The Peter Attia Drive - #80 - Celebrity AMA #1： Fasting, rapamycin, performance vs. longevity, 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

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00:00:41.400 Welcome to a special bonus ask me anything episode and what we are likely to call celebrity AMA number

00:00:48.040 one. In this and future celebrity AMA bonuses, instead of being asked questions by my head

00:00:53.340 research analyst, Bob Kaplan, I'll be asked questions by guests, either future guests,

00:00:57.760 special guests, or just other guests on the podcast. So for celebrity AMA one, I'm joined

00:01:02.680 by Olympians, Apollo Ono and Sasha Cohen. In this episode, we talk about fasting. We talk

00:01:08.900 about the role of nutrition during periods of study. And this is prompted by something that

00:01:14.020 Apollo is about to embark on. We talk about exercise, the ultimate gorge or feast meal.

00:01:19.060 And we talk about watches, which really I think was the question I struggled with the most.

00:01:23.020 From there, Sasha takes over and she asks me about things that excite me the most in longevity. We

00:01:29.100 talk about mTOR and rapamycin, how to measure results when you're doing a lot of interventions,

00:01:34.980 blood tests and supplements, along with a few other things.

00:01:37.960 As a reminder, AMAs are for subscribers only. If you're not a subscriber, you'll only be able to

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00:02:09.400 subscriber, to have access to the members only podcast feed, as well as other benefits, such

00:02:13.640 as detailed show notes and member only discount codes and the products I believe in. You can visit

00:02:17.980 peteratiamd.com forward slash subscribe. We'll continue to pull these questions from the AMA

00:02:23.980 forum, and we encourage all subscribers to participate, ask questions as we hope to get to all of your

00:02:29.640 questions in time through future AMAs. So without further delay, I hope you enjoy Celebrity AMA number

00:02:34.940 one. I'm Apollo Ono, eight-time Olympic medalist. Spent about 15 years of my life previously pursuing

00:02:44.160 the sport of short track speed skating, and I have the pleasure of doing a AMA with Peter Attia,

00:02:50.580 my good friend, and I've got some interesting questions here, and hopefully you haven't answered

00:02:55.140 all of them before in the past. I'd try to do as much due diligence as I could. Would love to

00:02:59.420 expand upon some of these further, so thanks for having me on, Peter, to interview you.

00:03:03.000 You're having me on, so take it away, man.

00:03:06.780 Yeah, let's jump right in. So my first question is centered around women and fasting, and to give

00:03:13.600 some context, my girlfriend, she has a very difficult time doing water-only fasts. Gets dizzy,

00:03:20.860 feels like she needs some sort of sugar, some kind of, just anything, any type of caloric intake,

00:03:25.700 and where I can do seven-plus days, kind of no problem most of the time. So what is the difference

00:03:31.520 here, and is there a separate protocol that you've seen for maybe perhaps clients who are female?

00:03:36.280 I have definitely noticed over the past few years that even when it comes to time-restricted

00:03:41.740 feeding, so not even getting to the point of a fast, but just saying not eating for 18 hours a day,

00:03:47.380 that there appears to be a gender difference. I can sort of concoct a bunch of evolutionary 0.95

00:03:51.740 answers that may or may not be true. Certainly one of the ones I'll come back to if we have a

00:03:57.220 moment is to talk about the impact of fasting on fertility in women. So my point being is I

00:04:02.640 definitely appreciate what you're saying, and we see it clinically with our patients. Now that said,

00:04:06.880 I also have seen many female patients who can fast independent of body habitus, because obviously 1.00

00:04:11.540 Bianca is tiny, and maybe that plays a role, but I don't think that that's it, because I think

00:04:15.960 there might be something else going on. So I think, I don't know the answer, but what I would say is

00:04:20.000 it might just mean that for some people they need more time to work up to a fast, which means longer

00:04:25.100 stretches of time-restricted feeding. And then what we would typically do is progress patients

00:04:29.920 through something as follows. So once a person can pretty consistently go 18 hours with a six-hour

00:04:35.140 feeding window, you then move to one meal per day. Can she do one meal per day? 1.00

00:04:40.040 Absolutely.

00:04:40.620 And in the afternoon she feels totally fine?

00:04:42.380 No problem.

00:04:42.860 Okay. So then the next thing I typically try is a 36-hour fast, where you'll do like dinner Monday,

00:04:47.680 lunch, breakfast, Wednesday. So you go a night, and then a full day, and then into the next day.

00:04:54.280 Is that something she's tried?

00:04:55.580 Yeah. She can do the 48-hour fast. Anything past, I would say, 72, really difficult for her.

00:05:01.480 She just is not able to physically, basically can't leave the house.

00:05:04.800 Is she experiencing lightheadedness, cramps?

00:05:08.740 No cramps, but definitely lightheadedness, severe lack of energy, and just doesn't have

00:05:14.380 the cognitive ability to do anything that would require semi-deep thought.

00:05:18.460 Yeah. Again, it's hard to know. I mean, does she check her glucose and ketone levels all the

00:05:22.700 way through this?

00:05:23.540 No.

00:05:24.660 Sometimes that provides a bit of an insight. You and I have talked about this a bunch, but

00:05:28.480 I find going into ketosis the week before makes that transition a lot easier.

00:05:32.780 So much easier.

00:05:33.340 And I've sometimes done the exact opposite and gone right into a fast out of a bender. 0.98

00:05:37.880 And that's, I mean, you'll pay the fiddler all day long.

00:05:40.880 The other thing that I think is important for everybody to understand is, one, I'm glad

00:05:44.120 to hear that when she feels that way, she stops. Because I do think it's important for people

00:05:47.520 to not hammer through fasts no matter what. You can, quote unquote, fail at a fast 99 times

00:05:52.680 and come back on the 100th and be successful. And in my mind, they're all successful. So I think

00:05:57.300 it's really important that people get it through their mind that, hey, if this isn't feeling

00:06:01.120 right or going right, I stop and I eat again. The second thing is a lot of people don't realize

00:06:06.380 how much food contains water. So when you're not eating, you have to make up that water that

00:06:12.140 you're not getting from food in addition to what you think you normally would need to

00:06:15.300 drink. So if you're a person who normally gets by sort of drinking, call it four liters

00:06:19.240 of water a day, say a gallon of water, you're going to need more than that for two reasons.

00:06:23.520 The first is when you're fasting, your body is typically excreting sodium at a higher

00:06:27.240 rate. So that's creating what's called a diuresis. 0.52

00:06:30.120 So you have to compensate for that. And then you also have to compensate for the fact that

00:06:33.180 you're not getting the water in the food. So that might be the other thing to think about.

00:06:37.160 And the easiest way, I mean, there's some technical ways that one can sort of measure

00:06:40.480 the volume balance. But honestly, just looking at urine output is a great way to do it. I mean,

00:06:44.660 when I'm fasting, one of the things I'm thinking about is how often am I going to the bathroom?

00:06:48.340 If I don't get up to pee about every 90 minutes, I'm not drinking enough.

00:06:52.040 Got it. That's great.

00:06:53.280 The other thing, by the way, is she a caffeine drinker normally?

00:06:55.580 She's not.

00:06:56.200 Okay. Because that's the other thing that you always want to think about in people is sometimes when

00:06:59.820 they stop caffeine as well, the one-two punch of no food, no caffeine can be really devastating.

00:07:04.600 And in those patients, I generally think it makes sense to probably allow them to continue

00:07:08.860 to drink black coffee or high caffeine tea or whatever to sort of pick and choose your battle.

00:07:13.440 Okay. Thank you for that.

00:07:15.100 Let's move to number two. 0.96

00:07:15.880 So my other question is, you have kids. So what are your thoughts on adolescent fasting? And is there

00:07:22.380 a place for it routinely? I.e., do you think that in 20 years, it'll be a regular part 50 years of

00:07:29.560 a curriculum or a dietary program? So I'm talking mid-teen to late-teen.

00:07:35.000 Boy, that's an interesting question. And it really depends, I suspect, on the health of the child.

00:07:40.220 So there are probably certain situations where it could make sense. Unfortunately, today we're in

00:07:45.640 kind of an epidemic of obesity, type 2 diabetes, non-alcoholic fatty liver disease amongst kids

00:07:51.020 and adolescents. And certainly in kids with metabolic conditions, under the right supervision,

00:07:58.000 I think one could make the case that some form of fasting, whether it be time restriction feeding

00:08:02.040 or even hypocaloric periods of time, for example, several days at a time with an energy input that's

00:08:09.260 below requirement could have enormous medical benefit. But at the same time, one has to be

00:08:14.140 very careful about threading this needle because they're still basically supposed to be in anabolic

00:08:19.160 mode. A 14-, 15-, 16-year-old adolescent is still growing. And so a lot of times doctors who take care

00:08:25.680 of kids that age that have obesity have a different goal, which is not weight loss per se,

00:08:30.980 but actually weight stability. So let them grow into this weight. Now that's a bit of a sort of

00:08:36.740 hokey concept because as an athlete, you'll appreciate that weight is not really the issue.

00:08:41.900 The issue is fat mass versus muscle mass. And in the end, what we're talking about is potentially

00:08:47.460 a treatment for excessive fat mass. The other thing, of course, that has to be really considered

00:08:53.800 is I do believe, and I don't have great evidence to suggest this, this is really based on

00:08:59.020 discussions with endocrinologists, my own personal experience in interacting with patients that have

00:09:04.100 had eating disorders. But I think there is a critical window during which deprivation of food

00:09:09.840 can be potentially harmful. And I think that's why I've certainly seen a subset of people who have

00:09:14.880 had disordered eating or eating disorders during adolescence, and it has sort of imprinted their

00:09:21.460 endocrine system in a way that's come back to haunt them as an adult. So kind of a long-winded

00:09:25.220 answer, which is to say, I think we don't know the safety of that yet. My view is that

00:09:30.420 unless you're an adult, really, this isn't something that should be considered as a regular

00:09:34.340 part of how you eat. But that's also acknowledging the fact that I know evolutionarily it's tolerated

00:09:39.940 because obviously we came from our ancestors who, whether they be children or adults, would have

00:09:46.140 gone through periods of time without food. So yeah, I don't know. I think this should be studied

00:09:51.180 though, because it's important and I wouldn't want to just speculate from or extrapolate rather from

00:09:55.320 adults. Okay.

00:09:56.600 That's a long list, man. That is a lot of questions I'm looking at over there, dude. You went whole

00:10:00.960 hog on this. Holy cow. You took it seriously.

00:10:03.400 And I apologize, everyone who's listening. Some of these are selfishly because I just really want to

00:10:07.120 know for myself. And speaking of that, I'm going back to school this fall.

00:10:11.340 Wait, I didn't know this.

00:10:12.280 I did know this. Yeah, yeah. So I'm doing this program at Wharton this fall.

00:10:15.180 Okay, that's what I was asking you about because I thought you were going to be in Philly this week.

00:10:18.640 Basically in a couple of weeks. Oh, all right. So in lieu of that, what is your preferred diet

00:10:24.540 for consuming large amounts of information, retaining it while still being alert? Because

00:10:30.160 the influx of information and critical thinking is going to be at an all-time high for me

00:10:35.140 for approximately eight weeks straight.

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00:11:00.940 and all things related to longevity, science, performance, sleep, et cetera.

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The Peter Attia Drive - November 18, 2019

#80 - Celebrity AMA #1： Fasting, rapamycin, performance vs. longevity, and more

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