The Statin Data Peter Attia Deleted

Wow, this is big, and honestly I'm pretty upset because Dr. Peter Attia is hiding something. And do you know what that something is? It's this graph. This graph shows that statins, specifically atorvastatin, the most profitable drug in history grossing over $150 billion, slashes levels of GLP-1 in a human-controlled trial. Peter, in what appears to be a response letter to me, a case I'll make in a moment, attempted to discredit this study. Yet, he completely and conspicuously omitted its central graphic. This one. He did manage to cherry-pick other panels from the exact same figure to include in his rebuttal, but the only graph of true and obvious relevance, he ignored it completely. And when the most important result disappears, that's not nuance and accuracy, it's curation. And if you're still not getting it, this is not a trivial omission. It's like asking someone to watch Star Wars with you, all 6 movies, and then playing a version without any Jedi or Sith. It just doesn't make sense. But before going further, let me simmer and be absolutely clear about what this is and what this is not. This is not going to be a personal attack. This is going to be about data and logic, not personalities. It is not an attempt to manufacture controversy, which honestly at this point will be like pouring water on a full cup anyway. And it is not me going after Peter. It is me responding directly and transparently to arguments Peter has chosen to make publicly in response to my work— mine and colleagues'. So my goal here is simple. It's not to give you drama, you don't need any Real House Bros of longevity. It's to give you something thoughtful and substantive, albeit unexpected— this video is gonna take some turns. Something that hopefully leaves you thinking and helps us collectively build a healthier, more authentic intellectual ecosystem around science and medicine and social media communication. And this is the abbreviated version. If you want a deeper dive, the full letter is linked below, but I do want to be respectful of your time, so let's get into it. Let me first double down on the context. The scene event here is not me responding to Peter, it's Peter responding to me. This is actually a pattern, it's happened repeatedly, but most recently Peter devoted an entire newsletter to a paper he described as as "recent" despite the fact that it was published 2 years ago. What was recent is that I covered it extensively across written and video formats—X-threads, IG posts, newsletters, videos—and tagged him directly. And as an illustration of impact, directly on the heels of my coverage, this paper jumped from basically obscurity to top of cell metabolism's most read list. That's honestly thanks to your curiosity and interest. Anyway, shortly thereafter, Less than 2 weeks after I commented on this paper and tagged Peter, his response appeared. The connection was so apparent that others pointed it out publicly, which is actually how I became aware of his letter in the first place. People were commenting that, "Hey Nick, Peter's responding to you." I asked, "Was I named in the letter?" It was like, "No, but it's obviously you." So that's how I became aware of his letter anyway. And as I said, this is not an isolated case. Shortly before that, Peter invoked the so-called hypothesized lean mass hyper-responder phenotype, an area of active academic debate which I and colleagues been deeply involved. In fact, we've been spearheading it, and Peter knows that. I've even collaborated with members of Peter's direct professional circle on this particular work, including his past head of research, Bob Kaplan. I've even offered directly to collaborate with Peter on this research, including in an editorial in the Journal of Clinical Lipidology. In this case, he declined, citing lack of his own credibility. There's some irony there. But the point here is not to litigate motives. It's simply to establish context. Peter is responding to my work repeatedly, and I'm happy to respond in kind. However, while he has granted me the privilege of anonymity, I prefer to be direct. But with that frame set, now on to the data. The study in question was published in Cell Metabolism, a top basic science journal. It followed 40 people who received either a statin or a control intervention. And the statin group exhibited a striking reduction in GLP-1 levels, again on the order of 50%. In this graph, you can see it. An 8-year-old could tell you what's going on. Alongside worsening glycemic markers and insulin resistance. And this is the graph Peter omitted, even though he prominently displayed other panels from the same figure showing the total cholesterol and LDL reductions. Talk about cherry picking. But beyond that omission, his rebuttal at length contains flaws. For example, Peter tries to argue that the absolute reduction in GLP-1 levels is small compared to the magnitude of the postprandial after-eating surge. That is a biological category error. Conflating transient meal-stimulated spikes with basal hormone levels is physiologically problematic to say the least. By that logic, fasting insulin would be irrelevant simply because insulin rises more after you eat carbs, a conclusion that no serious scientist or doctor who has thinking neurons would endorse. Now, to be clear on my own position on this paper, I have never claimed based on these results that this study proves statins are categorically harmful or toxic or should never be used. My concern is more nuanced. It's that these data exist, but they are absent from clinical and academic conversations. It strains credulity to suggest that a 50% reduction in a central metabolic hormone is clinically irrelevant, especially when paired with worsening glycemic control. And importantly, this human-controlled trial also identifies a plausible mechanism opening doors for risk mitigation strategies such as targeted bile acid supplementation. These are inexpensive and readily available treatments that could help patients. If you want more details, see the source video. My broader concern then is the deafening silence. We are talking about the single most profitable drug in history, atorvastatin, part of the most profitable drug class in history, statins, and a hormone central to metabolic regulation, GLP-1s, in a pathway that has become especially salient in the era of GLP-1-based weight loss drugs. Yet this information rarely surfaces in academic discourse and almost never reaches the doctor's office. Dismissing these findings is not cautious skepticism. It's ignorance masquerading as prudence. But this presents the opportunity for clarification. So now pivoting, here are 3 truths you need to know to be an informed consumer of science. And I'll try to be concise. The first truth is that absence of evidence is not evidence of absence. This is a foundational scientific principle. In the case of statins and GLP-1s, we know there is a clear metabolic effect. Statins, especially atorvastatin, slash GLP-1 levels. What we don't know yet is whether that effect translates into long-term clinical harm. The appropriate response to uncertainty is not to presume innocence, but to acknowledge unknowns. So for a very widely prescribed long-term medication given to tens of millions of people, the burden of proof lies with medicine to establish safety, not with critics to prove harm without a shadow of a doubt. At minimum, the effects of this magnitude this graph should be disclosed in discussion in shared decision-making conversations between patients and doctors. And as a quick aside, if you want more nuanced deep dives and dispassionate evidence-based non-dogmatic series of discussions covering everything from a masterclass on cholesterol-lowering medications, how they work, pros and cons, and other heart health topics, heart health supplements, historic trials, definitely make sure to check out the heart health library at staycuriousmetabolism.com. I'll include the links below. But with that, Moving on.

This also seems like a good moment to quash the myth that I'm anti-statin. I'm actually doing a statin randomized control trial on myself with atorvastatin, but you'll have to stay tuned for that.

The second irrefutable truth is that the incentive structures we build shape the data we get. Research does not occur in a vacuum, and clinical research is really expensive. That means the business models we have constructed, they incentivize studying large heterogeneous populations in order to identify broad effects that justify a wide prescription base. Precision medicine may better serve individuals, but population-level medicine is far more profitable. And when that reality is taken seriously, it becomes easier to understand why certain research questions are pursued while others are neglected. So returning to this example, the statin GLP-1 trial, the most obvious next step scientifically would be to conduct a larger-scale study to replicate and generalize the findings, and perform deeper, patient substratification to identify who is most likely to benefit from statin therapy and who may be harmed. Those are precisely the kind of data that would enable more personalized, rational, and healthful prescribing. Yet, given the prevailing incentive structures, the tendency is predictable and exactly what we see: risks are downplayed, benefits are accentuated, and population-level averages are favored over individual variability. The goal is not optimal tailoring of therapy, but maximizing the size of the treatable population, and this isn't a conspiracy. It's the predictable outcome of a business model. And the third truth is that failure to disclose risks risks failure of trust. When patients discover that information was withheld, whether intentionally or through ignorance—and in Peter's case, I think it probably was intentional—trust erodes. The irony is that transparency, even when the data are imperfect or ugly, builds trust. Saying, "Here's what we know, here's what we don't, and here are the open questions," is not weakness. It's one of the most powerful tools medicine has. Medicine doesn't fail when it's honest and imperfect. It fails when it's paternalistic. So returning to Peter's article, he asks whether patients on statins should be concerned about the potential metabolic effects of GLP-1s, and I believe the answer is an unequivocal yes. Not because panic is warranted, but because informed consent requires information. And I'd even go further, because I believe doctors, scientists, and public health communicators have the responsibility—that's my responsibility, his responsibility—to surface these data, not suppress them or respond defensively to their discussion. But that brings me to the end of our discussion and a more personal reflection, because I'm really new to the public science communication space. This was not my original career plan. I had a very nice polished path ahead of me in traditional academic medicine. But now my academic and public-facing lives have collided, and I'm still learning how to navigate this messy intersection. And one thing that matters deeply to me is authenticity in discussion and debate. Me, I truly enjoy being challenged. I enjoy engaging with people who hold different views and stress testing ideas in my head in good faith with other smart people. That process is sometimes uncomfortable, often illuminating, and is one of the greatest pleasures of being a true scientist. And to show that this isn't just rhetoric, I'm not just talking the talk, I walk the walk, I've made a point of doing exactly that. I've had public, substantive conversations with people spanning a wide range of ideological spectra, from Paul Saladino, the Carnivore MD— History, talking about funding, it's not that it's not important, and not incentive structure, I'm not trying to— It's super important. No, no, no, I'm really not trying to color the conversation, I just think it's important. We're trying to break down ivory tower. It's important for context. It's important for context. I'm a sleeper agent. We'll get to the science. To Professor Walter Willett, arguably the most prominent pro-plant-based researcher in the world. It doesn't mean that we should change necessarily. It doesn't mean we should gain weight to avoid this reaction. I would not recommend that. I can have discussions with both these people. I can chat with Paul, be super friendly, sit down at Walter Willett's house, and get along with both gentlemen. Have cordial discussions, thoughtful, genuinely enjoyable. I genuinely believe I have good relationships with both these gentlemen precisely basically because we approach each other as people first, not as walking, talking ideologies. But unfortunately, I've noticed that not everyone approaches disagreement in that way. Too often, difficult conversations are avoided, constrained, or redirected behind guardrails designed to preserve status rather than advancing understanding and nuance. And this all brings me to the real and kind of selfish purpose of this video. It's not to fact-check Peter. It's not to manufacture drama. It's a time capsule for me. I'm watching this space closely, learning from it, its incentives, its personalities, its failures. I'm deciding who I want to be in it and what values I want to carry forward. Authenticity, transparency, honesty, and respect for differing point of views. I don't want to slide even an inch from those values. So consider this an accountability statement from me to you and a question from me to you, a rather long-winded one. Who do you want me to be? What values do you want me to demonstrate? And in cultivating those values in this intellectual environment, will you be my partners and my teachers along this journey? Thank you. Stay curious. Let me know your thoughts. A lot more information below if you want to go down the rabbit hole.

I want to end this with totally unscripted, just thank you to the communities that are making my time newly as a rookie metabolic health educator in the public sphere really spectacular. I never could have imagined having such a breadth of parasocial relationships with people from such diverse backgrounds who are so interesting and thoughtful and who feed back my enthusiasm for metabolic health in such a deep manner. Like, I'm the person who will be up at 4 AM reading Cell Science and Nature anyway. The fact that I can talk about like mTOR mysteries and metabolic paradoxes and have people go, oh my God, that's so cool, Finding a way to translate that enthusiasm to you and actually having you feel it and feed it back to me, it is a career pleasure that I never could have imagined. And the best part about all of this is, um, and I don't say this in a negative way, but unlike the leading influencers in the space now, Peter, I guess, maybe, Andrew Huberman and others, this is a career opportunity that is native to where I am, as in I'm 30 and I get to choose a priori to go down this path rather than having a later career pivot just because the opportunity is available to me. So what I'm really saying to you genuinely is you are going to help shape me as an educator and I want you to. I don't mean to be differentiated. Sometimes people criticize the way I go about things. The intro to this video is a little bit provocative. Yeah, I can improve my messaging. But that's the goal. I'm really in my rookie year of doing this more seriously, and I see it as a multi-decade long journey, and I genuinely see you as my teachers. I spend a lot of time in the comment sections across platforms because I'm serious about getting feedback. Um, and I'm just really excited to go on this journey. So sorry, this is a long end of video, but thanks.