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Strong Convictions, Loosely Held | The Drive with Peter Attia #103

Check out The Peter Attia Drive Episode Page & Show Notes


Peter Attia (@PeterAttiaMD)

Bob Kaplan (@bobkaplan), Head of Research at Attia Medical, PC

Bob takes the lead in this episode and asks Peter questions related to topics he has changed his views over the past 1.5 years; the two also reminisce on the first 99 episodes of The Drive

This episode was intended to be released as episode #100 but Peter made a few special Coronavirus episodes, so we’re at #103


Metformin: Early Benefits

  • Early studies showed metformin’s potential to reduce cancer mortality and survival with cancer – and an all-around viable solution to longevity for people without Type II diabetes
  • Peter started taking and prescribing metformin for off-label use in 2011

Metformin and Effect on Lactate Levels

  • Peter started measuring his fasting, baseline lactate levels and was surprised at how high they were during Zone 2 training
  • After diving into the research, Peter learned that metformin is a mitochondrial toxin
  • Studies on metformin and training output are suboptimal because they don’t include all the analyses of the muscle you would want to see
  • Of course glucose is higher since stopping metformin, so the question is whether the net benefit is worthwhile

Peter’s Current View on Metformin Regimen

  • Peter experimented a lot with metformin and dosing to assess changes but ultimately stopped and realized that lactate levels went back down
  • Until further studies, Peter no longer takes metformin and only prescribes in his practice for patients who need it from the standpoint of insulin and glucose regulation but not yet as a pro-longevity agent
  • Peter notes he is waiting to see if TAME trial (Targeting Aging with Metformin) gets funded– it’s a new study asking whether metformin can extend life indirectly by mitigating chronic disease onset

Rapamycin: How Have Feelings Changed?

  • Peter has been interested in rapamycin since around 2012 when he read a paper showing that rapamycin augmented the strength of vaccination in healthy older subjects
  • Research article: Mannick, et al. that Peter says kicked off his dive into literature and data about rapamycin 

Without Biomarkers, It’s Really Challenging to Dose Rapamycin Correctly

  • If you take too much, you’ll get mouth sores – but “there’s a lot of gray area where you don’t know if you’re taking enough and you don’t know if you’re taking too much”
  • It took Peter around four years to settle on the proper dosing for himself
  • Peter wants to have two podcasts dedicated to rapamycin and mTor

Peter’s Current Views on the Utility of Rapamycin

  • Peter says his convictions are still high on the benefits of rapamycin

Aspirin and Baby Aspirin For Prevention Of Deep Vein Thrombosis (DVT) Before A Long Flight

  • There isn’t much evidence that aspirin or baby aspirin has any efficacy in mitigation of deep vein thromboses, especially on an airplane – but it was something Peter intuitively believed
  • The gold standard for use would be heparin but that’s an injection so it isn’t practical

Peter’s Current View of Aspirin Use As Prevention of DVT Before a Long Flight

  • There doesn’t appear to be any benefit to aspirin or baby aspirin for the prevention of DVT before a long flight
  • Instead, Peter found two over-the-counter supplements online that are backed by evidence suggesting they can prevent DVT:
    • Flite tabs and Nattokinase, a plant-derived supplement

Prescription Drugs: Generic vs Brand

  • Before diving in, Peter says that on the topic of generic drugs, The Drive Episode #71 with Katherine Eban is one of the ten most important podcasts that they’ve done in the first 100 episodes; he highly recommends everyone listen to it
    • “investigation into Indian and Chinese drug manufacturing plants which revealed that nearly 80% of them are tainted with fraud
  • Previously, Peter thought generic drugs are great and a fraction of the cost and branded drugs are a scam

Not All Generic Drugs Are Equal to the Brand

  • Peter gives the example of statin medication and patients receiving rosuvastatin instead of crestor – he noticed those patients didn’t have change in blood levels as you would expect

Peter’s Current View on the Use of Generic Drugs

  • Katherine Eban’s podcast drastically changed the way Peter runs his practice. They now work with one pharmacy that will only issue branded drugs and when they do generics, they take a deep look at the company that makes them and whether they are on the “FDA list of potential bad actors”

Omega-3 fatty acids and Polyunsaturated Fatty Acid (PUFA)

  • Peter is still working out his thoughts on Omega-3 but believes EPA and DHA (types of Omega-3 fatty acids) are potent drugs for patients at risk for cardiovascular disease
  • EPA benefits are clear, but Peter does note an interesting setback in a recent DHA clinical trial which was stopped because of futility
  • Peter suggests listening to Bill Harris (The Drive Episode #83) for more information on the topic
  • Bill and Peter had opposing views on omega-6 PUFA
    • Peter: excessive amounts of Omega-6 polyunsaturated fats aren’t a good thing
    • Bill: Omega-6 PUFAs aren’t inherently harmful; it’s just that diets that are rich in them are void of EPA and DHA
    • Takeaway: don’t think about Omega-6 PUFA, just add EPA and DHA
  • Peter would like to do a podcast that looks at the Omega-6 PUFA literature

Peter’s Current View on Omegas, Fatty Acids, PUFA

  • Discussion with Bill Harris increased Peter’s level of confidence in the necessity of EPA and DHA

Archery as Metaphor for Life

  • Peter sees archery as a great metaphor for life in that you must focus on the process instead of the target or you won’t improve
  • He also relates archery to people’s inherent craving to getting better at something and work toward mastery

Reevaluating Zone 2 Training

  • Ever since Peter stopped competitive cycling around late 2014/early 2015 he has missed low-intensity aerobic training but wanted his training sessions to be as efficient as possible
  • A talk with Iñigo San Millán, Ph.D (The Drive Episode #85) and going through literature on Zone 2 training got Peter thinking about the glaring gap in his fitness routine

Peter’s Current Feelings About Zone 2 Training

  • Peter practices Zone 2 training around 3-4 hours per week and enjoys how “easy” it is and that he never dreads it, sometimes listening to a podcast or audiobook with he trains
  • Peter also notes it’s something that can be done safely and yields huge dividends for training

The Importance of Deadlifting as an Adult

  • An injury led Peter to start thinking about longevity and the utility of lifting heavy and placing body under that much stress

New Approach to Lifting: Dynamic Neuromuscular Stabilization (DNS) With Coach Beth Lewis

  • DNS approaches lifting from a mechanics standpoint instead of for speed or pushing weight limits
  • The benefits of a deadlift are more about all the things you must do to perform a deadlift correctly, hip hinge, and create traction in the spine – which is a good audit for how well everything is working in your body
  • Plans to have a podcast dedicated to DNS and within the next year wants to put together a video on deadlift and deadlift preparation

Now, the Goal of Deadlifting for Peter Is To Take A Light Weight And Deadlift It Perfectly Several Times Per Week

  • Peter deadlifts about 2-3 times per week, both straight bar and trap bar
  • He focuses on slow eccentrics and films every rep of every set, studies it, and sends it to his coach

Book Recommendations

What is Peter currently reading

What is Bob currently reading:

Other Topics Covered

Peter’s Favorite Drive Episode

  • Naturally, Peter had a hard time answering but he does point to a few:
    • Technical podcasts:
      • Rick Johnson (The Drive Episode #87) and Keith Flaherty (The Drive Episode #62)
    • Other episodes Peter points out:
      • Damon Hill (The Drive Episode #86)
      • Rick Alias (The Drive Episode #79)
      • Katherine Eban (The Drive Episode #71)

Getting More Comfortable with The Idea Of Saying “No”

  •  “When you say yes to something, you’re saying no to something else you just don’t know what that thing is yet” – Peter
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