#108 - AMA #13： 3-day fasting, exogenous ketones, autophagy, and exercise for longevity
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Summary
In this episode of Ask Me Anything, I'm joined by my head of research, Bob Kaplan, as we discuss the differences between 7-day vs. 3-day water fasts, how to prepare for them, and the benefits and drawbacks of each.
Transcript
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Hey everyone, welcome to a sneak peek, ask me anything or AMA episode of the drive podcast.
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I'm your host, Peter Atiyah. At the end of this short episode, I'll explain how you can
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access the AMA episodes in full, along with a ton of other membership benefits we've created,
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or you can learn more now by going to peteratiyahmd.com forward slash subscribe.
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So without further delay, here's today's sneak peek of the ask me anything episode.
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Welcome to another edition of ask me anything AMA episode 13. I'm joined again today by my head
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of research, Bob Kaplan. In this episode, we talk about a bunch of things. It was supposed to be
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rapid fire, but we, on the first question, got so far off the rails, and I think it literally took
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up half the time, but it was basically a question about seven-day versus three-day water fasts,
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and then that evolved or devolved, depending on how you think of it, into all things related to
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fasting, how you cope with them, all the things that you would measure, what's happening physiologically,
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the use of exogenous ketones, et cetera. We then pivoted off to some other topics,
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such as favorite resources that I have for staying up to date on information as it relates
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to medicine, health, longevity. We talked a little bit about exercise and specifically how one
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might craft an exercise program around longevity. I hope you enjoy this episode of AMA 13.
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Hey, everyone. Welcome to another Ask Me Anything, or AMA, with Peter Atiyah. Peter,
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how are you doing? Doing well, Bob. How are you? Living the dream. Ready to ask you some questions.
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I'm nervous, man. You got that look in your eye that says you've got questions to make a fool of
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me or something. Well, we're just going to do a rapid fire and see which ones stick. Okay. Rapid fire,
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meaning you're going to be on the stopwatch or? Yeah, we could do a two-minute drill if you want,
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and then we'll just go over if we need to. It defeats the purpose. Okay. Go for it.
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All right. First question. Any early observations from your new three-day-per-month fasting regimen?
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So I guess for folks who maybe aren't familiar, I'll give a bit of background.
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For a great deal of time, I would do a seven-day fast once a quarter. And around Thanksgiving last
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year, I decided to try something different, which was more frequent fasts that were shorter.
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And so being completely arbitrary, I was like, well, if I was fasting seven days every quarter,
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three days a month is almost the same in terms of total aggregate fast time. By the way, Bob,
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this is not going to be a two-minute answer, just FYI. So I decided, well, what if I could do three
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days a month? And I think part of the rationale was twofold. One, the seven-day fasts are quite
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intrusive just in life in general. I've done enough of them that I can pretty much sail through them,
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but it's seven days of not eating, not drinking. And I just thought, well, every time I do one of
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those, I noticed that by about the second day of the fast, my glucose levels really start to normalize
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as in low levels of glucose. My ketone levels really start to rise. I started to suspect that
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maybe around day two and day three is when some really interesting metabolic stuff is going on
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and basically figured, well, what if we just did a slightly less extreme version where we got some of
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the benefit that we got from the seven-day fast, but maybe not all of it, but revisited that more
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quickly. So anyway, that was the rationale for it. So actually by total coincidence, I'm on day one of
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this month's fast. We're recording this on, what is it? March 2nd today. So this is the March fast.
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My last meal was Sunday evening. So I will break the fast Wednesday evening. So now having done one,
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two, three, maybe four or five of these shorter fasts, they're definitely easier. And that's saying
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even though the longer fasts, you get more and more used to them, you have periods during those longer
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fasts where you're, at least for me, I'm just sort of dragging. I'm kind of wearing it. I'm just not
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my normal self. For the three-day fasts, I seem to skate through them a little bit easier. That's one
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thing. I think the other thing is my exercise tolerance seems higher because obviously I'm not
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subjected to the same degree of glycogen depletion. So today, for example, not that today's workout
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counts because it was basically the first day after having a dinner. So this doesn't really a fasted
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workout, but I suspect I could do the type of work that I did today, which was two hours and super
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intense, lots of sled work, lots of deadlifts, lots of compound movements. I could do that easily
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through a three-day. Whereas in the longer fasts, I still try to do those activities each day,
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but I really have to reduce the volume. And I just find that during the three-day fast, nothing really
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seems to happen. I will say this, Bob, I have not done a lab test on myself at the end of a three-day.
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So that's kind of an important thing I still need to do is do a blood test. I have done a blood test
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on myself after a four-day fast, and I was very surprised to see it looked almost identical to the
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stuff you and I discussed at the end of a seven or eight-day fast. And again, to reiterate for folks
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what that was, insulin, of course, is basically unmeasurable. Glucose is very low. Triglycerides,
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not that low. Again, because you're probably, you've got so much flux of triglyceride to free
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fatty acid going through that that's basically your substrate for making all those ketones. So
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it's not like my triglycerides were high, but they were about the same as they are when I'm fed.
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Uric acid, very high. Free T3, very low. Reverse T3, very high. Testosterone, very low. Those are
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sort of the signature findings I see after a long fast. Oh, IGF also very low. And again,
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after a four-day fast, they looked almost the same. So I really do need to get around to doing a three-day
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post lab. Maybe I'll do it this time. I'll look at my schedule and see if it makes sense. But that
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would be kind of an interesting thing. So kind of a long answer to a simple question. And I hope that
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suffices. The seven-day fast that you were doing before, you were doing the nothing burger or the
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KFK. So you're doing a week of a ketogenic diet going into the fast and then a week coming out.
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Are you doing anything different or similar with the three-day fast? Since January, so for the last
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two months, I have not been on a full ketogenic diet, but I've been much more low carb than I normally
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have been, at least for the previous four or five years. So I'm not doing a very strict keto, but I'm
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really not eating any sugar. I'm not eating hardly any starch. The only carbs I'm eating are sort of
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vegetables. And my one little vice is fiber one cereal with 27 pounds of fiber in it, which is,
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it's amazing how it does not spike my blood sugar. And I mix it in with like some cashew milk and some
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yogurt, but that's probably sufficient to exclude me from making too many ketones. But just sort of a
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slightly more strict dietary restriction probably makes it also easier for me to slip in and out of
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this fast. So you started last night, Sunday night, do you get glucose and BHP on Monday morning?
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And what does that look like? And maybe relative to what you were doing when you're full keto,
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not half keto? Right, right. I didn't today. I'll probably do my first check tonight. I would
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expect ketones tonight to be in the neighborhood of 0.5 to one. And you may recall, I use these two
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devices. One of them seems, I think, a little bit more accurate at lower levels, which is the
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Precision Extra. The Keto Mojo seems to run very high at low levels. I'm also going to be testing out
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a new breath device for measuring acetone. I don't think it's commercially available yet,
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but Dom D'Agostino, who many listeners will recall having been on the podcast, and I might add,
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we're going to have Dom back on to do a follow-up because there's been so many great questions for
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Dom, who is one of the most knowledgeable people on this topic. But anyway, I'll be testing a breath
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acetone device that I think is still sort of in the research phase and looking to see if there's any
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correlation between that and BHP. Historically, the answer is no. Historically, breath acetone
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testing is not very well correlated with blood BHP testing. So for that test, I've got a breathalyzer
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here at home. I think it's called a ketonics. And it basically, it's acetone. And I think it gives you
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red, yellow, and green. And green means you're in, let's say, it's probably like the pea strips or the
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urine strips. It's not giving me an output of a number. It's just basically saying you're in deep
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ketosis. You're in moderate or probably undetectable. Does this new device have anything that's a little
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more accurate than the stoplight or the traffic light? It's sitting in the box. And one of the
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people who works with me in the practice has done all the vetting on it, including talking with the
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company. So I have to talk with her today to actually get the tutorial on it. So I don't know
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how quantitative versus qualitative it is. But based on an email she sent me last week, after she did a
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pretty deep dive into it, I'm going to guess that it's actually somewhat quantitative and hopefully
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pretty impressive. Look, for me personally, I just like checking my blood. I don't really see some
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great advantage in checking breath ketones. But I can understand that there are advantages to it.
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One, it's going to be a heck of a lot cheaper because when you're checking in the blood, those
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strips really do get expensive. And two, there are people who don't like to poke their fingers. So it's
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probably more accessible. And we shouldn't lose sight of what the purpose of this type of testing
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is, which I think is easy to do. It's basically there as a guidepost. And I think frankly, it's
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more helpful during a phase when someone is trying to go through nutritional ketosis than it is during
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fasting. During fasting, it's just kind of a way to gamify it a little bit. And look, I'm as guilty
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as the next person because I'm always checking my ketones three times a day when I'm fasting.
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But I truthfully don't know that that's that relevant. There's nothing I can do about it per
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se. I will say this. One interesting observation that I learned in a fast maybe two years ago was
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I decided to experiment and consume diet stuff, diet Cokes and Trident sugarless gum and stuff like
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that. So I wasn't adding any calories to the fast. And it could be true, true and unrelated,
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but I'll tell you, I never forgot the lesson, which was I've never had lower ketones and I've
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never felt more miserable during a fast. And that, by the way, can be sort of the power of
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suggestion. I think sometimes when your ketones are low, you think you feel crappy, maybe you don't.
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But the numbers clearly were low. That is not subject to a placebo effect. Whether I felt good or bad
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might be. But that was a sort of an interesting lesson that came from checking those ketone levels
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during the fast was I realized, hey, there's something about these non-nutritive sweeteners
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that might be impairing ketosis, or at least impairing some aspect of the fast that is
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increasing ketone production. So for people who are trying to get into nutritional ketosis, I think
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these devices are probably helpful. And who knows? I mean, I think we're probably within the next few
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years, we'll see continuous ketone meters, just as we have continuous glucose meters.
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