#63 - AMA #7： Exercise framework, deadlifting, lower back pain, blood pressure, nootropics, CGM, and more
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Summary
In this episode, we discuss how not to wake up in the middle of the night to use the bathroom, how to keep your notes organized, and why you should never drink in the early morning. If you're not a subscriber yet, you'll only be able to hear a preview of the AMA here. To become a subscriber and receive access to the members-only podcast feed, as well as other benefits such as detailed show notes and member-only discount codes, you can subscribe to The Drive in your podcast player.
Transcript
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Hey everyone, welcome to the Peter Atiyah Drive. I'm your host, Peter Atiyah.
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The Drive is a result of my hunger for optimizing performance, health, longevity, critical thinking,
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along with a few other obsessions along the way. I've spent the last several years working with
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some of the most successful, top-performing individuals in the world, and this podcast
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is my attempt to synthesize what I've learned along the way to help you live a higher quality,
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more fulfilling life. If you enjoy this podcast, you can find more information on today's episode
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Welcome to AMA number seven. I am again joined by my right-hand man, Bob Kaplan. This episode
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is dubbed the two-minute drill, even though none of the questions were answered within two minutes.
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I sort of tried. In this episode, we'll discuss how not to wake up in the middle of the night
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to use the bathroom. I go over my note card system to keep organized, including a list of dumb things
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I like to do, which was initially codified by Tim Ferriss, how to understand scientific studies
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that come out, how to obtain a CGM without a prescription, conversations around blood pressure,
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no tropics, concussions, and CTE, my current exercise routine, and how it can focus on healthspan
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and lifespan, my history with back issues, and my current deadlifting routine. And lastly,
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we end with an update on if the ATIAs got a dog. As a reminder, AMAs are for subscribers only. If you're
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not a subscriber, you'll only be able to hear a preview of the AMA here. If you are a subscriber and
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hearing this, it means you have yet to download our members-only podcast feed. With this members-only
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feed, you'll be able to subscribe to The Drive in your podcast player to get every episode of The
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Drive without the subscriber call-out, plus full episodes of the AMA podcast directly, along with
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other exclusive content. You can learn more about it at peteratiamd.com forward slash members. To become
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a subscriber, to have access to the members-only podcast feed, as well as other benefits such as
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detailed show notes and member-only discount codes and the products I believe in, you can visit
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peteratiamd.com forward slash subscribe. We'll continue to pull these questions from the AMA
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forum, and we encourage all subscribers to participate, ask questions, as we hope to get
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to all of your questions in time through future AMAs. So, without further delay, here is AMA number seven.
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Hi and hello, podcasters, or subscribers, actually. I think most of the subscriber demand is that the
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fact that I'm behind a paywall, so everybody's just clamoring to get more of the Bobatron. Bob
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Kaplan here, Peter Atiyah over there. I think this is AMA number seven, so time flies. Yes?
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Maybe more, because I remember Matt Walker did one, too.
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Oh, that's right. Yeah, it could be the eighth in order. So, I thought we might flip things around a
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little bit. We'll put the system on trial. We'll do the two-minute drill first, and then we'll do a
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couple deep dives, and then maybe you can chuck the ball out of bounds at first on first down,
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and then we can do a deeper dive later in this episode. So, here's the first question. What can I
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do to prevent myself from getting up to pee at night? At the risk of sounding like Captain Obvious,
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the first, second, and third step would be to not drink in the proximity of bedtime. But the second
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step would be not to drink alcohol, because alcohol inhibits a hormone called ADH, the
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antidiuretic hormone, also known as vasopressin. And as the name suggests, if you inhibit the
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antidiuretic hormone, it has the effect of acting as a diuretic. So, alcohol disproportionately
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will drive you to want to pee, which anybody who's ever been at a bar and had too many drinks
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knows. Somehow by the end of that evening, you're like going to the bathroom every 30 minutes or
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something like that. So, just taking more hygiene around how much water or any liquid you drink,
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but in particular being mindful of alcohol, are probably the most important steps.
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Just to cut you off for a second, it sounds trite, but you actually might be able to kill
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two birds with the Captain Obvious stone. A lot of people ask me how to avoid a hangover.
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What I tell them is, don't drink the night before. So, it's another tip right there.
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I love the free tips being infused. So, now for people who are, so let's say someone's gone through
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all the usual, they've done the common sense, like I'm not drinking, you know, I'm doing all
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these things. We have a journal that people can fill out that allows them to keep track of what they
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drink and how much they're voiding and when they're voiding, etc. When you've gone through all the
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usual housekeeping on that stuff, in men in particular, you then want to sort of investigate
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prostate size. So, I mean, you do the same thing with women. They don't have a prostate,
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but you can still do the same sort of exercise, which is called you measure a post-void residual.
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Now, everything I'm now talking about sort of falls in the lens of what you would need to do
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with your doctor. But just to help the listener sort of think about this, the test is you basically,
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they fill a person's bladder with water. So, they put a catheter in, they fill it with water,
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they take the catheter out, and then you go and you void it all. Or they can sometimes just have you
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go and void. And then they do an ultrasound of the bladder to see how much is remaining.
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Because if everything is working correctly, after you void, you should have very little,
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less than 30 cc of urine remaining in the bladder. So, another reason for people to be peeing a lot,
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although this doesn't necessarily just manifest at night, at night it can also manifest during the
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day, is you're not completely emptying the bladder. So, that thing has to be ruled out.
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Now, one thing I've done, and I don't know that I recommend this actually as sort of middle-of-the-road
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play, but you can actually take vasopressin, the hormone. So, back when I used to drink more than
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now, which is to say, now I very rarely drink alcohol at all. But when I was drinking maybe
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two drinks, two to three drinks, one or two nights a week, the impact of that on my need to get up to
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pee was so annoying that I would actually take vasopressin, the hormone, before bed, and then
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override that ability. Like, basically, I didn't have to go to bed. It was like a hack to the system.
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So, you would take like 0.2 milligrams of DDAVP or vasopressin before bed. You have to be a little
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bit careful with that. That's something you really couldn't do without your doctor prescribing it
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because you do run the risk of getting something called hyponatremia with excessive use of
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vasopressin. 0.2 milligrams in a normal person isn't going to remotely cause it. So, it does become
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kind of a neat little trick if you absolutely positively don't want to get up to pee. But not
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withstanding all of the other things I said, those are the things you start with.
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Is hyponatremia the thing people have to worry about with excessive water drinking?
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Yep. It's when sodium concentrations get low enough that you create an osmotic mismatch,
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which is most troubling in the brain. And so, you hear about this, unfortunately, every year,
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at least someone running a marathon is over-hydrating and they're diluting their sodium
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There's also a contest. It was called Hold Your Wee for a Wee. And I think somebody died during
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that contest. It's another little factoid as well.
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Yeah. I had a bunch of questions, I think, in there. So, also, best form of birth control is
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don't have sex. So, second question is, what is your note card system that I think I've heard about?
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This is the one question you told me I'd be asked. So, I even prepared by bringing the note card
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system over here. So, I have this little leather pouch. By the way, those of you listening to this
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on the podcast, this may be reason enough to just go and look at the video. I've been a note card
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taker, carrier for as long as I can remember. Though this leather one, which I got from the
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company, I think they're called Levenger. They make bags and stuff. I've had this one for about
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10 years. So, I use three by five cue cards and they all have different colors to do different
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things. Now, my daily list is the first card. So, these are the things that I
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want to do today. And truthfully, I don't always get everything done on my today card. Probably
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two-thirds of the time, I do go to bed with everything on the daily card done. But if not,
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you will flip it over and then the next day take something there, if it's still relevant,
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and put it on that card along with the next things that need to be done. I then have, and by the way,
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I sometimes use a white card or a green. It's either white or green is always my daily card.
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My pink card is my number two card. And you can see that this was last week. So, I'm like a car,
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I'm cheap with these things. So, it's like I just love the fact that I'm saving money by using both
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sides of it. So, for this week's pink card, I have all of the things that have to be done by Sunday.
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So, every week, I redo the pink card. And as you can see, for all of my things, there's like a
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little square box. And it says next to the thing. So, a lot of the times, it'll be a box with a half
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check through it, which is when I'm partially done with that task. So, the task is fully done when you
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have the two checks through the box. So, I have boxes here that have nothing. I haven't done them
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yet. I have others that have a single hash through, which means it's in progress. And I have others
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that are fully hashed through, which means they're all the way done. I then have my orange card, which
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is, notice this one? To get this color of orange, it has to come on this awful chartreuse stripy color
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on the back, which I don't reuse. This is very patient-specific. So, I have a very patient-specific
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group of things that go on here. The white card, which is different from the white card that I lead
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with because it sits far enough back in the pack, it never gets confused, has all of my long-term
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sort of just random personal things that I don't want to cloud on my weekly list. Although,
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intermittently, things from here will go on the weekly list. So, again, I don't want to read these
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things because they won't make any sense to you. But it's just a bunch of stuff like, oh, you got to
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fix the autoresponder in your email. And, oh, I got to return my rangefinder because it's not working
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very well. And, oh, I need to sync the way this thing works with that thing. It might take me
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two months to get through this list. And that's fine because intermittently, things from this list
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will make it onto the weekly pink list. And obviously, things from the weekly pink list
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intermittently make it onto the green list. Unrelated, my last card is just a place where I keep track of
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stupid things that I like to do. And I don't even know why I carry this. I think Tim Ferriss once
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asked me to make a list of all the dumb things I do. And I started carrying this list around,
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which has like egg boxing, tearing phone books, counting forks and knives, doing my TSA voice,
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playing the what if game, and pretending to be in a little bit of a rush. And every time I think of
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another dumb thing I like to do, it goes on that list. So that is the card carrying system. Obviously,
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highly modifiable. You can do anything you want. That's the beauty of the card system.
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I think I've used it before, too, as well. I have a purple card. It's called my people to kill list.
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Wow. Fans of Billy Madison are on there. Sometimes people are on there and then they get removed
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for good behavior. Next question. And an often repeated question. How do I get smarter in reading
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slash understanding the studies or the media's interpretation of them
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that get the headlines on health and or disease?
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You can find all of this information and more at peteratiamd.com forward slash podcast.
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There you'll find the show notes, readings, and links related to this episode.
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You can also find my blog at peteratiamd.com. Maybe the simplest thing to do is to sign up for my
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the most interesting papers I've read, and all things related to longevity, science, performance,
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peteratiamd. But usually Twitter is the best way to reach me to share your questions and comments.
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