The Peter Attia Drive - #108 - AMA #13： 3-day fasting, exogenous ketones, autophagy, and exercise for longevity

00:00:00.000 Hey everyone, welcome to a sneak peek, ask me anything or AMA episode of the drive podcast.

00:00:16.500 I'm your host, Peter Atiyah. At the end of this short episode, I'll explain how you can

00:00:20.460 access the AMA episodes in full, along with a ton of other membership benefits we've created,

00:00:25.440 or you can learn more now by going to peteratiyahmd.com forward slash subscribe.

00:00:31.120 So without further delay, here's today's sneak peek of the ask me anything episode.

00:00:39.260 Welcome to another edition of ask me anything AMA episode 13. I'm joined again today by my head

00:00:45.740 of research, Bob Kaplan. In this episode, we talk about a bunch of things. It was supposed to be

00:00:51.480 rapid fire, but we, on the first question, got so far off the rails, and I think it literally took

00:00:57.040 up half the time, but it was basically a question about seven-day versus three-day water fasts,

00:01:01.960 and then that evolved or devolved, depending on how you think of it, into all things related to

00:01:08.140 fasting, how you cope with them, all the things that you would measure, what's happening physiologically,

00:01:13.520 the use of exogenous ketones, et cetera. We then pivoted off to some other topics,

00:01:18.580 such as favorite resources that I have for staying up to date on information as it relates

00:01:25.340 to medicine, health, longevity. We talked a little bit about exercise and specifically how one

00:01:30.780 might craft an exercise program around longevity. I hope you enjoy this episode of AMA 13.

00:01:38.060 Hey, everyone. Welcome to another Ask Me Anything, or AMA, with Peter Atiyah. Peter,

00:01:49.820 how are you doing? Doing well, Bob. How are you? Living the dream. Ready to ask you some questions.

00:01:54.860 I'm nervous, man. You got that look in your eye that says you've got questions to make a fool of

00:02:00.140 me or something. Well, we're just going to do a rapid fire and see which ones stick. Okay. Rapid fire,

00:02:05.600 meaning you're going to be on the stopwatch or? Yeah, we could do a two-minute drill if you want,

00:02:09.860 and then we'll just go over if we need to. It defeats the purpose. Okay. Go for it.

00:02:15.680 All right. First question. Any early observations from your new three-day-per-month fasting regimen?

00:02:25.380 So I guess for folks who maybe aren't familiar, I'll give a bit of background.

00:02:29.060 For a great deal of time, I would do a seven-day fast once a quarter. And around Thanksgiving last

00:02:39.380 year, I decided to try something different, which was more frequent fasts that were shorter.

00:02:46.080 And so being completely arbitrary, I was like, well, if I was fasting seven days every quarter,

00:02:52.580 three days a month is almost the same in terms of total aggregate fast time. By the way, Bob,

00:02:57.660 this is not going to be a two-minute answer, just FYI. So I decided, well, what if I could do three

00:03:04.360 days a month? And I think part of the rationale was twofold. One, the seven-day fasts are quite

00:03:11.900 intrusive just in life in general. I've done enough of them that I can pretty much sail through them,

00:03:17.560 but it's seven days of not eating, not drinking. And I just thought, well, every time I do one of

00:03:24.100 those, I noticed that by about the second day of the fast, my glucose levels really start to normalize

00:03:30.380 as in low levels of glucose. My ketone levels really start to rise. I started to suspect that

00:03:37.540 maybe around day two and day three is when some really interesting metabolic stuff is going on

00:03:44.300 and basically figured, well, what if we just did a slightly less extreme version where we got some of

00:03:50.440 the benefit that we got from the seven-day fast, but maybe not all of it, but revisited that more

00:03:55.300 quickly. So anyway, that was the rationale for it. So actually by total coincidence, I'm on day one of

00:04:01.740 this month's fast. We're recording this on, what is it? March 2nd today. So this is the March fast.

00:04:09.760 And when was your last meal?

00:04:11.520 My last meal was Sunday evening. So I will break the fast Wednesday evening. So now having done one,

00:04:21.460 two, three, maybe four or five of these shorter fasts, they're definitely easier. And that's saying

00:04:27.220 even though the longer fasts, you get more and more used to them, you have periods during those longer

00:04:34.700 fasts where you're, at least for me, I'm just sort of dragging. I'm kind of wearing it. I'm just not

00:04:41.300 my normal self. For the three-day fasts, I seem to skate through them a little bit easier. That's one

00:04:47.100 thing. I think the other thing is my exercise tolerance seems higher because obviously I'm not

00:04:55.580 subjected to the same degree of glycogen depletion. So today, for example, not that today's workout

00:05:02.480 counts because it was basically the first day after having a dinner. So this doesn't really a fasted

00:05:07.860 workout, but I suspect I could do the type of work that I did today, which was two hours and super

00:05:12.560 intense, lots of sled work, lots of deadlifts, lots of compound movements. I could do that easily

00:05:18.600 through a three-day. Whereas in the longer fasts, I still try to do those activities each day,

00:05:22.980 but I really have to reduce the volume. And I just find that during the three-day fast, nothing really

00:05:28.060 seems to happen. I will say this, Bob, I have not done a lab test on myself at the end of a three-day.

00:05:35.780 So that's kind of an important thing I still need to do is do a blood test. I have done a blood test

00:05:45.060 on myself after a four-day fast, and I was very surprised to see it looked almost identical to the

00:05:54.240 stuff you and I discussed at the end of a seven or eight-day fast. And again, to reiterate for folks

00:05:59.420 what that was, insulin, of course, is basically unmeasurable. Glucose is very low. Triglycerides,

00:06:05.760 not that low. Again, because you're probably, you've got so much flux of triglyceride to free

00:06:12.340 fatty acid going through that that's basically your substrate for making all those ketones. So

00:06:16.780 it's not like my triglycerides were high, but they were about the same as they are when I'm fed.

00:06:20.940 Uric acid, very high. Free T3, very low. Reverse T3, very high. Testosterone, very low. Those are

00:06:31.680 sort of the signature findings I see after a long fast. Oh, IGF also very low. And again,

00:06:39.000 after a four-day fast, they looked almost the same. So I really do need to get around to doing a three-day

00:06:44.180 post lab. Maybe I'll do it this time. I'll look at my schedule and see if it makes sense. But that

00:06:48.720 would be kind of an interesting thing. So kind of a long answer to a simple question. And I hope that

00:06:54.280 suffices. The seven-day fast that you were doing before, you were doing the nothing burger or the

00:07:00.540 KFK. So you're doing a week of a ketogenic diet going into the fast and then a week coming out.

00:07:07.060 Are you doing anything different or similar with the three-day fast? Since January, so for the last

00:07:13.080 two months, I have not been on a full ketogenic diet, but I've been much more low carb than I normally

00:07:20.800 have been, at least for the previous four or five years. So I'm not doing a very strict keto, but I'm

00:07:29.940 really not eating any sugar. I'm not eating hardly any starch. The only carbs I'm eating are sort of

00:07:35.840 vegetables. And my one little vice is fiber one cereal with 27 pounds of fiber in it, which is,

00:07:44.240 it's amazing how it does not spike my blood sugar. And I mix it in with like some cashew milk and some

00:07:50.160 yogurt, but that's probably sufficient to exclude me from making too many ketones. But just sort of a

00:07:55.620 slightly more strict dietary restriction probably makes it also easier for me to slip in and out of

00:08:01.440 this fast. So you started last night, Sunday night, do you get glucose and BHP on Monday morning?

00:08:06.580 And what does that look like? And maybe relative to what you were doing when you're full keto,

00:08:10.880 not half keto? Right, right. I didn't today. I'll probably do my first check tonight. I would

00:08:18.060 expect ketones tonight to be in the neighborhood of 0.5 to one. And you may recall, I use these two

00:08:27.380 devices. One of them seems, I think, a little bit more accurate at lower levels, which is the

00:08:33.300 Precision Extra. The Keto Mojo seems to run very high at low levels. I'm also going to be testing out

00:08:39.580 a new breath device for measuring acetone. I don't think it's commercially available yet,

00:08:47.040 but Dom D'Agostino, who many listeners will recall having been on the podcast, and I might add,

00:08:53.260 we're going to have Dom back on to do a follow-up because there's been so many great questions for

00:08:57.920 Dom, who is one of the most knowledgeable people on this topic. But anyway, I'll be testing a breath

00:09:03.040 acetone device that I think is still sort of in the research phase and looking to see if there's any

00:09:07.840 correlation between that and BHP. Historically, the answer is no. Historically, breath acetone

00:09:12.840 testing is not very well correlated with blood BHP testing. So for that test, I've got a breathalyzer

00:09:20.880 here at home. I think it's called a ketonics. And it basically, it's acetone. And I think it gives you

00:09:27.120 red, yellow, and green. And green means you're in, let's say, it's probably like the pea strips or the

00:09:34.700 urine strips. It's not giving me an output of a number. It's just basically saying you're in deep

00:09:39.180 ketosis. You're in moderate or probably undetectable. Does this new device have anything that's a little

00:09:45.780 more accurate than the stoplight or the traffic light? It's sitting in the box. And one of the

00:09:51.640 people who works with me in the practice has done all the vetting on it, including talking with the

00:09:56.880 company. So I have to talk with her today to actually get the tutorial on it. So I don't know

00:10:05.200 how quantitative versus qualitative it is. But based on an email she sent me last week, after she did a

00:10:12.320 pretty deep dive into it, I'm going to guess that it's actually somewhat quantitative and hopefully

00:10:17.960 pretty impressive. Look, for me personally, I just like checking my blood. I don't really see some

00:10:23.000 great advantage in checking breath ketones. But I can understand that there are advantages to it.

00:10:29.140 One, it's going to be a heck of a lot cheaper because when you're checking in the blood, those

00:10:33.320 strips really do get expensive. And two, there are people who don't like to poke their fingers. So it's

00:10:38.720 probably more accessible. And we shouldn't lose sight of what the purpose of this type of testing

00:10:43.340 is, which I think is easy to do. It's basically there as a guidepost. And I think frankly, it's

00:10:48.180 more helpful during a phase when someone is trying to go through nutritional ketosis than it is during

00:10:53.540 fasting. During fasting, it's just kind of a way to gamify it a little bit. And look, I'm as guilty

00:10:58.240 as the next person because I'm always checking my ketones three times a day when I'm fasting.

00:11:03.160 But I truthfully don't know that that's that relevant. There's nothing I can do about it per

00:11:08.580 se. I will say this. One interesting observation that I learned in a fast maybe two years ago was

00:11:15.500 I decided to experiment and consume diet stuff, diet Cokes and Trident sugarless gum and stuff like

00:11:24.320 that. So I wasn't adding any calories to the fast. And it could be true, true and unrelated,

00:11:28.560 but I'll tell you, I never forgot the lesson, which was I've never had lower ketones and I've

00:11:33.320 never felt more miserable during a fast. And that, by the way, can be sort of the power of

00:11:38.780 suggestion. I think sometimes when your ketones are low, you think you feel crappy, maybe you don't.

00:11:43.760 But the numbers clearly were low. That is not subject to a placebo effect. Whether I felt good or bad

00:11:49.940 might be. But that was a sort of an interesting lesson that came from checking those ketone levels

00:11:55.720 during the fast was I realized, hey, there's something about these non-nutritive sweeteners

00:12:00.700 that might be impairing ketosis, or at least impairing some aspect of the fast that is

00:12:05.760 increasing ketone production. So for people who are trying to get into nutritional ketosis, I think

00:12:11.540 these devices are probably helpful. And who knows? I mean, I think we're probably within the next few

00:12:16.860 years, we'll see continuous ketone meters, just as we have continuous glucose meters.

00:12:22.240 Did you throw in insulin too?

00:12:23.240 Meaning continuous insulin?

00:12:25.820 Yeah, monitor.

00:12:26.980 Well, that's an interesting topic.

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The Peter Attia Drive - April 21, 2020

#108 - AMA #13： 3-day fasting, exogenous ketones, autophagy, and exercise for longevity

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