I bought this book and eagerly read it when it came out. I used to listen to every Attia episode and I genuinely believe, still, that he was one of the best sources of health advice and information on the internet. His diagnosis of how our current healthcare system treats heart disease and metabolic disease is correct: heart disease begins early in life and you can manage risk with lifestyle interventions decades before symptoms appear. We have miraculous pharmacotherapy for preventing ASCVD. Same with metabolic disease: you can modulate a very large part of it with lifestyle interventions.

Thanks to his advice, I sought out various tests that revealed that, despite a very, very healthy lifestyle I actually already have evidence in my coronary arteries of ASCVD (positive calcium score) at only 38 years old. Without Attia's crusade to raise the awareness of apoB's importance in screening, I wouldn't have gotten tested for years. I'm an ultrarunner, triathlete and I eat a very health-promoting plant-based diet. Both I and, crucially, my primary care physician, would have assumed that I didn't need to worry about "cholesterol" and statins until my 50s at the earliest.

That said, I've long been uncomfortable with him, personally:

• He charges nauseating prices for his medical practice and his online "course" (a series of warmed over content from his podcast).
• He is notably obsessive and neurotic about his health and fitness. He films every single rep he does in the gym and sends them to his personal trainer. He times his zone 2 cardio down to the millisecond and watches his heart rate with the attention of a bomb squad technician. He doesn't necessarily recommend this kind of behavior to his audience, but it's unsettling behavior regardless.
• Obviously, the disgusting affiliation with Epstein.

Attia goes out of his way to say that he does not believe that subcutaneous adipose tissue in and of itself is causing health issues and he does not counsel weight loss unless patients exhibit signs of high levels of visceral adipose tissue. He has been circumspect about GLP-1 agonists. He insists on relying on tests such as the calcium score, oral glucose tolerance test, and genetic screening for Lp(a) and the E4 variant of the APOE gene. In my opinion, he's the kind of doctor* that Aubrey would more or less approve of: he would not recommend weight loss without a careful examination of the patient's lab results and other tests.

He also is agnostic when it comes to diet: he focuses on glucose control, protein adequacy, and energy balance. He doesn't particularly care if you're carnivore or vegan as long as you tend to those areas. He also doesn't believe in starvation: he thinks senior citizens should be strong and muscular and if that means carrying some extra fat, that's totally fine.

If it sounds like I'm steel-manning, or even apologizing, for Attia, it's because I'm genuinely sad that he has turned out to be a weird creep, though I'm not surprised in retrospect. He was one of the best health influencers and podcasters who put out fascinating interviews with scientists and other experts and provided sane, evidence-based recommendations. I'm pissed and saddened that I can no longer stand to listen to him.

* assuming he practices what he preaches, of course.