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The Peter Attia Drive

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

The Peter Attia Drive

Peter Attia, MD

Health & Fitness, Medicine, Fitness

4.77.3K Ratings

🗓️ 15 September 2025

⏱️ 13 minutes

🧾️ Download transcript

Summary

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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.

If you're not a subscriber and are listening on a podcast player, you'll only be able to hear a preview of the AMA. If you're a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #75 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

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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Transcript

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0:00.0

Hey everyone. Welcome to a sneak peek, Ask Me Anything, or AMA episode of the Drive podcast.

0:16.0

I'm your host, Peter Attia. At the end of this short episode, I'll explain how you can access the AMA episodes in full,

0:22.3

along with a ton of other membership benefits we've created. Or you can learn more now by going to

0:27.0

Peter Atiyahmd.com forward slash subscribe. So without further delay, here's today's sneak peek

0:33.6

of the Ask Me Anything episode.

0:42.6

Welcome to Ask Me Anything AMA, episode 75.

0:48.4

In today's AMA, we're taking a closer look at how to choose a diet for yourself,

0:50.9

rather than which diet is the best of them all.

0:55.8

I start by laying out the five non-negotiables every sustainable eating pattern must hit. Energy balance, metabolic health, adequacy of protein, micronutrient

1:01.9

sufficiency, and long-term adherence. From there, we introduce a simple rubric. First, define the

1:08.6

diet's rules, then pinpoint its strengths and ideal users, and finally

1:12.6

surface the potential pitfalls so you can make corrections when necessary. With that framework,

1:18.0

I walk through the four diets you asked about most, ketogenic, carnivore, vegan, and Mediterranean

1:24.8

to show how to apply the framework. We discuss why I'm aiming this episode at the

1:30.0

majority of people who feel confused, not the diet zealots, so everyone has a common sense roadmap.

1:36.1

A deep dive into each of the five non-negotiables for any diet and how missing even one can sink

1:41.7

long-term results. Applying the define strengths weaknesses rubric

1:46.8

to keto, carnivore, vegan, and Mediterranean diets, highlighting metabolic effects, micronutrient

1:52.0

gaps, and adherence hurdles. Practical ways to track progress, dexas scans, important lab metrics

1:58.0

like fasting insulin, hemoglobin A1c, CGMs, and simple symptoms to log,

2:03.3

so you know whether a diet is actually working.

2:06.0

Why there's no single perfect diet, and instead the best diet meets those five core needs

...

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