369 ‒ Rethinking protein needs for muscle and longevity, and the benefits of creatine & sauna use

1. 0:00 – 7:12

   0:00:11-Why the current protein RDA is too low

   1. PAPeter Attia0:00

      [upbeat music] Hey everyone, welcome to the Drive podcast. I'm your host, Peter Attia. Rhonda, so great to see you, and I didn't realize until a few minutes ago that the last time we spoke it was virtual.

   2. RPRhonda Patrick0:16

      Yeah. Good to see you. We go back a long way.

   3. PAPeter Attia0:20

      You're still in the, in the same, our same former neighborhood in San Diego.

   4. RPRhonda Patrick0:24

      I know. And I'm thinking that, you know, you found the same feeling here in Austin.

   5. PAPeter Attia0:29

      Yeah, we did. Um, all right. Well, there's a lot we want to chat about today, and I'm a little hesitant to say this, but I do feel like reluctantly we need to have one more discussion about, uh, a, a particular macronutrient that seems to get a lot of attention lately. And, um, I, I don't necessarily want to talk about this because I think it's especially interesting, um, or even, uh, to which there's some new study that we need to shed light on. But it does seem to remain somewhat surrounded in some controversy, um, which I will refrain from publicly speculating on why said controversy exists, although privately I'm very happy to speculate on all the reasons for it. So with that said, let's talk about protein.

   6. RPRhonda Patrick1:17

      Let's do it. I do think it's an important topic. You know, you and I have probably talked to all the world's experts on protein and, you know, we were chatting a moment ago about this recommended daily allowance for protein, the so-called RDA. And really what it should be called is the minimal daily allowance in all, I would say. Uh, it, it, recommended almost sounds like optimal in a way.

   7. PAPeter Attia1:47

      Yeah.

   8. RPRhonda Patrick1:48

      Like I think people confuse that with the optimal amount of protein, right? So it's kind of tricky. Um, and I think that's an important place to start because of that reason, where this amount, which is 0.8 grams per kilogram body weight per day, is the RDA for protein, right? And I know that you've probably had countless experts on talking about this. I've had experts on talking about this, Stu Phillips being one. There's so many different publications that, I mean, people can start off by reading one of them here, uh, by Stu Phillips, Perspective: Protein Requirements and Optimal Intakes in Aging. Are We Ready to Recommend More Than the Recommended Daily Allowance? And there's several of these out there, okay? I'm just, this is just one. And essentially if you, if you have the time and the willingness to go into the scientific literature and actually read something for yourself or listen to the Drive or listen to my podcast and the actual experts talking about it, what you will hear or what you will learn is that a lot of the studies that were done to determine this RDA were flawed. Um, they were called nitrogen balance studies, and for many reasons they're flawed. I can't, I don't want to get into all the technical reasons, but for one, you know, what they are doing is measuring the amount of nitrogen that is excreted in urine after you are metabolizing protein, right? And some of the flaws that are I would say the most important here are that different types of foods that have protein in them have different nitrogen to protein ratios. They're collecting urine in which the, you know, the, the case is is that it's an incomplete collection. I mean, like when you pee in one of those cups, like you don't get all the urine. It's incomplete con- co- uh, collection. And so essentially what's happened-

   9. PAPeter Attia3:36

      And, and we lose nitrogen through other means-

   10. RPRhonda Patrick3:38

       Exactly

   11. PAPeter Attia3:38

       ... that is not just urine.

   12. RPRhonda Patrick3:39

       Sweat. Yes, exactly. We lose the nitrogen through other means. And so essentially the signal-to-noise ratio is pretty low, and ultimately what like countless experts have now agreed upon is that the protein for the RDA has been underestimated because of those reasons. And there have been new studies that have been done. These have been like more stable isotope studies. The major isotope that's used is the l1-three carbon labeling phenylalanine, in which case these studies take a small cohort of people, give them a known amount of protein with that isotope tracer, and then that, um, tracer is oxidized when it's, you know, metabolized, and that's measured through breath, the oxidation of phenylalanine, right? And so now you're getting a quantification that's much more accurate in terms of your protein, you know, steady state and turnover, right? And so the whole point here is that you're trying to figure out the minimal amount of protein you need to take in every day to make sure that you're not in a negative protein balance. Why is that important? Well, that's important because we don't store amino acids, right? We don't store amino acids like we store fatty acids as triglycerides or we store glucose as glycogen, right? The major source of our amino acid storage tank, so to speak, is our muscle, skeletal muscle tissue, and you don't want to be pulling from that skeletal muscle tissue to get amino acids every day. Why do we need amino acids every day? Because everything in our body requires proteins. Proteins are doing all the work in our body, and proteins are made up of amino acids. And so we have to be giving ourself an intake, um, daily intake of amino acids to make sure we able, we're able to do all those functions, right?

   13. PAPeter Attia5:20

       Just want to state that again because I, I do think there's a very important and fundamental, um, point here that, that is, is glossed over when we talk about it because we take it for granted, like if we studied biochemistry, and anybody who's, you know, studied biochemistry will know this, but we can store fat in unlimited quantities, right? So if you deprive a person of fat calories for a period of time, they have a long reservoir that they can dig into. Not indefinitely, but they can. We can store carbohydrates. Now, we can't store them quite as much because, you know, we only have so much glycogen we can store in the muscle and in the liver, but when we break down fat, we keep making the substrate to actually make glucose, so we get into a nice little rhythm. But to your point, the only place that an amino acid sits in residence in our body is in the muscle. Therefore, if we even get near the edge where we are not getting sufficient intake of amino acids, we don't have a buffer. We don't have a rainy day fund that we can dip into. We immediately start to catabolize or break down muscle. Now, I don't think we have to make the case that that's a bad idea, but for the sake of completeness, we should state there is not really a single scenario I can think of that is clinically relevant where it would be desirable to give up muscle mass. You know, maybe if you're Mr. Olympia, you can sacrifice muscle mass, but for you and me, and I think everybody listening to us, giving up muscle mass because we are falling short on our protein intake would be a strategic error and an unforced error.

   14. RPRhonda Patrick6:59

       Exactly. I mean, for short-term and long-term health. So I mean, I think that's pretty clear. And, and that's where, you know, it come... This, this RDA not being enough is a very important point

2. 7:12 – 11:46

   The case for raising the protein RDA by at least 50%

   1. RPRhonda Patrick7:12

      because if we look at the actual... So let me go back to this isotracer, isotope tracer studies. Those multiple studies, okay, multiple studies, as you know, have shown that the minimum-

   2. PAPeter Attia7:23

      And we'll link to these in the show notes, by the way, just so that people can go and actually look at the papers-

   3. RPRhonda Patrick7:28

      Yes

   4. PAPeter Attia7:28

      ... as opposed to reading about it on social media.

   5. RPRhonda Patrick7:30

      Right. Sounds good. Um, multiple of these papers have shown that, you know, really going up to more like 1.2 grams per kilogram body weight per day is what is needed to prevent people, us, adults, from being in this negative protein balance. That's quite a bit more than the 0.8 grams per kilogram.

   6. PAPeter Attia7:49

      50% more.

   7. RPRhonda Patrick7:50

      Right. It's 50% more. So like most of the studies done, isotro- uh, isotope tracer studies are between 30 to 50% more. So that's really important because, um, if we look at the actual protein intakes of adults, you know, these are nutritional surveys that are done. Of course, they're all flawed. We can talk about... I mean, we all know the, the, the flaws of questionnaires and... But let's just talk about, like, what we think people are actually taking in. Adults are mostly taking in, all adults are taking in about 0.9 grams per kilogram body weight per day of protein, so pretty close to what that RDA is, not what it should be, right? Older adults, um, if we look at the gender, male versus female, males are taking in about 0.9 grams per kilogram body weight. Females are taking in 0.8, so they're, they're really just hitting that, what we call RDA, which now we have established is not enough. The RDA is not enough to not, to basically be in a, a net protein balance. So that's really important, and that's essentially s- telling us that most adults are walking around without being in a good, you know, in steady state protein balance, right? So they're in-

   8. PAPeter Attia8:55

      So, so here's an interesting question, Rhonda. So we know the rates at which muscle mass, skeletal mass, um, are declining by decade in an aging population. Um, is there any way we can estimate... I'm guessing the answer is no, but on the off chance you would know. Is there any way we can estimate what percent of that decay is simply being driven by, uh, insufficient amino acid consumption versus other factors, right? Other factors would be anabolic resistance associated with aging. Other factors would be anabolic resistance associated with sedentary behavior. Other factors would be lack of sufficient resistance training. Like, there are many factors that explain clearly the fact that as a person goes from 50 to 60 to 70, on average, they're losing muscle mass. But it would be interesting to consider how much of that is explained by the fact that they are also barely skirting the minimum amount of nitrogen that they need, and in many cases falling below it.

   9. RPRhonda Patrick9:55

      Right. I... So to answer your question, I don't know that there's a direct way to do that, but I do know that there are studies that have shown that when older adults, so older adults, like, that are really more susceptib- susceptible to the things that you were saying like anabolic resistance, um, where people are basic- where your muscle tissue is not as sensitive to amino acids because of, mostly because of phys- physical inactivity, which increases with age. Um, but when older adults take in 1.2 grams per kilogram body weight per day of protein, it, it nearly eliminates, um, some of the age-related muscle loss that happens. So I think that is some evidence to sort of support what you were saying in that if you just increase your protein intake to what this minimum-

   10. PAPeter Attia10:40

       By 50%. Yeah.

   11. RPRhonda Patrick10:41

       Yeah, by 50% to this minimum what the RDA should be, 1.2 grams per kilogram body weight per day. I think that's pretty much what most all the experts agree is that, like, it's time to change that RDA to that number, right? The minimal amount that you need per day. If we just do, if older adults just do that, they're, they're actually preventing a lot of the age-related loss in muscle that occurs. And we also know that, um, w- older women, if they take in that amount of 1.2 grams per kilogram body weight per day, they're 30% less likely to have frailty in old age, which is also very important, right? So I think that's pretty good evidence that it's clear that just increasing your protein intake by 50% is really important for aging, right? For our muscle, for our muscle health, and also is getting us out of that net negative state that we're in. So I mean, I know we're gonna-

   12. PAPeter Attia11:30

       So, so step one is we should move the floor from 0.8 to 1.2.

   13. RPRhonda Patrick11:35

       Yes. I think the floor being the minimal amount of protein that we need to take in per day. This is not optimal. We're gonna get into optimal, right? This is just, like, the new RDA, right? And,

3. 11:46 – 18:40

   Anabolic resistance: why inactivity—more than aging—blunts the body’s response to protein

   1. RPRhonda Patrick11:46

      and as you mentioned, so you kind of hit on this anabolic resistance, and I think that's also a really, really important point because it does compound with the fact that we're already not getting enough protein to, to, to, to be in a, a positive state of protein balance, and then you compound that with anabolic resistance, right? Now, anabolic resistance is when your muscle pot- tissue becomes less sensitive to amino acids, and so you're not making as much muscle protein synthesis, isn't occurring as much as it does when you're younger. I think it's pretty consensus now that a lot of anabolic resistance is not necessarily aging, the aging process per se, so much as-

   2. PAPeter Attia12:28

      Inactivity

   3. RPRhonda Patrick12:28

      ... inactivity.

   4. PAPeter Attia12:29

      Yeah, and the experiment that Luke Von Loon shared when he was on the podcast I think was an, a very elegant way to do this, which is, um, they took, uh, young subjects. I don't remember if they were in their 20s, but it was thereabouts. M- maybe in their 30s. So cl- very young subjects, and they put a cast on one leg, no cast on the other, and they left them in this state for a period of time. Again, the details have now completely escaped me, but the, the point is, has not escaped me, which is after whatever period of time the individuals were casted on one leg, not casted on the other, let's just say it was two weeks, four weeks, something to that effect, they removed the cast. Uh, of course, while the person was casted, the casted leg did nothing. The other leg continued to go through exercises. They were doing just single leg, you know, leg extensions, leg curls, things like that. They then ran the stable isotope experiment in these individuals and looked at muscle protein synthesis rates, and lo and behold, the individual, the leg that was uncasted, perfectly normal. The other one, significant anabolic resistance. So to me, that's the clearest demonstration that inactivity is the main culprit. There's probably an all things equal age-related component as well. Um, but I suspect that inactivity is playing a larger role than aging per se.

   5. RPRhonda Patrick13:44

      I totally agreed. Um, yeah, I think there was, there's also another study that was done in older adults. So first of all, if we, if we look at... Maybe we should talk about-

   6. PAPeter Attia13:54

      Can we explain what anabolic resistance is?

   7. RPRhonda Patrick13:55

      Yes.

   8. PAPeter Attia13:55

      It's worth-

   9. RPRhonda Patrick13:55

      Yeah

   10. PAPeter Attia13:55

       ... I think it's worth people understanding why this idea matters.

   11. RPRhonda Patrick13:58

       Yeah. Anabolic resistance. So, so our, when we eat protein, right, we, we're breaking down amino acids and, you know, the primary amino acid that is, that is anabolic is leucine, right? So these amino acids like leucine are getting into the muscle tissue, and that is instigating, it's a signal to increase muscle protein synthesis, right? So you're making more mus- you're making more protein in your muscle, and that in, in turn increases muscle hypertrophy, right? Um, the other major, major signal to do that is mechanical force, right? So that would be the resistance training, the work- working of the muscles. So as we get older, our, our muscles do become less sensitive to those amino acids, like s- the leucine transporter being one of the major ways. Um, but I think there's others as well. And so what happens is, is that for the same amount protein dose, and this study has been done. And if you compare younger adults and older adults, 65 years age and older, you give them the same exact protein dose. The older adults are, have like... So I guess I'll, let me say it the other way. The younger adults have twice as much-

   12. PAPeter Attia15:05

       Yep

   13. RPRhonda Patrick15:05

       ... um, muscle protein synthesis, and for the older adults to get the same amount of muscle protein synthesis, they had to double their amount of protein to get the same amount of muscle protein synthesis as the younger adults. That's a lot. They had to double that amount of protein, okay? So, um, and that's because, again, you need, it's just your, your muscle tissue's not as sensitive to the amino acids. And so to get more of them in, you have to increase your intake of protein. Um, now to your point about physical activity being the major driver here, it's, I think that's 100% I agree. I think it's totally true, and there's so much evidence out there to, to prove that, Luke Van Loon's study being one. But also older adults that do engage in resistance training have the same anabolic response to the same amount of protein as younger adults. So in other words-

   14. PAPeter Attia15:51

       The activity makes up for it.

   15. RPRhonda Patrick15:53

       It does.

   16. PAPeter Attia15:53

       Yeah.

   17. RPRhonda Patrick15:53

       You don't have to, as you're aging, as you be- if you're a 65, s- 70-year-old male listening to this episode and you're engaging resistance training, you're likely not experiencing much anabolic resistance. Maybe a little, but not much. And so you don't necessarily have to experience it if you are physically active and training, and that's really the bottom line here. That's the most important thing. If there's a public health, health message, you know, in this episode, it really is you should be training.

   18. PAPeter Attia16:22

       Yeah, and think about the impact that physical training has on insulin resistance as well. Completely different mechanism of action. Uh, probably ties in more to, you know, uh, fatty acid accumulation within muscles and all sorts of other things that lead to it. But again, the most effective remedy is physical activity.

   19. RPRhonda Patrick16:40

       Right.

   20. PAPeter Attia16:41

       Um, and again, this is, yeah, I mean it's just, it's been demonstrated so conclusively that actually nobody really talks about it. It's just taken for granted.

   21. RPRhonda Patrick16:48

       No, it's a good point. Um, but you know, so, so the anabolic resistance, i- if we're, if we're, if we're talking about like general population, and again, we're going back to these surveys that are done looking at how physically active are people, 'cause those numbers are out there, right? We know that generally speaking, adults, including young and old adults, about 32% of them engage in resistance training.

   22. PAPeter Attia17:10

       How much?

   23. RPRhonda Patrick17:11

       32, and both young and old.

   24. PAPeter Attia17:14

       Hm.

   25. RPRhonda Patrick17:14

       If you just look at older adults, it's 22% of the population.

   26. PAPeter Attia17:18

       Hm.

   27. RPRhonda Patrick17:18

       So essentially, most older adults, most people are not engaging in resistance training. They're not, they're not doing resistance training, right? Um, and physical a- physical activity kind of mirrors a little bit those numbers, but I think the bottom line here is that most peop- putting in the effort, it's harder for people. Putting in the effort is harder. It's easier for them to just increase putting something in their mouth. That's why pills are so popular, right? I mean, people always kind of gravitate towards the easier thing to do, which is like, "I'm gonna eat something. I'm gonna put something in my mouth," versus like putting in the effort. It's unfortunate, but it's like it's a reality. And so I think that even just going back to this RDA being too low, it's just so important. It's so important because people are out there thinking they're getting enough protein, older adults, younger adults. It's really more important with older adults. You have a little bit of wiggle r- room when you're younger, right? But I mean... And then on top of that, first of all, it's not enough protein, and then this anabolic resistance is setting in, and most people are not being Active, they're not engaging in resistance training. So there's all these compounding factors that's really just digging into their muscle. It's taking away, this like insidious sort of taking away each year, each year, and then the next thing you know, you're frail, you have sarcopenia, you know.

   28. PAPeter Attia18:39

       Yeah, I, I,

4. 18:40 – 24:46

   How sarcopenia develops & the profound effect of frailty on quality of life

   1. PAPeter Attia18:40

      I-- my patients are obviously, um, indoctrinated into this, but I'm a bit surprised that there aren't more people that talk about this. You do a lot, um, but the, the medical system doesn't seem to talk enough about frailty and sarcopenia. It, um, and, and I worry that even when I wrote Outlive, I didn't do enough of a job emphasizing it. I mean, I certainly talked about it, but when I talked about four horsemen, I talked about cardiovascular and cerebrovascular disease, cancer, neurodegenerative and dementing diseases, and metabolic disease. Because of course, those are the things that are the main assault on your lifespan. Um, and relative to those, frailty is not as big as, as big an assault on lifespan. It is, as you know, the risk of falls are enormous, and the mortality is very high once you're north of 75. But relative to those four, it's, you know-- I had to pick four horsemen, I didn't want to go with five. But when you think about quality of life, which most people care about at least as much, if not slightly more than length of life, I think frailty just kind of wins the day. Um, I, I think along with cognitive health, right, and, and minimizing too much cognitive decline, frailty is the thing that seems to determine the quality of your final decade on this earth. And here we have lots of great tools, both in terms of training and nutrition, that can offset that. Um, and yet it is surprising that, that despite the fact that most people have witnessed it. That's the part that's amazing to me. It's not like the people who are suffering from frailty and sarcopenia are out of sight because they're our parents and our grandparents. We've watched it. We've been to the movie over and over and over again. We see how it goes. And yet somehow we either don't think it's going to happen to us, or it somehow still seems abstract because it's so many years off. I mean, what, what's your take on this overall challenge?

   2. RPRhonda Patrick20:37

      I, I mean, well, for one, I think that I, I completely agree with the frailty risk being as important, if not more. And, you know, witnessing it with like family members, you know, it's, it, I-- what, what I think it is, is that it's like this incremental thing, right? Where something happens to, like maybe there's a fall, or maybe there's just a surgery, a planned surgery, or a hip replacement or a knee replacement. And p- and your, your, your parents or your grandparents are inactive for many weeks, and they lose a lot of muscle mass, right? So they, this, this happens when you're youn- if this is, if this is a younger person, it's much easier to gain back that muscle mass, right? It's not the same with an older adult. It's just not the same. Even if you're engaging in resistance training after, it's, you're not gonna get the same amount of muscle mass back as you've lost. And these sorts of events, um, kind of happen like in periods of time, right? Where like there's a planned surgery, and then there's a fall, and maybe there's another surgery, or maybe there's an, the COVID or the flu or whatever it is. They keep hitting, right? And you, you reach this sort of what's called disability threshold, where all of a sudden your parents, like, they just can't walk much at all anymore. And it's like all of a sudden it's like, "When did this happen?" Well, the evidence was like mounting over the last five years when they had these points of inactivity that w- that were occurring. And so I think people kind of just don't follow the timeline, you know? Where it's like they see what's leading up to it and before this sort of catabolic crisis occurs, where then they reach this point now where they've just lost so much muscle mass from these several events that have occurred where they're just not mobile. And then of course, anabolic resistance is kicking in even more and more and more, and everything is just compounding. And I don't think they've like, they've like observed the timeline and said, "Oh, A plus B plus C is getting me to this point," right? And so I think that's kind of what happens, whereas with Alzheimer's dis- I don't know. It's just like this disease that everyone knows about, and it's like, yeah, this one thing causes the problem. Do you know what I mean?

   3. PAPeter Attia22:38

      Yeah. I, I think, and, and again, um, you know, Louke Van Loon made a really good point when we spoke, which was when we draw the curve for how people lose strength and how people lose muscle mass, we draw it in a curved, smooth line, which gives us the incorrect impression that this is a gradual and, um, imperceptible changing physiologic process. But he goes, "That's because it's averaging everything." If you zoom in and look at it at the individual level, it looks like this, exactly as you described. Discrete periods of loss from which there is no recovery, because at the later points in life, it becomes very difficult to make those recoveries. All of this, of course, points back to where we're going today, which is when you are young, and young is 40, 50, even 60, you have to build up as much physiologic headroom as possible. You have to prepare for the rainy day, 'cause the rainy day is coming. It's not a question of if. It's simply a question of when and exactly in what fashion it will be delivered. But you must prepare for this. You must steel yourself for what is coming, and you must build up as much muscle mass and strength and cardiovascular fitness as you can muster, because the longer you can ride it out, the better you're going to be.

   4. RPRhonda Patrick24:02

      The cliff is coming, for sure. I mean, it's like your retirement fund, right?

   5. PAPeter Attia24:05

      Yep.

   6. RPRhonda Patrick24:05

      You have to, you have to put money in, 'cause one day you will retire, and if you don't put any money in that fund, you're gonna be, you're gonna be screwed. And so with the muscle mass, um, you're right. You have to bank as much as you can while you're young. And we haven't even talked about optimal. We've just talked about like, like minimal.

   7. PAPeter Attia24:23

      Not going backwards, right.

   8. RPRhonda Patrick24:24

      Yeah.

   9. PAPeter Attia24:24

      Yeah.

   10. RPRhonda Patrick24:24

       We've talked about not going backwards, which is what most people are doing, right? Because this RDA is too low, for one. I think that's the, the big, the big problem. Um, but, but optimal is a whole other story, right? And that's, again, where it is hard to- It's hard to kind of wrap your head around why there's controversy around this,

5. 24:46 – 32:39

   The optimal protein dose

   1. RPRhonda Patrick24:46

      although coming from the field of aging, I do have somewhat of a-- I think there's been a little bit of a nuanced, um, you know, there's a nuanced approach to looking at how protein affects the way we age, and I think some of that data has biased researchers and, you know, people to think that protein is bad. I think some of it's coming from that evidence, which we can talk about.

   2. PAPeter Attia25:09

      That's an interesting point, yep. Yep.

   3. RPRhonda Patrick25:11

      But, um, but again, aside from that, it's really hard to understand why someone would be so opposed to increasing protein intake when there's really just no evidence that it's harmful, at, at least in healthy adults.

   4. PAPeter Attia25:25

      Yeah. I mean, I'd, I'd like to talk about harm down the line as we get further up the chain, 'cause we're, we've now just-- I, I like the way we're talking about this where we're going from sort of the .8 up to 1.2, and now let's talk about going from 1.2 to 1.6 and-

   5. RPRhonda Patrick25:37

      Yeah

   6. PAPeter Attia25:37

      ... 1.6 to 2, and-- But as you continue this, um, journey and you, let's say you look at the data, of which there are some studies looking at 3 grams per kilogram per, per day, um, which I think anybody who looks at the data would argue you're not really getting a benefit at 3 grams per day that you aren't getting at 2 grams per day. You're not-- Like, the, the curve is saturating. You know, you're hitting an asymptote of muscle protein synthesis at that point. So there may be other reasons a person would choose to consume that much protein, satiety and things of that nature. But from a purely anabolic reason, under normal conditions, so, uh, let's leave bodybuilding out of it, um, you, you're sort of hit the saturation curve, but can't seem to find the evidence that it's causing any harm, right? So this is experimental evidence, even epidemiologic evidence, just no evidence. So with that said, let's not get ahead of ourselves. Let's go back to we've established a new floor. Really, there is nobody that should be consuming less than 1.2 grams of protein per, uh, per kilogram per day. What happens as we start to increase that from 1.2 to 1.6?

   7. RPRhonda Patrick26:46

      Great question, and this is again is where I turn to the experts like Stu Phillips. In fact, he did a really great meta-analysis looking at about 49 different studies in adults that were undergoing this-- these are controlled trials, resistance training alone or resistance training plus supplemental protein. And the supplemental protein went up to 1.6-- Well, actually it went up above that. But, um, what was really found in that study was that even going from like 1.2 grams per kilogram body weight, per day obviously, to 1.6 grams per kilogram body weight, people gained about 27% more lean body mass and 10% more sh- muscle strength-

   8. PAPeter Attia27:33

      Hmm

   9. RPRhonda Patrick27:33

      ... compared to just training alone. Same training, just adding the protein, right? Um, that's pretty big.

   10. PAPeter Attia27:40

       I, I was gonna say that is bigger than I would expect.

   11. RPRhonda Patrick27:42

       It... Yeah.

   12. PAPeter Attia27:43

       Especially on the strength side.

   13. RPRhonda Patrick27:44

       Ex- In the strength side.

   14. PAPeter Attia27:45

       Yeah.

   15. RPRhonda Patrick27:45

       They were, they were gaining-- So the protein itself-- But if you think about it, in a way, we're talking about supply and demand, right?

   16. PAPeter Attia27:52

       Yeah.

   17. RPRhonda Patrick27:52

       So now we're talking about m- more optimal, a little more optimal. We're talking about people that are training. That's number one. You need to be training. If we're talking about optimal protein intake, you need to be training. Um, and then, you know, what's happening when you're training is you're breaking down muscle. You need protein to support the repair of that muscle and the rebuilding of it. And so that makes sense in a way.

   18. PAPeter Attia28:15

       Yeah.

   19. RPRhonda Patrick28:15

       Um, but yeah, I was surprised by the strength as well. And so really once you get up-- once you went above 1.6 grams, you would s- there was still increases in muscle protein synthesis.

   20. PAPeter Attia28:28

       Yeah, but the curve is slowing down.

   21. RPRhonda Patrick28:30

       It's, it was, it's-- I like the, the analogy that Stu Phillips uses. He says like if you have like a wet washcloth and you squeeze all, you squeeze it to get all the water out, you know, like most of that water's coming out at 1.6 grams per kilogram body weight. But you can keep squeezing a little and you're getting, you're still getting some water out. It's just, it's just sort of marginal. It's like most people don't care about that difference. Some people do. Now, let's say you're someone that's obsessed with banking muscle mass. You're gonna care about that. Let's say you're a h- you know, a high-level athlete. Definitely gonna have to go above 1.6, right? That's when you get into the more 2, 2.2 grams per kilogram body weight. So people that are doing a high level of training, whether that's endurance or strength training, resistance training, right? 'Cause endurance athletes, I mean, they're, they're-- You, you are battling cat- catab- um, being catabolic.

   22. PAPeter Attia29:20

       Right.

   23. RPRhonda Patrick29:21

       So, um, so that would be-- I think, I think the evidence for more optimal, you're talking about 1.6 grams per kilogram body weight, and then you can, you can get marginal benefits above that, right? Up to like 2, 2.2 grams per kilogram body weight. But again, that's ag- people that are really training.

   24. PAPeter Attia29:39

       Yeah. To me, there's an analogy here with ApoB and cardiovascular disease, right? So, um, if you look at the, uh, the three bodies of evidence, so if you look at all of the epidemiologic data, if you look at all of the clinical trial data, and if you look at all of the Mendelian randomization data, and you plot every single one of them on a graph, and there's a beautiful graph which we'll include in the show notes that does this. So on the X axis, you-- And it's done in LDL-C. But again, LDL-C, ApoB, easy, easy to sort of, uh, view them together. So you have on the X axis, you have LDL-C going down, right? So from 160, 140, 120, you know, 100, 80, 60. So descending LDL-C. And on the Y axis, you have mortality, cardiovascular mortality. So not surprisingly, all of these point down. As LDL-C goes lower, uh, mort- cardiovascular mortality goes lower. Um, what's interesting though is you can see that there are different points in the curve at which- It starts to matter more, and at some point it flattens out. You don't get as much benefit from reduction. And so we could use the same argument of, well, what is optimal? What is-- So, so-- 'Cause we're doing the reverse here. Here, lower is better as opposed to going up on protein. But, um, Peter Libby has done an analysis that has demonstrated that you will continue to see a meaningful reduction in cardiovascular disease as ApoB heads towards thirty milligrams per deciliter. Thirty milligrams per deciliter is really low by most people's standards. For context, sixty milligrams per deciliter is about the fifth percentile at the population level. Thirty milligrams per deciliter is about what a child is. So, you know, we're born with relatively low levels of ApoB, and as we age, they just keep going up and up and up. Um, which of course is one of the things that's driving cardiovascular disease is this rise in ApoB. So the question then becomes, how low do you need to go? Should everybody be walking around at thirty milligrams per deciliter? Is that the solution to eliminating ASCVD? And the answer is probably not, right? It probably depends on your previous exposure though, right? So if I have a patient who's already had two stents placed and has a significant burden of disease, you bet your bottom line they're at thirty milligrams per deciliter of ApoB, even if we have to put three drugs on them to make sure that's the case, because their burden of disease and their lifetime exposure to ApoB has been so high. But if I have an individual who's 40 years old who has perfectly pristine coronary arteries and is walking around with an ApoB of sixty milligrams per deciliter, I don't think you need to do a thing. I think they're just fine. And again, it's, it's, it's the inability, I think, for people to understand that level of nuance and understanding when it's worth the second squeeze versus when just the sloppy squeeze is good enough is, is, is, is very frustrating for a person like me who craves nuance.

   25. RPRhonda Patrick32:36

       Right. Agreed. I love that analogy. And I think it's perfect

6. 32:39 – 38:26

   Why aiming higher is smarter: the case for targeting 2g of protein per kg of body weight

   1. RPRhonda Patrick32:39

      because, again, I, I do think most people that are training probably are getting a, a great amount of benefit from 1.6 grams per kilogram of body weight. Um, but that doesn't mean you can't go above that and still get a little more benefit, right? And certainly when you start to get into that, you know, energy deficit phase as well, like so we were talking about elite, you know, endurance athletes, that's one way to be in an ener-energy deficit. But there's also people that are actively trying to lose fat, gain muscle. If you want to lose fat and gain muscle at the same time, you're going to have to take in a lot of protein.

   2. PAPeter Attia33:16

      Yeah. And, and so that's another very important point. Another point I want to make is you're still dealing with an asymmetric target. And so we tell our patients to be closer to two. Now, I know that's just going to get a whole bunch of people on the anti-protein train just losing their mind. I can just see the phosphorylation going off right now as they're watching this clip. How is this guy so irresponsible to tell his patients to eat two grams of protein per kilogram of body weight? Didn't he just hear what Rhonda said? 1.6 is good enough for most people. Well, my patients unfortunately don't live in labs. Unfortunately, Rhonda, my patients live in this place that's called the real world. And in the real world, you can't always hit your targets. Some days you do, some days you don't. Some days you're traveling, some days you're not. Some days you can figure it out, some days you can't. So if I'm telling somebody to hit 1.6 and one day they're at 1.2, another day they're at 1.7, another day they're at 1.5, another day they're at 1.9, on average, they might hit 1.6, but how many days were they below versus how many days were they above? Let's just say it's an equal split. But we've just established the shape of this curve is like this. So that means every day you're below the downside is much greater than the upside of being above. In other words, all the days you're above are not making up for all the days you're below. So what I'd really like to do is shift the range so that your low day is 1.6 and your high day is maybe 2.2. And then guess what? You don't have days where you are ever, ever amino acid restricted.

   3. RPRhonda Patrick35:02

      Right.

   4. PAPeter Attia35:03

      And this is the difference between people who take care of people in the real world and bozos who write on Substack who don't know the first thing about clinical medicine when it comes to managing athletes and people who have to fend for themselves every day with every meal. And this is why I'm so tired of talking about this, but I feel we need to talk about it. And so if you're sitting there listening to this and you're confused and you're asking, "Oh my God, should I be eating two grams per day?" Yeah, more or less. And that way if you fall short at 1.6, you can be confident that you're okay. But if you're aiming at 1.6 and you have a bad day, and you will, when you hit 1.2, you might be taking a step backwards and you won't make up for it the next day.

   5. RPRhonda Patrick35:45

      I, I can just tell you, um, from personal experience, it, it's actually smarter to aim higher because I'm constantly not re-meeting the 1.6.

   6. PAPeter Attia35:52

      I am not. This is the thing. People look at me like I'm a protein eating machine, which first of all, I'm not, but secondly, I have a hard time hitting my goals too. I'm busy. I miss meals. Sometimes we just have a low protein meal, like for whatever reason, my kids want to have pasta for dinner and they don- and we literally have pasta and sauce. It's like there's no freaking protein in this anyway. So it's very difficult if you don't have a chef preparing your every meal, and I never have a chef preparing any of my meals unless I'm out at a restaurant, to hit these targets every day.

   7. RPRhonda Patrick36:25

      Right. Um, and also I just, it-- I, I was thinking about this because we mentioned the 1.2 being the sort of the minimum buy-in. The 1.6 grams per kilogram of body weight isn't necessarily just for people training a little bit. It's also older adults that are not training. Like because we talked about the anabolic resistance, them needing twice as much protein as well. And so what you're talking about here is Going up to two so that you can really have an average at least of 1.6, right? You're, you're getting that average. But again-

   8. PAPeter Attia36:55

      Well, and it's just I never want to fall below that.

   9. RPRhonda Patrick36:57

      Below it.

   10. PAPeter Attia36:57

       That's really the point is I know bec- again, I'm training every single day.

   11. RPRhonda Patrick37:01

       Yeah.

   12. PAPeter Attia37:01

       Right now am I training like a madman? No. But seven days a week I'm either doing some form of cardio or something in the gym. So it's just I know that I'm gonna take steps backwards if I'm below 1.6, so I'm gonna overshoot so that my down day is 1.6.

   13. RPRhonda Patrick37:18

       Right.

   14. PAPeter Attia37:18

       And if my up day is 2.5 once in a while, who cares? Because that gets to the next point. Show me the data. Show me the data that eating 2.5 grams of protein per kilogram per day is even remotely harmful. I'm still waiting for it. I'm still waiting for the data. David Allison wrote a piece on LinkedIn recently where it was basically a call to anyone, just show me the data that meet these criteria, human clinical trial of this duration, da da da da da. Like nothing but crickets.

   15. RPRhonda Patrick37:49

       Yeah. I mean, I haven't seen any human data either, for sure.

   16. PAPeter Attia37:53

       I mean, the most negative data I saw recently was a study that looked at total parenteral nutrition in ICU patients where the question was, "Hey, should we be ramming high amounts of protein in these people?" And the most negative thing you could say is it had no benefit. And that's interesting.

   17. RPRhonda Patrick38:08

       Yeah.

   18. PAPeter Attia38:09

       Right?

   19. RPRhonda Patrick38:09

       Yeah.

   20. PAPeter Attia38:09

       So maybe we shouldn't be ramming high protein total parenteral nutrition into the central veins of critically ill ICU patients. Um, but it didn't harm them. [laughs]

   21. RPRhonda Patrick38:18

       Right.

   22. PAPeter Attia38:18

       And if anybody's gonna be harmed, I would think it's the people that are in renal failure.

   23. RPRhonda Patrick38:21

       Right. Yeah, exactly. Um, I haven't seen that data either.

   24. PAPeter Attia38:25

       We haven't

7. 38:26 – 41:05

   Protein needs for pregnant women & growing adolescents

   1. PAPeter Attia38:26

      spoken specifically about pregnancy or adolescence. What do we know about protein requirements? 'Cause there are clearly women listening to us right now who are pregnant or who will be pregnant. Um, and I don't think there are any adolescents listening to us, but I bet there are parents of adolescents. Um, so what, what kind of guidance would we want to, would we want to give these folks?

   2. RPRhonda Patrick38:44

      I mean, it's this, it, it, it goes up with, with pregnancy and also adolescence. I mean, so-

   3. PAPeter Attia38:49

      Are there formal recommendations? I, I don't pay enough attention.

   4. RPRhonda Patrick38:51

      I don't remember the exact... But again, it's all about like going a little bit above what's the RDA, and we've already established that's not enough.

   5. PAPeter Attia38:58

      Mm-hmm.

   6. RPRhonda Patrick38:59

      Right? So I mean, honestly, I think if people are listening to this episode, just knowing that 0.8 grams per kilogram body weight per day is just, it's not enough at all.

   7. PAPeter Attia39:08

      So if we accomplish nothing else, that, that, that's the single most important take home message here.

   8. RPRhonda Patrick39:13

      I really think it is because everyone looks at those guidelines, you know?

   9. PAPeter Attia39:16

      Yeah, it's really funny. The other day I was eating something, and I forget how much protein it had in it, but it had like percent of daily requirement, but it was obviously baked to a very low number. 'Cause I remember my son was looking at it with me and he goes, "Is that really like..." I forget what the number was. "Is that really like 40% of your daily protein requirement?" And it was a relatively sm- And I said, "No." But I just didn't have the energy to explain the RDA to him. So I was like, "No, this is just wrong. You can ignore this." [laughs]

   10. RPRhonda Patrick39:46

       Growing is also an important, um, time for protein, right? Because these amino acids and the essential amino acids are activating IGF-1 growth hormone, and that's really important for growth. I know there were studies done in like infants, um, and, and toddlers that were given egg versus like milk versus like some kind of vegan protein, and it was like clear that the egg was the winner here. Like giving protein with essent- more essential amino acids was important for growing taller. Uh, and that's always something that I as a, as a mom think about, right? I'm always trying to get protein in my son. Plus, the kids are more active. You know, kids are more physically active. They're doing sports and things like that, right? Adolescents. So i- it's really, it's really important to get the protein requirements. I don't, I haven't dug into all the nuance of that data. It's just kind of my... The way I look at it is, you know, it's, it's gotta, it's gotta be like a 1.2 even though that's in the adult. It's more like a 1.2 gram per kilogram for an adolescent who's pretty close in, in body size to, to an adult generally speaking. They start growing pretty tall.

   11. PAPeter Attia40:52

       Yeah, I mean, I, I would think for kids it should be at least the 1.2 to 1.6.

   12. RPRhonda Patrick40:57

       Yeah.

   13. PAPeter Attia40:57

       Anything, any... I mean, again, I, I just look at the activity level of my kids is they make me look sedentary.

   14. RPRhonda Patrick41:03

       Right.

   15. PAPeter Attia41:03

       So,

8. 41:05 – 45:31

   Why higher protein intake is crucial when trying to lose fat while preserving or gaining muscle

   1. PAPeter Attia41:05

      um, okay. Anything else we want to say on the topic of protein to help with some of the confusion that is out there? I think we should talk a little bit about some of the misconstrued understanding of mechanisms of action around mTOR-

   2. RPRhonda Patrick41:23

      Yes

   3. PAPeter Attia41:23

      ... cancer-

   4. RPRhonda Patrick41:23

      Yes

   5. PAPeter Attia41:24

      ... and stuff like that.

   6. RPRhonda Patrick41:25

      Um, I would say the other thing would be, um, the calorie restriction, people doing intermittent fasting-

   7. PAPeter Attia41:30

      Mm

   8. RPRhonda Patrick41:30

      ... people doing anything if they're wanting to be body recomposition, the, the gaining of muscle and, you know-

   9. PAPeter Attia41:35

      Yeah

   10. RPRhonda Patrick41:35

       ... losing fat. I think that is a very specific, you know, group of or population of people where the high protein intake is critical, right? Because if you're in a caloric deficit, you really are battling your body pulling from your muscle reserve. If you're resistance training, that helps somewhat, but you're certainly not gonna gain muscle, and we just talked about wanting to bank as much muscle as possible as we're younger while we can, right? Because we need that reserve 'cause we're gonna start pulling from it eventually. And so I think that that's where you start to get really high numbers, 2.2, even higher. I mean, there, you, you can find studies, the studies out there, it's like 3 grams per kilogram per body weight. Uh, all, going above the 1.6 in this, in this scenario seems to be key as well when you, you're getting up to that 2.2 grams per kilogram body weight per day because it does give you a little bit more edge over, uh, gaining muscle, muscle protein synthesis in combination with resistance training, um, as well as it's like you mentioned, it's, you know, satiating. It's a little bit thermogenic. I don't know that that's the big, the big mechanism here, but I think the big mechanism here is just that like you're, you're, you're really wanting to prevent this catabolism, right? So I think that's just another important point. 'Cause there are a lot of people that do inter- intermittent fasting, time restricted eating. You know, they're, they're trying to do body recomp, gain muscle, lose fat. It's a-- I think a lot of people are interested in that.

   11. PAPeter Attia43:00

       There was one period in my life when, um, over the course of a year, I made a very dedicated goal to lose body weight and gain muscle. So I wanted to see, like, could this be done? And it did require quite a bit of intermittent fasting, um, or time restricted eating, I suppose, to be more accurate. But the amount of attention I had to pay to protein intake was pretty incredible. And what I did that seems counterintuitive, 'cause I, I wasn't intermittent fasting because I believed that a fasted state was producing some benefit, right? So you know, there are some people who think that, "Oh, if I don't eat breakfast, I'm kicking off some autophagy or something." No, no, it wasn't. It was purely a caloric restriction ploy. [lips smack] So my fasting window did not prevent consuming liquid protein. In other words, if I wasn't eating breakfast or lunch, which I wasn't, I was only having a meal a day, which was dinner, but I would still consume protein shakes outside of those windows, otherwise I could never hit the protein target. So I was in a caloric deficit, but an amino acid excess. And again, you can actually do that with liquid protein pretty easily because basically all you're getting is, you know, you're getting relatively few calories 'cause you're just consuming whey protein.

   12. RPRhonda Patrick44:16

       Did you have any, like, GI, like, problems consuming so many shakes? No, really? I get-

   13. PAPeter Attia44:21

       No, but I did a lot of experimentation, right? So ultimately I settled on a brand, I'm blanking on the name of it now. I have no affiliation with these guys and I'm blanking on their name. Ascent maybe? Does that ring a bell?

   14. RPRhonda Patrick44:31

       Yeah.

   15. PAPeter Attia44:32

       Yeah. I really like them. Again, I'll give them a shout-out because, one, it was the only protein I found I could mix directly in water and not have it be lumpy. I didn't even need a blender. This was a hu- this sounds silly-

   16. RPRhonda Patrick44:46

       No

   17. PAPeter Attia44:46

       ... but the hassle of me having to, like, wash a blender twice a day was sometimes an impediment to not making a shake. Um, so just to be able to p- put the scoop or two scoops I would usually put into a glass with water and mix it with a fork and actually drink it and have it be totally fine and not, you know, lumpy. I don't know how they do this, but it was amazing. It actually tasted fine. I don't like sweet drinks that much, but it, it was not too sweet. Um, and absolutely no GI issues at all. Whereas sometimes the pure egg proteins, I just, I, I didn't like the feeling on my gut. Um, so for whatever reason that worked for me. Um, but, but to your point, it is-- it's another level of challenge if you're trying to recomp in that way.

   18. RPRhonda Patrick45:30

       Right.

9. 45:31 – 53:54

   GLP-1 drugs: protein needs, muscle preservation, dosing strategies, evidence of broader health impacts

   1. RPRhonda Patrick45:31

      Or, or people on GLP-1, right, receptor agonists-

   2. PAPeter Attia45:34

      Yes

   3. RPRhonda Patrick45:34

      ... right? I mean, like-- And I don't know how, how, you know, I-- how difficult it is, like, to eat a meal versus, like, take a protein shake, 'cause I know you're like, you don't have a, a real-- you're, you're satiated pretty much all the time. You don't have a real appetite. But also digestion is slowed, so if you're, like, consuming more protein, like, I don't know how that all affects-

   4. PAPeter Attia45:53

      We, we've seen in our patients, so again, I would say, um, I get asked this all the time. I would say 15 to 20% of our patients are on tirzepatide. Um, and unlike five years ago when we started using semaglutide in patients and were just watching muscle fall off these people and, and frankly, my point of view five years ago was, "I don't know about these drugs. I, I think, you know, I think there's some benefit in some people, but I, I think there's a lot of downside." I, I today think that virtually anybody can use these drugs safely, but, uh, and by safely, I, I don't just mean in the obvious sense of the word. I mean safely for long-term muscle health as well, right? Um, but it requires a ton of deliberate attention. So I'm glad you brought it up. That's-- this is exactly the group of people who you wanna be using easy to digest protein sources. Um, and if you're on tirzepatide, you don't really want a steak. You know, you don't really wanna have a big chicken breast. You know, you know, it, you might not wanna even have an omelet. Um, but if we have to make sure you're hitting that 1.6, um, you might be doing a bunch of liquid shakes.

   5. RPRhonda Patrick47:08

      Right. And training.

   6. PAPeter Attia47:09

      And yeah, we can sit here and poo-poo processed food and say, "How disgusting is it that people have to resort to eating shakes?" Okay, fine. But if the alternative is they're not getting enough protein and they're on a drug that is making them anorexic, I mean, we know-- we, we also know the downside of that.

   7. RPRhonda Patrick47:27

      Well, the answer's clear, right. Y- you don't wanna be losing muscle mass, for sure.

   8. PAPeter Attia47:30

      My point is, you know, we do DEXA before and after. We're not seeing the type of muscle loss we saw with our, you know, V1 approach to this.

   9. RPRhonda Patrick47:40

      Right. What, what kind of dose are you-- are they on, like, a higher dose? Lower dose?

   10. PAPeter Attia47:43

       No, I mean, I think for, look, for, you know, tirzepatide starts at 2.5. Some people are, are getting enough benefit there. I mean, the other thing that I, I think our approach has been is that, um, slow and steady wins the race, right? So we've seen anecdotally some data. Uh, I've seen, I've heard from, uh, from others, and we've seen it as well, that yo-yoing on and off these drugs is probably a bad idea. So I always tell a patient, "Look, I'd, I'd probably rather you were on 2.5 milligrams until there was a new drug that we felt was even better than you, you're on 10 milligrams, you lose a ton of weight, you come off, you gain, you go back on, you lose." Like, uh, this-- the idea of being on a, a SAW is, is probably a bad idea. Um, I think the data, uh, suggest you're getting most of the value by about 10 milligrams. So once you go to 12.5 and 15, which are the two highest doses, you're still getting a benefit. Um, but it's, you know, it's like most drugs. You're getting most of the benefit at the lowest dose. So 5 to 7.5 milligrams of tirzepatide is probably where you're getting the majority of the dose. And again, I, I'd much rather a patient be sort of slow and steady on it and as opposed to try to go for m- maximum and rapid weight loss.

   11. RPRhonda Patrick49:00

       What do you, what do you think about some of that data on, like... Heart issues or bone loss, um, do you think-- uh, does that concern you at all?

   12. PAPeter Attia49:09

       Sure. I think it all does. I mean, I think all of this stuff has to be paid attention to. And, and I think the question, again, comes back to how much of that is occurring due to, um, due t-due to training, right? How much of that is happening due to the loss of amino acid intake and the loss of training?

   13. RPRhonda Patrick49:25

       Or the neuropsychiatric, I mean, like, that's another one on the eyes. Uh, what I'm interested in is, you know, we have these GLP-1 receptors, like, on so many different tissues. So what-- systemically, like, how... Is it beneficial? Is it not beneficial? Like, I don't know that we really know. We have, we have data where there's obviously positive effects. You see, like, reduced Alzheimer's disease incidents with people taking these GLP-1 receptor agonists. But is that-- how much of that is due to, like, weight loss, right?

   14. PAPeter Attia49:53

       Yeah. We've, we've looked into this a lot because I'm-- I do remain... You know, it's funny, we did a podcast on this somewhat recently where, um, I went through this particular question, which is, will GLP-1 receptor agonists ultimately prove to be geroprotective? And I defined-- I came up with a very obscure way to define that, which is independent of weight loss. [chuckles]

   15. RPRhonda Patrick50:18

       Yeah.

   16. PAPeter Attia50:19

       Right. 'Cause obviously at the macro level, they're gonna be geroprotective because if you apply them to people with type 2 diabetes and significant obesity and you correct the metabolic dysfunction, you're going to live longer. So by that regard, it's a geroprotective agent. But the real question is, if you take a person who is of normal weight, who does not have type 2 diabetes, but maybe has a higher risk for Alzheimer's disease, and you microdose them, so you're giving them two point five milligrams per day, which by the way, we are doing in some patients for metabolic-- for obscure metabolic condition without obesity, right? So we have patients who have, um, um, who have diabetes but are already at very low body weight. We have two patients actually in our practice in this, in this regard. And after lots of detailed back and forth machination with, uh, Ralph DeFronzo, who's a previous guest on the podcast, you know, we sort of realized that the at least one component of the drug regimen for these patients was going to be a GLP-1 agonist. Now, it seemed very counterintuitive to give tirzepatide to people who have a BMI of twenty-three. Um, but we've been able to do it without them losing weight. Um, so again, very careful strategies around nutrition and the effect on their diabetes is profound.

   17. RPRhonda Patrick51:37

       So they're look- they're looking more metabolically healthy.

   18. PAPeter Attia51:38

       Oh my God, totally f- I mean, these are, these are, these are, these are really interesting cases that, uh, you know, maybe at some point, obviously in a de-identified way, it would be interesting to talk about where you, you know, you have OGTTs that are unrecognizable. Like, you simply cannot believe the degree of metabolic dysfunction in a person who otherwise looks the way they look. And in one case in particular, it was so confusing that even after all the genetic testing we did, like, we simply couldn't figure out an answer for this. We couldn't understand where the beta cell fatigue was coming from, absent a formal diagnosis of type one diabetes. Um, and within three months of being on two point five milligrams of tirzepatide, this individual's OGTT had almost normalized, and I suspect, uh, by about six months it will.

   19. RPRhonda Patrick52:22

       That's fascinating.

   20. PAPeter Attia52:23

       And, and we've managed to do this without any weight loss. So this to me is the interesting question, right? Which is when you look at some of the Alzheimer's biomarkers, um, which are improving, uh, improving significantly, um, it begs the question, should this be part of the playbook for an individual who's at high risk? Especially given that [clears throat] we now, I think, really understand how to make sure people don't lose weight and don't lose lean mass, and therefore, I suspect don't lose bone density and all these other things that matter.

   21. RPRhonda Patrick52:51

       Or like you said, you know, if you're doing, if you're doing, like, this microdose, like, maybe you're, you're not gonna be as satiated. Like, you'll, you'll still have somewhat of an appetite 'cause you're on such a low dose. Maybe you're gonna do-- have a little bit of an effect.

   22. PAPeter Attia53:05

       We've also seen some other weird things anecdotally. Um, patients have told us that when they inject in the abdomen, uh, so when you inject in, you know, the fat, in the subcu fat of the abdomen, the, uh, the anti, uh, uh, basically the anorexic effects are greater than if you inject in the leg or butt.

   23. RPRhonda Patrick53:22

       Hmm.

   24. PAPeter Attia53:22

       And we looked into this and there was some, some mechanistic data to suggest that maybe you're getting more vagal tone when you inject in the abdomen. Again, I, I do- I just don't know if any of these things are correct. They would need to be studied. But again, that would be a very important piece of data, right? If there's a way that-- If there's a location you can inject this where you minimize the, uh, anorexic effect of the drug. Again, for some people that would be a feature, not a bug.

   25. RPRhonda Patrick53:45

       Right, right. [chuckles]

   26. PAPeter Attia53:45

       For some people, that would be a bug as opposed to a feature.

   27. RPRhonda Patrick53:47

       Right.

   28. PAPeter Attia53:47

       So you gotta, you have to understand how to, how to, how to use y- how to use the tool.

   29. RPRhonda Patrick53:51

       Yeah. Um,

10. 53:54 – 55:29

    How overweight individuals should calculate protein needs based on target body weight

    1. RPRhonda Patrick53:54

       and this just reminded me of something that we should have pointed out, like talking about the protein requirements, grams per kilogram body weight, I do think it's important, like, 'cause we're talking about o- we were just talking about obese people overweight.

    2. PAPeter Attia54:06

       Yes. This is-- I'm glad you brought this up.

    3. RPRhonda Patrick54:08

       And we're-- Yeah, exactly, where it's like, you know, most people aren't gonna do a DEXA scan to see what their lean body mass is, but, like, ultimately, I think, you know, and I've talked to a variety of experts, Brad Schoenfeld, Sue Phillips, they agree that really if you're someone that's overweight or obese, you shouldn't be calculating it based on your actual weight 'cause your protein require-- um, it'll be way too high.

    4. PAPeter Attia54:26

       Yeah, yeah. That's right.

    5. RPRhonda Patrick54:27

       It's more like your target weight, right? Or that would be-- I mean, if you empirically could measure your lean body mass, that would be better. But, um, yeah, I just wanted to point that out.

    6. PAPeter Attia54:36

       Yep, and, and I'm glad you did. So that's right. For most people, probably not much of an issue. But if you're, if you're at three hundred pounds right now and your ideal body weight is two hundred and twenty, um, and again, I don't-- uh, you don't need a DEXA to figure that out. A DEXA can help, but most people who are three hundred pounds remember You know, gosh, you know, at the end of high school I was 220. That was my good weight. Or maybe, you know, at the end of high school I was 200 pounds, which is, I'll probably never get back into those jeans again. But, you know, by the end of my freshman year of college, I was 220. That was kind of a good weight for me, and then it's just kind of gone downhill from there. You know, I had this orthopedic inj- like, there's the story of how you got to be 300 pounds. Yeah, most people can figure out-

    7. RPRhonda Patrick55:18

       Right

    8. PAPeter Attia55:19

       ... 220 is probably my goal weight-

    9. RPRhonda Patrick55:21

       Exactly

    10. PAPeter Attia55:21

        ... and that's what I should be targeting.

    11. RPRhonda Patrick55:22

        Yeah. Yeah. Um, but yeah, so should we get back into like where this all came from?

    12. PAPeter Attia55:26

        Yeah, so let's, so, so you made a great point, right?

11. 55:29 – 1:05:21

    The relationship between protein intake, mTOR activation, & longevity

    1. PAPeter Attia55:29

       Which is how do we reconcile the following? So caloric restriction as an intervention, uh, as a geroprotective intervention is the oldest one in the book. I, I'm not really aware of an intervention where, uh, a, a non-genetic intervention that has from, from a longer-standing perspective produced a more consistent outcome in terms of laboratory animals, where you restrict them of calories and they're gonna live longer. So again, to my knowledge, there are only two interventions that have extended life across all four models of organisms from yeast, worms, flies, and, uh, uh, uh, mammals, rodents, and that is caloric restriction and rapamycin. And they have something in common, which is they both result in the downregulation of mTOR.

    2. RPRhonda Patrick56:23

       Right.

    3. PAPeter Attia56:24

       So we also know that an amino acid you just mentioned a moment ago called leucine is the single most important of all the amino acids at turning up mTOR. So how can we reconcile the idea that protein seems to be good for you, but mTOR going down seems to be good for you, at least in another way?

    4. RPRhonda Patrick56:48

       Well, for one, this is-

    5. PAPeter Attia56:50

       I'm being very facetious-

    6. RPRhonda Patrick56:51

       I know. I know

    7. PAPeter Attia56:51

       ... 'cause you know I know the answer to this question. [laughs]

    8. RPRhonda Patrick56:53

       And it's like, oh gosh, where do we start? I mean, you know, because let's ignore the worm and the fly and all that because who cares? I mean, even the rodents is like we're, we're getting to like it's a stretch, right? But obviously, you know what else turns on mTOR? Exercise. [laughs]

    9. PAPeter Attia57:11

       Yeah.

    10. RPRhonda Patrick57:11

        Physical activity, mechanical force turns it on in our muscle, and we know exercise is like one of the best things that we can do for our health. Um, I think here, I think simpl- for simplicity, the best way to think about this is that you want mTOR active in your skeletal muscle. You want it active in your skeletal muscle. You don't necessarily always want it active systemically, but if you are exercising, if you're moving around and you're taking in your protein, it's going to your muscle. Ex- we know that for a fact. Uh, I just, I talked about anabolic resistance and how exercise can counter that while it's increasing the leucine transporter, the expression of the leucine transporter. It's causing leucine and other branched-chain amino acids to go up into skeletal muscle. Multiple human studies have shown this. These are, you know, tracer studies, beautiful data, no argument. Exercise causes leucine and other branched-chain amino acids to be taken up into skeletal muscle, where you want it to be so that it activates mTOR, increases mut- muscle protein synthesis. When it comes to deactivating mTOR, whether that's through protein restriction or rapamycin, I mean, that would be like an hours-long podcast talking about all the nuanced data there because there's all sorts of differences with the, you know, s- sex differences in, in the rodents, everything. You, you, you're aware of all this data. My biggest thing here with the protein restriction, let's talk about one. I, I did spend six years in grad school working with mice. I did a lot of animal studies, okay? These mice are in a small cage. They are not physically active. They are not running around. They're, I mean, they move a little bit, but they're ultimately just-

    11. PAPeter Attia58:57

        They're not under threat

    12. RPRhonda Patrick58:58

        They're not under threat. They're being fed, they're ad libitum. They're just being fed a, you know, as much protein as they want, but-

    13. PAPeter Attia59:04

        Perfectly thermoregulated

    14. RPRhonda Patrick59:05

        ... totally no, they're not being exposed to influenza or COVID or the, you know, whatever viruses, anything that's gonna take them out for a period of a couple of weeks. Um, they're in a sterile environment. And so, I mean, they're happy. They're happy and that, that's it, right? People are not mice, right? We, like we talked about earlier, um, as we get older, we're being exposed to infectious diseases. Things are gonna make us immobile for a period of weeks, and that is devastating to us, especially when you add them up and they happen this year, and then the next year it happens again, and then you're just losing that muscle mass, right? And then you reach that disability threshold. You talked about Luke Van Loon, um, talking about those curves. It's very clear. I mean, you can see the data where there's a disability threshold. You get enough of these like s- catabolic crisis events, right? Where you're just immobile for a certain period of time because you've had a surgery or you've had the flu or whatever has kept you inactive. Um, that doesn't happen to these mice, right? So protein is much more important to humans because we, of course, need that muscle mass, and we need to bank it early. We've established that. And I think that's a really important difference here is that, you know, we can't just look at the data in mice and go, "Oh, you can restrict them from protein and they live longer and they're fine." Well, they're not going through these catabolic crises. They're not going through these, you know, points of n- you know, not moving for a period of time for like, you know, and losing all this muscle mass, then that happening and they re- reach this disability threshold and then, you know, it's very different. Um, so I think that's first and foremost important to point out. Um, the second thing is, is that if we're talking about protein intake, I think that you and I agree the optimal scenario here isn't a sedentary person just sitting there eating as much protein as they want. No. They need to be moving, physically active. Like, that's the whole point. You, you're s- supporting your physical activity by increasing your protein intake. And so in that scenario, again- The, the amino acids that are activating mTOR are going to skeletal muscle. Like that's been shown. Leucine is going into skeletal muscle. So who cares if you aren't taking in more?

    15. PAPeter Attia1:01:19

        Yeah, in fact, I, I, I think that's such an important point, Rhonda, that I would even go one step further, which is if you told me, "Come up with the optimal nutrition strategy for the individual who is active, and then come up with the optimal nutrition strategy for a person who is going to be sedentary," they would be very different. I'm gonna try to talk that sedentary person into not being sedentary. But if at the end of the day I can't, if that individual says, "I just, I don't want to do anything. I just want to sit in front of my computer," um, you know what? It probably makes sense to be a little bit caloric restricted.

    16. RPRhonda Patrick1:01:53

        Right.

    17. PAPeter Attia1:01:54

        Because at least I want to make sure -- I can't solve your metabolic, um, challenge through activity, but what if I could at least solve it through, uh, nutrition restriction? Um, and, and again, I think it's the inability of people to understand that, that those are very different states, right?

    18. RPRhonda Patrick1:02:16

        Yeah.

    19. PAPeter Attia1:02:16

        You cannot treat those two people the same way.

    20. RPRhonda Patrick1:02:19

        Right. A- a- and it's really, it's, it's -- There's even -- There was a study by, um, Valter Longo of all people, like years ago, came out. It was a large cohort study looking at dietary protein intake from vegetable versus meat sources, right? And we all know that meat sources have higher levels of essential amino acids like leucine. And all-cause mortality was looked at and, you know, the same, you know, statement that you've heard millions of times from other studies about, "Okay, if you -- You know, vegans have a lower all-cause mortality than meat eaters." Well, turns out when you actually start to analyze like the data and, and correct for a lot of confounding factors, p- meat eaters that were f- that were physically active, were not obese or overweight, didn't smoke, didn't drink excessive alcohol. So in other words, they didn't have all these unhealthy lifestyle factors. They had the same mortality rate as the, the, you know, vegans. So I think that also is a good, is a good point here, where it's like, okay, if you're going to be a sedentary person that's smoking and dr- if, if you have unhealthy lifestyle factors, you know, maybe you don't need to be so obsessed. You definitely want to make sure you're at least getting the minimal amount of protein because you don't want to be in the deficit. But, you know, you don't want to necessarily just be constantly activating mTOR if you're just going to sit around and smoke and be overweight and not do anything with that protein, right?

    21. PAPeter Attia1:03:39

        Yeah. And the other thing I think that, that is, is missing from this discussion is -- and, and where -- This is where I think inflammation serves as a great analogy, right? So I think most people on the surface understand that a constant on state of the inflammatory system would be bad. But of course, if you had no inflammatory response, that would be also bad. So the ideal state is inflammation when you need it, otherwise off. Inflammation when you need it, otherwise off. And I think that's probably the right way to think about this, right? Which is we, we want mTOR on when it has a job to do and we want it relatively silent when we don't. And I think if rapamycin is geroprotective and, um -- And when I say if, I mean in humans. I think it's unambiguously protective across most species, but we still don't know if the species of interest is, is, is going to benefit from this drug, and we may never, by the way. But it's probably working by tamping down the chronic inflammatory component of what we see with mTOR activation, which by the way might actually involve inflammation as well as one of the many things. So th- there's also this challenge of, of trying to, to, to get folks to understand the difference between chronic and acute things. Um, again, cortisol, right? Great example, right? So cortisol, vital hormone, pulse it -- You know, the, the appropriate rhythm of cortisol is essential for life. If you took that away, you would actually be dead. That's called Addison's disease. But co- cortisol constantly being on would also be a problem, right? That would be Cushing's disease. So both extremes bad. It's do you h- do you know when you need it and what it's supposed to do? And I think the same is true with

12. 1:05:21 – 1:11:33

    Why it’s unclear whether rapamycin is geroprotective in humans, & how misinterpreted animal data have fueled misconceptions about protein or mTOR activation being harmful

    1. PAPeter Attia1:05:21

       mTOR.

    2. RPRhonda Patrick1:05:21

       I'd also like to see data comparing like even, even if it's animal data, um, comparing like giving, giving rapamycin or inhibiting or, you know, somewhat inhibiting m- mTOR versus like physical activity, like in these m- like making them, making them run on a treadmill, like being physically active.

    3. PAPeter Attia1:05:39

       Yeah.

    4. RPRhonda Patrick1:05:39

       Because if you look at a like -- a lot of the protective effects of rapamycin, I'm like, "This is what exercise does, and exercise does it better." So I'm just not convinced that someone who is -- who's already bought into like how important exercise is-

    5. PAPeter Attia1:05:53

       Yeah

    6. RPRhonda Patrick1:05:53

       ... both cardiovascular and weight training.

    7. PAPeter Attia1:05:56

       Well, Eric Verdin made a very interesting podcast, a, a very interesting comment on my podcast a while ago. And, and so Eric is in the camp that he does not believe rapa will be geroprotective in humans. And he talked about the longevity quotient. So for listeners, the longevity quotient is a plot, a very famous plot that on the X-axis, uh, puts body size and on the Y-axis puts lifespan. And you just plot all the organisms on this thing. And as a general rule, it rises up and to the right. The larger an animal is, the longer it lives. And it's a pretty straight line. In fact, we should find a good, uh, example of it and link to it in the show notes. But there are always animals that punch above and below their weight. So there are animals that fall off that line either too high, so these are animals that live much longer than you would expect based on their body size, and there are animals that punch well below their body weight. They live much shorter than they should based on their body weight. Well, it turns out two interesting examples are mice and humans. Mice live on average two years. I forget the exact number. They should be living close to four or five years, I think, based on the longevity quotient line. So they are punching well below their weight. And humans, we live 80 years. We should probably be 40 according to the data. By the way, we did live 40 years until modern medicine came along, so maybe we were totally on the curve correctly until Medicine 2.0 came around at the turn of the last century and basically over five generations doubled our lifespan. Um, Eric argues, um, and I, I think this is a very interesting argument, rapamycin disproportionately works well in animals that are below the longevity quotient, so that's why it works so reproducibly in mice, right? But he argues it might not have any effect in humans because we're already, we've already captured so much of our genetic potential in terms of lifespan now that the idea that rapa would give us an extra 15% of life, he, he feels is just kind of hard to imagine. And again, this is kind of a theoretical argument. It's super interesting, but I'd never heard it in relation to the longevity quotient before, and I, I thought it was very, uh, uh, very much worth pondering.

    8. RPRhonda Patrick1:08:08

       Yeah. Well, that's interesting. I've also seen data with rapamycin given to people un- that were undergoing resistance training, and it, like, blunted obviously some of the muscle protein synthesis, as would be expected. I don't remember the dose of mTOR, but it wasn't like... I'm sorry, of rapamycin.

    9. PAPeter Attia1:08:21

       No.

    10. RPRhonda Patrick1:08:21

        It wasn't super, super high, but to me that was, like, enough to be like, well, I mean-

    11. PAPeter Attia1:08:27

        Yeah, and then the question of course is could, is there a way around that, right? Is there a way where you could intermittently dose it? You just take it once. You time it so that it's not in proximity to a bout of resistance training by a couple of days or something like that.

    12. RPRhonda Patrick1:08:39

        Yeah.

    13. PAPeter Attia1:08:39

        But yeah, there's a lot there. Uh, there, there's a great expression I heard, um, recently, which is, uh, mice usually lie, monk- monkeys sometimes lie, it's humans we care about.

    14. RPRhonda Patrick1:08:51

        [laughs]

    15. PAPeter Attia1:08:52

        I thought it was just fantastic, right?

    16. RPRhonda Patrick1:08:54

        Well, to get back to the mTOR story, I think that's like the, that recent study, I don't know, it was in the last couple of years that came out. It was the animal study where they gave mice 25 grams of protein and, you know, mTOR was activated in macrophages, and it was like this, this whole story was pieced together about how much-

    17. PAPeter Attia1:09:11

        25 grams of protein?

    18. RPRhonda Patrick1:09:13

        Sorry, maybe it was the equivalent dose.

    19. PAPeter Attia1:09:14

        Equivalent. Okay, okay, yeah.

    20. RPRhonda Patrick1:09:15

        It was, sorry, the human equivalent dose. [laughs] Yeah.

    21. PAPeter Attia1:09:16

        I was like, wow, that's the, the wei- they're eating their body weight in-

    22. RPRhonda Patrick1:09:19

        The human equivalent dose-

    23. PAPeter Attia1:09:20

        Yeah, yeah, yeah

    24. RPRhonda Patrick1:09:20

        ... was 25 grams, yeah. Um, but it, it was essentially, like, arguing that atherosclerosis was being caused by protein, and I'm like, "Are you kidding me?" Like, well, for, for one, we know atherosclerosis, like the bigger story there, right, is not protein. But again, it comes down to this whole activating mTOR in, like, systemic circulation versus the leucine going to the muscle because you're physically active. And keep in mind, like, those transporters, like the leucine transporters, they're pretty sensitive for quite a while. I mean, you're talking about at least 24 hours, right? Maybe even longer, but definitely 24 hours.

    25. PAPeter Attia1:10:00

        I, I, I always... I think the, I think the mice atherosclerosis studies are very dangerous. Um, y- y- w- it's, it's, it... we have to be very careful. They have a very different lipoprotein system than we do. Uh, they evolved in a totally different manner than we did. Their amount, the amount of protein they require is totally different from us. So I'm always, I'm always really wary when I see these studies that are using the mouse model of atherosclerosis. Um, I, I think I understand why we do it, 'cause it's much easier and cheaper than looking at, um, at primates. Uh, and obviously, you know, we can't do these studies in humans. But, um, you can find a lot of things in mice when it comes to atherosclerosis that don't seem to matter-

    26. RPRhonda Patrick1:10:39

        Mm

    27. PAPeter Attia1:10:39

        ... whatsoever in human biology. I would chalk this up to one of those examples.

    28. RPRhonda Patrick1:10:43

        So then there you have it. I mean, that's like a lot of the controversy around protein being bad for you and activating mTOR is coming from that study, and then there's countless studies on cancer increasing with IGF-1 and mTOR. And again, same deal where, you know, IGF-1 exercise is causing IGF-1 to go into the brain, to go into muscle. So-

    29. PAPeter Attia1:11:05

        People also don't appreciate how short the half-life of IGF-1 is. Like, it's a staggeringly short half-life molecule. [laughs]

    30. RPRhonda Patrick1:11:12

        Oh, really?
13. 1:11:33 – 1:14:52

    The unmatched longevity benefits of exercise, & Peter’s recommended protein intake

    1. PAPeter Attia1:11:33

       yeah. Uh, look, all roads for me still point back to this idea that, and I know you would agree with me, so it's not gonna be that controversial, but, you know, exercise is the most important drug. I just don't, I'm just not aware of a drug, in quotes, that is, that is better than exercise. And I know there's this enormous effort to figure out a way to put exercise into a pill. I just can't imagine it'll ever happen.

    2. RPRhonda Patrick1:11:58

       It's not. This-

    3. PAPeter Attia1:11:58

       There might be, there might be several pills that come out of it, right? We might figure out a way to make Klotho. We might figure out a way to make BDNF. We might figure out a way to deliver IGF directly to muscles. Like, there might be a whole bunch of little things, but-

    4. RPRhonda Patrick1:12:11

       There's like 500 molecules a day. [laughs]

    5. PAPeter Attia1:12:12

       Yeah, that's, this is the, this is the... Remember, remember, I don't, I don't know if you remember this. I'm dating myself, but G- I don't know if you remember irisin?

    6. RPRhonda Patrick1:12:17

       Yeah.

    7. PAPeter Attia1:12:17

       Yeah. Like, I mean-

    8. RPRhonda Patrick1:12:19

       No, I-

    9. PAPeter Attia1:12:19

       There are no shortage of these things.

    10. RPRhonda Patrick1:12:21

        Right, and, and it, it's, there's so many things going on for sure that is beneficial with exercise. Um, and just to kind of bring it back to the protein, you know, I think that they go hand in hand. Like, we're talking about being optimal, increasing our healthspan, increasing our lifespan, having a good quality of life. Then you're talking about having a higher protein intake to support your physical activity, period. And athletes, they're some of the longest lived individuals on the planet, and we talked about this in our last podcast. I mean, Olymp- Olympic athletes live on average five years longer than the gen population. Same goes with a lot of these athletes playing these indoor team sports, and there are several studies out there looking at elite athletes, including people in the NBA, um, Major League Baseball, all, you know, a lot of these big, um, professional sports leagues. They're taking in an at least, you know, 2g per kilogram of protein per day. So- Clearly protein isn't killing them. [laughs] In fact, they're living longer than the, the general population.

    11. PAPeter Attia1:13:20

        Yeah.

    12. RPRhonda Patrick1:13:20

        So again, it comes down to that supporting, like exercise. Exercise is the king, right? Exercise is, like, the most important thing, but you need a protein to support, to support that physical activity. And, and so the... I don't understand why anyone's arguing about that. Like, what's the argument?

    13. PAPeter Attia1:13:37

        Yeah. I'm, I'm, despite all the, despite all the flak I'm taking, um, I'm gonna just defend this one and continue. And, and by the way, if new data emerge, I'm always happy to change my mind. I've changed my mind about so many things. It is absurd the number of things I've changed my mind on. I've changed my mind on GLP-1s. I've changed my mind on saunas. I mean, I can count the list of things I've changed my mind on over the past 10 years. And if there are data that will make me change my mind, I will stand up here with a straight face and I will eat crow and I will tell you that I've changed my mind. But I'm gonna stand by my recommendation, two grams per kilogram per day. And h- my rationale, again, I explained it earlier in the podcast, but just to restate it, if you aim for two, on the day you fall short, you'll still be at 1.6. If you aim for 1.6, on the day you fall short, you'll be 1.2, and that 1.2 won't be made up for on the next day because the downside is asymmetric compared to the upside. So that's, that's, that's our recommendation clinically, and that's how we work with real people in the real world, not on our Substack pages, to try to help them live a longer life.

    14. RPRhonda Patrick1:14:42

        Yeah. Is there anything else with the protein? I mean-

    15. PAPeter Attia1:14:45

        No. Let's never-

    16. RPRhonda Patrick1:14:46

        I [laughs]

    17. PAPeter Attia1:14:46

        ... talk about this again pending new data that fundamentally change the way we think

14. 1:14:52 – 1:23:26

    How Rhonda became fascinated with creatine—a well-studied, safe, & effective supplement for improving exercise performance

    1. PAPeter Attia1:14:52

       about it. All right, I wanna pivot to another topic which you may be single-handedly more responsible for the buzz on this topic than anybody else I can think of, and that is creatine. So, um, should we start with... Well, first of all, just tell me what got you interested in this topic, right? So, so this is, when, like, you're y- you know, you're not the typical demographic, no, no offense intended by that. But, like, when I was in high school, right, and I'm probably 15 years older than you, like, we as young boys in high school in the '80s were mainlining creatine like it was our day job. Uh, but here's the thing. I don't remember why, right? Like, I, it must have been from body-

    2. RPRhonda Patrick1:15:35

       'Cause your friends were doing it. [laughs]

    3. PAPeter Attia1:15:36

       Well, no, no, but it must have come from bodybuilding magazines.

    4. RPRhonda Patrick1:15:39

       Yeah.

    5. PAPeter Attia1:15:39

       Like, I don't know what the, I don't know where we got the information. 'Cause, like, I was thinking about this the other day 'cause I knew we were gonna talk about this, and I was like, "Okay, there was no internet." Like, like what was our source of truth? It was Muscle & Fitness. So there must have been something in Muscle & Fitness that told us this. And then you know what I realized we did? We would hang out at supplement stores. Like, we'd literally go in, and the supplement stores always had some big bro in baggy pants-

    6. RPRhonda Patrick1:16:06

       No. [laughs]

    7. PAPeter Attia1:16:06

       ... that tapered down to his feet, and he was barely wearing a shirt, and he was yoked, and he was explaining to us, and we were, like, at the altar of this guy. And he was telling us, "There's creatine monohydrate, and then there's, like, creatine phosphate." And at the time, everyone said creatine phosphate is better, and you have to load 30 grams a day for two weeks. Then you go into your maintenance phase at five grams a day, and then you repeat the cycle every eight weeks or whatever it was. And we were, like, buying this stuff by the truckload, and this is, like, almost, I don't know, what, 40 years ago, right? Or, you know, 30, 30, yeah, easily 35, 40 years ago. Okay. Fast-forward, I don't know, a few years ago, we're paying attention to creatine again.

    8. RPRhonda Patrick1:16:47

       Well, you just made a really important point, and I'll talk about my journey in a minute, and that is it's one of the most well-studied sports related supplements ever, right?

    9. PAPeter Attia1:16:57

       Yeah.

    10. RPRhonda Patrick1:16:57

        I mean, there's just decades and decades of research out there on creatine. A lot of it has to do with muscle. We'll talk about, you know, the brain, which is sort of my, my interest. But, I mean, it's, it's, it's one of the tried and true. I mean, it's safe. I, I don't know that there's any other sports supplement out there that's as safe as creatine. There, I don't think there is. So, um, that's an important point, right? My journey with it began with my obsession with increasing my resistance training after-

    11. PAPeter Attia1:17:27

        Like, your performance-

    12. RPRhonda Patrick1:17:29

        My-

    13. PAPeter Attia1:17:29

        ... or your hypertrophy or your recovery? What specifically?

    14. RPRhonda Patrick1:17:31

        In everything that we talked about in the first ha- like, half of this, this episode where I realized that I was so focused on endurance training for long-term health, for brain health, that I sort of neglected my muscle mass and thinking about how important muscle mass was for long-term health.

    15. PAPeter Attia1:17:47

        And you've been, you've chronicled this pretty well on your social media. You've got videos of you deadlifting.

    16. RPRhonda Patrick1:17:52

        Yeah.

    17. PAPeter Attia1:17:52

        Like, you're-

    18. RPRhonda Patrick1:17:53

        I'm all in

    19. PAPeter Attia1:17:53

        ... you're really embracing this now.

    20. RPRhonda Patrick1:17:54

        Yes, yes.

    21. PAPeter Attia1:17:55

        Yeah. Awesome.

    22. RPRhonda Patrick1:17:55

        So this is, um, so, you know, after, after having a couple of experts on and just, when I have an expert on, I read the literature voraciously. Like, I just dive in and I, I wanna be in it, right? Um, and it's part of the fun. I love it, right? Like, this is, like, I get to learn all this new material that I'm interested in. And so I finally realized that I wasn't doing enough training, resistance training, and so I, um, got a tra- I have a personal trainer now. I'm doing resistance type training. I do, like, a CrossFit type training for at least three hours a week I'm doing now. It started out I was doing, like, 30 minutes a week. So I've gone from 30 minutes to, like, three hours a week. Big difference, right? And that's when I became really interested in creatine where I was like, "Okay, I know this one supplement is obviously, like, shown to benefit people that are working out." I didn't know why everything until I got into the literature, but that's kinda what got my interest into creatine. So, um, I started supplementing with... Well, let's talk about creatine, right? So creatine, most people know creatine is stored in our skeletal muscle as creatine phosphate, and it's essentially used to rapidly recycle ATP, adenosine triphosphate. This is the major energy currency in our cells. And, um, so creatine phosphate is able to help, help rapidly recycle that so you can make energy quicker. Very relevant for a lot of scenarios, including high intensity interval training, resistance training, even endurance training 'cause it in- it increases... it sl- uh, sorry, it decreases recovery time 'cause you're recycling that ATP. So it, it's really relevant for a lot of scenarios. And, um, we do make creatine endogenously. That's another thing where it's like, okay, we... this is a molecule that we make in our body. It's not, like, a dangerous thing that I'm really scared of. Um, we make about one to two grams in our liver. Our livers make about one to two grams a day, and then we can take in another, depending on how much meat we eat. Meat is the major source of dietary source of creatine, right? So vegetarians 100% rely only on their one to two grams a day, and they're probably the population that benefits the most with supplementing with creatine. And there's just countless studies out there showing this because they are just not getting anything from their diet essentially. I mean, there's like, it's, like, neg- negligible whatever is in plants.

    23. PAPeter Attia1:20:19

        Does the type of meat matter? Does fish versus beef versus chicken? I would imagine there are differences.

    24. RPRhonda Patrick1:20:24

        Yes, there are. There are differences. Like, beef-

    25. PAPeter Attia1:20:26

        Beef would be the most

    26. RPRhonda Patrick1:20:27

        ... beef would be the most.

    27. PAPeter Attia1:20:27

        Yeah.

    28. RPRhonda Patrick1:20:27

        Yeah.

    29. PAPeter Attia1:20:28

        Yeah.

    30. RPRhonda Patrick1:20:28

        Um, and it, it's probably why people on a carnivore diet, they, they just get so, like, jacked, right? [laughs] They're getting the creatine, they're getting the protein, and they're working out, and it's like this combination, right? They're just getting so much.
15. 1:23:26 – 1:34:27

    Creatine for the brain: how higher doses may enhance cognition under stress & support resilience against aging & disease

    1. RPRhonda Patrick1:23:26

       But then, um, you know, I started getting interested in some of these brain studies. As you know, I'm very interested in, in brain health, neurodegenerative disease risk, anything that can improve cognitive function in a safe way, like any kind of safe nootropic. Um, and, and that's where I really started to get interested. And this, this has build up, built up over years where I was getting interested in the brain effects even though I hadn't been supplementing with it. Um, I had been sort of just keeping an eye on the literature. And finally when I started using it, I got pushed over. I'm like, "Okay, I'm all in and I wanna, like, get into this."

    2. PAPeter Attia1:24:00

       And so are you, you, you felt like you got all in because you actually felt a difference or you were like, "Well, look, I'm already taking it for these muscle purposes. Let me really now go deeper on the cognitive science"?

    3. RPRhonda Patrick1:24:11

       Yes. I was already like, this is clearly improving my... I, first of all, the literature was clear with the muscle. There's a lot of literature. You can't deny it. You just can't. Like, whatever one-off study comes out-

    4. PAPeter Attia1:24:21

       Yeah, it is, it is a little odd. There, there aren't that many things that show up where the consistency of the studies is always in the same direction, and really what you're basically looking at is the magnitude or the effect size, but, but you're always on the same side of the tornado plot.

    5. RPRhonda Patrick1:24:35

       Exactly.

    6. PAPeter Attia1:24:35

       Yeah.

    7. RPRhonda Patrick1:24:35

       Right. And when we're talking about 40 years or whatever-

    8. PAPeter Attia1:24:38

       Yeah

    9. RPRhonda Patrick1:24:38

       ... of, of research, that's a lot of data. Um, the, with, with the brain, um, the... So for one, your brain does make a little bit of creatine as well, something I don't remember. I think it's somewhere between one to three grams a day. But, um, the data on the effects of supplemental creatine on the brain isn't dating back as far. And so you do have to kind of take the data with somewhat of a grain of salt because there's a lot of small studies and they're not like, you know, I wouldn't... You can't hang your hat on it and be like, "This is the end all be all." However- I feel like as more data's gonna come out, I'm pretty certain that it's gonna jump

    10. PAPeter Attia1:25:16

        And, and let's talk about some of the measurements because I, I think one of the advantages of studying the effects of creatine on physical performance is we have really good objective measurements that you can demonstrate in a short period of time. You can do a 12-week study, and in just 12 weeks you could objectively, unambiguously determine if there was hypertrophy and if there was an increase in performance.

    11. RPRhonda Patrick1:25:38

        Right.

    12. PAPeter Attia1:25:38

        How do we do that on the cognitive side?

    13. RPRhonda Patrick1:25:40

        Right.

    14. PAPeter Attia1:25:40

        What are the data that you've been looking at that have given you, uh, an increasing level of confidence?

    15. RPRhonda Patrick1:25:44

        Okay. Well, first let's talk about dose because that's important, and I think that that was where initially when researchers were looking into like the effects of creatine on the brain, the five grams a day didn't seem to be doing anything in terms of like getting creatine into the brain. And so the question-

    16. PAPeter Attia1:26:02

        So creatine is crossing the blood-brain barrier, that's established?

    17. RPRhonda Patrick1:26:04

        It, it is.

    18. PAPeter Attia1:26:05

        Okay.

    19. RPRhonda Patrick1:26:05

        However, the muscles are greedy as hell. [laughs]

    20. PAPeter Attia1:26:09

        Ah, those lovely greedy muscles.

    21. RPRhonda Patrick1:26:11

        Yeah, the greedy muscles. And so they're... When you're taking in up to about five grams of, of creatine, they're, they're consuming it. They're, they're taking their share.

    22. PAPeter Attia1:26:21

        Especially if you're training.

    23. RPRhonda Patrick1:26:22

        S- if you're training, it's like, yeah, exactly. Um, but even if you're not training it's, it's still going to muscle. But yes, especially if you're training. And so it was a, there was a German study that, that was published a few years back that did dose, dose dependent effect and looked at creatine levels in certain brain regions. And that study-

    24. PAPeter Attia1:26:42

        So naive question, are they using an isotope? Are they labeling the creatine and-

    25. RPRhonda Patrick1:26:45

        I believe they were using an isotope.

    26. PAPeter Attia1:26:46

        They're not using like CSF levels or anything?

    27. RPRhonda Patrick1:26:49

        I believe it was an isotope.

    28. PAPeter Attia1:26:50

        Okay.

    29. RPRhonda Patrick1:26:51

        Um, and but don't hold me to it because, you know, I, I don't remember exactly. Um-

    30. PAPeter Attia1:26:56

        You need more creatine.
16. 1:34:27 – 1:41:54

    Optimal creatine use: dosing for adults & teens, safe product selection, debunking kidney myths

    1. PAPeter Attia1:34:27

       are you having any... I, I was, I remember as a kid I never had the GI side effects with even 30 a day, but is, is for some people, is, is 10 to 20-

    2. RPRhonda Patrick1:34:36

       In one, in one dose it would probably affect a lot of people's GI. I do five gram doses.

    3. PAPeter Attia1:34:43

       And you'll just put the five grams into water and just-

    4. RPRhonda Patrick1:34:45

       I put the five grams into water or, like, tea, and then I just take it like that. And you know-

    5. PAPeter Attia1:34:51

       Yep

    6. RPRhonda Patrick1:34:52

       ... I do it mostly before noon. So I, I like to take it in the mor- because for, I, you know, like I said, I don't know if this is placebo, but I don't get sleepy in the afternoon anymore. If I miss, if I, if I only get five grams, I get the sleepiness. Now again, it could be complete, like, bias, and who cares? If it's not, like-

    7. PAPeter Attia1:35:12

       If the placebo's working for you, take it

    8. RPRhonda Patrick1:35:13

       It's work- exactly.

    9. PAPeter Attia1:35:14

       Yeah.

    10. RPRhonda Patrick1:35:14

        It, 'cause it's, 'cause it's, it's physiologic, right? I mean, it's a, it's a, it's a biological mechanism that's working for me. And if you listen to this episode and it works for you, that's great because there's really no downside. And in fact, I think we're gonna get more and more evidence out there that it's gonna be beneficial, and 10 grams is gonna be the new-

    11. PAPeter Attia1:35:30

        The new baseline

    12. RPRhonda Patrick1:35:31

        ... five grams. Yeah.

    13. PAPeter Attia1:35:32

        Yeah.

    14. RPRhonda Patrick1:35:32

        It's gonna be the new baseline.

    15. PAPeter Attia1:35:34

        But if you aren't in this state of jet lag, 10 grams per day, you do two shots of five-

    16. RPRhonda Patrick1:35:39

        I do

    17. PAPeter Attia1:35:39

        ... and you're, you're feeling great.

    18. RPRhonda Patrick1:35:40

        That's what I do.

    19. PAPeter Attia1:35:41

        Okay.

    20. RPRhonda Patrick1:35:41

        10 grams a day.

    21. PAPeter Attia1:35:41

        Let's talk a little bit about brands. Um, are you, are, are most of the companies out there that are otherwise very reputable in making supplements, so whether that be Thorne, Momentous, like I've lost track of all the names of the companies out there that make supplements. But there, there are a handful of, like, supplement companies that actually really seem to be credible. Do you have any difference between them? Do you always look to make sure that Creapure is the active ingredient within it, or does it matter?

    22. RPRhonda Patrick1:36:06

        I don't. I think the most important thing is that it's creatine monohydrate.

    23. PAPeter Attia1:36:09

        Yeah.

    24. RPRhonda Patrick1:36:09

        The reason people like Creapure is because it's, like, pure.

    25. PAPeter Attia1:36:12

        Mm-hmm.

    26. RPRhonda Patrick1:36:13

        But what I like even more than that is NSF certification because there's rigorous testing to make sure there's no, like, lead contamination and these, like, heavy metals and things that sort of hitchhike on a lot of these supplements. And so I, I personally, that's what I look for. I mean-

    27. PAPeter Attia1:36:29

        Okay

    28. RPRhonda Patrick1:36:30

        ... I think Creapure is great, too. Um, I don't know if that... Depen- depending on whatever brand, you know, is using Creapure.

    29. PAPeter Attia1:36:36

        It gets... Yeah. Lots of brands are using it.

    30. RPRhonda Patrick1:36:37

        It's... Exactly.
17. 1:41:54 – 1:52:32

    Sauna: how deliberate heat exposure mimics exercise, boosts cardiovascular & brain health, & shows promise for improving mood & mental resilience

    1. PAPeter Attia1:41:54

       more time, I wanna talk something about a topic that is near and dear to both of our hearts, which is temperature. Um, you know my journey on the sauna train, right? I was probably the biggest sauna skeptic for many years. Um, not because I didn't love it. I love, I've always loved a sauna. I just had a hard time believing that the data were causal, right? I was just like, there's too much healthy user bias in here. Um, but you know, over the last five years as I've looked closer and closer at the data, um, while I can't comment on the effect size, I think it's very difficult to comment on the effect size from all the epidemiology. It's very difficult for me to believe that there isn't a positive effect in terms of at least cardiovascular disease and dementia. Um, so that, those are my priors. My priors are I'm now in a place where I actually view sauna as an intervention that can help an individual reduce their risk. And for me personally, because I don't really worry about cardiovascular disease anymore, it's so easy to manage the risk around that otherwise, but dementia is a very difficult risk to manage 'cause, you know, there's fewer things we understand about the causal pathways to get there than we do ASCVD. So in many ways, I'm in the sauna, not just because I enjoy it, not just because it's a wonderful social opportunity to be with your spouse if that's how you choose to do it, but because I'm also banking a little bit on, hey, I wanna get some benefit to my brain. So- Tell us where you are currently because I, you're one of the people who I think keeps up with this literature more than anybody. So tell us if anything has changed in your mind one way or the other, both in increase in confidence, decrease in confidence. You know, just, just update us on where you are.

    2. RPRhonda Patrick1:43:37

       Yeah. I, I am still a huge proponent of using deliberate heat exposure to improve your health, both cardiovascular and brain. I do think that the physiological mechanisms, um, are s- somewhat, in many, in, in some ways mimicking some aspects of moderate intensity cardiovascular exercise, and that is how it is improving cardiovascular health and also s- a p- an a- an aspect of that brain health. Um, cardiorespiratory fitness, that's been shown. There's been not only, like, observational data, but there's been intervention studies looking at endurance, getting someone on a stationary cy- cycle and then adding the sauna on top of that, and VO2 max improvements were greater in individuals that are also doing the sauna right after their-

    3. PAPeter Attia1:44:26

       Yep

    4. RPRhonda Patrick1:44:26

       ... training. So, um, anything that improves cardiovascular health is going to improve brain health. But there's another aspect to this story here, and this kind of dates back to, like, the origins of my, like, one of my first biology, you know, experiments I did in, um, when I was actually a technician at the Salk Institute before I went to graduate school, and that has to do with the heat shock protein response. And so we do know that heat stress in the form of either hot baths or going into a hot sauna... E- infrared sauna, a little different. You'd have to stay in there really long, like a long time to get, to get a real heat shock response. But if you're in like 163 degree Fahrenheit sauna for 30 minutes, we know that heat shock proteins increase about, uh, 50% over baseline.

    5. PAPeter Attia1:45:15

       And what would be the equivalent exposure in steam or water?

    6. RPRhonda Patrick1:45:18

       In the water, it's about 104 degrees for 20 minutes, like shoulders down.

    7. PAPeter Attia1:45:24

       Okay.

    8. RPRhonda Patrick1:45:24

       So you're-

    9. PAPeter Attia1:45:25

       20 minutes?

    10. RPRhonda Patrick1:45:25

        Mm-hmm.

    11. PAPeter Attia1:45:26

        Okay.

    12. RPRhonda Patrick1:45:26

        Yeah, about 20 minutes.

    13. PAPeter Attia1:45:27

        And then presumably if you're in a hotter dry sauna, less time is needed?

    14. RPRhonda Patrick1:45:32

        Presumably. Uh, we don't have that data. [laughs]

    15. PAPeter Attia1:45:35

        Yeah.

    16. RPRhonda Patrick1:45:35

        I'm just quoting the data we, that we, the empirical data that we have.

    17. PAPeter Attia1:45:38

        And, and what-- Tell me more about the IR, 'cause there are no questions I get asked more than, "Hey, are all the benefits you're talking about," which all seem to come from studies in dry sauna, "are they also applicable to, to infrared saunas?" To which the only data I can find is if you're using infrared, you actually have to rely on the change in skin temperature to know you've hit the... Whereas in sa- in dry sauna, we can look at time and temperature and humidity, right? Like if I know the temperature of the sauna, the humidity of the sauna, and then the duration that you're in there, I know what-- I know how to measure the effect size. We can't do that in IR. So we looked at some data that, that looked at basically thermal skin change, and I, I can't remember the number, so I don't want to get it wrong. It was either five or eight degree increase in skin temperature was necessary to produce similar benefits. What-- Do, do you know about this?

    18. RPRhonda Patrick1:46:26

        I, so I ha- not that. I don't know specifically about that, but I do know most of the studies that have been done comparing, and there have not been many, maybe three or four that I can think of, they have compared a regular hot sauna to infrared sauna at the same amount of time. So in other words, the dose is the same. Obviously, the temperature difference is pretty vast. Depending on the study, the hot sauna could be, you know, 160 or it could be 175 or 180, and the infrared is like 140 or something like that, right? So a lot of variation in terms of t- you know, the temperature of the saunas. If you're looking at... There, there have been-- In fact, there's like one study, like the title is something like "Infrared Saunas" or so- like "Does Not Mimic Cardiovascular Effects of Exercise" or something like that, and that's because at this, the given dose, right? If you're just doing like 20 or 30 minutes, it's not gonna be the same. Like your heart rate doesn't go up as much. You don't feel as hot because the temperature's not as hot. Now you will sweat based on a different mechanism, but as far as my take of the literature, it's pretty clear to me that infrared saunas, if you want it to mimic the cardiovascular exercise response, you might have to double that. You might have to double-

    19. PAPeter Attia1:47:44

        The duration.

    20. RPRhonda Patrick1:47:45

        Yeah. So rather than spending 20 minutes in 175 degree, 180 degree sauna, you're gonna spend 40 minutes.

    21. PAPeter Attia1:47:53

        Wow, yeah.

    22. RPRhonda Patrick1:47:54

        Right? So you're giving up your time-

    23. PAPeter Attia1:47:57

        Mm-hmm

    24. RPRhonda Patrick1:47:57

        ... if that's the kind of sauna that you either have or enjoy because you, if you do, and I've been in infrared saunas many times, if you stay in long enough, like you get that. You feel hot, and you feel that like heart rate going up just like you do when you're in a hot sauna. It just takes a lot longer. Um, now I know you've had Dr. Ashley Mason on this on, um, on your, your podcast. She's been on my podcast as well. I've be- I'm a c- we collaborate.

    25. PAPeter Attia1:48:21

        Isn't she awesome?

    26. RPRhonda Patrick1:48:22

        She's awesome.

    27. PAPeter Attia1:48:23

        Just love her.

    28. RPRhonda Patrick1:48:24

        She's awesome, and we collaborate on a variety of sauna studies. She does a lot of-- She wears a lot of hats. And her data looking at, you know, she's a psychologist by training, and she looks at depression, and she's looking at depression as an endpoint in terms of, you know, these infrared saunas, and she's looking at core body temperature increases, right? So people, their core body temperature is going up by like almost two degrees, and, um, in tho- in that case, I mean, she's got them in an infrared sauna for like 85 minutes. They're in there a long time. They are getting hot, and she'll, like she'll talk about it, you know, the people are-- They've got-- She's got assistants that are cal- cooling them down on their head 'cause it's a head out infrared sauna. It's like a, it's like a, basically like a bed. Um, and, and, uh, anyways, that's, that's a whole other area looking at the effects on mental health, and this, this actually stems from her mentor, Dr. Charles Raison, who I had on the podcast many years ago. Um, he did this like really phenomenal pilot study looking at-- It was a, it was a- Kind of funny. It's called hy- hyperthermia.

    29. PAPeter Attia1:49:30

        Yeah.

    30. RPRhonda Patrick1:49:30

        So, like, you're inducing hyperthermia, right?
18. 1:52:32 – 1:57:33

    The benefits of sauna for reducing risk of dementia, & why hotter may not be better

    1. RPRhonda Patrick1:52:32

       that said, the effect on the head... And, you know, if you think about, like, hot tubs, jacuzzis, right? We're all sitting with our head out as well, right?

    2. PAPeter Attia1:52:40

       Mm-hmm.

    3. RPRhonda Patrick1:52:40

       We're in there, and, uh, it- it- it's, it's, it's, it's a good question because I agree with you. When I'm in a hot sauna, and I'm also on the top, and it's, like, the same deal. I wanna get out in 20 minutes. If I stay in too long, I will get a headache, and I, I've know my... I know my threshold now. I know the temperature and the duration and the amount of water and all the... Like, I know all those variables.

    4. PAPeter Attia1:53:03

       Isn't it amazing how much water you can drink in a sauna? [laughs] Like, I just-

    5. RPRhonda Patrick1:53:07

       I know. It's, it's, it-

    6. PAPeter Attia1:53:08

       I worry I'm gonna get hyponatremia. I'm like, "You gotta slow this down, man." [laughs]

    7. RPRhonda Patrick1:53:11

       [laughs] Um, so the interesting thing is, is that talking about dementia risk, I talked about heat shock proteins, and I q- I kind of didn't even... I, like, went off on this tangent. Sorry. But the heat shock proteins, what they do is they prevent proteins from misfolding and forming aggregates, right? And so, um, you know, it's, it's... Obviously, when you're getting into a hot sauna, you are denaturing some proteins, and so your heat shock proteins are a stress response that's activated to help with the proper folding of those proteins that were kind of denatured somewhat from the heat that you were exposing yourself to. Well, it turns out the heat shock proteins stay active for a long time, and so they end up having this, like, effect where you're now just improving the folding of proteins in general, even after you're out of the hot sauna, right? So, um, he- there's a lot of animal studies that have been done. I did a lot of studies in worms, like, many, many years ago, where you can take amyloid beta 42, inject it into a worm muscle tissue, and then activate heat shock proteins, and it, like, prevents the aggregation, and it prevents y- the, the muscle sort of paralysis that occurs in these worms. Animal studies have been done looking at amyloid beta and heat shock proteins in Alzheimer's disease. Again, it's having a protective effect. Now, is that the whole story? No. The cardiovascular effects are also important for brain health, in my opinion, right? You know the data coming out of Dr. Jari Lautonen's lab showing that dementia and Alzheimer's disease risk is 66% lower in people that are using the sauna four to seven times per week versus just one time a week. Of course, all the taken-

    8. PAPeter Attia1:54:45

       And that was at 179 degrees or greater for 20 minutes or greater, right?

    9. RPRhonda Patrick1:54:49

       Yeah, like 175 or 179 exact for 20 minutes. Um, now here's where your question comes in, and that is, like, what about the head? And there was another study out of Finland. It was not Jari's lab. It was another professor that I, I, uh, I'm not aware of. But, um, this study looked at sauna use and dementia risk, and then it sort of... It stratified the data based on temperature. And it was protective again. People that are using the sauna, again, they're getting a protective effect against dementia. But when people were going extreme, so if they're going above 200 degrees Fahrenheit, and they were... On average, it was, like, if they're getting to, like, 212. People do this, by the way. This is, like... You can go on-

    10. PAPeter Attia1:55:30

        Yep

    11. RPRhonda Patrick1:55:30

        ... Instagram and see it's not an uncommon thing. Their dementia risk was actually increased. With that temperature where it was like really hot. And my concern is the head at that high of a temperature.

    12. PAPeter Attia1:55:45

        I've started wearing one of those um-

    13. RPRhonda Patrick1:55:46

        Sauna hats?

    14. PAPeter Attia1:55:47

        The sauna hats.

    15. RPRhonda Patrick1:55:48

        Yeah. Yeah.

    16. PAPeter Attia1:55:48

        It, it-- And again, I don't know why it works. Do you?

    17. RPRhonda Patrick1:55:52

        Um, I mean, it's-

    18. PAPeter Attia1:55:52

        It sh- it doesn't-- it's not logical to me why it's hurting.

    19. RPRhonda Patrick1:55:54

        It's-

    20. PAPeter Attia1:55:55

        Uh, why it's helping rather.

    21. RPRhonda Patrick1:55:55

        I don't know. It's, it does seem to help. [laughs] I mean, it shields probably some of the heat that you're being exposed to, right? 'Cause there's gotta be like some ambient-

    22. PAPeter Attia1:56:02

        Yeah, I suppose. But it, but the fact that that's a net benefit 'cause it's also gotta be preventing you from dissipating heat, but-

    23. RPRhonda Patrick1:56:07

        True

    24. PAPeter Attia1:56:07

        ... clearly what it's preventing coming in-

    25. RPRhonda Patrick1:56:09

        Is it coming in

    26. PAPeter Attia1:56:09

        ... exceeds what-- But, but it makes such a difference. Um-

    27. RPRhonda Patrick1:56:13

        Those-- I mean, these cultures in like Finland, they wear it

    28. PAPeter Attia1:56:15

        ... but I've al- I've also dialed mine down a little bit.

    29. RPRhonda Patrick1:56:17

        Yeah.

    30. PAPeter Attia1:56:17

        I used to be consistently going to at least two hundred, and now I'm like, "You know what? Honestly, like one eighty-five to one ninety is good enough."
19. 1:57:33 – 2:01:14

    The FoundMyFitness podcast

    1. PAPeter Attia1:57:33

       one, one question and topic, which is what year did you launch your podcast?

    2. RPRhonda Patrick1:57:37

       I launched it in-

    3. PAPeter Attia1:57:38

       Fourteen?

    4. RPRhonda Patrick1:57:39

       ... twenty fourteen.

    5. PAPeter Attia1:57:40

       So here we are. We're eleven years in. You are the OG in this space. You have an incredible podcast. Um, are you still enjoying it, and what are you most excited about?

    6. RPRhonda Patrick1:57:53

       I love doing the podcast. I don't do it every week like some people. I like to sort of fi-find the guests that I'm really interested in learning from. What I love the most is I've always learned more from the conversations I would have with my colleagues or professors than I would from reading a paper, and now I get to do that for a living, where I'm just having like these superstars on my podcast, and I get to like learn so much from... I read their papers first, but I also, I, I learn so much from the conversation and, and then people get to like benefit from it, right? I mean, it's so rewarding. So I get to like itch my own s- you know-

    7. PAPeter Attia1:58:30

       Yeah

    8. RPRhonda Patrick1:58:31

       ... or scratch my own itch, and then I also get to like help people.

    9. PAPeter Attia1:58:33

       Well, you know, I just wanna make sure that everybody listening kind of understands your place in the, in the podcast, podcast landscape, which is I've, I've talked about one of my favorite podcasts. Probably my favorite podcast or one of my two favorite podcasts in the world is called Acquired. So Acquired is a podcast about companies, great companies, and what makes them great. And the hosts of that, uh, Ben Gilbert and David Rosenthal, they only put out one a month on average. But the reason is the amount of work that they have to put into the preparation is insane, and I've, I've gotten to know, uh, Ben especially, and you know, I think Ben is putting at least a hundred and twenty hours of preparation into each podcast, and therefore, you can only do one a month. Um, and it shows. So in many ways, I think of you as the Acquired podcast version in our space, which is just the, the breadth and the depth of what you're doing is, is awesome. It's such a treat. And, um, it's just, it's always, it's always quality over quantity. And yeah, I'm sure if you could put out one a week, you would, but the reality is you wouldn't be able to put in the quality if you were trying to bang one of these things out a week. And, um, so anyway, I'm just, I'm glad to hear you're still loving it. Um, and it's hard to believe how fast time has gone. I remember being on your podcast in twenty fourteen, so that's kind of insane.

    10. RPRhonda Patrick1:59:48

        Yeah.

    11. PAPeter Attia1:59:48

        It's been that long.

    12. RPRhonda Patrick1:59:48

        You were like one of the first ten guests I've had. Mm-hmm.

    13. PAPeter Attia1:59:50

        I don't think I knew what a pod-- I mean, I sort of knew what a podcast was 'cause Tim Ferriss had had me on his. But it was like I didn't really understand what this was. I was like, "I wonder, why does she wanna talk to me? Like this seems kind of random." But, uh, look at how much it's evolved, right?

    14. RPRhonda Patrick2:00:04

        I know. Well, thank you for the kind words, and I feel the same about your podcast. You know, when I'm, when I'm looking for information that I know I can trust, it's always like, I'm like, "What, uh, uh, Peter. [laughs] When's Peter?" Peter, Peter's someone that I've always been able to trust for being rigorous, right? And really, like, like you said, if something changes, then you change, and I respect that.

    15. PAPeter Attia2:00:25

        Well, Rhonda, it is, it, this has been super interesting. As is always the case, there were about eighty percent more things we were supposed to talk about today, but I'm really glad that we got to the topics we talked about. I think the, the protein question, the creatine question, and this nuance around temperature are all things that matter to everybody. And, and in two of the three cases, I learned a lot. Obviously, on the protein side, it was more about you and I trying to set the record straight. But I-- this creatine stuff is new. It's gonna change what I do, and also you're gonna, you've, you've already made a change to what I'm gonna do in the sauna. So anyway, thanks again. This was awesome.

    16. RPRhonda Patrick2:01:02

        Thanks, Peter, for having me on. I really appreciate it. [outro music]

Episode duration: 2:01:14