The Joe Rogan Experience – Dr. Peter Attia

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Intro
  • Dr. Peter Attia (@PeterAttiaMD)  is a longevity doctor, but he dabbles in cycling, and long distance swimming
  • Check out his blog
Swimming
  • Peter has swam from Maui to Lania (both are Hawaiian islands) and back
    • He was the first person to do it (round trip it’s 20 miles)
    • It took about 12 hours of swimming
  • He had read a book about a woman who swam the Catalina Channel in 7 hours and 21 minutes (it’s about 21 miles) – this translates to a speed of about 3 mph and a stroke rate of 90 strokes per minute
    • He was really intrigued, and wanted to try it himself (and did in October 2005)
      • The swim started at 12am to avoid shipping traffic
  • Perhaps women are better than men at marathon swimming
    • They may have a higher pain tolerance, evolved from being able to give birth
    • They also naturally have more body fat, and this provides them better buoyancy, in addition to helping them avoid drag
  • “In life, velocity means very little, acceleration means everything”
    • Emotionally this is also true
      • Kind of like thinking you’re going to die in the middle of the swim, and then you finally make it to the shore and it’s the best feeling ever
  • It’s important to spit salt water out of your mouth ASAP to avoid getting sick
Diet and Nutrition
  • Peter splits his time between NYC and California
    • When in NY, he eats one meal a day due to his hectic schedule – he fasts for 22 hours and eats for about 2
    • In California (his practice is in San Diego) he usually fasts for a minimum of 16 hours each day, and sometimes he only eats once a day
    • By restricting his eating window, he can be much more lenient about what he’s eating
  • What’s he eat?
    • When he eats once a day, he eats about 3,000 calories in that one meal
    • It’s usually a combination of…
      • A huge salad – Romaine lettuce, tomatoes, mushrooms, cucumbers, carrots, EVOO, freshly squeezed lemon, salt, and pepper
      • A serving of protein – he cycles through salmon, pork, steak, or game meat
      • A starchy vegetable – potatoes or rice
    • While in NY, he tends to eat more leniently
    • He only drinks black coffee in the morning (no MCT oil – this technically breaks the fast)
    • He doesn’t do a scheduled cheat day
    • “Moderation is the only thing worth doing in moderation”
  • There is not significant evidence to support that this type of time restricted eating will lead to an increase in longevity – this is contrary to popular belief
    • The only things to increase lifespan across all model organisms (yeast, worms, flies, mammals) are:
      • Caloric/dietary restriction
      • Rapamycin, which is a drug – Peter believes we’ll all be taking it one day
        • Rapamycin targets a protein called TOR (Target of Rapamycin) 
        • Rapamycin inhibits MTOR (Mechanistic Target of Rapamycin) by targeting TOR
        • Somewhere between 2-6 mg every 5-7 days is probably the sweet spot according to Peter
        • Matt Caberlin at The University of Washington is doing Rapamycin studies in dogs
          • Dogs usually die of cancer and heart failure
          • The data in dogs studies is remarkable for improving heart ejection fraction (the percentage of blood that leaves the ventricular chamber with every contraction – when this number drops, and it does as dogs age, bad things happen)
        • There are some negative side effects – it can suppress the immune system, so it’s really about getting the dose and timing right
          • This is why it’s given to transplant patients – so the body won’t reject the new organ
            • Rapamycin was originally approved as an immune suppressant by the FDA
          • Mouth sores are also common when taking Rapamycin
        • Three things will happen if Rapamycin is working
          • Your glucose metabolism will improve – you can test this with an oral glucose tolerance test
          • Your immune function will improve
            • When you’re taking it every day, immune function goes down
          • You will see an uptick in autophagy
            • Cells self destruct – this is the same things that happens with fasting
              • The under performing cells are told to eat themselves
              • When we refeed after fasting, we then repopulate the better/healthy cells
              • Rapamycin does this in a pill
            • However, we can’t actually measure autophagy with a blood test (it’s much more complicated)
              • There’s ways to measure it with muscle biopsys
              • Fun fact – a decade before you develop diabetes, you’ll notice insulin resistance in the muscles of the legs
  • “If our ancestors couldn’t function when they were hungry, we wouldn’t be here. Short term adaptation to starvation is beneficial.”
    • During these periods, our epinepherine and norepinepherine levels rise, we get sharper and more focused
  • A 16 hour fast in a mouse, even if they are allowed to eat whatever they want for 8 hours, essentially prevents them from gaining any weight
    • This doesn’t really transfer well in terms of human metabolism, a 16 hour fast in a mouse would be much longer in human time
  • Google “Peter Attia fat” – he used to be chubby while eating a normal American diet which was high in carbohydrates
  • Peter guesses that as we age, LPL (lipoprotein lipase) enzymes become more prevalent on fat cells compared to muscle cells
    • When we’re younger, we have much greater LPL enzyme numbers on muscle cells, and can eat much more leniently
  • “Your body can’t tell the difference between a glass of orange juice and coca cola”
Exercise
  • Peter normally exercises in he morning, in the fasted state, and doesn’t eat until dinner
  • Joe has noticed that he can train his legs every day in one form or another (mostly sprinting hills)
  • When it comes to lifting weights, Peter says you can lift heavy every day if you are willing to do away with the negative motion (shortening the muscle)
    • This is equivalent to doing deadlifts, but dropping the weight instead of slowly lowering it
  • Peter’s friend, Ryan Flaherty, came up with the concept of mass specific force
    • This is the average force your foot has when striking the ground when running, divided by your body weight
    • The higher the number, the faster you run
      • The harder you hit the ground, the higher you go, the longer you travel with each stride
    • To improve this number, you get stronger, and lighter
      • How? – Heavy hex bar dead lifts,
        • Do 5 sets of never more than 5 reps, every single day – but you’re dropping the weight
        • One day you might do 5 sets of 3 reps each, the next day you might do 5 sets of 5 reps each
      • This doesn’t allow the actin myosin filament to tear – that’s what happens in the negative concentric movement – this microtear, over time, is rebuilt into something bigger
        • When you drop the weight, you unload the muscle (you’re relaxing it) so the muscle doesn’t get larger, just stronger
    • We can jump higher after deadlifting (without the negative motion)
      • So one really good exercise to improve speed is heavy deadlifts super set with plyometrics
    • So the more you can deadlift relative to your body mass, you’ll run faster
  • Lance Armstrong was probably as good as he was due to his lactate tolerance
    • The hydrogen ion accompanying the lactate, aka lactic acid (the acid part is the hydrogen), prevents the effortless contraction of the muscle
    • Other people, like Michael Phelps, are suspected to be very efficient as shuttling lactic acid out of the muscle cells to the liver to be converted to glucose in the Cori Cycle – so he never has high levels of lactate
  • The Tour de France is very destructive to cyclists
    • “The Tour de France is one of the most unhealthy things on the face of the earth”
    • After completing the race, cyclists are osteopenic (very low bone mineral density – their bone density has eroded) and they’ve lost tons of muscle mass
    • That’s why some people say it would be best if cyclists were actually allowed to do steroids, at least to some degree
  •  Steroids
    • Enable you to recover faster from the brutal work it takes to be a professional athelete
    • They really just allow you to train more and harder
  • Sometimes the things you do to enhance performance, may decrease longevity
    • The instance of AFib (a heart disrythmia) in highly trained athletes is 10x higher than in non-athletes
      • Why this occurs – your heart is constantly being stretched and exposed to a high ejection fraction load, you’re stretching out the electrical system of the heart which runs within its muscles
Longevity
  • How much of longevity is due to supplementation?
    • “The only difference between a drug and a supplement is one’s regulated and one is not”
    • Both a statin and red yeast rice, for example, inhibit the enzyme that catalyzes the first step of cholesterol synthesis
    • Peter thinks the optimal range of vitamin D is 40-60 ng/mL
      • But perhaps certain people of certain backgrounds have evolved to live with lower vitamin D levels
    • Clinical trials are really the gold standard for determining the effectiveness of something
      • The problem is, if you want to know how you should eat, how you should exercise, and what supplements to take – we can never know the truly correct answer in humans because there is no clinical trial that can answer that question
      • We can do trials in non-humans, but sometimes what happens there doesn’t translate to humans
  • What can we do?
    • Look at centenarians, what can we learn from them?
    • Look an animal studies – what’s common/effective there?
    • Examine the underlying molecular mechanisms
  • About 100,000 papers are published on PubMed every month
    • Peter says about 99% of them are useless
  • Many times our knee jerk reactions to certain things are wrong
  • The average life expectancy for a man and women today in the US is 79 and 81, respectively
    • It’s been going up at 0.3-0.6% per year
  • Learning how to safely deliver babies, in addition to sanitation developments, were huge step function improvements in longevity
    • We haven’t had a step function improvement in 100+ years
Fat Cell Disucssion
  • Really, when we say we want to lose weight, we mean we want to lose fat – what does that mean?
    • Most of the time it means we want to make our fat cells smaller, as opposed to having less fat cells (which doesn’t really change us metabolically, it’s like getting lipsuction)
  • Check out this awesome blog post by Peter – READ THIS
    • A fat cell has two inputs
      • De novo lipogensis – turning carbohydrates into fat
      • Re-esterification – bringing free fatty acids back into the fat cell
    • A fat cell has one output/exit (lipolysis) – exporting fat from the cell to be used elsewhere
    • Each of those three doors is controlled by hormones
      • The purpose of nutrition (fasting, diet, exercise, supplementation, drugs) is to manipulate those hormones in the direction of negative fat flux (or negative fat balance)
      • The hormones that drive this include insulin, hormone sensitive lipase, testosterone, estrogen, and cortisol
        • Insulin seems to be most important, and how do we lower insulin – fast, or reduce carbohydrates (and protein slightly)
        • When people can’t lose weight, you look at the other hormones controlling fat balance
        • Cortisol is linked to stress, so stress is certainly linked to weight loss
        • Woman can have a hard time losing fat, especially once they go through menopause, because they lose estrogen and testosterone
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