Peter Attia

Contractions cause most labor pain. Delivery of the head forms only a thirty second part of labor while contractions continue for hours.

Most of labor is contractions. The delivery of the head is a thirty second part of the whole thing. Contractions go on for hours. A nurse described the pain of contractions to a husband who did not want an epidural by comparing the sensation to having balls slammed in a drawer again and again and again. The pain goes on for so long. Delivery of the head is very very painful. An epidural was used with all three labors. On the third one the medicine was more dilute and supposed to spread around better to give better coverage. There was no coverage right at t

Most women possess the physiologic capacity to produce breast milk. Breastfeeding requires a maternal and neonatal partnership. Complex hormonal interplay in the endocrine system drives milk production. A lactating woman has a harder time ovulating. Lactation was generally viewed as one method of birth control.

Missing one feeding makes lactation not a good form of birth control. A lactating woman will have very suppressed levels of estrogen and progesterone. If a woman skips any feeds then suppression of the cycle stops. Lactation only works as birth control when a mother maintains an uninterrupted feeding schedule. Women should not rely on lactation for birth control because one missed fe

Premature preterm rupture of the membranes at 28 weeks requires hospital admission. About half of patients deliver in the next seven days. The remaining patients stay in the hospital with ruptured membranes and receive monitoring all the way up until 34 weeks if everything looks reassuring. Antibiotics given at presentation help prolong latency without preventing all infections.

When water breaks at 28 weeks doctors call the condition premature preterm rupture of the membranes. Patients come into the hospital. About half of patients deliver in the next seven days after spontaneous labor begins. Other patients sit with membranes ruptured and low amniotic fluid but continue to make the fluid

A uterine rupture is an emergency and a surgical emergency. Surgery on the uterus from big fibroid removal or a prior classical C-section cuts through the musculature of the uterus. The type of incision from a classical C-section is much more likely to rupture during labor with a risk of like ten percent. Ten percent risk is too high so the group should not labor.

A low transverse C-section is preferred in term patients where it is almost always possible. Delivery of a preterm baby is one of the most common reasons for a classical C-section. The uterus has not expanded enough and the lower uterine segment is not developed. An incision in the lower part of the uterine segment may not safely

C-section rates in the United States increased dramatically from ten percent to thirty percent over the last fifty years. Different drivers explain the three X increase. Pregnancies are higher risk than they used to be. An increase in maternal obesity has raised the number of larger fetuses or cases where labor does not progress normally. The switch to continuous fetal monitoring during the active phase of labor in most hospitals leads to more C-sections when the tracing is not reassuring.

Once a patient has one C-section, the patient is more likely to have another one. Multiple C-sections increase the risk for abnormal placentation in the next pregnancy. The specific issue is placenta accr

Hypertension from preeclampsia follows a different resolution timeline than gestational diabetes does after delivery. A woman can be off insulin by the time she goes home when gestational diabetes resolves. Hypertension from preeclampsia does not resolve in the same way. Some women will have hypertension resolve very quickly after delivery. Many women need antihypertensive medications for several weeks after delivery because hypertension can take six to twelve weeks to come back to more of a baseline.

There are other women who will have persistent hypertension after delivery and never quite resolve the hypertension. Lots of women will come back and develop hypertension within the next five

It is not an oversimplification to say that every woman has to become insulin resistant during pregnancy because the adaptive response preferentially directs nutrients to the fetus. Genetic factors probably amplify the response in some women. Environmental factors would also amplify the response in some women. The environmental factors could be stress, sleep, nutrition, et cetera. The framework is a great one for the point.

Interestingly, gestational diabetes does not always recur in every pregnancy. The process is not fully understood. Like almost everything in medicine, if a woman has had gestational diabetes before, the woman is more likely to have gestational diabetes again. Not everyon

First line treatment for gestational diabetes consists of dietary modifications along with nutrition consultation and glucose monitoring in women who presented metabolically healthy prior to pregnancy. Targets include fasting values under ninety five and one hour postprandial values under one forty. Monitoring continues until more than half the values stay below targets.

The short interval between diagnosis at twenty eight weeks and delivery limits lifestyle intervention to roughly two weeks. Elevated values in the first week lead directly to medication rather than extended attempts at control through diet alone. Insulin functions as first line medication during pregnancy due to insufficien

Folic acid must be at adequate levels prior to conception. Good evidence shows that folic acid deficiency increases the risk of having a neural tube defect in the baby. By the time a woman recognizes the pregnancy, it is already too late to bring up folic acid levels if a deficiency had been present. Folic acid is one of the most essential things early on.

Fifty percent of pregnancies are unplanned. Prenatal vitamins should be recommended to all women of childbearing age. A well-balanced diet works because much of the food supply is supplemented with B vitamins and folic acid along with other nutrients that women need to replenish during pregnancy.

Genetics provided great insight into hyperemesis gravidarum by flagging the GDF15 gene as really important in driving the condition. The GDF15 gene is now a developing target for therapeutics and the discovery suggests prior understanding of causes for hyperemesis gravidarum was not correct.

For a long time people thought HCG caused nausea and vomiting of pregnancy. Researchers studied folks who had hyperemesis gravidarum and found a signal at the GDF15 gene. Women who experience hyperemesis gravidarum in a first pregnancy often experience hyperemesis gravidarum in all pregnancies. Less than one percent of folks require hospitalization for hyperemesis gravidarum with IV hydration and even I

On Huberman Lab, semaglutide is catabolic across the board, so patients lose fat and also lose muscle. Semaglutide is not a miracle drug, and the dose in the main trial sits above the amount many clinic patients need.

The trial ran for one year, or maybe a little over that, maybe 60 weeks. About 16 weeks went into getting patients comfortably up to 2.4 milligrams weekly, and patients stayed on 2.4 milligrams. In clinic use, enough benefit usually shows between one and two milligrams, and people move along a little quicker. Some patients cannot tolerate semaglutide because of nausea. Dr. Peter Attia says nausea might be part of how semaglutide works, as appetite suppression taken to an extre

On Huberman Lab, dietary cholesterol plays no role in serum cholesterol and has no bearing on it. Ancel Keys acknowledged the finding in the 1960s, and the American Heart Association acknowledged it another 60 years later. Saturated fat is a separate molecule, and saturated fat consumption raises LDL cholesterol in many people.

Cholesterol in food is esterified, and an esterified cholesterol molecule cannot pass into circulation the way non-esterified body cholesterol can. On Huberman Lab, the body probably de-esterifies ten to fifteen percent of dietary cholesterol. Small amounts do reach circulation, yet they remain a small fraction of the total body pool. Saturated fat is a fully saturat

Peter Attia says the only purpose of fixing testosterone is to give someone the capacity to work harder, recover more from workouts, and experience more muscle protein synthesis. Extra testosterone with the same nutrition, no exercise, and time spent on the couch brings no benefits.

As an adult, his most extreme physique was at 38. A DEXA scan put him at 7% body fat, with a fat-free mass index of 23.2 to 23.3 kilograms per meter squared. He was huge, strong, and totally ripped while testosterone was in the toilet. He exercised about 26 hours a week, swimming and cycling, and was grossly overtrained. He looked like twice the man he is today, and he says today his testosterone is probably twi

Peter Attia gives patients who arrive on a long supplement list a homework exercise: answer seven questions for every supplement. He calls the exercise another Peter principle. The result is sobering. A lot of patients come back and report that they cannot produce any reason, along a rigorous line of thinking, for taking 80 percent of the supplements.

At intake, Attia asks which drugs and supplements a person takes. Some say they take nothing and want Attia in charge of the plan. Others need extra pages of documentation because they travel with a suitcase of pills that rattles through an airport. Attia hands them a spreadsheet. The spreadsheet walks through the logic of why the patient take

On Huberman Lab, a clinician stopped using Anavar to lower SHBG. The question was whether Anavar was still used because Anavar is too potent. The reply was that Anavar is simply too complicated for patients. Anavar cannot be taken orally, so each dose has to sit under the tongue, like a troche.

One patient was told about 87 times and still swallowed the Anavar tablets. The dose was 10 milligrams three times a week. The clinician first said three months of swallowing, then corrected the span to two months. Two months of swallowing Anavar every time tripled his liver function test. After the liver function test tripled, Anavar was not worth the hassle of chasing perfection.

On Huberman Lab, insulin suppresses sex hormone binding globulin. As insulin comes down, sex hormone binding globulin goes up, and if testosterone has not gone up with it, free testosterone falls. Helping a person get metabolically healthy can lower free testosterone in the short run, all things equal.

A patient can show a total testosterone of 900 nanograms per deciliter, about the 70th percentile on the scale they look at, with free testosterone at 8 nanograms per deciliter, less than 1 percent free. A man should be about 2 percent free, closer to 16 to 18 nanograms per deciliter. Sex hormone binding globulin in that situation is really high, probably in the 80 to 90 range, above an upper

On the show, hormone replacement therapy for a woman is preferred from her gynecologist, with an endometrial ultrasound every year and a pap smear every year, so the cervix and the endometrium can be checked and the lining is not too thick. When a woman still has her uterus, estrogen solves most of the problems. The next decision is whether she can tolerate progesterone, because not all women can.

Systemic progesterone is a hundred to two hundred milligrams. For some women that dose is a life-saving intervention: they start sleeping better, their hair gets thicker, and they feel better. For some women it drives them crazy. On the show, that reaction is probably the reciprocal of what shows

On Huberman Lab, estrogen plus synthetic progesterone reached one breast cancer case in a thousand and just hit statistical significance at a p-value of 0.05. Estrogen alone, given versus placebo to women without a uterus, went the opposite direction: a 24 percent risk reduction of about one in a thousand, with a p-value of 0.06 or 0.07. On Huberman Lab, the pattern suggests synthetic progesterone was playing more of a role than anything else.

Two findings in the combined arm were negative: a small increase in the risk of heart disease and a small increase in the risk of breast cancer. The breast cancer increase just reached a p-value of 0.05, one in a thousand cases. In women without a ute

On the show, the relative risk increase of breast cancer in the estrogen plus synthetic progesterone group versus placebo was 25 to 27 percent. The only headline said HRT increases risk of breast cancer by 27 percent. The absolute risk increase was 0.1 percent, a difference between five cases per thousand and four cases per thousand, one case in a thousand. The breast cancer headline turned out not to be true.

Preliminary results were first made available before peer review and before publication, and a huge press announcement said women receiving CEE plus MPA in the group with a uterus had a higher incidence of breast cancer. Going from four in a thousand to five in a thousand is a 25 perc

On Huberman Lab, a low dose of progesterone through the last half of the luteal phase, and sometimes through the entire luteal phase, makes all premenstrual syndrome symptoms vanish. The enormous reduction of progesterone so quickly is described as probably impacting the brain in a susceptible woman, and the symptoms are stated as a legitimate effect because progesterone for the seven days makes the symptoms go away.

Progesterone does nothing for 14 days in the follicular cycle, then rises and dominates the luteal cycle. At about 21 days the body has figured out whether she is pregnant. Most of the time she is not, so progesterone and estrogen start crashing, the uterine lining sheds, and t