The Peter Attia Drive - #63 - AMA #7： Exercise framework, deadlifting, lower back pain, blood pressure, nootropics, CGM, and more

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

00:00:23.620 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 AMA number seven. I am again joined by my right-hand man, Bob Kaplan. This episode

00:00:49.780 is dubbed the two-minute drill, even though none of the questions were answered within two minutes.

00:00:54.260 I sort of tried. In this episode, we'll discuss how not to wake up in the middle of the night

00:01:00.140 to use the bathroom. I go over my note card system to keep organized, including a list of dumb things

00:01:05.980 I like to do, which was initially codified by Tim Ferriss, how to understand scientific studies

00:01:11.840 that come out, how to obtain a CGM without a prescription, conversations around blood pressure,

00:01:17.840 no tropics, concussions, and CTE, my current exercise routine, and how it can focus on healthspan

00:01:25.420 and lifespan, my history with back issues, and my current deadlifting routine. And lastly,

00:01:31.820 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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00:02:12.780 detailed show notes and member-only discount codes and the products I believe in, you can visit

00:02:16.980 peteratiamd.com forward slash subscribe. We'll continue to pull these questions from the AMA

00:02:22.980 forum, and we encourage all subscribers to participate, ask questions, as we hope to get

00:02:28.020 to all of your questions in time through future AMAs. So, without further delay, here is AMA number seven.

00:02:34.420 Hi and hello, podcasters, or subscribers, actually. I think most of the subscriber demand is that the

00:02:43.920 fact that I'm behind a paywall, so everybody's just clamoring to get more of the Bobatron. Bob

00:02:49.300 Kaplan here, Peter Atiyah over there. I think this is AMA number seven, so time flies. Yes?

00:02:57.080 Maybe more, because I remember Matt Walker did one, too.

00:03:00.080 Oh, that's right. Yeah, it could be the eighth in order. So, I thought we might flip things around a

00:03:04.960 little bit. We'll put the system on trial. We'll do the two-minute drill first, and then we'll do a

00:03:09.800 couple deep dives, and then maybe you can chuck the ball out of bounds at first on first down,

00:03:14.440 and then we can do a deeper dive later in this episode. So, here's the first question. What can I

00:03:19.760 do to prevent myself from getting up to pee at night? At the risk of sounding like Captain Obvious,

00:03:26.740 the first, second, and third step would be to not drink in the proximity of bedtime. But the second

00:03:34.140 step would be not to drink alcohol, because alcohol inhibits a hormone called ADH, the

00:03:42.460 antidiuretic hormone, also known as vasopressin. And as the name suggests, if you inhibit the

00:03:48.700 antidiuretic hormone, it has the effect of acting as a diuretic. So, alcohol disproportionately

00:03:55.720 will drive you to want to pee, which anybody who's ever been at a bar and had too many drinks

00:04:01.260 knows. Somehow by the end of that evening, you're like going to the bathroom every 30 minutes or

00:04:06.020 something like that. So, just taking more hygiene around how much water or any liquid you drink,

00:04:12.540 but in particular being mindful of alcohol, are probably the most important steps.

00:04:16.640 Just to cut you off for a second, it sounds trite, but you actually might be able to kill

00:04:20.040 two birds with the Captain Obvious stone. A lot of people ask me how to avoid a hangover.

00:04:24.680 What I tell them is, don't drink the night before. So, it's another tip right there.

00:04:29.840 I love the free tips being infused. So, now for people who are, so let's say someone's gone through

00:04:35.440 all the usual, they've done the common sense, like I'm not drinking, you know, I'm doing all

00:04:39.280 these things. We have a journal that people can fill out that allows them to keep track of what they

00:04:43.600 drink and how much they're voiding and when they're voiding, etc. When you've gone through all the

00:04:47.740 usual housekeeping on that stuff, in men in particular, you then want to sort of investigate

00:04:52.180 prostate size. So, I mean, you do the same thing with women. They don't have a prostate, 1.00

00:04:56.240 but you can still do the same sort of exercise, which is called you measure a post-void residual.

00:05:00.180 Now, everything I'm now talking about sort of falls in the lens of what you would need to do

00:05:03.800 with your doctor. But just to help the listener sort of think about this, the test is you basically,

00:05:09.060 they fill a person's bladder with water. So, they put a catheter in, they fill it with water,

00:05:12.880 they take the catheter out, and then you go and you void it all. Or they can sometimes just have you

00:05:17.300 go and void. And then they do an ultrasound of the bladder to see how much is remaining. 0.68

00:05:21.200 Because if everything is working correctly, after you void, you should have very little,

00:05:25.380 less than 30 cc of urine remaining in the bladder. So, another reason for people to be peeing a lot,

00:05:32.040 although this doesn't necessarily just manifest at night, at night it can also manifest during the

00:05:36.040 day, is you're not completely emptying the bladder. So, that thing has to be ruled out.

00:05:39.980 Now, one thing I've done, and I don't know that I recommend this actually as sort of middle-of-the-road

00:05:44.960 play, but you can actually take vasopressin, the hormone. So, back when I used to drink more than

00:05:52.300 now, which is to say, now I very rarely drink alcohol at all. But when I was drinking maybe

00:05:57.280 two drinks, two to three drinks, one or two nights a week, the impact of that on my need to get up to

00:06:03.720 pee was so annoying that I would actually take vasopressin, the hormone, before bed, and then

00:06:09.100 override that ability. Like, basically, I didn't have to go to bed. It was like a hack to the system.

00:06:13.360 So, you would take like 0.2 milligrams of DDAVP or vasopressin before bed. You have to be a little

00:06:20.100 bit careful with that. That's something you really couldn't do without your doctor prescribing it

00:06:23.640 because you do run the risk of getting something called hyponatremia with excessive use of

00:06:28.740 vasopressin. 0.2 milligrams in a normal person isn't going to remotely cause it. So, it does become

00:06:33.600 kind of a neat little trick if you absolutely positively don't want to get up to pee. But not

00:06:38.380 withstanding all of the other things I said, those are the things you start with.

00:06:41.700 Is hyponatremia the thing people have to worry about with excessive water drinking?

00:06:46.020 Yep. It's when sodium concentrations get low enough that you create an osmotic mismatch,

00:06:51.720 which is most troubling in the brain. And so, you hear about this, unfortunately, every year,

00:06:56.320 at least someone running a marathon is over-hydrating and they're diluting their sodium

00:07:01.020 concentration too much.

00:07:02.380 There's also a contest. It was called Hold Your Wee for a Wee. And I think somebody died during

00:07:07.320 that contest. It's another little factoid as well.

00:07:10.600 All right.

00:07:11.140 Yeah.

00:07:11.600 I probably went over two minutes there.

00:07:12.880 Yeah. I had a bunch of questions, I think, in there. So, also, best form of birth control is

00:07:17.500 don't have sex. So, second question is, what is your note card system that I think I've heard about?

00:07:25.140 This is the one question you told me I'd be asked. So, I even prepared by bringing the note card

00:07:30.080 system over here. So, I have this little leather pouch. By the way, those of you listening to this

00:07:36.180 on the podcast, this may be reason enough to just go and look at the video. I've been a note card

00:07:41.300 taker, carrier for as long as I can remember. Though this leather one, which I got from the

00:07:47.920 company, I think they're called Levenger. They make bags and stuff. I've had this one for about

00:07:52.540 10 years. So, I use three by five cue cards and they all have different colors to do different

00:08:00.240 things. Now, my daily list is the first card. So, these are the things that I

00:08:06.000 want to do today. And truthfully, I don't always get everything done on my today card. Probably

00:08:13.900 two-thirds of the time, I do go to bed with everything on the daily card done. But if not,

00:08:20.780 you will flip it over and then the next day take something there, if it's still relevant,

00:08:25.740 and put it on that card along with the next things that need to be done. I then have, and by the way,

00:08:29.900 I sometimes use a white card or a green. It's either white or green is always my daily card.

00:08:34.580 My pink card is my number two card. And you can see that this was last week. So, I'm like a car,

00:08:40.160 I'm cheap with these things. So, it's like I just love the fact that I'm saving money by using both

00:08:44.720 sides of it. So, for this week's pink card, I have all of the things that have to be done by Sunday.

00:08:52.000 So, every week, I redo the pink card. And as you can see, for all of my things, there's like a

00:08:58.040 little square box. And it says next to the thing. So, a lot of the times, it'll be a box with a half

00:09:05.960 check through it, which is when I'm partially done with that task. So, the task is fully done when you

00:09:10.920 have the two checks through the box. So, I have boxes here that have nothing. I haven't done them

00:09:17.040 yet. I have others that have a single hash through, which means it's in progress. And I have others

00:09:23.040 that are fully hashed through, which means they're all the way done. I then have my orange card, which

00:09:28.260 is, notice this one? To get this color of orange, it has to come on this awful chartreuse stripy color

00:09:35.540 on the back, which I don't reuse. This is very patient-specific. So, I have a very patient-specific

00:09:40.900 group of things that go on here. The white card, which is different from the white card that I lead

00:09:46.320 with because it sits far enough back in the pack, it never gets confused, has all of my long-term

00:09:52.360 sort of just random personal things that I don't want to cloud on my weekly list. Although,

00:09:59.400 intermittently, things from here will go on the weekly list. So, again, I don't want to read these

00:10:04.140 things because they won't make any sense to you. But it's just a bunch of stuff like, oh, you got to

00:10:08.720 fix the autoresponder in your email. And, oh, I got to return my rangefinder because it's not working

00:10:14.140 very well. And, oh, I need to sync the way this thing works with that thing. It might take me

00:10:20.120 two months to get through this list. And that's fine because intermittently, things from this list

00:10:27.300 will make it onto the weekly pink list. And obviously, things from the weekly pink list

00:10:31.560 intermittently make it onto the green list. Unrelated, my last card is just a place where I keep track of

00:10:37.900 stupid things that I like to do. And I don't even know why I carry this. I think Tim Ferriss once 0.75

00:10:42.360 asked me to make a list of all the dumb things I do. And I started carrying this list around, 0.98

00:10:48.040 which has like egg boxing, tearing phone books, counting forks and knives, doing my TSA voice,

00:10:54.020 playing the what if game, and pretending to be in a little bit of a rush. And every time I think of

00:10:58.640 another dumb thing I like to do, it goes on that list. So that is the card carrying system. Obviously, 0.94

00:11:05.740 highly modifiable. You can do anything you want. That's the beauty of the card system.

00:11:10.500 I think I've used it before, too, as well. I have a purple card. It's called my people to kill list.

00:11:14.940 I hope I'm not on that list.

00:11:16.700 Wow. Fans of Billy Madison are on there. Sometimes people are on there and then they get removed

00:11:20.760 for good behavior. Next question. And an often repeated question. How do I get smarter in reading

00:11:27.500 slash understanding the studies or the media's interpretation of them

00:11:31.060 that get the headlines on health and or disease?

00:11:36.440 You can find all of this information and more at peteratiamd.com forward slash podcast.

00:11:41.700 There you'll find the show notes, readings, and links related to this episode.

00:11:45.820 You can also find my blog at peteratiamd.com. Maybe the simplest thing to do is to sign up for my

00:11:51.480 subjectively non-lame once a week email where I'll update you on what I've been up to,

00:11:55.640 the most interesting papers I've read, and all things related to longevity, science, performance,

00:12:00.800 sleep, etc. On social, you can find me on Twitter, Instagram, and Facebook, all with the ID

00:12:06.160 peteratiamd. But usually Twitter is the best way to reach me to share your questions and comments.

00:12:11.400 Now for the obligatory disclaimer. This podcast is for general informational purposes only and does

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00:12:41.200 condition they have and should seek the assistance of their health care professionals for any such

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00:12:59.580 Thank you.

The Peter Attia Drive - July 22, 2019

#63 - AMA #7： Exercise framework, deadlifting, lower back pain, blood pressure, nootropics, CGM, and more

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