Why Dr. Peter Attia Changed his Mind on Fasting (and 4 other Longevity topics)

Dr Peter attiev we all change our mind on things uh I want to go into some detail with some things you've changed your mind over the last five years Let's Just Jump Right In um let's start with a couple in um nutrition so I think the the the first one that I would say I've changed my mind on is the importance of regular fasting so I used to really do a lot of regular fasting um probably considered excessive by by some um so probably did a seven day seven to ten day water only fast once a quarter in a three day water only fast once a month and um I think while there were clearly some benefits of doing that um I think you know it's very difficult to measure what's happening cellularly but my belief at least was that the benefits of that outweighed the downside the downside of doing that by the way is you're going to lose a lot of muscle mass um you know as much as you might exercise during those periods of fasting which I tried to uh you know you're just not going to be able to maintain lean mass so you you basically I was always sort of accumulating a little bit of a debt of lost muscle mass and over a period of about three years I probably lost about 10 pounds of lean mass um and so today I just don't feel that that trade-off is worthwhile at least at that extreme level uh that I was doing and so I don't I haven't done a prolonged multi-day fast since the end of 2020 actually I popped the link down below for House of macadamia if you want to try them out too they are where I get my macadamia nuts these days they're all grown in South Africa when you buy from them you're directly supporting the farmers as well so the farmers really do take a hit in South Africa so by going through House of macadamia a lot of it goes back to working through the farmers and helps support those Farmers but everything is harvested and packaged less than an hour from each other they harvest them and then they drive them less than an hour away package them everything's Super Fresh not going rancid which macadamia nuts don't really go that rancid anyway but the point is they have macadamia nut oil macadamia nut bars straight up macadamia nuts with all kinds of different flavors so really easy to add to your diet I just I recommend them if you're going to get it you're going to spend a fortune at the grocery store macadamia nuts are not the cheapest nut but using that discount you can save a few bucks I'm getting some good macadamia nuts from House of macadamia plus with any purchase using that link a free 20 ounce bottle of cold pressed macadamia nut oil literally the only cold pressed macadamia nut oil that I know of that's on the market and you're getting one completely free if you just use that link down below there's no catches it's just to get the word out there where do you stand nowadays on the occasional 24 hour or the occasional 20 hour yeah I think that's totally fine yeah yeah okay what else another one in nutrition is um I've really had a change of heart around agriculture right so I used to sort of subscribe to the view that there was nothing wrong with GMO like just from a scientific basis I always felt it was misunderstood right like GMO is really just a crop trait strategy right so GMO is modifying organisms to make them resistant to pesticides and you know I thought that people's opposition to that was a little conspiracy theory-ish and you know there's nothing wrong with a plant that was genetically modified um I also felt that sort of the entire organic industry was kind of a scam sort of masquerading as you know kind of a you know a tribe of you know like a food tribe basically just another sort of dietary phony altruism yeah yeah yeah I have a much more nuanced of that today and I would say that I do have actually more concern of GMO today again not because of the actual Gene modification of the plant but because of the herbicide because of the pesticide I don't think we have sufficient long-term data on the effects of glyphosate and I think that we have been probably overly concerned with acute toxicity which is I would be fairly comfortable to say the acute toxicity of glyphosate and herbicides and fertilizers is very low if not non-existent but I don't think we have sufficient data on The Chronic side and therefore I think that the um the precautionary principle would actually suggest we're doing this incorrectly and so on a personal level today I am far more interested in what I'm learning about regenerative agriculture and the principles of optimizing around nutrient density as opposed to yield um furthermore the more I learn about this and I would still consider myself quite early in that Journey having only read you know three books on the subject matter so far but it's been very influential and it's really shifted my thinking about this to the point where I'm now basically asking the question yes I think organic is still a bit of a bad term because it doesn't mean anything um and organic food can still be horribly grown but there's something in this about the importance of how we grow food and to the best of my understanding right now I think if I could wave a magic wand I would never eat anything that was not produced regeneratively meaning crops that are grown not as mono crops not without cover crops without using any nitrogen spiking but rather done through this longer life cycle of regenerative production what does nitrogen spiking actually do I'm curious well what it's basically doing is altering the soil environment so just as we are pretty familiar with how we have our gut biome the soil is the biome of the plant and when we nitrogen Infuse that which was really a process that was started uh kind of roughly around World War II uh which is really when we saw crop yields explode right we you know we had historically been producing about 20 bushels per acre per year of corn uh globally let's just say in the United States even for you know most of the modern history and and then post World War II that number has just gone up and almost increased in some places tenfold so you know in the United States today you're probably seeing 140 to 200 bushels per acre per year of corn production um and that came through a lot of things that um you know involved just pumping more and more nitrogen in because of course plants have to fix nitrogen externally and carbon from the air but what that's done is completely changed the health of the soil and so at the risk of being a bit sort of cute about it you if you don't have healthy soil you won't have healthy plants if you don't have healthy plants you won't have healthy animals if you don't have healthy animals you don't have healthy humans I think we're kind of in a little bit of that life cycle um and while I don't think that this is something that you know can't be managed um I definitely have worry about long-term soil health and as a result of that I I I've become much more interested in something that I had been quite dismissive of in the past yeah well it's it's a good way to look at it as far as GMO inherently isn't the problem it's the fact that that's sort of a canary in the coal mine for okay well what are we protecting this plant from does that indicate that there's more crap on this plant yeah you know and that's a really interesting way to look at it all right what's next say overall on just exercise in general I think despite the fact that I've been a lifelong exerciser I love exercise it's always been kind of enjoyable to me it's never been something that's required like discipline I've got to make sure I got an exercise I don't think I fully appreciated how powerful exercise was as um as a drug frankly for lack of a better word uh until really the last five years I think I had you know sort of thought it was beneficial in a sort of holistic way but I don't think I understood what its effects were specifically on the brain what its effects were specifically on the nervous system what its effects were on the cardiovascular system at a really deep level and and and overall what its effects are in terms of lifespan and health Span in other words how much it reduces all-cause mortality and how important it is at preserving quality of life which again it seems pretty obvious but I think I had been overly fixated on nutrition and that that just came at the expense of me thinking really long and hard about exercise and how we need to be more thoughtful in our application of that tool has that changed how you personally exercise and I'll couple that with I know you have a different life circumstances now you're focusing on different things and that's changed how you look at exercise but has your view of exercise itself changed how you exercise it certainly has because if because this is the first time in my life where I'm truly time Limited so up until I was you know in my early 40s I don't know even though I was always busy I I've somehow always had seemingly as much time as I wanted to exercise and therefore I could always kind of just pursue my Bliss in that whatever way I was doing now I'm truly limited by time I really I mean if I had more time I if I had more time to exercise I would today but I can't I'm really stuck at you know what still sounds like a lot for people but for me is historically low you know 10 to 12 hours a week is the most I can really make time for with the other commitments I have that are more that I deem you know for any marginal time I would deem those other commitments more important so yes in that sense my view is much more disciplined about how that time is spent you know if it were 10 years ago I might use that time today to just focus on one thing whereas now I have to spread that time out across stability strength uh low end aerobic efficiency high-end Peak aerobic output I have to spread it across those four pillars so if you could go back to say prime time maybe early 30s uh or you know whenever you were putting a lot of time into your endurance work if there was something that you could do differently than what would it be well I would still allow myself to kind of pursue my Bliss right so in my early 30s or yeah in my early 30s I guess mid-30s it was swimming ultra distance swimming I think I would have just been a little more thoughtful about what I was doing in dry land so instead of spending you know 25 to 30 hours a week swimming I should have been in the weight room at least you know three hours a week on top of that uh same thing when I was at you know when I was just cycling non-stop I think I could have been more thoughtful about other types of activities uh to balance out some of the obvious imbalances that come with being crunched over on a bike all day yeah I think I can speak for myself with uh yeah I mean resistance training I probably went too full bore into that for a while where you know I had to unravel walking like a robot for quite a while you know and so okay what's uh what's next on the list here uh probably my skepticism for the use of Metformin as a zero protective molecule so metformin is a drug that has been widely used for the early intervention of patients with type 2 diabetes and even patients with you know severe insulin resistance who are not yet type 2 diabetics uh and in that regard it's been a productive drug uh so it it seems to work by reducing hepatic glucose output and so in other words it works by putting less glucose into the system uh but of course it became a drug of interest about a decade ago because of some epidemiology that suggested that people who took metformin uh with type 2 diabetes had better odds at surviving cancer than people who didn't have diabetes and didn't take metformin and that was an enormous suggestion because we understand very clearly that people with type 2 diabetes are at a much greater increase for cancer so how is it that people with this disease who have a much higher incidence of cancer if they take this drug seem to not get cancer at the same rate as non-diabetics who don't take the drug and there's clearly some interesting mechanisms of action for why that might be the case it could be that um you know activation of ampk itself is protective it could be that just lower in glucose and lowering a growth factor like insulin and igf is protective there are lots of explanations for this and as a result of that gosh I mean I was taking metformin prophylactically I.E is zero protective agent starting in about 2011 is when I began taking it and by about 2018 2019 so about five years ago you know I noticed a couple of things that I didn't like one was as I track my lactate levels I noticed my lactate levels were always higher than I thought they should have been this was most notable even at rest and also doing kind of zone two activity um that might not be surprising when you understand how metformin Works which is it's at least in part a weak mitochondrial toxin so if you're poisoning the mitochondria just slightly which is what you're doing to get that ampk activation you're also impairing somewhat oxidative phosphorylation and that's why you're going to see a higher lactate that struck me as not a great idea uh at least in a person who's capable of exercising greatly as I am and many of my patients are furthermore there was a a study that came out quite recently that only had me kind of double down on that thinking which was it was a repeat of the epidemiologic analysis that suggested that metformin was beneficial relative to non-use in non-diabetics but just done on a different cohort of patients and frankly done a little with a little bit more statistical rigor and it came to the opposite conclusion it came to the conclusion you would expect which is that patients with diabetes who take Metformin still actually fare worse than the other than non-diabetics not taking metformin when adjusted for all of their variables and uh you know for reasons that I cover in a newsletter that I wrote which you know we can maybe link to I find the latter study more compelling not simply because it agrees with my newfound thinking but because I simply think it's a more reasonable uh scientific analysis ultimately we will find this out one way or the other because there is a clinical trial that is going on that's asking this question and so my hope is that in five years we'll just have the answer and we won't have to rely on this indirect Insight or indirect information that's always going to be prone to biases and therefore is ultimately not dispositive in helping us understand this and if we're sitting here in five years in the tame trial which is the name of the trial found that metformin is indeed zero protective I'll be the first one to be taking it again so a question that I've always had that might sound like a total Noob question but if if metformin is a mild mitochondrial stressor and activates ampk is it potentially going to inhibit hypertrophy like I mean are you are you potentially limiting the rate of muscle preservation or potentially growth it's possible I don't know yeah yeah it's an interesting interesting thought that it's always crossed my mind but well all right so we've got one more put you on the spot uh potentially the the most important just in terms of quality of life has been you know something I write about a lot in the book or not a lot but it's something I write about at the end of the book which is the importance of emotional health um and I think that I just had never really considered that an important part of the equation of this you know longevity equation right um it didn't fit neatly into a box of you know delaying death from cardiovascular disease cancer neurodegenerative disease it was a little amorphous and I I think you know I just had my own blind spot to it which was ironic given that it was a part of my life that wasn't especially healthy so I think now having been through all I've been through and you know sort of reflecting on what I've learned I realize not that not only for me was this a very important thing but I suspect it is for many people as well um if they will you know take the opportunity to to kind of probe that yeah it's I mean it's a it's a huge umbrella that people definitely miss and it's just It ultimately is the umbrella literally of just how I guess not literally figuratively but how we look at life and how it changes how we look at exercise and how we perform and how we eat and how we and not to mention the actual physical effect that we have of being in a good mood and what are some things that you're doing today to improve that well luckily I'm kind of more in a maintenance mode now I mean I think I had to go through sort of the heavy the heavy lifting um you know six seven you know or you know three four five six years ago um so so what I do today I think is is much easier than what I did in the past but I still work with a therapist once a week um and I still practice uh something called dialectical behavioral therapy so that's one form of therapy that I do and um and that is just what it is right it's like a practice so it's sort of like saying like we'll you know you know is it enough to know that a workout is important no you actually have to do the workout so similarly it's not just enough I think to kind of show up for an hour a week to do the therapy you have to be able to kind of take what you learn in that therapy and then put it into daily practice and if you succeed you note it if you fail you note it but you're just constantly trying to to sort of get better and DBT or dialectical behavioral therapy is a system that I really like and it really works for me and it works for many people um I've done a podcast on it actually which maybe we could link to I think it's a it's something I think a lot more people should know about yeah I mean my life changed for the better when therapy became a regular part of my life and I think there's a stigma that's attached to it and that needs to get broken down significantly because people don't go to therapy until there's a cause for it or a reason for it and especially this day and age not to you know go off on a tangent but it's very it's difficult to have that connection and sometimes therapy is the only place you actually get that connection especially if you're not married you don't have a spouse you don't not going home to someone you know and you're just on your device all day so I think that's really really good advice and it's something that I would Echo I think over the last five six years I would have I don't think I would have casted judgment upon someone that was going to therapy but I certainly wouldn't have looked at it with the same lens that I look at it now so I think that's a great one yeah well we'll link out to those episodes down below we'll also link out to your book so as always keep it locked in here and Dr Tia thank you very much yeah thanks Tom

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