The Peter Attia Drive - #11 - AMA #2： the Nothingburger — results from Peter's week-long fast between two weeks of nutritional ketosis — and answering questions on all things fasting

00:00:00.000 Hey everyone, welcome to the Peter Atiyah Drive. I'm your host, Peter Atiyah.

00:00:10.140 The Drive is a result of my hunger for optimizing performance, health, longevity, critical thinking,

00:00:15.600 along with a few other obsessions along the way. I've spent the last several years working with

00:00:19.840 some of the most successful, top-performing individuals in the world, and this podcast

00:00:23.600 is my attempt to synthesize what I've learned along the way to help you live a higher quality,

00:00:28.360 more fulfilling life. If you enjoy this podcast, you can find more information on today's episode

00:00:33.000 and other topics at peteratiyahmd.com.

00:00:41.460 Welcome to this episode of The Drive. This is sort of a cross between what I would call an AMA and a

00:00:48.140 show-and-tell. I think it's billed as an AMA, and we certainly do our best to kind of answer all the

00:00:53.320 questions about this particular thing, but it was also a little bit of a, as I say, a show-and-tell

00:00:58.860 where I kind of go over in detail what this fasting protocol was all about. So this particular

00:01:04.360 episode is very specifically about questions that folks have asked around why I did this,

00:01:09.960 you know, for lack of a better description, this week of keto followed by a week of fasting followed

00:01:14.160 by a week of keto. I call it the KFK sandwich, but Bob has referred to it as the nothing burger,

00:01:19.820 which probably makes more sense. So this was, again, kind of a first for us where we were

00:01:25.740 kind of just spending a bit of time talking very specifically about this, you know, experiment I've

00:01:31.380 done. And when I say experiment, I use that term pretty loosely. I mean, quotes, self-experiment,

00:01:37.100 maybe, you know, N of one nonsense, whatever you want to call it. But hopefully I provide at least

00:01:41.900 some rationale for why this was interesting to me. More importantly, what hypotheses could be generated,

00:01:47.740 and ultimately I think where I'd like to be able to take this sort of insight because

00:01:51.580 my real motivation for doing this, I hope comes across clearly. This was the first time Bob and

00:01:56.760 I ever didn't record one of these things together. So any other time that we've done sort of interview

00:02:02.480 slash AMA stuff, we're in person. So, you know, this was kind of working out some of the kinks of not

00:02:08.000 sitting in front of each other, but I don't think that really turns into a major hiccup. And then this

00:02:13.040 is going to be one where I think if you don't have the show notes in front of you, you know,

00:02:18.120 at the very least you want to go back and look at them. And the reason is there's just so much

00:02:21.960 data that I end up putting out there. So there's sort of like, here's how my body weight changed.

00:02:27.860 Here's what my ketone levels were. Here's the trailing averages of my blood glucose levels from

00:02:32.740 the CGM, et cetera. And then of course I did a blood test every seven days. So on a three week

00:02:38.060 sandwich, that's basically four parallel sets of blood tests and there's just a bunch of other

00:02:43.980 stuff. So all of that's going to be laid out in the notes. And so I guess the easiest way to

00:02:48.260 ingest this info would be sort of sitting in front of, you know, your whatever device you would read

00:02:53.400 this stuff on and looking at it. Alternatively, you know, I think you can sort of listen to it and

00:02:57.340 then kind of come back and skim the notes and they'll make more sense. So I suspect either one of

00:03:01.680 those will be appropriate. And then again, I suspect next time I do some sort of goofy self

00:03:06.040 experiment, we'll continue to do that. That said, we are going to do another AMA. We'll record it next

00:03:13.220 month, which will be in September. And by then we hope to have an AMA page on the website. We're in

00:03:21.360 the process of trying to figure out how complicated it is to produce an AMA page of the caliber that I've

00:03:26.700 seen on others like Sam Harris's site and really like. And the reason is I think that'll be easier

00:03:31.440 for people than what we're doing now, which is basically people are tweeting us questions,

00:03:36.840 CCing Bob, and then he's aggregating them in a spreadsheet. So not that efficient for Bob and

00:03:42.120 not that efficient for you because how are you going to keep track of what questions are being

00:03:45.840 asked if that matters? So hopefully by September, we'll have this new thing up and running. Folks can

00:03:51.000 blast AMA stuff into that. And then we can also more efficiently aggregate it and probably tabulate it

00:03:56.720 once people start voting and stuff, giving us a sense of what people like. I think that's about

00:04:01.220 all I want to say going into this and the rest of this episode kind of speaks for itself. So I hope

00:04:05.820 you enjoy this discussion about my little fasting experiment. Hey everyone, welcome to a sort of bonus

00:04:14.900 episode, AMA slash discussion slash whatever. As some of you may have noted from some social media

00:04:23.820 stuff I was posting. I did a little nutritional experiment kind of recently and a lot of people

00:04:31.200 have asked a lot of really interesting questions and Bob and I figured the easiest way to address

00:04:34.440 it would be to do it sort of as an AMA style where Bob has aggregated a bunch of questions and then he's

00:04:40.300 going to kind of interview me like we did this the first time. And you've probably noticed we are

00:04:45.620 releasing this as a bonus episode, meaning not as a dedicated Monday release podcast. So this will be

00:04:53.020 considered after school education. Bob, where are you today, man? I'm in my mom's basement, right?

00:05:01.400 I figured that would be, that'd be the perfect place when I'm online. So I'm actually, I'm in

00:05:07.020 Wayland, Massachusetts, which is a suburb of Boston on Skype. This is our first time not doing one of

00:05:14.160 these things in person. Yikes. All right. Well, you take it away. You're in charge, Bob. I'm here to

00:05:21.300 answer your questions. Okay. So a lot of questions came in for the, I guess it's this bonus episode of

00:05:28.320 AMA for Peter's fast. And Peter, I'll let you explain what exactly you did because I think it's

00:05:37.140 more akin to a nothing burger where you sandwich the fast between two ketogenic diets. And the

00:05:42.980 questions were somewhat far ranging in some ways, but they all kind of centered around what did you do?

00:05:50.340 What were the results? Things like that. And also what should I do? And what I thought would be a

00:05:56.420 good idea is to sort of approach this scientifically where we do a little write-up of your fasting

00:06:04.180 experiment. And so if you look at a most scientific journal papers, they'll have an abstract and they'll

00:06:11.500 go over a little bit of the background and the rationale. They'll talk about the methods or the design of the

00:06:16.760 study. Then what happened, which are the results and then a discussion and conclusions. So I thought

00:06:24.520 that would be a good place to start really is the background and rationale. So I would ask what was

00:06:31.780 the point in doing this experiment? If there was a, in a primary objective, it was to save money while I

00:06:38.680 was in New York, which was the week that I was fasting. And normally because food in New York is so

00:06:44.140 expensive, I thought, what better way to save money than to not eat anything for the whole seven days

00:06:50.700 I was there. That was the primary objective. The secondary objective was actually to try to work

00:06:58.520 out the kinks on a protocol that I would like to study later on to see if I can, in collaboration with

00:07:05.640 a number of scientists, figure out what a signature of autophagy looks like. So if you have listened to

00:07:11.080 this podcast, you've probably heard me talk about this. I think in particular, we've talked about

00:07:15.620 this a lot on the podcast with Rhonda and probably with Dom, probably even David Sabatini and even a

00:07:21.400 couple of other podcasts that I don't think are out yet, where I know we've already prerecorded stuff

00:07:25.100 on autophagy. But basically this idea of eating oneself, where in a state of nutrient deprivation,

00:07:31.280 the body does something that's evolutionarily quite sound, which says, look, I got to figure out a way to

00:07:37.080 conserve energy here. And I also probably ought to start recycling pieces of cellular machinery that are

00:07:42.760 in otherwise maybe suboptimal cells. So it would appear that the greatest way to get into autophagy is

00:07:49.660 to completely restrict all nutrients, i.e. water only fast. Obviously, there are other things that might

00:07:56.720 stimulate autophagy. Exercise probably does to some extent. Certainly the use of rapamycin likely does,

00:08:03.060 depending on how it's administered. But to really develop a signature for autophagy, to be able to

00:08:08.260 draw a blood test and to look at a series of small molecules, metabolites, proteomic changes,

00:08:14.500 and know that, hey, this produced a positive signal in the direction that we want to go,

00:08:21.060 that might allow us to have some insight into a question that I certainly don't know the answer to.

00:08:26.480 And I frankly get a little miffed at the frequency with which I see people acting like they know the

00:08:32.560 answer. And the question being, what's the optimal fasting protocol? So I think most people realize

00:08:38.960 both scientifically and practically that to just take an individual and constitutively restrict

00:08:44.520 their calories by, say, 30% or more, one, it's not clear that that actually produces a longevity

00:08:50.600 phenotype in humans in the wild. And two, even if it did, it's not clear you'd want to do it.

00:08:55.560 So it would seem that some amount of cycling nutrient exposure, periods of fast and famine,

00:09:00.840 are optimal. But I have no idea what that should be. Should that be daily intermittent fasting?

00:09:07.600 Should that be prolonged fasts at some frequency? Should that be a day a week not eating? I mean,

00:09:14.620 you could come up with obviously an infinite number of these things. And rather than pretend like we know

00:09:20.000 what they are, I'd rather sort of work on developing a tool that we could measure proxies of the benefits

00:09:25.640 of those fasts so that we might once and for all have some way to at least take a more educated

00:09:32.480 approach to this and potentially customize it. Because the other thing to keep in mind is

00:09:36.400 we have no idea if two people would benefit equally from the same fasting protocol. So that was kind of

00:09:43.660 the long-winded rationale for this type of an experiment. Now, as to why I chose to do it as a week of

00:09:52.080 ketosis, a week of nothing, a week of ketosis, and by ketosis, I should be clear, nutritional ketosis,

00:09:59.300 which will explain what that means versus starvation ketosis, that was mostly self-preservation. I know

00:10:06.100 from previous attempts at fasting that to go into a fast out of a high carbohydrate state is a little

00:10:14.320 more painful because the body hasn't quite ramped up the process of making ketones. And obviously that

00:10:21.200 becomes the most important thing that's happening when you're in starvation. So that's sort of why

00:10:26.600 I did it. And then as at the front end and at the back end, it was actually, yeah, this is not a

00:10:32.100 scientific reason. It was, I wanted to ward against, guard against the risk that I was going to go ape

00:10:39.520 shit on the refeed and just like go and eat burgers and pizza every day. So I was like, well, if I force

00:10:46.480 myself to go into ketosis as I exit this fast, I will at least continue to eat in a reasonable manner.

00:10:54.000 So hence the symmetry and the nothing burger-ness.

00:11:00.420 So we can probably just jump right into the methods of that. Well, actually we can't. One thing that I

00:11:07.540 really appreciate when I see this in papers, but I don't often do, is that typically you'll see table

00:11:14.660 one in a paper where they have the baseline characteristics of the population. What I love

00:11:20.820 seeing is pre-baseline. So what is wild type Peter doing prior to the intervention? Like what is your

00:11:30.640 diet like in your exercise prior to doing this intervention? So I would say that in the months

00:11:37.780 leading up to this, I have been very consistently doing a time restricted feeding window of on the

00:11:47.620 low end, maybe 14 to 16 hours of time restriction. And on the high end, uh, you know, sort of 20 to 22

00:11:57.200 hours of time restriction. And I would say six out of seven days a week, if not seven days a week,

00:12:04.060 that's what I was doing. There was not much of a dietary restriction to that other than I was

00:12:10.480 limiting just abject junk most of the time. So when I'm hanging out with Tim Ferriss in Austin,

00:12:19.540 not limiting my junk so much because you know, Tim and I are a really bad influence on each other and

00:12:24.600 we eat a ton of shit. Although actually Tim is coming to New York today and I texted him last night

00:12:30.760 and I was like, dude, what kind of food do you want in the apartment? And he was so good and so

00:12:36.200 disciplined. And he was like, I want veggies, I want protein and I don't want, and then he rattled

00:12:41.920 off all of this bad stuff that we like to eat. So I, we are perfectly set. So basically it was

00:12:47.660 time restricted feeding where I was for the most part, not eating junk food, meaning really going

00:12:52.100 out of my way to avoid sucrose and high fructose corn syrup and junky sort of processed, you know,

00:12:57.520 carbohydrates and things like that, like potato chips and stuff. But what I wasn't restricting,

00:13:01.520 and this might be sort of the more relevant question, I wasn't really making any restriction

00:13:05.780 of carbohydrates explicitly and certainly not restricting sort of starches that aren't junk.

00:13:10.720 So I was still eating rice, eating potatoes, eating vegetables, ad libitum, and not otherwise making

00:13:15.960 any other particularly interesting restriction. As far as exercise goes, as I think I've talked about

00:13:21.600 this before, I don't train anymore. I haven't trained in three and a half years for anything,

00:13:25.520 anything athletic that is. So I just exercise now. And what that means is Monday, Wednesday,

00:13:30.500 Friday, I lift weights. And the other four days I'm doing something aerobic slash anaerobic.

00:13:36.740 And it usually involves either the Wahoo kicker or the Peloton.

00:13:41.040 Okay. A couple of other components, sleep and stress, and actually supplements and medications too.

00:13:49.740 Sleep, you probably, you do have data. Stress might be a little bit more squishy

00:13:54.140 prior to the intervention. But can you comment on those things?

00:13:58.760 Yeah. So sleep, I use an aura ring, which people have probably heard me talk about a lot.

00:14:03.200 And I wear it almost every single night. If I am not wearing it, it's because I put it on the

00:14:07.840 charger and forgot to put it on before bed. So I have lots of aura data. I am generally a guy who's

00:14:14.180 going to get seven to seven and a half hours of sleep a night. That doesn't mean time in bed.

00:14:19.440 That means actual sleep time. My efficiency is good, meaning I have low latency time and infrequent

00:14:25.120 wake-ups. So if I'm in bed for seven hours and 45 minutes, I'm pretty much guaranteed to get 715-ish

00:14:33.540 of sleep. As people who use the aura ring will know, you get a sleep score, which is kind of

00:14:39.700 interesting. But I like to kind of look at the actual numbers. And the aura ring, using an algorithm

00:14:45.220 based on the inputs that it measures, estimates the time you're spending in stage one and stage

00:14:50.680 two sleep, which are known as sort of light sleep, and then stage three and stage four or delta wave

00:14:56.060 sleep, known as deep sleep, and then REM sleep. Obviously, they're not measuring eye movement. So of

00:15:00.940 course, these are estimates. I would say that historically, I tend to be a little light on the

00:15:07.700 heavy and heavy on the light. Meaning, my delta wave sleep, stage three, stage four, generally fall

00:15:16.020 lower than what we would ideally want to see if I were doing an EEG-based sleep study. It's not clear

00:15:24.400 how much of that is an artifact of the algorithm, or if it is true, because I have not done a formal

00:15:30.060 sleep study with the aura ring on simultaneously. That is something I have on my to-do list, and I just

00:15:35.760 haven't mobilized to do it. But nevertheless, this will become relevant when we get to the experiment.

00:15:42.360 Because, as I'll discuss, one of the most interesting changes I observed was the change in

00:15:46.980 my sleep. As far as stress goes, I would say I was under sort of baseline stress, which is to say

00:15:54.400 probably higher than maybe the average person. But luckily, I'm not the president of the United States

00:15:59.540 or the CEO of a major company. So I guess it's all relative. I was, however, in a pretty good

00:16:05.620 meditative spot. And I've been in a pretty good meditative spot for about the past six months,

00:16:09.660 which means I've been in a really good, consistent routine of mindfulness meditation.

00:16:16.260 And I actually did something quantitative two weeks before the fast, which is a, I did what's

00:16:22.440 called a Dutch test, which is a test that looks at urine, dried urine, and measures cortisol and

00:16:27.860 cortisol metabolites, because I actually felt I was sort of hypercortisolemic. And at least on the two

00:16:35.100 days that I did that test, I was not. And I think it's too elaborate to post those results here,

00:16:40.420 because it would take a day to explain how that test works. But I did not appear to have

00:16:44.720 hypercortisolemia based on that test. I had kind of low adrenal, low-ish total adrenal output,

00:16:50.280 but totally normal levels of free cortisol, which is actually what matters.

00:16:53.600 Okay. I'm sure you're going to get plenty of comments about being elaborate on that Dutch test at

00:16:58.520 some point. I'd love to see you geek out on that.

00:17:01.260 Yeah. I mean, at some point we will. I mean, the biggest thing that one should take away from

00:17:04.240 really, if you want to understand the adrenal thing is people talk about this idea of adrenal

00:17:08.400 fatigue and they throw that term around a lot. It's, it's a real misnomer. It is almost unheard

00:17:13.660 of to actually see clinical adrenal fatigue. I've probably seen it twice in my life, meaning

00:17:19.680 patients whose adrenal glands are so dysfunctional that you actually have to give them steroids,

00:17:23.940 corticosteroids. So you can, you can measure how much adrenal output is being produced, but to do

00:17:30.480 that you can't look at cortisol because cortisol or it's inactive sister cortisone represent a fraction

00:17:37.720 of the total adrenal output, which you have to instead look at cortisol metabolites like

00:17:41.340 tetrahydrocortisol, tetrahydrocortisone to truly measure that. And that's why as, as cumbersome

00:17:48.020 as the Dutch test is, it's really the only way that I'm aware of that we can measure these things.

00:17:52.400 So yeah, we'll, we'll park that. It's kind of an interesting little back burner discussion.

00:17:56.560 Okay. Supplements. God, if I could remember them all again, which is not to say I take that many

00:18:02.260 things. What do I take? You know, I take vitamin D, I take methylfolate, methyl B12. I take an over

00:18:09.460 the counter dose of lithium. Okay. Caveat here. I'm happy to tell what supplements I take. I have zero

00:18:17.160 interest in going through a lengthy justification of them all at this point in time. So maybe in like,

00:18:22.600 you know, the future, we could do a much longer deep dive into how I determine which supplements

00:18:29.140 I take and which supplements my patients take. And by the way, I don't think I have a single patient

00:18:33.760 taking exactly what I'm taking. In fact, I might not have any two patients taking exactly the same

00:18:38.640 thing. So with that said, I think I also take a few other things. I take EPA and DHA. I take,

00:18:46.860 I take selenium. I take, I don't know why I'm spacing on this. I load that silly pillbox every

00:18:55.580 single Sunday. I think I just do it by sort of rote. Oh, I take a baby aspirin. I think I probably

00:19:01.340 take a couple of other things that I just can't remember at the moment. There was no change in any

00:19:06.480 supplement or medication that I took during, you know, the months leading up to this or throughout

00:19:13.580 this experience. And sometimes I do get asked that question, which is, Hey, Oh, I take, you know,

00:19:17.940 so this is not a supplement, but I take metformin. I've been pretty vocal about the fact that I take

00:19:21.660 metformin. I've been taking it for probably eight years. I had contemplated stopping the metformin

00:19:26.180 during the fast. It seemed a little counterproductive to inhibit hepatic glucose output when you were

00:19:32.140 fasting. But I also realized I didn't want to create any artifact. And I wasn't obviously concerned

00:19:37.560 about having hypoglycemia as a response to metformin. So there, I think the more important takeaway

00:19:42.940 here is there were no changes in anything pre or post. Okay. And we could, let's see,

00:19:51.580 we could jump into the methodology of the ketogenic diet in week one. Oh, there's one other thing to

00:19:57.500 point out here in an ideal world. I would have done this entire experience in one place and got DEXA

00:20:03.280 scans at the beginning. And through like, basically I would have got four DEXA scans, right? The,

00:20:09.480 on, you know, the beginning and end of each week. It's not clear that DEXA scans spaced seven days

00:20:15.940 apart, even under the conditions as extreme as this would produce enough signal to differentiate

00:20:23.780 one from the other. Because as much DEXA scanning as I've done, I have not done them in that type of a

00:20:30.240 succession. However, I know enough about DEXA to know that if you're not doing it on the same machine

00:20:35.380 with the same operator over short periods of time, you're very likely to have artifacts of

00:20:41.420 methodology. So instead I opted for something a lot cheesier, but I was very interested in knowing

00:20:48.000 how much muscle mass I was going to lose. So what I did was I took photos seven days apart and I linked

00:20:55.020 to those in the spreadsheet or we'll figure out a way to show that. Now, again, I feel like a total

00:20:59.380 douchebag taking shirtless pictures of myself because it's, it's funny when you're the fat guy

00:21:05.040 doing it. It's not funny when you're not the fat guy doing it, but if nothing else, I would say it

00:21:10.240 was just kind of a very zeroth order way to assess, Hey, was I like hemorrhaging muscle throughout

00:21:18.140 this experience, which would certainly be one hypothesis I'd want to test. And, and although we

00:21:23.400 didn't stated explicitly, I did not make any change in my, at least I don't make any attempted change

00:21:29.380 in my exercise routine. Uh, in other words, the objective was to continue exercising identical to

00:21:35.640 identically to how I did, uh, or how I do in my regular sort of feeding window. Okay. And people can

00:21:41.300 just go to your Instagram account for those selfies. No, no, no, no, no, no, no. We'll, we'll put them in

00:21:46.320 here. Yeah. They're not going to go on Instagram. I'll never hear the end of that. I thought you did

00:21:50.540 them in real time. Okay. No, I took them in real time, but I never posted them. I'm saying we'll,

00:21:55.000 we'll link to them within the notes of this as part of the data. Like the, here are the pre labs.

00:22:00.560 Here's the goofy pre photo, blah, blah, blah, blah, blah. Got it. Okay. Okay. You think Olivia would

00:22:07.480 give me one bit of slack if she knew I was posting goofy pictures of myself like that on Instagram?

00:22:13.600 Zero, zero. Yeah, no, no slack. So how about we go, we can go,

00:22:20.540 over your, um, the baseline labs that you took so we can kind of go through what you're looking at

00:22:24.920 here. So what I wanted to do was just sort of display some of the main labs I looked at. I did

00:22:31.700 check a bunch of other things, but I also realized like, I'm not, you know, just in, for the sake of

00:22:37.080 being lazy, I just wanted to kind of post what I thought were the most interesting things. So at

00:22:41.500 baseline, um, which was on June 21st, this is basically following about six months of time

00:22:47.540 restricted feeding, restricting sugar, but not carbohydrates. You see a total cholesterol,

00:22:52.500 LDL cholesterol, HDL cholesterol, triglyceride, non HDL cholesterol, and VLDL cholesterol. So those

00:22:58.020 are what we would call a very standard lipid panel for what it's worth. The LDL cholesterol is a direct,

00:23:03.340 not a calculated. Beneath that you have the NMR results. That's the LDL particle, the small LDL particle,

00:23:10.380 the small or small dense LDL cholesterol, the HDL particle. And then beneath that, you have some

00:23:17.920 markers of oxidation and inflammation. So fibrinogen and C-reactive protein, along with an

00:23:24.580 ox, an assay for oxidized LDL. Beneath that, you have some metabolic markers that I pay great

00:23:29.920 attention to like uric acid, homocysteine. I included blood urea nitrogen or BUN as a proxy for how much

00:23:37.080 protein was probably in my diet. BUN is a really, really poor man's sort of nitrogen balance

00:23:43.380 assay. And then I included cortisol, but it is really important to understand that that's almost

00:23:49.140 a useless number because that is measuring total cortisol in the plasma. Cortisol is about 97-ish

00:23:57.520 percent bound to albumin and cortisol binding protein. And it's really only the free cortisol

00:24:03.960 that is metabolically relevant or endocrinologically active. And so when you see at my baseline that my

00:24:11.480 total cortisol was 16.6, I mean, I'm mostly interested in understanding that as a function

00:24:16.500 of, you know, change and not, you know, trying to actually draw any conclusions. Again, it's also a

00:24:22.200 spot in time. These blood tests were all at about the same time during the day, just to say kind of

00:24:27.940 first thing in the morning on whatever the respective day was. I realize that you're, some of

00:24:34.000 you are going to look at this and think, what are the reference ranges on these things? I don't care

00:24:38.700 about reference ranges because I have my own. So instead of what I've done is I've sort of highlighted

00:24:43.500 things in red that are way off the mark. Then we get into markers of insulin resistance and or

00:24:53.060 adipocyte function. So leptin levels. So I guess we're not going to talk much about leptin levels

00:24:57.960 because they didn't really change at all throughout this experiment. Same with adiponectin. I think for

00:25:01.860 the sake of time, we'll ignore what that is. Obviously fasting insulin level and free fatty acid I

00:25:06.940 measured. I forgot to measure it one of the days for some reason. I look at iron and some metrics

00:25:11.660 around that. And then I look at hormones, specifically thyroid hormone, which I suspected might be

00:25:18.060 interesting and sex hormones, which turned out to be kind of interesting as well, though I wouldn't have

00:25:22.420 predicted this necessarily. And then I just look at some metrics like white blood cell count,

00:25:27.100 hematocrit, hemoglobin platelets. So all of that stuff is kind of listed and you'll then see four

00:25:32.760 of these numbers going from the baseline to the following a week of ketosis, to following the week

00:25:39.000 of fasting, to following the week of ketosis. Okay. And then you also had some more basic markers.

00:25:47.920 You looked at, for example, your weight and your, was it beta-hydroxybutyrate? I think you were

00:25:54.360 testing pretty frequently. Yeah. Thanks for reminding me of that. So starting on whatever day

00:26:00.160 that was, July 8th. So the baseline labs were done like whatever, two weeks before I started,

00:26:06.940 but I started the whole shtick on July 8th. So my weight that morning was 184.6 pounds.

00:26:15.420 I didn't measure BHB because I knew it was going to be low. I wasn't in ketosis. So I didn't feel

00:26:19.700 like wasting a strip. And then I looked at a 90 day trailing CGM. So I use the Dexcom G6. I'm pretty

00:26:31.180 much always wearing it, even though obviously you change it out every 10 days. And I just look,

00:26:37.860 you can generate reports. What's my trailing seven day, 14 day, 21 day, 30 day, 60 day, and 90 day

00:26:44.100 blood glucose. And so my trailing 90 day blood glucose was 99 milligrams per deciliter with a

00:26:52.100 standard deviation of 15. Now that's a little bit higher than I would like to be. Truthfully,

00:26:57.120 if someone, some people may remember, I've talked about this in the past. I, I think sort of 85 to

00:27:01.960 90 for an average blood glucose is the sweet spot. So a trailing 90 day blood glucose of 99 milligrams

00:27:09.760 per deciliter places you at about a hemoglobin, a one C of 5.0. If I recall, let me, can I look this

00:27:19.340 up right now, Bob? Am I allowed to putz around here? I'll allow it.

00:27:24.760 A one C. Um, yeah, that would be about 5.0 to five. It's about halfway between 5.0 and 5.1.

00:27:34.760 So I, again, I think for me, that's a little on the higher side, but, uh, you know, sort of reflects,

00:27:41.740 uh, me eating carbs. Like my job is eating carbs. The other thing I recorded in this spreadsheet was

00:27:48.280 what the exercise du jour was. So, and I wasn't very specific. So please, I mean, not that I don't

00:27:54.440 know what I did on those days, but I don't, I didn't, I was too lazy to write it out. So ride means

00:27:58.320 either I'm on a Peloton on a Wahoo kicker, or maybe once in a blue moon actually outside, but

00:28:03.380 these are not like super long workouts. This is like 45 minutes or something like that. And the

00:28:08.020 lifts are probably 90 minutes. And then you can see, I would just basically look at AM and PM,

00:28:13.880 uh, BHB level. I was using the key to the, what is it? It's a ketone mojo or keto mojo or something

00:28:21.320 like that. Like the one that I like a heck of a lot better than the precision extra. Yeah. So during

00:28:26.380 that week of ketosis, you'll see, obviously weight starts to go down ketones. Finally, you know,

00:28:31.420 they start to show up and, uh, and then you can sort of follow what happened. So I think I've

00:28:36.280 color coded this spreadsheet such that green, the green background is the first week of ketosis.

00:28:42.440 The yellow background is the week of fasting. And then the green background is the other week of

00:28:47.060 ketosis on the backend. Cool. Okay. Are you going to share any of your, um, sleep data? Is there a

00:28:54.920 good way to show that? That might be cool to show. Yeah. So yeah, what I should probably do,

00:28:59.260 we should just, we'll figure this out. I'll just take some screenshots of those and show those.

00:29:03.780 Okay. Oh, you're making more work for me, Bob.

00:29:08.280 I really want to be done with this man. Fewer follow-up questions probably at least from the,

00:29:14.460 uh, from the peanut gallery. So let's get into, do you want to go over all in one shot? Do you want

00:29:20.660 to go over like your baseline labs, what they are, what they were right now? Or do you want to just,

00:29:25.960 we'll go through what week one looked like in terms of the methods week two, week three,

00:29:29.840 and then we can just circle back and go over everything at once where you talk about your

00:29:33.580 baseline numbers and all the follow-ups or do you want to? Good question. I wish we could ask

00:29:38.360 people live what they would prefer. I think it might be easiest to just go through what happened

00:29:43.440 after week one through all the issues, then week two at three, et cetera. So with that said,

00:29:51.340 and again, I think this is one of those podcasts where it's going to make a lot more sense if you're

00:29:56.420 looking at the data, because I don't really think it's palatable for me to just read off lab after

00:30:03.620 lab after lab, especially for people who aren't, you know, who don't necessarily know what all of

00:30:08.260 these numbers mean. It's just going to seem a little bit, uh, sort of overwhelming. But what I would

00:30:13.460 say is during the first week of getting back in ketosis, what did I notice? So subjectively having not

00:30:20.340 been in nutritional ketosis for a long time, I definitely felt a tiny bit, not nearly as bad

00:30:26.860 as it was when I first did it in 2011. I felt a tiny bit of the keto flu as they would call it.

00:30:32.620 I think it's kind of a dumb ass term. It doesn't feel anything like the flu.

00:30:35.980 I just felt orthostatic. Every time I stood up, I felt a little bit lightheaded.

00:30:40.960 I supplemented. Oh, that's sorry. This is one change. I lied earlier. There is one change I did make

00:30:46.700 in my supplements during this time that goes beyond what I do normally. So normally I take

00:30:52.620 magnesium. See, I forgot to mention that. I normally take 400 milligrams of mag oxide and

00:30:57.540 about two slow mag every day. During this period of time, I increased that to eight. I doubled it

00:31:04.800 basically 800 of mag oxide and four slow mag tablets. Um, and the reasons for this have been

00:31:11.120 well described, but for the person who might not, uh, when you're in ketosis, your body basically

00:31:16.000 starts wasting sodium. Your body responds by trying to save sodium and usually ends up

00:31:21.020 shunting magnesium and potassium out of the kidney. So you do tend to cramp more. And if you're not

00:31:27.080 supplementing that sodium and magnesium, you can also tend to get a little lightheaded. So

00:31:30.880 I was using bullion as needed during the fast quite regularly during the ketosis week, not as regularly,

00:31:37.960 but I did double my magnesium. That said, outside of being a little bit lightheaded upon first standing,

00:31:44.040 I did not experience any change positive or negative that I could perceive subjectively

00:31:50.380 in how I felt or performed. So, you know, workouts felt just the same sleep felt about the same and,

00:31:58.500 you know, more or less, it was just, you know, kind of business as usual. Uh, I guess it's probably

00:32:02.480 worth mentioning. What did I do dietarily? I went for a very boring, repetitive ketogenic diet

00:32:08.120 where I was still usually skipping breakfast anyway, or sometimes I would have like maybe an

00:32:13.820 egg or some bacon or something, but usually I didn't have breakfast. I would just have coffee

00:32:17.420 with a bit of MCT powder in it. You know, lunch, I would have some macadamia nuts, maybe an avocado,

00:32:23.100 some olives, and then dinner would usually just be a salad and a modest enough serving of protein that

00:32:28.460 I could be confident I wouldn't boot myself out of ketosis. So you can see baseline cholesterol levels,

00:32:35.880 lipid levels. Now I do this sort of blood testing on myself pretty frequently, probably about every

00:32:41.460 two to three months. So these baseline levels from June 21st are pretty standard levels for me.

00:32:50.600 You're always going to see perturbations on these things for the most part. I generally like to see

00:32:55.460 my LDLP lower, kind of like to be at the 800 nanomole per liter level. This was 920, but again,

00:33:04.480 that's sort of within the ballpark. I like seeing C-reactive protein below 1, ideally below 0.5. I

00:33:10.960 like seeing oxidized LDL below 40. I like seeing uric acid below 5, homocysteine below 9. These are

00:33:18.680 some of the metrics that I'm really looking at consistently. Let's see. I was kind of pleasantly

00:33:23.740 surprised that my free testosterone was 15.5 nanograms per deciliter. Every time you look at a

00:33:29.960 hormone level, you really have to evaluate it in the context of that lab. So 15.5 nanograms per

00:33:36.360 deciliter on this lab represents almost exactly the 50th percentile. It might be the 55th percentile.

00:33:44.480 So that's an important reference point. As we go through this experiment, you'll see how that changes.

00:33:49.180 The other thing to notice is my thyroid labs at a baseline. They look really, really about as normal

00:33:56.240 as they can be. So a discussion of thyroid endocrine systems is way beyond the scope of

00:34:01.760 what we want to talk about today if we're going to finish in time. But you basically, by looking at

00:34:06.400 TSH, free T3, free T4, reverse T3, and the ratio of free T3 to reverse T3, you can kind of infer

00:34:13.240 a lot about what's going on with the enzymes that are called diodenizes that turn T4 into either T3 or

00:34:21.160 reverse T3. So at the risk of explaining nothing but just giving you the punchline, you want to see

00:34:27.500 your TSH kind of below 2-ish, and that tells you that your brain is adequately seeing T4 converted

00:34:34.960 into T3. You want to see your ratio of free T3 to reverse T3 above 0.2 as a general rule that tells

00:34:44.780 you that the balance of T4 being converted into the active hormone T3 is in favor of T3 over reverse

00:34:52.840 T3, which antagonizes T3. So as that ratio goes down and gets down below 0.2, it suggests that the

00:35:01.360 body is in some way compensating and wanting to reduce thyroid activity. So the common reasons that

00:35:08.020 we see reverse T3 go up and or free T3 go down, but in particular, this ratio go down is things like

00:35:16.900 post-obesity. So in people who have lost a lot of weight, insulin resistance, leptin resistance,

00:35:23.040 infection, inflammation, sleep deprivation, hypercortisolemia, there are a number of things

00:35:28.560 that can basically alter that thyroid axis. So at a baseline, my TSH was 2.4. Yeah, usually is a

00:35:35.700 little bit lower than that, but I'm happy. My reverse T3 was 11. Great. My free T3, 3.7,

00:35:41.600 my ratio 0.34. So feeling like a thyroid champ. I think those are kind of the interesting, I mean,

00:35:47.880 the rest of it, I think people can just read and get a sense of like at baseline, I looked,

00:35:51.900 you know, I was an eight out of 10 at baseline relative to my standards. Okay. So what happened

00:35:58.740 after a week of ketogenic diet? Virtually no change whatsoever in my standard lipid panel,

00:36:05.420 other than interestingly, my triglycerides went up, which is, you know, kind of unusual when you're

00:36:10.600 on ketosis. Typically your trigs go down. Mine actually went up from 54 to 90 milligrams per

00:36:16.080 deciliter. It's important not to read too much into triglycerides and things like that because they

00:36:21.600 can certainly vary from day to day and be a function of, you know, what was going on in a

00:36:28.080 previous meal or something like that. But otherwise, if you look at total cholesterol and LDL cholesterol,

00:36:32.640 they were virtually unchanged. Interestingly, my LDL particle number went way up and that to me

00:36:38.440 represents a real movement going from 920 to 1380. So that represents going from about the 10th

00:36:45.560 percentile of the Mesa population to about the 55th percentile of the Mesa population, which is way

00:36:53.180 higher than someone like me wants to be. Also my small particle where I really like to see that below

00:36:59.000 500. That went up to almost 800. By the way, one thing worth noting for people who are also measuring

00:37:05.500 NMR or using NMR is there's basically two ways you can get an NMR done in the United States. One is

00:37:11.840 using LabCorp. The other is using THD. Really important to know they're using different magnets

00:37:18.360 basically. And the THD numbers, which are believed to be more accurate, run considerably higher. So LabCorp

00:37:26.460 is using an NMR developed by liposcience on the first generation magnet. THD is using the NMR also

00:37:35.260 developed by liposcience, but they're on a second generation magnet. And I have scrutinized these

00:37:39.360 results side by side because on a number of our patients, we do them side by side. And I've looked

00:37:44.040 at all of the data. And as a general rule, if you do a parallel NMR with liposcience through what is

00:37:51.860 now LabCorp versus THD, the THD numbers tend to run about 20% higher. No real change in my oxidative

00:37:59.620 numbers, but I was very interested to see that my uric acid bumped from 4.8 to 6. 6 is, again,

00:38:06.600 depends how you define high. I think most doctors would not consider a uric acid of 6 particularly

00:38:10.600 high. It's not certainly putting you anywhere in the danger zone of having a gout attack the next day.

00:38:15.960 But I'm really maniacal about uric acid being low because of the impact uric acid has on blood

00:38:23.380 pressure and on atherosclerosis, so uric acid. There's some evidence that uric acid can crystallize

00:38:30.020 inside of atherosclerotic plaque along with the sterols that can crystallize there as well.

00:38:36.240 Homocysteine took a bump up to 11. Again, no change in my methylated B vitamin regimen,

00:38:41.440 so that also suggests something funky metabolically was going on this week getting back into ketosis.

00:38:47.920 Let's see what else was interesting. Oh, of course, the thyroid stuff, right? So my thyroid took a hit

00:38:52.780 that week, and it wasn't a central hit, meaning my TSH stayed totally reasonable, so my brain didn't

00:39:00.160 think anything was wrong, but my free T3 went down quite a bit from 3.7 to 2.5, and my reverse T3 went up

00:39:07.780 from 11 to 17. So this ratio of free T3 to reverse T3 that was initially great at 0.34 was now kind of

00:39:17.100 in the crapper at 0.15, which if you're going to interpret that, you might say, well, something,

00:39:24.560 there was some force, you know, something in my body was sort of wanting to slow my metabolism down.

00:39:28.700 Now, during that period of time, I lost a little over four pounds. So I started this whole experiment

00:39:35.500 at 184.6, and I wound up at, or at the time of this blood test, which I think was on the 13th,

00:39:43.780 I was 180.4. So I was actually a little surprised to see the deterioration of thyroid function,

00:39:52.140 because that doesn't strike me as nearly enough weight to lose, especially when you realize that

00:39:56.200 most of that was water weight for my metabolism to, or my metabolic rate, as it would seem to take

00:40:02.820 a hit. Testosterone actually went up a little bit. It went total testosterone, which we rarely talk

00:40:07.200 about, since again, it's sort of like talking about total cortisol. It's kind of irrelevant,

00:40:11.080 but total testosterone went up from 764 to 920, and free testosterone went up as well,

00:40:17.160 even though sex more binding globulin went up with testosterone. And so the free testosterone went

00:40:22.780 from 15.5 to 17.4 nanograms per deciliter. Again, that's not a huge change, but that does put me

00:40:29.520 now at maybe the 60th or even 65th percentile. Also, the IGF did not really take a bow. So started

00:40:37.800 out at 201, which for my age is about, and on this assay is about 80th percentile, which is, I think,

00:40:44.140 actually the sweet spot, 70th to 80th percentile, I think is the sweet spot, down to 196, which is

00:40:49.260 effectively no change whatsoever. That's within the margin of error. So a week on a ketogenic diet did

00:40:54.620 not seem to lower IGF, which is interesting because I know that when I'd been on a ketogenic diet in the

00:40:58.720 past, for long periods of time, my IGF was consistently lower, which might suggest to me

00:41:03.700 that a ketogenic diet does lower IGF, but it needs more than a week to see the results. And also a

00:41:09.540 discussion on IGF is way more elaborate than I'm going to get into today. But, you know, Bob, you

00:41:14.260 and I have talked a lot about this. I think that the right IGF algorithm is actually cyclic and not

00:41:19.660 just always low or always high, but that's another story. I could go on and on, but I realized like

00:41:25.000 we're probably past the point of diminishing returns. So anything else, Bob, that I haven't

00:41:29.500 touched on that you care about as far as week one? One question that I have is with the ketogenic

00:41:34.880 diet, I know you've done prolonged ketogenic diets in the past. And what was your approach for the week?

00:41:42.020 I know that you don't need to necessarily weigh and measure things. You probably eyeball stuff. Did you

00:41:48.020 have a particular target when you say, this is the number of grams of carbohydrates that I'm going to

00:41:53.100 eat a day? This is the number of grams of protein. And then in terms of fat, were you trying to,

00:42:00.080 you know, was this like a four to one ketogenic diet or was it something a little bit different?

00:42:05.840 Great question. Thank you for clarifying that. So unlike when I was in ketosis for the long haul

00:42:11.000 and I was maniacal, meaning I had a spreadsheet of every single thing that I would eat and I would

00:42:18.640 measure out exactly how many grams of X, Y, and Z were going into me for this, it was all smoking

00:42:26.300 and joking. So I just, I guess the, fortunately I've been in ketosis long enough to kind of

00:42:31.740 directionally know like this much protein is too much. This is probably okay. So I made zero effort

00:42:38.000 to focus on whether I was in three to one, two to one, four to one. I didn't care. I just wanted to

00:42:44.540 kick off some ketones. And luckily I was able to sort of get, you know, to consistently be above

00:42:50.040 about one millimolar that week. So I, it'd be hard for me to even estimate what I was ingesting,

00:42:55.680 though I would guess probably 30 grams a day of carbs. You know, I think my biggest intake of carb

00:43:01.340 would have been the avocado I had every day. And then, you know, the salad and stuff like that.

00:43:06.060 So maybe 40 grams of carbs. Protein was probably a buck 10 to a buck 20 a day. And I wouldn't even

00:43:15.640 be able to guess how much fat intake I had, but I was not in any way, shape or form trying to restrict

00:43:21.280 input. Okay. How do you think the volume of food compared to like baseline or prior to baseline?

00:43:28.480 Do you think it was about the same more less? I think I felt like I was eating a little bit less

00:43:33.100 again with volume. It's so hard because the shift towards so much higher fat content,

00:43:37.760 but I definitely felt less hungry, which I think anybody who's been on a ketogenic diet realizes

00:43:43.420 is, is generally a consequence of that. And yeah, there were just times when I was sort of like,

00:43:49.400 I'd kind of eat a little bit just cause I was sort of bored. And I was like, Oh, those,

00:43:52.640 I like the taste of macadamia. So I'm just going to eat some, but if you really push me on this,

00:43:57.520 I'm not that hungry. So if you talk about pure food volume, it was definitely less,

00:44:01.620 but if you mean caloric density, you know, my guess is it was a little bit less.

00:44:06.280 All right. So week one is complete. And then, so that was seven days, right? Days one through

00:44:12.880 seven, you're on the ketogenic diet. And then on day eight, you're now embarking on a water only

00:44:18.620 fast. I don't know the day number, but it was the day I left San Diego. So there was a Saturday,

00:44:23.500 I think it was July 15th. The other thing I wanted to do, I should have expressed this at the

00:44:27.740 outside. Part of the reason I did seven days was that's how long I was in New York.

00:44:32.700 And I didn't want to fast at home because I didn't want to kind of weird out my kids.

00:44:39.280 So I, that was the other, you know, cause you could ask, well, why didn't you do it for five

00:44:44.300 days? Why didn't you do it for 10 days or whatever? It was like, look, I'm in New York from a Sunday to

00:44:49.280 a Saturday, the entire time from, you know, up to down, I will just not eat. So, um, and then that way

00:44:57.200 I just didn't have to get into all weird stuff with my kids being like, what's wrong with daddy?

00:45:02.140 So yeah, whatever that Sunday was, I think it's the 15th was the day I just stopped.

00:45:06.760 Okay. And then that day, I remember I landed in New York and you'll notice there for exercise that

00:45:12.000 day, I just went for a five mile walk with a buddy of mine in the park. And that was cause

00:45:16.420 normally the day I get to New York, I usually will do a Peloton ride that evening, but I, for whatever

00:45:23.220 reason, just bagged the ride and instead went for a walk with my buddy. Um, and you'll see that night,

00:45:28.640 my BHB level was really not particularly high cause it had basically just been now like a day of not

00:45:33.440 eating. So it was 1.2 millimolar. And you'll also notice at this point, Bob, I started doing trailing

00:45:41.000 seven day CGM checks. So I gave you my baseline CGM as a trailing 90 day, which is basically my

00:45:48.340 hemoglobin A1C going into this whole shtick. But then it was like, we're going to do this every

00:45:53.700 single day and do trailing seven days so that you're getting a much greater sense of what's

00:46:00.560 happened in the past week. So what you see on the 15th is that my trailing seven day CGM went

00:46:07.080 slightly down from 99 to 97 milligrams per deciliter, which is about a one 10th of a point

00:46:18.020 to reduction in hemoglobin A1C. Uh, my volatility went down a little bit. So my standard deviation

00:46:23.500 went down from 15 to 11 over that period of time. But from this point on Bob, I did, I did that

00:46:30.240 trailing seven day every single day. So you'll now be able to see with some clarity what was going on

00:46:37.240 with my glucose levels throughout this. And this obviously is much more insightful than doing

00:46:42.780 finger sticks. The Dexcom G6 is so staggeringly accurate that it does not even require a single

00:46:50.220 calibration. That said, I still did a spot check twice a day. I have to go back and look at the data

00:46:56.020 probably plus or minus 2% with the spot check. And I was spot checking on two devices, the Keto Mojo

00:47:03.440 and the OneTouch Ultra. So I'm doing twice day, two device calibrations on a machine that doesn't

00:47:10.900 even require a calibration. It's plus or minus 2%. So these of all the numbers here, the CGM trailing

00:47:18.220 is, you can take that to the bank more than anything else. Okay. So this should be pretty

00:47:24.520 clear, but water only fast, literally no coffee, nothing but H2O in terms of. Yeah. I didn't, I was

00:47:33.520 super strict. Yeah. No coffee. A couple of times I had tea, a caffeine free, like I'd brew some,

00:47:40.080 some tea. I had bouillon, as I said, a bouillon that was basically just sodium. There was no fat

00:47:45.660 in it or anything like that. Cause obviously if you have real bone broth or, or, or similar things,

00:47:49.700 you're going to get some calories, but absolutely no coffee, which was again, I'm not a coffee addict,

00:47:55.020 but I love me some coffee. That was just out of routine and ritual. It was painful to look at my

00:47:59.440 beautiful French press and all of my trimmings and not make coffee every day. And I also didn't chew gum

00:48:05.120 or use, or have any sort of artificial sweetener. I mean, obviously I wasn't going to drink a diet Coke or

00:48:09.660 anything, but I also thought that maybe chewing gum would be a slippery slope. So yeah, it was

00:48:14.400 kind of weird. I think I made this point to you at one point about three days into the fast, I

00:48:18.560 realized, Oh God, I just love brushing my teeth. Like I just love having that toothpaste in my mouth.

00:48:25.120 As I started, I was like brushing my teeth three times a day and just like, and even after I finished,

00:48:29.880 I wouldn't spit the toothpaste out. So I try to walk around the apartment for like five minutes with

00:48:34.200 the toothpaste in my mouth just to get the taste. I can understand why you didn't want to do this.

00:48:38.240 That's pathetic.

00:48:39.040 Yeah. I can understand why you didn't want to do this in San Diego and weird out your kids.

00:48:44.860 So do you want to go over the labs after the days of fasting and we can circle back around on the

00:48:50.800 subjective stuff?

00:48:51.420 Yeah. We'll circle back to kind of the other stuff. Yeah. So after the week of fasting,

00:48:54.860 my lipids did actually change both at the standard lipid level, but also at the particle level.

00:49:01.200 The total cholesterol went down and I think that's a real drop. It went from, you know,

00:49:04.760 about a buck 20 to 90 milligrams per deciliter. The LDL plummeted to 37 milligrams per deciliter.

00:49:10.640 I don't think I've ever seen a number that low. The HDL cholesterol went down with it. The trigs

00:49:15.020 actually remained surprisingly high, 76 milligrams per deciliter. Again, we generally like to see

00:49:21.140 triglycerides below a hundred, but I was sort of surprised that they weren't lower. And also I was

00:49:26.660 kind of surprised that the VLDL cholesterol wasn't a bit lower. The LDL particle number did go down a

00:49:32.480 little bit, probably to more what I think my baseline is, which is about 800. And the small

00:49:37.080 particles sort of returned to what I think my baseline is. Interestingly, the cholesterol content

00:49:42.980 of the small LDL particle fell to quite low levels, which is nice. That's a, you know, that's sort of a

00:49:48.120 marker we care a lot about. And the HDL particle number also went down quite a bit. The inflammatory

00:49:54.120 numbers got, you know, as good as they get typically. So very low fibrinogen, CRP. This is a very

00:50:02.280 sensitive assay. So 0.4 is pretty low. And an ox LDL of 31 is righteous, as the kids would say.

00:50:10.000 The uric acid just skyrocketed, 8.0. I was like, wow, that is something else. Again, now you're

00:50:16.440 actually getting to a point where, you know, if you get uric acid too much higher than that,

00:50:21.360 you actually are running the risk of having a gout attack. And you could certainly say that, well,

00:50:26.140 and to be honest with you, I actually, I have some speculations on why that happened, but I actually

00:50:30.700 need to reach out to Rick Johnson, who's the world's expert on uric acid to pick his brain on

00:50:35.760 this. Cause I think he would have much more interesting assessment. I mean, my, I'll give

00:50:39.420 you what my very crude assessment is. My crude assessment is there was probably some muscle

00:50:43.780 breakdown and it was effectively just, you're seeing an increase in DNA turnover and you're seeing,

00:50:49.060 you know, pyramidines, pyramidines, et cetera, going up. And those things as a by-product will

00:50:55.420 generate more uric acid. So we know what it wasn't right. It was not an increase in fructose

00:51:00.360 consumption. It was not an increase in ethanol consumption and it was not an increase in

00:51:04.760 exogenous protein consumption. Those are the three things that far and away drive uric acid

00:51:09.240 more than anything else. So my only explanation is there's just a huge turnover of DNA and the

00:51:15.420 backbone of DNA is one of the things that when it's broken down leads to this by-product of uric acid.

00:51:20.700 In fact, it made me wonder if could uric acid levels or changes in uric acid levels be a small

00:51:26.500 part of the signature of autophagy we might be interested in. And the reason I don't think it's

00:51:31.240 just dysfunctioning metabolism is the homocysteine went back down. You see, if the homocysteine had

00:51:35.960 gone from 11 to 14, I'd say, oh, something's wrong there. But the homocysteine actually corrected.

00:51:42.640 And yet the uric acid went to a level that I've never seen before in myself. So kind of interesting.

00:51:47.800 The blood urea nitrogen went down to 12, which again, that makes sense in the context of there's no

00:51:53.160 protein coming in. I was at best in a neutral nitrogen balance, but almost assuredly was in

00:52:00.360 a negative nitrogen balance, meaning that I was losing, I was, I was losing nitrogen or losing

00:52:08.120 nitrogen from within my system because I was not taking in enough protein. You know, leptin can't

00:52:13.680 get lower than where it is. Adiponectin didn't go up. I'll tell you, this actually really surprised me.

00:52:18.180 So adiponectin is, as its name suggests, an adipokine or a fat cell or adipocyte derived.

00:52:24.880 And it usually rises as lipolysis rises. So as fat cells turn over fat more, we usually see

00:52:31.480 adiponectin go up. I was very surprised to see no change in adiponectin, despite the fact that my

00:52:39.260 insulin levels at this point were unmeasurable and my free fatty acid levels were very high.

00:52:43.740 Both of those things you would expect after not eating for a week. Insulin should be unmeasurable.

00:52:49.220 And as evidenced by the fact that I was making ketones, like my life depended on it, which it was,

00:52:54.860 my free fatty acid levels were quite high. The other thing you'll notice if you're going through

00:52:59.100 this is my ferritin went up and ferritin itself is also an acute phase reactant. I didn't discuss

00:53:04.440 this earlier. Most people think of ferritin through the lens of only iron displacement, but it's also an

00:53:10.880 interesting marker of inflammation. And we did see a little bit of a bump in ferritin. It basically

00:53:16.380 doubled, though it was still within what we would call the normal range. And then to me, the most

00:53:21.080 interesting was the complete and utter destruction of my thyroid function peripherally. So centrally,

00:53:28.380 no issues whatsoever. TSH actually went down a little bit more to 1.34. But in, I don't know how

00:53:36.060 many years and how many patients, labs I have looked at, I have never seen thyroid numbers this

00:53:42.760 bad. It's free T3 down to 1.8 and reverse T3 up to 38 for a ratio of free T3 to reverse T3 of 0.05.

00:53:52.400 Keep in mind, anything below 0.2 is generally consistent with, you know, hypothyroidism in the

00:54:00.120 periphery, which generally produces symptoms. And as we'll talk about when we get to symptoms,

00:54:04.840 I was certainly experiencing at least one of them, which was, I was incredibly cold most of the time.

00:54:10.660 Again, the best explanation for this is the body basically said, Hey dude, don't want you losing any

00:54:16.620 more weight than you're going to. We are going to shut down your metabolic rate. And I think if you

00:54:21.680 look at the trajectory of my weight loss, I suspect it's actually quite consistent with that. I don't

00:54:28.720 think I lost nearly as much weight as one would expect. Again, when you consider how much of the

00:54:34.240 weight I lost was probably water. My sex hormones also took a little bit of a nosedive. So without

00:54:39.260 any change in DHEA, I just stopped making testosterone. How do I know that? Well, I know

00:54:44.800 that because my luteinizing hormone and my follicle stimulating hormone, which are very consistently

00:54:48.880 around seven and three respectively, went down to about four and a half and two and a half. And along

00:54:54.840 with it, my testosterone went down from 920 where it was previously to 539. But again, more importantly,

00:55:01.380 the free testosterone went down from 17.4 to 7.8 nanograms per deciliter. Now placing me

00:55:08.400 at about the 15th percentile. So yeah, I got more testosterone than a 13 year old girl, but

00:55:15.160 not by a lot. I'm being a bit facetious. I have a lot more than a 13 year old girl, but being at the

00:55:20.980 15th percentile still sucks. Now you also saw the huge hit on IGF. So IGF down to 93. That's about the

00:55:29.160 10th percentile for my age. And interestingly, the hematocrit and the hemoglobin went down.

00:55:36.400 And this is interesting for a couple of reasons. If anything, I would have been a little bit

00:55:39.480 dehydrated during this period of time, although not necessarily. And certainly the fact that my

00:55:44.220 platelet count and my white blood cell count didn't change would suggest that this wasn't a dilution

00:55:48.540 effect, but rather an actual reduction in production. And that makes sense in the context

00:55:54.680 of testosterone. Testosterone is a very potent signal to tell your bone marrow to make red blood

00:55:59.880 cells. Obviously not as potent as EPO, which is a naturally occurring hormone that does that.

00:56:04.940 But as testosterone goes down, we sort of see my hemoglobin hematocrit go down. Good thing that

00:56:09.900 that week I was not in the tour. I would not have done well. Mr. 40. Nor would I have done well

00:56:16.480 anytime, but yeah, Mr. 40, Mr. 43. Yeah. Okay. So that's fasting. Yeah. Okay. So then,

00:56:24.420 oh, the other thing, I mean, I guess we'll get to, I don't know, we'll be talking about exercise and

00:56:27.300 the subjective stuff later. So I guess we'll just finish up with the lab since it's the least

00:56:31.460 interesting stuff, I guess, or not the least interesting, but it's the most boring to talk

00:56:34.260 about. So then coming out of, so, so I nadered at 174.0 pounds. So if you're keeping track from the

00:56:41.600 beginning, I was at 184.6, you'll actually see my weight rebounded a little bit. So the first morning

00:56:48.160 after the start of the fast, I was 182.4. I was actually heavier than I was three days earlier.

00:56:54.180 I thought at the time it might be that I was overdoing it on the bouillon, which would make

00:56:58.720 sense. Putting, you know, pounding down water and sodium, I would actually pack on more, you know,

00:57:03.700 mass, but then the weight started to kind of come off a little bit. And so by that last day,

00:57:09.740 I was down to 174 pounds, which was a 10, a little over 10 pounds down from two weeks earlier

00:57:17.500 and probably about eight pounds down during the period of the fast. And truthfully, I would have

00:57:25.920 expected a greater weight loss when I had previously done like five day FMDs where you're taking about

00:57:32.180 750 K cal per day, I would easily lose 10 pounds during that five day period. So a little surprised.

00:57:37.860 I think the most interesting thing here obviously is the ketones now all of a sudden get to be much

00:57:42.840 higher levels. These weren't even my highest levels sometimes, but these were the ones that I was

00:57:47.460 always checking first thing in the morning and last thing at night. Sometimes during the day,

00:57:51.200 I would do spot checks and have even higher levels, but I don't think I, I think I only once got above

00:57:55.980 seven millimolar on BHB. The other thing you'll notice is how quickly that seven day trailing average

00:58:02.980 CGM starts to go down such that by the last day of the fast, it's 79 milligrams per deciliter.

00:58:11.040 So it's fallen almost 20 milligrams per deciliter in average during that period of time. And again,

00:58:16.980 that just reflects the fact that you're, you're going to, you're going to find an equilibrium

00:58:20.500 pretty quickly. And I suspect had I gone on even longer, it probably would have centered out at about,

00:58:26.240 I would guess around 70. So with that said, we go into the last, we go into the refeed week and then

00:58:32.380 we can be done with labs. Yeah. All right. So refed on a ketogenic diet, although in truth,

00:58:39.080 the actual day I refed my first meal was probably a little higher in carbs and vegetables, meaning

00:58:48.220 starchy carbs and some veggies than normal. But I had enough ketones floating around that it didn't

00:58:53.420 seem to matter. I still sort of stayed in ketosis. And so then I just go back into a straight up

00:58:59.960 ketogenic diet. Okay. So then these labs here, there, there are a couple of things that surprised

00:59:03.960 me. The first was in all of the crazy ass feeding experiments I've done in myself, I have only once

00:59:11.100 seen a very elevated triglyceride level in myself. And this was one of them. So I remember drawing this

00:59:17.320 blood on myself and after I, so the way it works is you're drawing a tube of blood. Each tube has a

00:59:23.220 different protocol. So some of them, you have to let them clot for a while. Others, you spin them

00:59:30.380 right away, et cetera. But the, once I spun the tubes down, I knew the triglycerides, or at least

00:59:36.000 I suspected the triglycerides were very high because of how cloudy the serum looked. So when you,

00:59:42.500 when you take blood and you spin it, you're basically taking all the cellular content, the red blood cells,

00:59:47.260 the white blood cells, the clotting factors, and you're putting them in the bottom of the tube. And then

00:59:50.220 there's usually a little serum separator gel in the middle. And then above that, you have this clear

00:59:55.200 ish plasma, but it was actually foggy. So I was like, that's weird. It was a fasting blood draw.

01:00:01.940 So I wasn't that surprised to see that the triglycerides were so elevated when I came back,

01:00:06.040 except for the fact that I was surprised that my triglycerides were so elevated when I got the

01:00:10.180 blood test back. I don't know what to make of it. I think it's also interesting that my LDLP had never

01:00:15.440 been lower. So after that week of being on a ketogenic diet, surprisingly, my LDLP went down

01:00:22.480 to 516 and the small LDLP were unmeasurable. Again, kind of an unusual thing to see. And I don't

01:00:30.700 know what to make of it. I'll probably get around to rechecking my blood in another couple of weeks.

01:00:36.620 And I would be shocked if I wasn't sort of more back to where I was in June, but I haven't,

01:00:43.220 I haven't really come up with a great explanation for why on that ketogenic diet, my LDLP, which

01:00:48.820 normally goes up a little bit on a ketogenic diet would go so low and why those trigs would go so

01:00:53.660 high. Uh, you'll also see my CRP actually got up above one, which I don't like to see. And I don't

01:01:00.020 know what to make of that. The only thing I can think of, and this could be a totally nonsense

01:01:03.980 explanation, even by my standards, I was consuming a ton of dairy in that last week on ketosis in the

01:01:12.600 form of heavy cream. So I kept making whipped cream out of heavy cream and I was eating it by

01:01:16.860 the truckload. So who knows, maybe at some point, just enough dairy is going to bump your CRP.

01:01:23.560 Nice to see that the uric acid and the homocysteine returned right back to normal.

01:01:28.260 And even though my thyroid function was still a little out of sorts, it was moving back in the

01:01:35.700 right direction. So the free T3 went up from 1.8 to 2.9, the reverse T3 from 38 down to

01:01:42.320 14, the ratio 0.21. And I made a little bit of a gonadal comeback. So the LH back up to seven,

01:01:50.020 the FSH down to three, testosterone up to eight and change. And the free testosterone back to 13.3,

01:01:57.540 just a little bit below the 50th percentile, but not that far off from the 15.5 I started at.

01:02:04.060 And with it, for what it's worth, hemoglobin hematocrit started to move back to the baseline

01:02:08.840 direction. On the LDLP, let's see. Bob, you didn't even make a comment about my gonadal

01:02:15.120 comeback. I thought you would appreciate that stupid. That was an on the spot, like little joke.

01:02:20.540 I'm laughing off Mike, I think, trying not to interrupt. I do like that. The LDL, so let's see

01:02:28.400 your numbers. The small LDLP, is it possible that it's, I don't want to say an artifact, but maybe it's

01:02:34.780 trailing more. So you did five days of fasting and then you did a, or sorry, six or seven days of

01:02:40.300 fasting. You did a, you took a draw then, and then seven days later you took another draw. But if,

01:02:48.740 maybe it's possible that it's, it's almost trailing a little bit more. Do you know what I

01:02:52.240 mean? With the, with the particles? Yeah, I don't think so, given how short their half-lives are.

01:02:57.200 You know, the LDL, a low-density lipoproteins, you know, half-life is like about a day, maybe closer

01:03:03.660 to two days. Not what is commonly discussed as two to four days. That's incorrect. The residence time

01:03:10.020 might exceed that, might be at that level, total residence time, but not the half-life. So I don't

01:03:14.780 know. I think we're getting pretty quick feedback on those particles, actually. The HDL particle is the

01:03:20.980 longest surviving. That could be six days, five days, easily. So there might be a little bit of lag

01:03:26.960 time in HDLP, but you'll notice, look at the big rebound in HDLP. All right, 35.1. So yeah,

01:03:34.580 I'm not sure. Again, I don't, the good news is I'm going to be doing this kind of nonsense a lot.

01:03:39.520 So, you know, one has to be very careful about not over-interpreting a bunch of N of one nonsense,

01:03:44.820 which is all this is. Let's not lose sight of that. Yeah. CRP too. I don't know what you did for,

01:03:51.660 I mean, I think you might have lift and then no exercise, but I think exercise, just an acute

01:03:56.200 bout of exercise, like hard exercise can probably raise that CRP too. It's a possibility.

01:04:03.000 Possible. So what day was that blood draw? So that blood draw was on the 27th. So I did it the

01:04:07.960 morning of a lift, the morning before I lifted, but I hadn't exercised the day before. Yeah. I don't

01:04:14.980 know. I don't know that I could say hard exercise would have been the answer either

01:04:18.840 because I had a full day off before. Okay. One other speculative thing on the sex hormones,

01:04:28.460 your cholesterol. So the six days after fasting in particular, like your, your LDL-C, just the

01:04:35.520 standard lab measurement. You're not quite like a hypo functioning PCSK nine mutant, but you're pretty

01:04:42.600 darn low on your LDL-C. And I'm wondering if, can it be part of the, the, the idea that cholesterol is

01:04:49.660 used for hormone synthesis, that if that's going down a lot, maybe your, the sex hormones are taking

01:04:56.040 a hit on that. You know, it's funny. I, I realized that that's a popular thought. I don't think that's

01:05:03.380 the explanation. In other words, I don't think that cholesterol shortage is the, is the explanation.

01:05:08.840 And for the following reason, when you see my total cholesterol of 90 milligrams per deciliter,

01:05:13.700 my LDL cholesterol of 37, my HDL cholesterol of 35, that doesn't give you, me, or anybody else,

01:05:20.120 even the slightest iota of how much cholesterol exists within the cells. In particular, my Leydig

01:05:26.160 cells, the cells that make testosterone. So, you know, it's a little bit like looking at the volume

01:05:32.580 of water in the ocean. It's a little bit more. It's a little bit less. The icebergs are melting.

01:05:38.080 They're not melting and trying to infer how much water is on the, the steam liner rolling through

01:05:44.520 the ocean that they use to make coffee and tea. It's very difficult. I mean, how could you even do

01:05:50.820 that? Right? So I don't think that's the explanation. I suspect, and I'll tell you another

01:05:57.640 reason why I don't think that's the explanation. Look at my DHEA level. I mean, DHEA is the precursor

01:06:01.720 hormone. It actually went up. So it's not like my body didn't have the substrate to make testosterone.

01:06:08.440 It actually had slightly more of it. In fact, the following week, it went from 230, the DHEA went

01:06:13.300 from 230 down to 180 and the LH and FSH rose. The body responded, made the testosterone. So no,

01:06:21.160 I don't think this was a substrate driven issue, which is not to say I have an answer to what it was,

01:06:26.960 but, but I don't think it was substrate issue. I do think the, the thyroid where you, you mentioned

01:06:32.400 this guy doesn't need to lose, you know, talking about yourself, doesn't need to lose much more

01:06:36.860 weight here. There's nothing coming in and there's sort of, there's a preservation going on

01:06:42.760 with the thyroid. I'm wondering if the same thing happens with the sex hormones as well, that

01:06:47.540 you're not exactly focused on reproducing. You're focused on survival at that point,

01:06:53.040 you know, a week later. See, to me, that's, to me, that's a more logical hypothesis. That makes

01:06:59.620 more sense than I ran out of cholesterol. I think it's much more in line with when you're starving,

01:07:06.660 I want you to have a little less interest in getting laid and a little more interest in getting

01:07:11.480 food. I mean, it's the risk of just sounding a little crude, right? Like if that, that to me,

01:07:17.120 you know, kind of makes more sense. Yeah. I remember, um, that paper you mentioned,

01:07:23.300 I think with Dom D'Agostino, Craig Thompson, Matthew Vanderheiden, and Lou Cantley, where

01:07:28.140 there's like a comment in that article that always, that stuck with me. And they were talking about

01:07:34.440 basically, they're talking in the context of cancer, but they were saying you always more or

01:07:39.600 less, you have an excess of energy outside of the cells. It's a matter of the receptors or

01:07:45.380 something basically telling the cell to take it up. And in this case, I'm wondering if there's

01:07:51.140 something to that effect as well, that it's not necessarily that you have like a, it's not that

01:07:58.100 you're deficient in cholesterol or that you have a deficiency per se. It's that the receptors or

01:08:03.840 something basically is getting downregulated. Agreed. I think, yeah. I mean, I just agree full stop.

01:08:10.600 The system is more complicated than just we've run out of the precursor. Like

01:08:14.260 there, there just doesn't strike me as a way that it's reasonable that a molecule as vital as

01:08:19.680 cholesterol could ever get to the point where like we become, we allow ourselves to become rate

01:08:26.100 limited under, especially under a situation of fasting or something like that. Man, it just doesn't

01:08:30.220 make any sense. So let's, when we move into the subjective results. Yeah. So, I mean, I think there

01:08:38.680 were a number of things that stood out to me and obviously I'm just going to mainly talk about the

01:08:43.860 week of the actual fast. I think the, the bread, so to speak on the nothing burger is not that

01:08:49.320 interesting. So the first thing that interested me, I only had one concern going into this week of

01:08:54.780 fasting, which was every time I do those five day FMDs sleep just drives me nuts. I hate going to bed

01:09:02.500 so hungry. And when you're like eating 750 calories a day, you're generally going to bed hungry. And I

01:09:07.880 generally find it quite miserable. So that's the one thing that kind of was a bit of a, I was kind of

01:09:12.620 dreading. I was like, you know, I'm going to be in New York. I'm going to be working my ass off.

01:09:17.280 And I don't like the idea that every night I'm going to lay in bed, staring at the ceiling for

01:09:20.780 10 hours, starving, wishing I could eat the sheets. And even though I didn't think it would last the

01:09:25.760 whole week, cause I knew at some point the ketones would sort of kick in, even just having to do that

01:09:30.600 for two or three nights was, was a little unpleasant to me. And yet immediately from the very first night,

01:09:37.300 that Sunday night, I was hungry cause I hadn't eaten all day. I mean, I slept like a champ.

01:09:41.880 There was just such an improvement in my sleep, not in the duration. Actually,

01:09:46.680 I generally sleep a little bit shorter when I'm in New York. Part, part of it's the jet lag,

01:09:51.280 but part of it's just the noise and the stimulation and then I'm a lot busier. But I woke up the next

01:09:55.760 morning and I was like, I felt like, I felt like I'd slept 10 hours, even though I'd probably slept,

01:10:01.800 I'd have to go back and look, but it might've been six and a half or something like that or seven.

01:10:05.580 But my stage three, stage four numbers, which are typically the lowest numbers were surprisingly high.

01:10:10.160 Um, about two to three X what they normally are. And that just continued without exception for that

01:10:17.400 entire week. And it abated the second I refed. So, I mean, we can explore that a little bit more,

01:10:26.320 but that was sort of the most surprising quasi subjective, quasi objective finding.

01:10:31.960 Uh, I think the second thing that really kind of, uh, surprised me was, um, how strong I felt when

01:10:45.060 I was lifting weights. So I did not experience any deterioration of strength and it, it actually got a

01:10:51.480 little bit better by the end of the week that Friday, which was day six, which was a squat row press

01:10:58.080 day. That's a very heavy day. I mean, I felt like a beast. Now I was lightheaded every time I would

01:11:03.980 finish a set, especially squatting. I thought I was going to fall over and I think I held off a little

01:11:09.840 bit. I probably stayed about 20 pounds below maybe where I would have gone otherwise on that day.

01:11:15.980 But I mean, absolutely no deterioration of strength whatsoever. Conversely, I felt, felt impossible

01:11:24.400 to move my legs quickly. So walking felt super unpleasant on day three or four. I went for a walk

01:11:32.800 in the park with a friend of mine and we were going to walk the loop of the park, which is about five

01:11:37.880 or six miles. And halfway through, he could just see how much I was dragging my ass. And he's like,

01:11:44.360 dude, let's just, let's just cut across here and cut it short. And I was, I didn't argue. I was like,

01:11:48.940 okay. Also riding the Peloton was super painful. Just couldn't generate the cadence. Couldn't keep

01:11:56.140 the cadence above 90, you know, in the 90 to a hundred zone where I would normally like to be.

01:12:00.720 And actually it's funny, I'm embarrassed to say this, but on that Friday, the day six,

01:12:05.740 after I finished having a great workout of squats and, you know, rows and all of these, you know,

01:12:10.660 heavy compound movements, I, the thought of walking the mile home from the crunch to my apartment was

01:12:18.340 so unbearable. Even though it was a perfectly nice day, I took a taxi. Never done that before in my

01:12:22.440 life. Just, I was like, there's no goddamn way I'm walking home. Like it'll take a day is what I

01:12:28.240 thought. And walking upstairs, super uncomfortable. And again, I don't mean uncomfortable like it hurt the

01:12:34.640 muscle. I mean, I don't know what I mean. Just there's some level of uncomfort that was there that

01:12:39.840 drove me nuts. The final really, really interesting. Actually, there were two other

01:12:44.500 interesting things. One of them was, I talked about how I came into this with a really good

01:12:49.180 meditative routine, but that week it went to another level. Uh, so I meditated in a way I'd

01:12:56.320 never meditated before. And normally when I'm walking around the street, I always have headphones on and

01:13:02.020 I'm always doing something. I'm either listening to a podcast, listening to an audio book, listening to

01:13:07.240 music or talking on the phone. In other words, I am never just walking around, spacing out or

01:13:14.620 taking in the ambient sound. For some reason on that week, I pretty much always, I'd walk out of

01:13:20.440 my building or walk out of the office or walk out of wherever I was leaving. And I wouldn't even

01:13:24.980 remember to put my headphones in and I would just walk and I would just look at stuff and, you know,

01:13:32.180 be as present and mindful as any human could be and not even kind of realize it was happening until

01:13:38.240 20 minutes later when I'd be like, geez, I haven't even like made a phone call or checked my phone or

01:13:45.460 done any of these other things. So, so that to me kind of fit hand in hand with how I felt during the

01:13:50.440 meditation, which was just a, a very unique sense of calmness that, that was, that is quite uncommon for

01:13:56.120 me. I think the, you know, final sort of subjective, interesting surprise was in December of 2016,

01:14:07.420 I hurt my right wrist moving a bunch of dumb, heavy stuff, like totally not a good excuse to hurt

01:14:14.500 yourself. And about six, about a year ago, the summer, last summer, I hurt my left elbow. So I've got

01:14:21.280 this left elbow thing that's kind of nagging me in this right wrist thing that's nagging me and they're

01:14:27.000 kind of, if I'm, if I'm deadlifting heavy, I need to wrap them in a certain way. And if I, you know,

01:14:32.760 it's just, they, they just, I'd been constantly giving attention to these things, sort of constantly

01:14:37.760 getting, you know, Josh working on them and we'd made, we'd made progress, but I mean, I still felt,

01:14:45.120 you know, significant pain, especially in the elbow. And at the end of that whole

01:14:50.960 experiment. So it's hard to know how much of it was ketosis, fasting, ketosis, but I would

01:14:55.060 just venture to guess that the fasting played the biggest role. Even now, how many weeks out we are

01:14:59.760 from this, the right wrist pain is a hundred percent gone. I mean, I can't even remember what

01:15:04.400 it felt like now, which is odd for something that, um, ailed me for so long. And the left elbow pain

01:15:09.620 is almost gone. Uh, and it's to the point where I don't have to even put a wrap on it when I'm holding

01:15:15.780 the bow. So one area where I really suffered was holding the bow when I was arching, arching,

01:15:21.380 is that even a word doing archery? So if I'm holding it out with my left arm, just the pain,

01:15:26.140 the left elbow became kind of my rate limiting step on shooting. And that's a completely gone.

01:15:32.480 So I don't know if nothing else, the whole thing was worth it just for that.

01:15:37.000 Hmm. Do you have any speculation as to why sort of the wise behind feeling this calmness and the,

01:15:43.120 maybe being more present while fasting?

01:15:46.520 Oh, I was hoping you would. I have no goddamn idea. What do you think?

01:15:52.660 So I, I mean, I did a fast, I did a seven day fast maybe a year ago. And I noticed that as well,

01:15:58.420 that I'm usually not, let's say present or in the moment. And I felt that I'm not a very religious

01:16:06.200 person, but I, it felt almost like if what a religious experience might feel like. And I know

01:16:11.700 that a lot of religions do fasting. If I were to wildly speculate, part of it, I think is you think

01:16:19.700 about alertness, just awareness and alertness. And you think it's going to go in the tank. If I'm

01:16:26.100 not eating, I'm lethargic. I've missed all of my meals the last four or five days. And then I think,

01:16:33.740 well, maybe from an evolutionary perspective that you, you can get a heightened sense of awareness

01:16:39.340 because if there's something to be killed or picked out of the ground or something like that,

01:16:45.260 you may need to hop on that opportunity. So you may need to have this heightened sense of awareness.

01:16:50.620 And I don't know if that carries over to cognition. And then I kind of, I thought about, you know,

01:16:56.680 the low and slow exercise that you were doing where it's not very, you know, fight or flight

01:17:03.380 necessarily, even though you're going up like say a flight of stairs and it's, it's taxing. Like it

01:17:08.640 feels taxing when it shouldn't feel taxing. It never has in your life really, but the sort of

01:17:14.340 fight or flight, deadlifting, squatting, doing something that, you know, high intensity sounds

01:17:21.180 almost counterintuitive. But again, it kind of goes to this heightened sense of awareness or readiness

01:17:26.600 in, it might sound counterintuitive that you've had four or five days of fasting, but it's really

01:17:31.820 like you're, you may, from an evolutionary perspective, you may really need to seize that

01:17:36.500 opportunity. And I don't know if those two things square with this idea of having this awareness,

01:17:43.460 have it like, you know, I don't know if you guys talked about it, you and Tim Ferriss with

01:17:47.260 psychedelics, for example, when you, you talk about like appreciating things, particularly nature,

01:17:52.880 where you're just more aware of those things. And I don't know if with fasting, if there's

01:17:58.620 some relationship to that, that you're just, you have this heightened sense of awareness

01:18:02.700 and you're, you become more sort of conscious of your surroundings. Don't know if that makes sense.

01:18:09.520 No, it does. And as it's a really interesting idea. And I, I know Tim actually did a fasting

01:18:14.680 meditative silent retreat. So he did a Vipassana retreat for seven or 10 days. I think it was seven

01:18:19.960 days and he also fasted during that period of time. So again, I'm curious as to how that

01:18:25.460 experience compared to Vipassana retreats he has done where he has not fasted and to experiences

01:18:31.800 where he's fasted and not done the meditative retreat. I also wonder how much of a common

01:18:39.460 element or elements are consistent between the experience I had with sleep and this state that

01:18:46.240 you're describing. Because I, again, that, that whole sleep thing has really made me

01:18:52.840 question this, you know, addiction I have to the societal norm of making dinner, the social meal.

01:19:00.880 You know, when I, if you look at Satchin Panda's work and we were all laboratory animals, we really

01:19:06.740 ought to be eating first thing in the morning and then tapering off later in the day. If we're really

01:19:11.360 going to follow both our circadian rhythm, but also optimize around glucose disposal and insulin

01:19:17.480 sensitivity. So why don't we do that? Right. Or why don't I do that? Why do I generally not eat in

01:19:23.120 the morning and then backload it? And it's all social, right? It's like, I'm not going to have

01:19:27.940 breakfast with everybody, but I'm going to have dinner with everybody. But of course I have to

01:19:32.020 wonder how much of that experience due to the, not just the ketones, because I don't, I don't think it

01:19:38.300 was just the ketones. Cause I had this experience even on the first night when my ketones were

01:19:42.760 probably like one, one and a half millimolar, which is very easy to attain during nutrition,

01:19:47.660 nutritional ketosis. But it was some combination of the ketones and, or the complete and utter lack

01:19:54.480 of digestive process. And that's made me think maybe I should just be getting up, eating the biggest

01:20:01.220 breakfast in the world and then not eat the rest of the day. Could I pull that off? And I just,

01:20:05.660 I've been too lazy to try frankly, but that sleep, like that shit was awesome. Like I want that.

01:20:15.100 I want that every goddamn night because like you could do anything. I feel like there's no end to

01:20:23.680 the type of regeneration you could have with, with what I was experiencing there. So anyway, that's,

01:20:29.960 that's probably my best hypothesis on that. I think the last point I kind of forgot to make it earlier

01:20:34.160 because we haven't alluded to it. Again, if you look at the pictures, apologizing for the fact

01:20:38.180 that I'm posting dorky, goofy selfies, I honestly didn't feel like I lost any muscle mass. I obviously

01:20:45.480 lost a little bit. If you're going to lose 12 pounds, my guess is I lost a pound or two of muscle,

01:20:52.040 probably five, six pounds of fat. And the rest of it would have been water mass, both mass with

01:20:58.840 like glycogen loss in the muscle. So every gram of glycogen you lose, you're losing three or four

01:21:03.960 grams of water that go with it. Some reduction in plasma volume as well. So again, we didn't talk

01:21:10.540 much about that, but I, I couldn't believe I didn't lose more muscle mass. Like I, I'm embarrassed to

01:21:16.240 say this, but at the end I was like, Oh, I kind of think I look better now than I've ever looked.

01:21:20.400 And you would normally think after a fast, you'd be a little kind of decrepit looking.

01:21:24.240 Um, I certainly looked better than I looked, I think going into this experience, uh, which is

01:21:28.660 not to say I look good going into it. Cause I've, I'm sort of not at my, what I would consider ideal

01:21:33.140 leanness or anything, but that was a, that was a pleasant surprise. And again, I wasn't, you know,

01:21:38.680 I wasn't using even a, even a gram of branched chain amino acids during that fasted a week of working

01:21:43.900 out. So at some point that's going to change, you know, if I did a 10 day fast, a 14 day fast at some

01:21:50.200 point I expect that would change dramatically, but it was interesting to see that even seven days of

01:21:55.960 not fasting, I don't think it cost me any measurable amount of lean tissue.

01:22:01.560 Yeah. I think that's fascinating. And it's, I think it's a, either a point of contention or

01:22:06.420 it hasn't really been sussed out whether these periods of fast would lead to lean tissue loss over

01:22:12.860 time, which would be particularly if you're thinking of health span and lifespan and over

01:22:20.040 time, if you want to implement, we can probably get into this, you know, when, how often would you

01:22:25.780 implement say a one week fast or intermittent fasting and, and things like that. But if you

01:22:31.560 were to do say, let's say like a week long fast twice a year or once a quarter, whatever the,

01:22:38.880 whatever the case may be, if you lost a significant amount of lean mass and over time you're aging.

01:22:45.860 And I don't want to just say that like when you get older, there's sarcopenia, but if you're each

01:22:50.520 time you're going through this fasting period, there might be some benefit. But if you were to

01:22:54.640 take a hit on your lean tissue sort of consistently over time and you're, that would be something that

01:23:01.960 you, you know, you want to sort of jealously preserve is all that lean mass. So that would be

01:23:08.840 one of the, you know, potential contraindications of doing frequent fasts. Yet if you, if you can

01:23:17.420 preserve that lean tissue, I think that would be, it would be super important to, to understand and

01:23:23.680 find out. And I, I think a lot of times when you look at the studies like Cahill studies, I, the

01:23:28.800 subjects, it's a different population, but I also think that they're not engaging in a lot of,

01:23:33.160 you know, weight bearing activity. And just from, you know, the literature, even on say low calorie

01:23:39.860 diets or high protein, low calorie diets, when people do those types of, whether it's calorie

01:23:45.080 restriction or dietary restriction, and they engage in a weight bearing exercise program, they're

01:23:50.120 lifting weights. They tend to preserve a lot more lean tissue. That's probably outside of eating

01:23:55.400 protein. Actually, probably number one is weight training is probably the best way to either

01:23:59.820 add lean mass or preserve it. And then maybe protein intake itself is, is second.

01:24:06.300 Yeah, I totally agree with this. And I think this is a great example of selective mTOR inhibition

01:24:13.620 in an ideal world. You don't really want to turn off mTOR in the muscle. I mean, you don't want it on

01:24:20.100 every minute of every day or you'll get muscular dystrophy, but the far bigger issue as we age is mTOR

01:24:26.220 activity going down in the muscle. That's what's leading to sarcopenia. Where I really wanted mTOR

01:24:30.820 to go down for that week was in my liver, in my fat cells, probably in my, you know, myocardial cells

01:24:37.820 and other places like that. But when it came to skeletal muscle, you know, you're exactly right.

01:24:42.280 I think that that's the week you double down on what you're doing in the weight room. If anything,

01:24:45.920 you go out of your way to make sure you send that signal to the muscle. Hey dude,

01:24:51.680 no shrinking allowed. Now that said, when you did your week, what happened to your muscle mass?

01:24:57.980 Even if you didn't take the goofy selfies, did you just have a sort of subjective sense of what

01:25:03.140 happened? Yeah. I mean, I was weight training, I think the entire time. And because to be,

01:25:07.940 to be clear for the listener, you have a hell of a lot more muscle mass than I do. So that if there's

01:25:13.480 going to be a difference, you are going to see it even more amplified. Yeah. I don't,

01:25:17.560 I don't think I've lost all that much. Might've lost a little bit. I was definitely engaging in

01:25:23.020 weight training. I had a, I have like a Tenita bioimpedance scale. And I do remember just in

01:25:30.120 terms of, you know, taking out the lean tissue and lean tissue, the fat free mass and the fat mass.

01:25:35.580 It didn't look like, at least on the scale, although that's heavily weighted with your hydration and

01:25:42.060 water status. So I don't know how consistent I was when I was doing it. It didn't seem like I lost all

01:25:46.920 that much lean tissue. And I always think like, if I were to do these experiments that I might be

01:25:53.120 different than other people, but the one thing like, I don't want to do is just stop exercising.

01:25:57.120 I think it'd be really hard for me to do like a week long fast and not exercise, but it would be,

01:26:02.480 I would suspect that you might lose more lean tissue that way, completely speculative, but I didn't.

01:26:08.840 And there was no similarly, but I don't think that I was doing what you do with those Peloton workouts.

01:26:15.100 I think you were talking about cadence. I was going to follow up and ask you

01:26:18.140 if that gives you Watts as well. And you can kind of see like what your

01:26:21.660 average power was.

01:26:23.380 No, no, my wattage was decimated. So I normally ride in power zones. So Peloton now allows you to

01:26:27.980 see your zones. So there's seven zones. It's like the, uh, Andrew Kogan is a bike, you know,

01:26:33.980 physiologist who's created a system and Matt Wilpers, who's my favorite Peloton instructor. He does all of

01:26:38.820 his classes as power zones. So I know exactly what zone one, two, three, four, five, six, and seven are.

01:26:44.220 And every workout we do is congruent with that. Well, I even going into this said, don't reset your

01:26:50.020 expectations. You will do a discount of one zone. So if you're doing a zone, if you're doing a workout

01:26:55.640 where you're going, you know, two minutes of zone three, two minutes of zone four, one minute of zone

01:27:01.960 five repeat, I would just do it all minus one. And even doing that, I could not keep up.

01:27:08.760 So in other words, relative to my former self, I was at least 60, if not 80 Watts less capable.

01:27:20.200 There was just no denying it. So there was, you know, just a fraction of the ability to put out

01:27:25.460 power on a bicycle. And that might just suggest two different types of demands on the muscle. You

01:27:31.320 know, if you're doing a squat or a row or a deadlift, that's different. That's much harder. It's much,

01:27:37.360 you're asking much more of the sarcomere than if you're riding a bike per contraction.

01:27:44.960 But on the bike, you're asking for many, many, many more of those contractions.

01:27:49.700 And there was just something that I couldn't do on the ladder that I seem to have no difficulty

01:27:55.260 doing on the former. I mean, I look forward to revisiting all of this stuff, of course, and,

01:28:00.480 you know, maybe recruiting a few knuckleheads to join.

01:28:04.540 Yeah. I was also thinking with your wild type diet, you pretty much do one large meal a day,

01:28:11.020 right? You were alluding to this, that if you did just move, you could try moving that one meal a day

01:28:15.420 to the morning and see how it impacts your sleep and not really change all that much in what you do

01:28:20.420 in a daily routine, other than backloading that, your food.

01:28:24.360 Yeah. Although it would change one other thing, which I wouldn't be able to work out first thing

01:28:27.980 in the morning. So, I mean, I guess, or what I could do is I could work out first thing in the

01:28:31.100 morning and then say, eat that monster meal right after, and then sit there and twiddle my thumbs at

01:28:36.880 dinner and have the same issue I was worried about having with fasting at home, which is,

01:28:41.800 daddy, why aren't you eating? Oh, um, autophagy. What?

01:28:46.500 The thing on my license plate.

01:28:48.180 The thing on my license plate. Yeah, yeah, yeah.

01:28:49.940 Yeah. Okay. So, I think, well, I'm guessing there are more questions, actually, because we've

01:28:58.700 basically all we've done is kind of go through, I mean, I know you've embedded a bunch of people's

01:29:02.340 questions into those questions, but are there any other questions? Yes. So, I...

01:29:09.480 I was afraid you were going to say that. So, I have, let's see, we have, I segmented them into,

01:29:15.700 so I have fasting modalities, frequencies, duration. So, we've talked about a few of these

01:29:21.760 intermittent fasting. The FMD, actually, I want to circle back on that. You mentioned that

01:29:26.060 you've done FMDs in the past, and I think you've done, you've done like a, let's call it

01:29:31.820 the Prolon protocol, where it's relative, it's low protein, high carbohydrate. And I think you've

01:29:38.780 also done an FMD that's not the opposite, but you've done a relative, like 700 calories,

01:29:46.560 low carbohydrate. Yeah, I've done like ketogenic FMD. Yeah, I've done them across the board.

01:29:50.600 And do you notice a difference in those protocols?

01:29:52.520 I notice a difference in my enjoyment level, as counterintuitive as it is. First of all,

01:30:00.340 that it's so easy for me to just eat one meal a day. So, whenever I'm FMDing, I'm only doing it as

01:30:06.220 one meal a day. Like, the way I look at it is, if I'm going to blow my load, like, do it once,

01:30:10.140 right? Like, I'm going to have my 750 calories in one sitting. I'm not going to sprinkle it out

01:30:14.520 over the course of the day, which is not how they advise you do it via Prolon. So, every time I do it,

01:30:20.820 I do it by just consuming that input at dinner. And that way, it also gets to scratch the social itch,

01:30:27.040 which is, I'm going to sit there and have dinner with somebody, like, at least I can do this thing.

01:30:30.100 So, that said, I actually prefer doing a very high-carb, low-protein, almost no-protein,

01:30:36.880 low-fat version where I'm getting fat. Basically, my favorite meal when I'm Proloning,

01:30:41.980 or, I mean, I'm just using that term, but you know what I mean, is salad and rice.

01:30:47.400 750 calories of salad and rice is, like, from a volumetric standpoint, actually pleasing enough

01:30:54.480 that I feel like I'm eating. The problem with doing the 750-calorie-a-day keto diet,

01:31:02.060 which probably in the end is more satiating, is just volumetrically, it's trivial, right? Especially

01:31:07.520 with the stuff I like to eat, macadamia nuts, avocado. I mean, you're, you know, you're olive

01:31:12.780 oil. You're kind of done. You know, you're sort of, you don't get to eat a whole heck of a lot.

01:31:17.720 So, but again, I want to take a step back from all of this. I'm not even suggesting that I have a clue

01:31:24.000 what the optimal fasting regimen is. Whether you should be doing a five-day FMD quarterly,

01:31:28.900 whether you should be doing a seven-day fast quarterly, whether you should be doing a five-day

01:31:31.880 fast water-only quarterly, whether you should be doing a day a week, you know, with nothing in it.

01:31:37.000 I mean, that's the whole point here. Nobody knows the answer to this question because it would be

01:31:42.160 impossible to study this in humans using the metrics that are necessary to actually extrapolate

01:31:51.120 to the things that matter most with the technology we have today. We just don't have the tools developed

01:31:55.580 to do this. So obviously the FMD has been probably studied. The five-day FMD has been studied more than

01:32:02.720 any of these other routines because it's at least been studied in Longo's lab. But you know, we're

01:32:08.420 comparing it to what? We're comparing it to someone eating a standard American diet. Well, a lot of

01:32:12.820 things are better than a standard American diet. So, and I think Walter is honest in his assessment of

01:32:19.240 that, which is, look, he's not, I don't think he's claiming this is the optimal way. He's claiming

01:32:23.940 this is an effective way. In other words, it's not the most efficacious. It's not the quote-unquote

01:32:30.460 dietary regimen that will produce the best result. It is one that is very easy to follow. For that

01:32:36.240 reason, I think it's, you know, it's a great tool. We use it constantly with our patients, but I'm looking

01:32:41.300 for something different, right? I'm looking for the best, not the easiest. And so you may have

01:32:46.400 answered the question by saying there is no answer, but there are a lot of questions about

01:32:51.100 the optimal number of fasts per year. And in terms of what is the optimal frequency and duration

01:32:58.460 and things like that. It doesn't say, obviously we don't have a concrete answer on that stuff,

01:33:02.320 but is there something that you, you think is likely to provide benefit as far as if you're going

01:33:09.580 to do a one week fast once a year, man? Depends on the person. I wish, I wish, I wish I knew.

01:33:16.540 I would say the following, and this is a hundred percent speculation. So it's, it's just, it's

01:33:21.320 got to be able to sort of take it with that. I'm convinced that an important tenet of longevity

01:33:29.740 is exposure to nutrient cycling. What that does is autophagy up and down, anabolism, catabolism,

01:33:38.640 mTOR up, mTOR down. I think if you want to live long, those things have to be happening.

01:33:44.860 So I don't think that doing a seven day fast once a year and for the other 51 weeks of the year,

01:33:51.680 just eating like shit is going to do that much. It's probably better than just eating like shit

01:33:57.860 52 weeks a year, but I don't know if it's enough to move the needle. I mean, I don't know.

01:34:02.760 Again, I have a sense of what we would have to be able to measure to at least directionally answer

01:34:11.160 that question, but we don't know. Because I don't think the answer to that question can be

01:34:15.960 addressed through standard blood draws or, you know, scans or things like that. I mean,

01:34:20.740 these are cellular questions. So there's probably a little bit of the frequency of the fast might be

01:34:28.000 a function of the damage you do off the fast, if that makes sense. I think it does. The worse you

01:34:34.280 want to behave when you are not fasting, it might be that you need to fast more frequently.

01:34:39.960 The better you want to behave. So if someone said to me, hey, if Dom said, hey, Peter, I'm going to

01:34:44.860 go on a ketogenic diet, you know, completely strict, super clean, whatever. And it doesn't have to be

01:34:49.740 keto. I'm just using that because Dom's on a ketogenic diet a lot of time. And once a year, I'm going

01:34:53.480 to do a seven or 10 day fast. Is it adding value? My guess is, yeah, it's probably adding value.

01:34:58.460 Because he doesn't have that much damage to undo. And he's using that week just mainly as a way to

01:35:03.700 really shut down tour. But if, you know, someone says to me, look, man, I'm a burger and fry guy.

01:35:10.240 But I'm willing to not eat at certain points in time. What should I do? Then the answer is,

01:35:15.180 you know, maybe do time restricted feeding as a way to minimize the damage of the burger and fry.

01:35:19.760 And then maybe do these fasts more frequently. But again, you can see, I don't know.

01:35:28.820 Yeah. I think it makes intuitive sense, too, that Longo pointed this out. I'll probably butcher the

01:35:35.140 idea or the protocol, but I'll hopefully get the gist, which is not just how bad is... I think he

01:35:42.180 advocates for essentially more or less, it rhymes with a reasonable diet where you're cutting out

01:35:49.740 refined grains, carbohydrates, sugars, et cetera. But really, what state are you in? I think he asked

01:35:55.860 that question as well. Are you diabetic? Are you hyperinsulinemic? Do you have metabolic syndrome?

01:36:01.380 All these different things. And if you're in a relatively poor state, I think he advocates for

01:36:07.340 doing more FMDs, you know, doing them more frequently. And as you get to a better state,

01:36:13.840 a leaner state, then maybe you can get away with doing fewer FMDs in terms of optimizing your health.

01:36:21.320 Sounds sort of similar to that.

01:36:22.720 Yeah. Again, I can't tell you how much I want to, you know, help generate or be a part of generating

01:36:30.460 some of these tools so we can actually start to look at trade-off and start to figure out,

01:36:35.580 like, what's the gain? You know, how much incremental benefit do you get by increasing

01:36:41.280 the frequency of the fast? I mean, I don't even know when I'm going to do the next one of these.

01:36:44.260 I mean, I sort of directionally came up with a protocol that said, look, this should be done

01:36:48.140 every quarter. You do the KFK sandwich per quarter, and then that gives you, you know,

01:36:54.480 13 weeks to a quarter. So you do that for three weeks, and then you've got 10 weeks of going back

01:36:58.600 to relatively clean time-restricted feeding. Okay, cool. That's probably better than, you know,

01:37:05.020 eating normally. But is it overkill? Is it enough? Drives me nuts not to know that. But I'm really

01:37:13.160 not interested in talking about it that much more because I don't think I'm going to learn anything

01:37:16.580 more just by sort of imagining what it could or couldn't be. I think we just have to go after

01:37:22.480 some of these cellular assays that can measure metabolic, as I said, proteomic and other molecular

01:37:29.960 markers or signatures of what we believe is happening in these states. Right. So this one,

01:37:36.340 I think, is relevant, and maybe you can help answer this one. This is something I experienced as well,

01:37:42.480 and there were several questions about this. So if you do a seven-day fast or a 10-day fast,

01:37:48.480 I think I'm stealing this from Dave Asprey, where he calls it disaster pants. I think he's talking in

01:37:55.020 terms of like MCT oil, taking too much. But after my fast, at least my mentality was I had like set

01:38:02.160 a date on the calendar. I went to a steakhouse and was just, you know, ready to eat my face off,

01:38:09.700 and I probably did. And it more or less went through me. And it sounds like a lot of people out there

01:38:15.580 are saying the same thing, that they get a lot of GI distress when they're reintroducing food after a

01:38:20.660 fast. And they were wondering if you have like your best practices, what works for you, or what are the

01:38:27.180 things to avoid in terms of breaking your fast? So I didn't have, I didn't have any GI distress

01:38:32.680 breaking the fast. And I only, actually, I didn't get into this, but if anything, I mean, what the other

01:38:37.540 thing that I didn't, I just forgot to mention was the entire time I was fasting after the first day,

01:38:42.600 there was no normal bowel movement. It was pure liquid. And it was basically bile. So it was just

01:38:48.700 bile coming out of me as liquid. And so that's just a different sensation. So it's all of a sudden,

01:38:54.000 it's like, there were times when I'm walking down the street where I was like, I probably need to

01:38:58.700 find a bathroom at some point. Like I felt like there was this collection of bile waiting to exit

01:39:02.720 my body. The biggest issue I've had, and I've had this so many times, and you'd think I'd learned my

01:39:07.280 lesson. And even though intellectually, I know this, I still screw it up like a moron. It's the

01:39:14.400 volume. When you've been fasting, I am convinced, because we used to see this in patients with

01:39:19.380 nasogastric tubes in, in the hospital, the stomach is so decompressed for so long that if you overfeed

01:39:26.080 and just put so much volume back in the stomach, you get the hiccups. And again, I used to see this in

01:39:31.160 the hospital all the time. You had a patient that had a nasogastric tube in for a week, you take it out

01:39:35.220 and they start eating or drinking again. And all of a sudden, even if they're just drinking a bunch

01:39:38.500 of water, they just get the hiccups. And so sure enough, that first night when I ate and I made the

01:39:45.700 Atiyah curry stir fry, which is certainly among my three favorite meals, not a particularly caloric

01:39:53.340 meal, right? It's mostly vegetables and stuff like that. But I just, I ate and ate and ate and ate.

01:39:59.840 And I got the hiccups like I've never had it in my life. So much so that I actually had to take

01:40:04.880 like a pretty interesting drug, a Neurontin, which I had some of it lying around just to try to like

01:40:13.300 chill out my diaphragm a little bit. And I probably had the hiccups for like three hours, which is if

01:40:19.380 anybody's had the hiccups for more than 10 minutes, I think they'll attest to the discomfort of that.

01:40:24.780 That said, from a GI standpoint, I didn't have any issues. You know, once I got some fiber back

01:40:30.060 in my diet, I was sort of right back to feeling completely normal in that regard. But yeah,

01:40:35.140 I'll definitely, I say I'll do it. I might not, but I'd like to think that the next time I fast,

01:40:40.240 I will be much more thoughtful about my re-entry volume strategy.

01:40:44.420 When you, your first meal and after the fast, as I recall, you didn't necessarily go to town

01:40:50.260 with whatever the meal was, right?

01:40:52.380 Oh, that's a good point. You're right. You're right. My very first meal, I had a little snack

01:40:55.640 before I had the stir fry and you're right. I was actually pretty timid. I had a small salad

01:40:59.980 and a small cup of chili, which was odd, but that was sort of like what was laying around

01:41:04.300 and that felt totally fine. But then a few hours later when I went for the big cojona,

01:41:09.820 that's when the hiccups ravaged me.

01:41:11.900 Okay. I've got the whatabouts as I like to call them, which is, am I breaking the fast if,

01:41:18.420 if I'm taking MCTs, if I'm taking exogenous ketones, if I'm drinking coffee, if I'm drinking

01:41:25.380 tea, if I'm adding artificial sweeteners to those things?

01:41:28.900 I mean, all, all great questions. And of course we simply don't know the answer to these questions.

01:41:33.820 It is a function presumably of what you are fasting for. So if someone says I'm fasting

01:41:39.980 because I want to have no calories because I want to lose weight, which there's no more direct way

01:41:49.420 to lose weight than to not eat anything, then it probably doesn't matter if you're consuming

01:41:54.540 non-caloric entities regardless of their impact on you. So, you know, in theory, I don't think having

01:42:01.580 a diet Coke or a coffee, a black coffee with nothing in it is from a caloric standpoint,

01:42:09.300 impacting energy balance. Now, I think the problem with having a diet Coke during a fast is

01:42:15.500 it's going to F up your S. I'm glad you got that. Like, I love when I'm just telling jokes for you.

01:42:22.100 I've got like a quarterback wristband where I have all the abbreviations.

01:42:24.940 That's, that's like, that's effing up his ass, man. Okay. Let me check that out. Okay. Got it.

01:42:34.480 You know, but I think it's just, it just, it just resensitizes your appetite, you know,

01:42:39.600 certain appetite centers centrally to like, oh my God, should I be eating more? And again,

01:42:43.500 whether there's a cephalic insulin, you know, spike or not, I, that would be measurable. And my

01:42:48.100 guess is that would be variable. There's some people that might experience it. Some people might not,

01:42:51.680 but I just think sort of, there is something to be said for just kind of keeping it clean in that

01:42:57.540 regard. Now, I think with coffee, the bigger issue is that caffeine can truly affect lipolysis and,

01:43:02.340 and it might sort of artificially create a slight environment of a fed state.

01:43:09.440 So that was the reason that I just decided to say no on that. But obviously I didn't say no to,

01:43:14.160 you know, non-caffeinated tea, but you know, the way I would say it is like, use your common sense.

01:43:19.840 First things first, if you're fasting, know why you're fasting. If you think you're fasting because

01:43:23.780 of something to do with nutrient sensing, autophagy and things like that, then you're

01:43:27.600 probably best off having as much nothing as possible. But at the same time, like, you know,

01:43:34.360 let's major in the major and minor in the minor. And I think whether you're having a green tea versus

01:43:40.700 a rooibos tea versus, you know, a coffee is probably a fourth order consideration.

01:43:47.080 If you're doing a three, five, seven day fast, you know, it probably isn't nearly as important as

01:43:53.900 say the fasting. Right. And depending on the protocol, there is not a ton of data, but there

01:44:00.940 is some data. For example, the, what's the, the, the alternate day feeding where every other day

01:44:07.640 you're fasting. Although technically when you read these papers, your fasting day is, I think it's up

01:44:13.580 to 500 calories is still considered a fasting day or the, the five, two diet. So there's two days of

01:44:21.380 fasting. Right. You know, theoretically, but again, but they're not back to back. Right.

01:44:27.000 And I don't, I think there's some flexibility, but I don't know if there's like a standard protocol.

01:44:32.480 Typically it's probably that there's, you know, you're wedging it in between, in your week. But again,

01:44:38.820 on that, on those, those two days, I think it's five, 500 calories or less. And then Longo's fasting

01:44:45.380 mimicking diet, I think day one is something like a thousand calories. And then days two through five

01:44:52.420 are 700 calories. And based off of his experience, I think he looks at IGF one

01:44:59.380 a lot and some other marker and IGF BP, I want to say three is what he looks at. He looks at those

01:45:08.020 two things. And part of why he says it's a fasting mimicking diet is because he sees some of these

01:45:13.940 markers move in a similar direction to where you're fasting. So coffee, tea, that might be majoring in

01:45:21.680 a minor in some of these instances. But I think I just wish we had more information on all this stuff.

01:45:27.760 Yeah, me too. For sure.

01:45:30.160 So I think we, we covered a lot of questions within just going over your experience and some of those

01:45:39.800 follow-up questions. I'm trying to think if there's anything else. I mean, I would, although the labs are

01:45:46.320 somewhat boring, it would be great to do a deeper dive into the labs and things like, you know, why

01:45:52.720 are some of the numbers doing what they're doing? I think you mentioned it, that you weren't flagging

01:45:56.280 things with reference ranges that, you know, you know what your numbers are and you also, so if

01:46:02.260 there's something that you, if you flagged as like, that's interesting or that's strange, you flag

01:46:08.780 those things. And I think I'm going to, again, I'm trying not to open too many windows on my

01:46:14.740 computers because I, I don't know, I don't know if it's superstitious with Skype, but I think it was

01:46:20.140 Isaac Asimov who said something like, you know, the great discoveries in science are not Eureka.

01:46:27.400 They're, that's funny. You know, so even though it's an N equals one and it's very little data,

01:46:35.080 I do, it's, it's always very interesting. It's interesting when you find something that's a

01:46:38.960 little askew and maybe it's just a, you know, an artifact or a rounding error, but some interesting

01:46:44.680 stuff. The thing that fits that description the most for me is actually the uric acid of eight

01:46:48.960 after the fast. So even though the thyroid numbers are comical and the testosterone story is

01:46:55.260 interesting, I can, I think I can generate reasonable hypotheses around them, especially

01:46:59.940 the thyroid stuff. But given my interest, particularly in understanding any and all inputs

01:47:06.960 to an autophagy model or predictor, it's the uric acid. I'm really going to want to watch in

01:47:12.940 other people that do this and in myself when I do it subsequently, because if that is in

01:47:18.000 any way a proxy for cell breakdown and nucleotide breakdown, so DNA and RNA destruction, that,

01:47:26.660 that could be a little piece of this question, which is, are we actually undergoing autophagy

01:47:33.620 at a meaningful enough level? So yeah, there are a million labs on this page. There's a million

01:47:38.720 numbers here. There's a, you know, there's an infinite amount of data one could extract from

01:47:43.440 all of this. That's my interesting moment. Yeah. Which by the way, might turn out to be

01:47:48.200 entirely irrelevant. Uh, probably will, but can't wait to get on it. Yeah. It's funny. It's like a

01:47:55.320 double whammy. You've got almost like an infinite number of variables that you can speculate about.

01:48:00.380 And yet you're also limited in the equipment that you can use to actually look at many of the things

01:48:05.860 that you want to look at, um, in terms of things that would push the needle. Yep. So anything else

01:48:12.160 question wise from folks that, um, that we haven't sort of implicitly or even explicitly covered?

01:48:22.020 I think we covered most of it. I mean, we have a bunch, I have a bunch of questions at the bottom,

01:48:26.520 but I think we covered just about all of it. I think like many things you'll put this out and

01:48:32.460 then there'll be a lot of follow-up, a lot of follow-up questions and things like that. But I

01:48:36.280 think you covered a lot of ground. All right. Well, sweet. So this, this will be our, um, so we are

01:48:43.020 sitting here recording this on August 14th. I'm hoping we can get this out next week, right after

01:48:50.320 the Matt Caberlin, uh, podcast. Is that, do we think that's feasible? I think so. I think that'd be

01:48:55.680 excellent. We can turn it around. That'd be great. Sweet. All righty. Well, Bob, thank you very much

01:49:04.100 for cataloging and organizing all of this info. You're very welcome. You can find all of this

01:49:11.220 information and more at peteratiamd.com forward slash podcast. There you'll find the show notes,

01:49:16.700 readings, and links related to this episode. You can also find my blog and the nerd safari at

01:49:22.140 peteratiamd.com. What's a nerd safari, you ask? Just click on the link at the top of the site to

01:49:27.440 learn more. Maybe the simplest thing to do is to sign up for my subjectively non-lame once a week

01:49:32.300 email, where I'll update you on what I've been up to, the most interesting papers I've read, and all

01:49:36.920 things related to longevity, science, performance, sleep, et cetera. On social, you can find me on

01:49:42.400 Twitter, Instagram, and Facebook, all with the ID peteratiamd. But usually Twitter is the best way to

01:49:48.040 reach me to share your questions and comments. Now for the obligatory disclaimer. This podcast is

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The Peter Attia Drive - August 23, 2018

#11 - AMA #2： the Nothingburger — results from Peter's week-long fast between two weeks of nutritional ketosis — and answering questions on all things fasting

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