Peter Attia, MD: The Centenarian Olympics, Exercise, Fasting, Metformin, Meditation, Optimizing Sleep, and More – The Tim Ferriss Show

Check out The Tim Ferriss Show Episode Page & Show Notes

Key Takeaways

  • Aim to be a kick-ass 100-year-old
    • When you’re 100, you should be able to: Get up off the floor under your own support, walk up and down a flight of stairs carrying groceries, lift ~30 lbs. over your head, and do a 30-pound goblet squat
  • “The more you exercise, and the healthier you are, the less benefit, and potentially more detriment, you could experience from metformin”Peter Attia
  • There are TONS of different fasting regimens, but because we can’t measure autophagy, we have no idea which is most optimal in terms of longevity/lifespan
  • Your negative personality traits are NOT set in stone – with enough work, they can be changed for the better
  • “If you’re really committed to brain health, you want to be exercising every day” Peter Attia
  • Two of the best things you can do to improve your sleep:
    • Go to bed and wake up at the same time every single day
    • Cut out alcohol; it destroys sleep quality 

Products and Supplements Mentioned

  • During his prolonged fasts, Peter supplements with:
  • Sleep products:
    • Peter uses an OOLER Sleep System, a mattress topper that circulates temperature-controlled water (varying between 55-110 °F), allowing you to optimize your sleep environment (with the OOLER, you can schedule temperature changes throughout the night)
      • For 15% off the OOLER, use the code “Podcastnotes15” at checkout
    • Peter wear an Alaska Bear Eye Mask (Peter has TONS of them, so he’s never without one)
      • We at Podcast Notes love the Manta eye mask – use the code “PODCASTNOTES15” for 15% off
    • Peter wears Felix Gray blue light blocking glasses a few hours before bed. Using his Oura Ring (Tim owns one too), Peter has noticed his deep sleep numbers increase from doing so.

Intro

Peter is Training for the Centenarian Olympics

  • “Before many people die their physical death, they tend to die some kind of combination of cognitive and exoskeleton death” Peter Attia
  • In your 90s-100s, you should be able to:
    • Get up off the floor under your own support
    • Pick up a child that’s running at you (or, similarly, do a 30-pound goblet squat)
    • Walk up and down 3 flights of stairs with 10 lbs. of groceries in each hand
    • Pull yourself out of a pool
    • Lift a 30 lb. suitcase over your head (i.e., when you’re putting your luggage in an overhead bin on an airplane)
  • Backtracking, to do the above, you need:
    • Stability – the ability to control your exoskeleton such that load is transferred safely through muscles as opposed to joints
    • Aerobic efficiency
    • Adequate strength
    • Anaerobic performance
  • A few nuggets of Peter’s exercise routine:
    • He deadlifts twice a week – one day is straight bar deadlifts, the other is hex bar deadlifts
    • He also does a lot of single-arm press movements

Peter Has Changed His Mind About Using Metformin in Healthy Individuals

  • Back in 2010 or so, Peter viewed metformin as “a very low-risk cancer-mitigating drug, in anybody”
    • That said, Peter believed it to be more so in diabetics 
  • What does metformin do?
    • Perhaps most importantly, it’s a mild mitochondrial toxin – it inhibits mTOR Complex 1 (mTORC1)
      • This causes the body to act as if it’s in a fasted state (the amount of glucose the liver puts into circulation is lowered)
        • “It’s sort of like a junior fast in a pill” – Peter Attia
  • About a year ago, Peter started to realize metformin’s adverse effects on a type of exercise known as zone 2 training (exercise aimed at enhancing mitochondrial function)
    • Zone 2 is the maximum amount of work (power output) you can maintain while keeping your lactate levels stay below ~2 mmol/L (lactate is a byproduct of metabolism under which energy (ATP) is produced faster than can be made using oxygen alone)
      • Whenever you have metformin in your system, this maximal power output is reduced 
      • 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
  • Metformin also appears to impair muscle growth (specifically the inflammatory response that’s necessary for muscles to grow)
  • For the above reasons, Peter stopped taking metformin and has instead decided to focus more on exercise
    • “The more you exercise, and the healthier you are, the less benefit, and potentially more detriment, you could experience from metformin”Peter Attia

Treating Diabetes with the Basics

  • “If you take somebody who has diabetes, I don’t think people appreciate how potent a tool fasting, exercise, and sleep are” Peter Attia

Peter Can’t Get Enough of Egg Boxing

  • What is it?
    • It’s a game – whenever you’re making something with eggs, you bang two of them off one another
      • The egg that doesn’t crack wins the round
    • You then use that same egg and smash it against another egg, etc.
    • The last egg standing wins the carton and moves on to face the next carton
  • Peter once had an egg last more than a year!

We Don’t Know the Best Fasting Protocol

  • “If fasting is such a potent tool… it’s sort of odd we don’t know how to dose the tool” – Peter Attia
    • Peter talked more about this in these Podcast Notes
    • There are TONS of different fasting regimens, but because we can’t measure autophagy, we have no idea which is best in terms of optimizing for longevity/lifespan
      • This is testable in mice, but not humans (for obvious reasons, until we can specifically measure autophagy via a variety of blood biomarkers)

Peter’s Fasting Routine

  • He does a 7-day water-only fast once per quarter sandwiched by a week of following a ketogenic diet on each end
    • He only does his fasts while he’s in NY for work (his home base is in San Diego), and does so from Saturday evening to Saturday morning
    • Why keto?
      • On the way in, to generate ketones. This way, when you enter the fast, you suffer slightly less.
      • On the way out, to prevent Peter from “eating like an idiot”
    • That said, Peter is thinking about changing things up and only doing a 3-day fast once per month
  • What does Peter supplement with during his fasts?
  • Tim’s preferred fasting regimen: A 3-day water-only fast from Thursday dinner to Sunday dinner
    • He’s found that going for long walks on Friday morning helps ease the transition into ketosis

Tearing Phonebooks

  • Back in college, Peter could tear a phone book in half (and made a habit of doing so)
    • It all comes down to grip strength, hand size, and technique – Peter demonstrates how in this video
    • “I’m nowhere near as good at it as I used to be” – Peter Attia

Peter’s Recent Interest in Archery & Hunting

  • In the summer of 2016, mostly spurred by Tim, Peter decided to buy a bow
    • The rest is history: “It’s now at the point where, in some ways, my life revolves around this thing” – Peter Attia
  • Peter has an archery range at his house and shoots every morning
  • “Archery is always going to be an amazing teacher. Either you go up there and have this amazing day where you’re in a flow state, and everything goes well… Or, it’s some variation of not going that way, and you get to practice this skill of distancing yourself from the narrative that is, ‘Dude, you suck. How could you be so bad at this?'” – Peter Attia
  • Hunting has changed the way Peter looks at food
    • “It’s reduced my appetite for consuming food that I haven’t had some relationship with. My aspiration is that by 2021, only to eat food I’ve killed.” – Peter Attia
  • If you want to learn more about archery, Peter highly recommends John Dudley’s Nock On Podcast
  • The nitty-gritty:

Childhood Trauma

  • No matter what a child experiences, odds are it will have a significant effect on their personality as a teen/adult
    • “I don’t think we’re paying enough attention to how these things that kids experience can change their personality” – Peter Attia
    • Kids internalize things differently than adults – be careful of how you act around them

Your Personality Isn’t Set in Stone

  • “I think the fate of one’s personality may not actually be set… I don’t think these flaws in our personality are deterministic”Peter Attia
    • For instance, Peter spent most of his life as an “angry individual,” but has since changed his personality for the better
      • “With enough work, you can start to overcome these deficits. I think I’m only about 50% as angry as I was during my anger heyday.”
  • So.. don’t buy the narrative, don’t buy the story, you CAN change
  • One thing that might help:
    • View your negative personality traits as coping mechanisms that may have helped you in the past, but no longer serve a purpose

What’s helped Peter tone down his anger?

  • Mediation
    • How so? – It allows you to more effectively pause between stimuli and response (and because of this, you’re more likely to take control and not react in a manner you might regret later on)
    • Peter uses either Sam Harris’ Waking Up app or Dan Harris’ 10% Happier app to meditate
  • Therapy 
    • Specifically, therapy aimed at taking a look back at Peter’s childhood to discover where his anger originates from
    • What Peter’s learned:
      • Most of his past outrage originates from a feeling of failure/being inadequate
      • “Anger is like honey with a poison tip; it’s a short-lived transient benefit that comes with a long tail of misery”Peter Attia
  • Taking Ryan Holiday’ course: Taming Your Temper: The 10-Day Stoic Guide to Controlling Anger
  • Watching David Foster Wallace’s famous This is Water commencement speech once per month
  • All in all:
    • “Once you start to accept that anger is not something you’re hard-wired to, like your height or shoe size, you can start to change it. You just have to work at it.” Peter Attia

How should you go about picking a therapist?

  • (Peter actually has 3 therapists; two of them being Esther Perel and Terrence Real)
  • You have to have a connection with them – there should be some sort of chemistry
    • “Their insights have to be such that I exit almost every session thinking, ‘Wow, I see something I didn’t see before.'” – Peter Attia
  • They have to be able to produce results
    • “In the end, none of this stuff matters if it’s not reducing your suffering” – Peter Attia
  • “For me, the therapists that are really valuable are also the ones that, frankly, don’t have a hard time telling you that you’re wrong, full of sh**, or if you’re just being a d***”Peter Attia

Exercise

  • “I’ve changed my mind on the benefits of exercise being much greater than I ever envisioned” – Peter Attia
  • Hands down, exercise is the best thing you can do to reduce your risk of Alzheimer’s disease
    • “If you’re really committed to brain health, you want to be exercising every day”Peter Attia
  • Which type of exercise is best: low-intensity cardio, high-intensity cardio, or strength training?
    • We don’t quite know, so it’s best to incorporate them all
      • They all appear to increase levels of brain-derived neurotrophic factor (BDNF) and benefit the cardiovascular system

What about nootropics?

  • “If you think about Silicon Valley right now, everybody’s obsessed with this nootropic and that nootropic, but I don’t think people understand correct nutrition, exercise, and sleep are far better nootropics than something like modafinil Peter Attia

How to Improve Your Sleep

  • You HAVE to prioritize it, just like exercise
  • Peter:
    • Wears Felix Gray blue light blocking glasses a few hours before bed. Using his Oura Ring (Tim owns one too), Peter has noticed his deep sleep numbers increase from doing so.
    • Limits device/social media use before bed
    • Tries to go to bed/wake up a the same time every single day
    • Wears an Alaska Bear Eye Mask (Peter has TONS of hem, so he’s never without one)
      • We at Podcast Notes love the Manta eye mask – use the code “PODCASTNOTES15” for 15% off
    • Uses an OOLER Sleep System, a mattress topper that circulates temperature-controlled water (varying between 55-110 °F), allowing you to optimize your sleep environment (with the OOLER, you can schedule temperature changes throughout the night)
      • For 15% off the OOLER, use the code “Podcastnotes15” at checkout
    • Has mostly eliminated alcohol
      • Alcohol destroys sleep quality – it reduces REM sleep, lowers heart rate variability, raises your resting heart rate, increases body temperature, and increases the number of times you wake up throughout the night

Stop Drinking Sugar

  • “The single worst thing you can do is drink your sugar”Peter Attia
    • Mouse studies have shown that liquid sugar (fructose), compared to solid sugar (glucose), dramatically increases the risk of colon cancer

The Art of Podcasting

  • On starting his podcast: “This whole thing started as an experiment a year and a half ago, and I couldn’t have imagined how enjoyable it is”Peter Attia
  • Conducting a good interview is truly an art form
    • “I think the hardest thing is to somehow parallel process being engaged in the discussion you’re having, but allow a part of your brain to be thinking about where you are on an interview path and where you want to go” – Peter Attia
    • “It’s a fun craft… Anybody can do it, but it’s hard to do really, really well.” Peter Attia
    • “What surprised me maybe the most about the podcast interviewing game… is how coachable and improvable many of the component skills are” – Tim Ferriss
  • Both Peter and Tim frequently go back and listen to past interviews to improve their skills
    • “Listening to your own audio really showcases any tics you have, or any pet phrases” – Tim Ferriss
  • Peter does most of his interviews in person
    • He never goes into a conversation with specific questions to ask, but always has an idea of which topics he wants to explore
  • “In the end, I think I’ve learned it comes down to prep. The better interviews are ones in which I feel like I’m more prepared.” – Peter Attia
    • Peter, of course, credits his team to helping with that prep. Before every interview, they provide Peter with a large prep document.

Additional Notes

  • Check out this video of Kevin Rose throwing a raccoon
  • Peter and his wife met at Johns Hopkins
  • Peter was on The Joe Rogan Experience last April – check out the Podcast Notes
  • Peter has chickens in his back yard (that’s where he gets his eggs from)
  • Growth hormone is a performance-enhancing drug that’s very difficult to test for
    • Why? – It’s a “human recombinant equivalent”
      • Unlike with something like exogenous testosterone, signature biomarkers won’t change when supplementing
  • Oddly enough, psilocybin isn’t banned by the World Anti-Doping Agency, but MDMA is
    • Many people report low-dose psilocybin or LSD (AKA microdosing) enhances athletic performance
  • Peter has an iRacing simulator at his house and regularly trains with his coach, Thomas Merrill
  • Tim highly recommends the Senna documentary
  • When Peter DOES drink, he prefers Clase Azul Reposado
  • In high school, Peter once drank a 705 ml bottle of lemon juice for $2
  • Tim once offered Kevin Rose $10k to eat a lobster shell (he obviously failed)
  • If you’re digging into Peter’s blog posts for this first time, start with  Studying Studies
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