Dr. Peter Attia: All Things Longevity, NAD+, Rapamycin, IGF-1, Fasting, Zone 2 Cardio, & More – Kyle Kingsbury Podcast

Check out the Kyle Kingsbury Podcast Page

Key Takeaways

  • The 5 pillars of longevity:
    • Nutritional biochemistry
    • Exercise physiology
    • Sleep physiology
    • Emotional health
    • Exogenous molecules/supplements
  • Spend more time doing zone 2 cardio (zone 2 is about the highest level of exertion where you can still carry out a conversation)
    • Peter does 3 hours of zone 2 cardio per week
    • The more efficient your mitochondria, the less lactate they produce. If you test your levels during or after completing a zone 2 cardio session, they should be <2 mmol/L.
  • Gamify the way you eat with a continuous glucose monitor, gamify the way you sleep with an Oura Ring
  • As we age, our NAD+ levels drop
    • NAD+ is needed to create energy and for sirtuin function (sirtuins are a class of genes which protect the body against deterioration and disease)
    • For this reason, it’s valuable to supplement with an NAD+ precursor such as nicotinamide riboside (NR) or NMN
      • But..take caution, Peter is skeptical that this method is effective
  • Data seems to suggest that the best thing to do is cycle high and low IGF-1 levels
  • “A lot of people, myself included, believe rapamycin is probably the most interesting drug we have in our toolkit for longevity”

Books Mentioned

Products Mentioned

  • Peter does 3 hours of zone 2 cardio per week on his Peleton bike
  • Peter uses both the Lactate Plus and the Lactate Pro to test his lactate levels 
  • One of Kyle’s favorite workouts – jumping on a Concept2 rower and rowing a 10k while breathing through his nose the whole time 
  • Because our NAD+ levels drop as we age, it’s thought to valuable to supplement with an NAD+ precursor, such as:
  • Kyle wears a WHOOP watch

Intro

The Peter Attia Background Story

  • Peter grew up just outside of Toronto and lived there until college
  • He began boxing at age 13 and had dreams of being a professional fighter
    • Peter planned to forgo college to make this dream a reality until a teacher had a chat with him, acknowledging Peter’s extreme talent for mathematics
      • That conversation shook Peter’s world and convinced him to change directions – he went on to university and graduated with dual degrees in math & mechanical engineering
  • Although Peter thought about going on to pursue a Ph.D. in aerospace engineering, he decided to take the med school route
  • Peter didn’t start swimming until his 30s but has since completed many record-breaking swims in the Pacific Ocean since
  • Peter has always loved cars and recently doubled down on his interest in motorsports (Formula 1 and Indy Car)
    • He has an iRacing simulator at his house and regularly trains with a coach
      • Peter adds – “Great coaches aren’t just telling you what to do, they’re telling you what you should feel when you do it correctly”
  • If all that wasn’t enough, Peter is a huge archery fanatic – he got his first bow in 2017

The Longevity Table

  • Imagine longevity as a table
    • A great table has 4 strong legs
    • If only 3 of the legs are strong and 1 is wobbly, the table still works 
    • If only 2 of the legs are strong…ehhh, it’s not a very strong table
    • With just 1 strong leg…. forget about it
  • What do the legs represent?
    • Nutritional biochemistry
    • Exercise physiology
    • Sleep physiology
    • Emotional health
      • This leg includes everything from meditation to psychedelic therapy to managing healthy relationships
    • Exogenous molecules/supplements

Optimizing Mitochondrial Health

  • What are the most important things we can do to improve mitochondrial health?
    • Examine people who have the best mitochondria on the planet – endurance athletes (like cyclists)
  • If you take two people, one with top-tier mitochondria and one with sub-par mitochondria, and give them the same amount of work to do (which can be measured in their power output (AKA watts)) – one of them will do so producing less lactic acid (thus meaning they have more efficient mitochondria)
  • Peter does 3 hours of mitochondrial-enhancement-based exercise (AKA zone 2 cardio) per week on his Peleton bike
    • It’s either split up into 3 60-minutes sessions or 4 45-minute sessions 
    • Throughout and at the end of each workout, he’ll test his lactate levels (he uses both the Lactate Plus and the Lactate Pro)
      • He’s checking to make sure his lactate levels stay below ~2 mmol/L while still being able to generate a significant power output (measured in watts) on the bike
    • If you don’t feel like checking your lactate levels, know that zone 2 is about the highest level of exertion where you can still carry out a conversation
  • Kyle does something similarly
    • He’ll frequently jump on a Concept2 rower and row a 10k while breathing through his nose the whole time (forcing him to stay in zone 2)
      • Peter has done something similar in the past – he used to frequently wear a mouthguard while training to force him to rely on 100% nasal breathing

Peter’s Stint with the Ketogenic Diet

  • Peter spent 3 years following a ketogenic diet from 2011-2014
  • This was back when he was swimming/cycling at INTENSE levels
    • Around this time, Peter estimates that he was working out 12x a week, each session lasting 60-120 minutes (3 lifts, 5 swims, and 4 cycling workouts)
  • To stay in ketosis, he had to eat <50 grams of carbs/day and <110-20 grams/day of protein (meaning 90% of his calories came from fat)
    • He ate ~4500 calories/day in total
  • Macadamia nuts and olive oil were staples
  • “I never had a Bulletproof coffee once during those 3 years”
  • Peter says he ate a HUGE amount of vegetables (as it was an easy way to get more olive oil)
  • Peter tracked his ketone levels every day during this time period
    • He averaged 1.7 mmol every morning

Fasting

  • Every quarter, Peter will do a 1-week fast sandwiched by a week of following the ketogenic diet on each end
    • Peter says this is way easier than constantly remaining in ketosis
    • He only does his fasts while he’s in NY (where he frequently travels for work). This way, when he’s fasting, he’s never around his kids.
    • For the most part, these 7-days fasts are fairly easy for Peter
      • You might think it surprising, but the idea of fasting totally takes the question of discipline out of the equation
    • “Fasts serve as a great way to remind myself how capable I can be when I’m not eating and you bring that back with you to the world outside of the fast”
      • Expanded: Having a fasting practice and being accustomed to going without food makes it much easier to neglect eating, despite being hungry, right before bed because you know a meal will be detrimental to your sleep
  • Kyle has done three 5-day water-only fasts
  • To learn more about fasting, Kyle highly recommends The Complete Guide to Fasting by Dr. Jason Fung

Time-restricted Feeding

  • Peter is an adviser for the Zero fasting app
    • If you’re curious about fasting and want to give it a go, start with time-restricted feeding. Use the Zero app to time how long you go between your last meal one day and your first meal of the next.”
  • “The first thing you want to do before you change a behavior is understand your current behavior”
    • Most people are surrounded by a constant IV drip of food 
    • “Even if time-restricted feeding brings with it no medical benefit… I still think it’s a valuable tool because it’s the thin end of the wedge that brings you over to intermittent fasting.”
      • Peter defines intermittent fasting as fasts lasting 2-3 days or longer

Gamifying Eating and Sleep

  • “The CGM [continuous glucose monitor] has really helped me. This has become a total game-changer for the way I function.”
    • Check out the Podcast Notes from Kevin Sayer’s appearance on Peter’s podcast – Kevin is the CEO of Dexcom who makes the best CGM on the market
    • Peter estimates it costs ~$10 day to wear (all costs added up)
  • “For me, it’s a totally worthwhile investment… you get a whole set of insights. I’m coming up to 4 years of wearing a CGM and I still learn little things. I’m still blown away by the things I eat that will impair my glucose metabolism and, at the other end of that spectrum, the times when I’m metabolically in such a good place that my tolerance for carbohydrates, and even junk carbohydrates, is much higher”
    • Simply put – wearing a CGM makes someone way less likely to eat a cookie because then they’ll be forced to stare the negative result of what it does to their blood sugar in the face
  • Similar to a CGM, the Oura Ring has helped Peter dial in his sleep
    • Purchase a ring using the above link for a $40 discount
    • “Every night I’m thinking, ‘Is it cold enough? Is it dark enough? Have you dialed yourself back? Are you making sure you’re taking blue light away? Are you not eating? Are you not drinking?”
      • “For me, the CGM and the Oura Ring have become great tools to improve my behavior even when I’m not learning something new just because of the game I play with myself”
  • Kyle has noticed time-restricted eating improves his cognitive function, prevents afternoon crashes, and reduces overall aches/pains 

Mitochondrial Damage

  • As we age, inflammation increases within our muscle cells
    • If you took muscle biopsies of someone aged 30 and someone aged 60, you’d see more inflammation in the muscles of the 60-year-old
  • Mitochondrial damage is uniquely inflammatory
    • Here’s the hypothesis:
      • Mithochdria have their own DNA/genes 
      • When mitochondria are damaged and break down, that mitochondrial DNA gets into the cytoplasm of the cell and elicits an immune response because it’s seen as foreign
        • To the cell, the mitochondrial DNA looks like a foreign pathogen
  • “Just as we see autophagy where the body self-recycles whole cells, you can self-recycle these mitochondria. I think there’s no better way to accelerate that process than by fasting.”

NAD+

  • What is it?
    • It’s an electron/proton acceptor – it helps transfer electrons
    • Metabolism involves taking the energy of chemical bonds in food, breaking them down, and freeing energy up which is then used to create electrical energy via the electron transport chain 
      • NAD+ helps with this transfer of energy
  • Sirtuins are a class of genes that are instrumental in the body’s protection aging
    • They require NAD+ to do their job (think of NAD+ as the sirtuin fuel)
      • As we age, our NAD+ levels diminish…. but we don’t know why. It could be:
        • Because we make less
        • Because we use more if it (the older you get, the more you need the repair benefit of sirtuins) (this is thought to be the primary reason)
  • So what can we do about the above?
    • You can’t supplement with NAD+ (it’s way too large of a molecule)
      • For this reason, intravenous NAD+ doesn’t allow NAD+ to enter the cell
        • “There’s just no evidence that the NAD+ in your bloodstream, which is where they’re administering it, is making it into your cell”
    • You can supplement with nicotinamide riboside (NR) (it’s an NAD+ precursor)
      • Elysium and Chromadex are the big players in this space – “In my mind, they’re basically equivalent”
      • But here’s the problem…
        • Peter recalls a study by Josh Rabinowitz at Princeton that found, in mice, the majority of orally supplemented NR was converted to NAD+ by the liver – which leaves us back at the same problem (NAD+ is a large molecule and as mentioned, has a hard time entering cells)
          • Folks at Elysium/True Niagen argue that some NR bypasses the liver and directly enters cells
    • You can supplement with NMN, another NAD+ precursor
      • This is what Dr. David Sinclair recommended in these Podcast Notes
      • Referring to NR and MNM – “They’re almost identical. One might be more stable than the other.”
    • “If you take oral NR or NMN and have it get into cells that matter and become NAD+, I’m the first guy in line to be doing it.”
    • Peter took True Niagen for 90 days 2-3 years ago as an experiment:
      • “I didn’t feel worse and I didn’t feel better”

IGF-1

  • Peter talked about IGF-1 heavily in his interview with Dr. Rhonda Patrick (check out the Podcast Notes)
    • Here’s what they concluded: Data seems to suggest that the best thing to do is cycle high and low IGF-1 levels
  • You can raise IGF-1 easily by eating protein/meat (in particular, it’s the amino acid methionine that affects IGF-1)
  • “I think IGF is very beneficial in the brain”
    • It’s very neurogenic – “If you bathe your brain in IGF I think your probability of getting Alzheimer’s disease goes down”
  • Many argue high IGF-1 levels increase risk of cancer, but the jury’s still out on that one
  • “I think IGF [AKA growth hormone] is probably the single most used performance-enhancing drug in all of sports because it’s largely undetectable”
    • “It’s always been interesting to me we don’t see more cancer in those who are clearly using growth hormone”
    • “I think I could argue pretty convincingly that half the NFL is on growth hormone”
  • “There’s no easier way to reduce IGF than to fast”
    • (Following a ketogenic diet will also reduce your IGF levels due to the protein restriction)
    • Peter has found that a 7-day fast will cut his IGF levels in half
      • He estimates that it takes 2 months after finishing q fast to return to his pre-fast IGF-level

Rapamycin

  • Peter calls it his “favorite drug on the planet”
  • It’s been approved as an immunosupressant 
    • It’s frequently given to organ transplant patients 
  • In 2009, a study which gave rapamycin to both male and female 600-day-old mice (which is the equivalent to a 60-year-old human) and found that the drug extended life
    • It’s since been found to expand lifespan across all lines of biology – from yeast to worms to flies to mammals to bacteria
      • “To my knowledge, there is no other compound that has ever demonstrated that”
  • “A lot of people, myself included, believe rapamycin is probably the most interesting drug we have in our toolkit for longevity”
    • Peter is currently supplementing with it
      • In these Podcast Notes, he hinted that he takes ~5 mg every 4-7 days
  • One of the most obvious negative side effects of rapamycin is mouth sores (apthous ulcers) – Peter equates them to “super annoying canker sores

How have psilocybin and MDMA personally impacted Peter?

  • Peter rates them both extremely high in terms of substances/people/insights that have affected his life in a positive way
    • “You could make the case that MDMA is the single most important synthetic creation of humans”
  • Many people, when they’re younger, experience some form of trauma that forces them to develop certain adaptations which then serve a protective role
    • But those adaptations become maladaptive as we age
    • Psilocybin and MDMA serve as a tool for untangling these adaptations/traumas and allowing one to examine them from an outside-observers perspective
  • For more on the benefits of MDMA-assisted psychotherapy check out these Podcast Notes with Rick Doblin, the founder of MAPS
  • Psilocybin and MDMA are both currently Schedule I compounds
    • This means they have no medical benefit and/or a high potential for abuse
      • “Have you ever once finished taking psilocybin and thought to yourself I can’t wait to take it again? … It’s the opposite of addictive.”
      • And to say they don’t have medical benefit is backward
        • For one, they drastically improve symptoms of depression and suicidality
  • MDMA is currently in phase III clinical trials
    • In phase I testing, a drug is determined safe
      • “We now know MDMA is completely safe”
      • In Peter’s interview with Rick Doblin, Rick dives deep into the false literature surrounding MDMA’s toxicity
    • In phase II testing, a drug is proven efficacious 
    • In phase III, the efficacy is tested in a more rigorous manner
  • Just how long until MDMA is approved?
    • Probably a year away from compassionate-exemption use
    • “Maybe 3 years away from a descheduling”
      • “And psilocybin is right on its heals”
  • It seems to be that treating PTSD is MDMA’s most useful quality
    • That of psilocybin remains to be determined 
      • It’s proven useful for smoking/alcohol cessation, treatment of drug-resistant depression, and treatment of end-of-life anxiety in cancer patients

Something Everyone Needs to Watch

  • Peter listens to This is Water, a commencement speech given by David Foster Wallace, every few months
    • “It’s the greatest commencement speech ever given and arguably one of the most important speeches ever given”
    • The main point – “Every experience we have is living the world through our own eyes”
      • EVERYTHING is perceived from our own point of view
        • “When you stop and remind yourself that no one is experiencing this moment or any other moment the way you are…. that has to bring a little humility. This is what allows me, at least 10% of the time, to pause when I’m being a d*** and say, ‘Oh… there might be another way to view this. That other person has a totally different point of view that I’m not able to appreciate because I’m not them.'”
          • “That humility is a big part of not being miserable”

Additional Notes

  • Peter has an interview coming out with Kyle for his own podcast
  • Peter is in the process of putting together a book about his own story and the science of longevity
  • If you’re interested in reading more about flow states, check out Stealing Fire and The Rise of Superman
    • Kyle adds – “That state of flow… it’s this feeling of timelessness. It’s the feeling of all your f***ing troubles just washing away.”
  • Tim Ferriss and Kyle have “taken some things in before and had a bonding experience”
    • AKA – sounds like they’ve done mushrooms or Ayahuasca together
  • Peter has his chickens
    • “It’s awkward and weird for me now to want to go to the grocery store and buy eggs. Why would I want to buy eggs from a chicken that I don’t know anything about, that I haven’t fed?”
    • Related – “By this time next year, I want to be in the situation where I never have to eat a single piece of meat that I or my friend didn’t kill in the wild under the most natural setting possible.”
  • Kyle highly recommends people listen to Peter’s interview with Robert Sapolsky (AND read Robert’s book – Why Zebras Don’t Get Ulcers)
  • Peter weighs 178 lbs.
  • Kyle wears a WHOOP watch
  • Peter plans to have Dr. Rhonda Patrick back on his podcast in the fall
  • Dr. Matt Kaeberlein and Dr. David Sinclair and (both giants in the field of longevity) were postdocs Leonard Guarente‘s lab, the founder of Elysium
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