post why private funding alone is inadequate for biomedical research- and yet you just lay down a blanket statement that public funding is somehow “stealing” which seems to suggest that you didn’t understand my original post to begin with. Do you think private funding provides a mechanism to prevent corruption? On the contrary, it’s worse, if anything. Pharma has the ability to suppress negative results; they ghost write research papers and put the names of doctors as authors who have never even seen the research; they can exclude people from the study who will be nonresponders and therefore bias the research more favorably. I’m not a regular reader, but I would hope that if you would be more accurate in your understanding of this issue.

      • Laf.

        I don’t even know where to begin, so I’ll just be dismissive for a second time.

        This is all baked into the cake. By virtue of public funding and public/government oversight, people have been relieved of their essential calling to look out and judge for themselves. This is of course necessary because without the aura of authority and all that goes into it, nobody would take a drug unless:

        1. They’re dying anyway so take the chance.

        2. It’s proven effective, such as with the first antibiotics, and such.

        You fail to understand. This is not a problem with ingenuity, invention, advancement. It’s a problem with people always believing they have a savior in heaven looking out for them, and one on Earth, appointed by the one above.

      • …and johnny, you really need to be reading the series I’m going right now. Start at Part 1 and don’t stop until you get through part 4. Part 5 will be up later today.

      • johnnyvento says:

        I’ll read your series. And I suspect that we may agree on more than we disagree on- but since I started this I’ll make one more statement. I won’t waste your time beyond that.

        All that you say may be true, but the opposite is also true. My problem with the libertarian mindset is it’s always only theoretical; nobody actually has to live it while having the luxury to espouse it. Case in point: if “government funded” research found a cure for Alzheimer’s disease, who would reject taking it because it came out of research funding that was “stolen” from the public? Every libertarian would line up at the trough to get it, even those who spend their entire lives ranting against that very thing.

        So your smug dismissal actually cuts both ways- libertarians can be smugly dismissed for the same reason, and there is much evidence for this in the past few decades to prove my point. We see this time and time again; the “libertarians” wanted to save their social security when Bush tried to privatize it in 2005.

      • Yes, NIMBY is definitely an issue. This is why I say that such moves toward a more anarchist sosiety must begin at home, in one’s own mind, family, culture, who they choose to associate. It’ll be a long haul social change, if it happens at all. I expect to see, over time, more an more small communities forming in jurisdictions where the State leaves them alone. That would just be a start.

      • johnnyvento says:

        I’m not even sure we disagree- but the fed/state/local cudgel can be applied differently. It’s not always obvious. If we can find common ground perhaps we (people like us) can agree to come together to make change.

        for instance:
        local- food production and distribution
        state: distribution of aid; allocation of resources for education, infrastructure
        fed: weather monitoring and disaster response; medical funding and research

    • You’re forgetting that private can also mean nonprofit organizations (that’s what NUSI is). A lot of medical research is funded by similar entities.

      Sure, NIH might have done some useful stuff, but you can’t know if it wouldn’t have been done anyway. NIH is controlled by the government, and they’re not exactly neutral when it comes to health issues.

      • johnnyvento says:

        I’m not forgetting that. Non-profit does not mean lack of conflict of interest. If the owners of the research center want a particular result, then they will find a way to get it. This is not my original thought, many in the ancestral health community who are generally favorable to these people and their concept are putting this objection forth as a possible conflict of interest.

  7. What’s the 34% obesity rate based on, BMI? You have to remember then it can be misleading since it uses weight and height and doesn’t measure the actual body fat percentage. Someone like Arnold in his prime would be considered overweight. I believe Fat Head brought this to my attention for the first time.

    On the other hand, according to this CNN article, the obesity rate may be even higher than we think.
    http://www.cnn.com/2012/04/03/health/obesity-rates-maybe-worse/index.html

  8. ” and they eat too much because they eat the kinds of engineered foods that tend to be both psychologically addictive and dysregulating of appetite and fat storage and mobilization hormones”

    Add nutrient deficient to this, or is that part of disregulation. Personally I love the malnutrition argument for driving hunger, but am not sure how accurate that is. You can eat an excess of calories in flour, sugar, and corn, and still be driven to hunger because of a variety of missing nutrients, which has nothing to do with energy processing hormones, or is that way off base?

    • “Add nutrient deficient to this, or is that part of disregulation. Personally I love the malnutrition argument for driving hunger, but am not sure how accurate that is. You can eat an excess of calories in flour, sugar, and corn, and still be driven to hunger because of a variety of missing nutrients, which has nothing to do with energy processing hormones, or is that way off base?”

      Paul C: this is my chief interest. I’m experimenting with different highly nutritionally dense foods now to get my thinking straight. Just a trailer but you know what seems most profound in appetite regulation? Milk. It would make sense, however, in an evolutionary context. Funny thing about milk is the a little makes you want more, then more, then more–even at 2-4am. Once you have had enough, you have no desire for anything for 12 hours easy.

      This sort of thing will never be studied. You have to do it on your own.

  9. I am in Russia at the moment. Still crowd looks strangely thin for me after Florida . Mothers walking with small children in park are thin, more than 90% of people in metro look thin or normal weight. May be some guys hide their beer and bread bellies with jackets, I don’t know. It is an autumn now, and there is a lot of critic of agiculture results in news – it is less productive and intense than in more developed countries. Even cows give less milk than the same breed in Holland . May be it is the secret? Of course, thin people are not perfectly healthy and their life expectansy is less than in the US.

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