#364 – AMA #75: Diets: how to evaluate and implement any diet including keto, carnivore, vegan, Mediterranean, and more

The Peter Attia Drive

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In this “Ask Me Anything” (AMA) episode, Peter explores how to determine the right diet for yourself rather than searching for a universal “best” diet. He begins by laying out five non-negotiable criteria that any sustainable eating pattern must meet—energy balance, metabolic health, adequate protein, micronutrient sufficiency, and long-term adherence—before introducing a practical rubric for evaluating different diets. Using this framework, Peter walks through the ketogenic, carnivore, vegan, and Mediterranean diets, highlighting their strengths, ideal candidates for each, and common pitfalls such as micronutrient gaps or adherence challenges. He explains why this guidance is aimed at people who feel overwhelmed by diet choices, not zealots defending a single approach, and provides practical advice on using tools like DEXA scans, lab markers, continuous glucose monitors, and symptom tracking to assess whether a diet is truly working.

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We discuss:

• Peter’s family chess battle [3:00];
• Framing the diet discussion: moving past tribalism to practical frameworks for evaluating various dietary strategies [5:00];
• Peter’s high-level nutrition framework [11:00];
• Why diet is such a uniquely polarizing subject [14:15];
• The five non-negotiables that apply to any diet [17:45];
• How to think about energy balance in the context of evaluating a specific diet [20:15];
• How diet can address metabolic health [21:45];
• Protein as a dietary foundation [23:30];
• Micronutrient essentials: avoiding deficiencies in restrictive and processed diets [24:45];
• Why adherence and sustainability are essential for diet success [27:15];
• Examining the standard American diet through the five non-negotiables [31:00];
• The evaluation framework for specific diets [33:30];
• The ketogenic diet: defining ketosis, clinical origins, modern uses, and potential health benefits [35:00];
• The main strengths and weaknesses of the ketogenic diet [43:00];
• How to avoid micronutrient deficiencies while on a ketogenic diet [47:15];
• Electrolytes and fiber and the ketogenic diet: preventing magnesium loss and maintaining digestive health [49:15];
• Adherence challenges of the ketogenic diet [51:30];
• The carnivore diet: definition, motivations, anecdotal benefits, and possible mechanisms [53:15];
• The main strengths and weaknesses of the carnivore diet [57:30];
• Plant exclusion on the carnivore diet: nutrient gaps, gut changes, and unanswered questions [1:03:15];
• Adherence challenges of the carnivore diet [1:04:45];
• The vegan diet: definition, core beliefs, and various motivations for this strategy [1:05:45];
• The main strengths and weaknesses of the vegan diet [1:09:15];
• Adherence to the vegan diet: social acceptance, edge cases, and personal sustainability [1:13:15];
• The Mediterranean diet: definitional challenges, traditional patterns, and its relatively strong evidence base [1:15:15];
• Limitations of the Mediterranean diet: loose definitions and indulgence risks [1:19:30];
• Measuring diet success: why setting clear goals and tracking outcomes matter [1:21:00];
• Tracking body composition using DEXA scans [1:22:15];
• Tracking metabolic health: key blood tests and advanced glucose monitoring tools [1:22:45];
• Using elimination diets to identify food sensitivities that may cause digestive problems, autoimmune symptoms, or low energy [1:23:30];
• Evaluating “anti-inflammatory diets”: confirming inflammation through symptoms and hs-CRP testing [1:25:15];
• Final takeaways: flexibility, structure, and avoiding dogma in dietary choices [1:27:00]; and
• More.

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