Dr. Peter Attia, MD — Fasting, Metformin, Athletic Performance, and More | The Tim Ferriss Show

1. 0:00 – 5:37

   Intro

   1. TFTim Ferriss0:00

      Optimal minimal At this altitude, I can run flat out for a half mile before my hands start shaking. Can I ask you a personal question? Now would seem an appropriate time. What if I did the opposite? I'm a cybernetic organism, living tissue over metal endoskeleton. The Tim Ferriss Show. This episode is brought to you by HVMNS Beet Elite. The product is Beet Elite, not Meat Elite, not beet, B-E-A-T, but beet, B-E-E-T Elite, which you might consider an endurance superfood or what they would call a nitric oxide activator. Really all I care about is this product, Beet Elite, was introduced to me several years ago by a multiple-time world champion and has since been recommended to me by multiple world-class athletes, and I use it pre-workout for endurance training. That could be cycling. That could be swimming. It is very rarely running. But, uh, my subjective experience supports what some of the research would seem to indicate, and that is that you can work out, say, up to 15 to 18% longer if you're looking at high-intensity interval training, HIIT, for instance, and, uh, at recovery times. So the, uh, let's call it the refractory period for getting back to peak power output, for instance. So I use Beet Elite, just used it this morning before a 30-minute, somewhat intense swim workout. And I have found that particularly for someone like myself who has really terrible endurance, genetically speaking, my presets are horrible, that it really does allow a 10 to 20% boost in shorter workout performance especially, although I do know people who've used it for 20-mile runs, 30-mile runs, much longer endurance events. And, uh, they've got all sorts of different points about the mechanisms of action and so on, but suffice to say that it is a lot easier to consume Beet Elite than to eat the nitric oxide equivalent of six whole beets, for instance. Much more rapidly assimilated, and, uh, it tastes great. Uh, it will also stain your pet polar bear or your white cotton or your down pillows, so [laughs] don't spill it on anything, but it does taste delicious. I tend to mix this into a shake that I have pre-workout in the mornings. So there you have it. I've used Beet Elite for a number of years now. It is trusted by hundreds of elite teams, athletes, and organizations all over the world, and it is also Informed Sport certified, which means that it is certified to not contain any banned substances. So if you're a competitive athlete, that is one fewer thing that you need to worry about. So take your performance to the next level with Beet Elite. Try it out. Go to livehuman.com/tim to get 20% off your first purchase. The team at HVMN, that's the company, is making this offer exclusive to you, my dear listeners, so check it out. Go to livehuman.com/tim. Super simple. Livehuman.com/tim. Give it a shot. [electronic music] This episode is brought to you by Peloton. I love Peloton. Peloton is a cutting-edge indoor cycling bike that brings live studio classes right to your home. You don't have to worry about fitting classes into your schedule, making it to the studio, or dealing with some commute to the gym. I have a Peloton bike in my master bedroom at home, and it is one of the first things that I do in the morning. I wake up, meditate for 20 minutes, and then I knock out a short 20-minute ride, usually high-intensity interval training, or HIIT. Then I take a shower, and I'm in higher gear for the rest of the day. It's beautifully convenient and has become something that I actually look forward to, and I was skeptical in the beginning. I didn't think I would dig it, and I really do. So [laughs] you have a lot of options. For one, if you like, you can ride live with thousands of other Peloton riders from across the country on the interactive leaderboard to keep you motivated. I tend to use a lot of the classes on demand and have four to six of them that I've bookmarked and use over and over again. There are up to 14 new classes every day with thousands of classes on demand, and there are a variety of workouts to choose from. 45-minute classes, 20-minute burns, hip hop, rock and roll, low impact, or high intensity. Pick the class structure and style that works for you. Peloton has an amazing roster of incredible instructors in New York City. They really do have great instructors of every possible personality [laughs] and style, and you can find one that you love, no matter what you're in the mood for. Personally, I use Matt Wilpers a lot, but I use a bunch of them. I'm promiscuous and enjoy classes from a lot of their instructors. With real-time metrics, you can track your performance over time and continue to beat your personal best. I did not think the gamification would work for me, and, uh, they really hit the nail on the head. It does work, at least for me, tremendously well to keep me pushing consistently. So discover this cutting-edge indoor cycling bike that brings a studio experience to your home. Peloton is offering listeners of this podcast a limited time offer. Go to onepeloton.com. That's spelled O-N-E-P-E-L-O-T-O-N.com.

2. 5:37 – 10:08

   Show kickoff + the “Five Things” format with Peter Attia

   1. TFTim Ferriss5:37

      Enter the code TIMPODCAST, all one word, at checkout and get $100 off accessories with your Peloton bike purchase. Get a great workout at home anytime you want. Go to onepeloton.com and use the code TIMPODCAST to get started. [electronic music] Well, hello, boys and girls. This is Tim Ferriss, and welcome to another episode of The Tim Ferriss Show. I am here with some, might mistake him as Borat sample

   2. PADr. Peter Attia6:07

      A, a man is, uh, like a horse. A, we say in the Kazakhstan, if a man is, uh, happy, h- happy, you know, happy, is like if a horse is a happy.

   3. TFTim Ferriss6:20

      [laughs] But on the internet and in his clinical duties, he's known as Peter Attia. Dr. Peter Attia, welcome back to the show.

   4. PADr. Peter Attia6:33

      Thank you. Thank you for having me.

   5. TFTim Ferriss6:35

      And, uh, Peter, for those who do not know anything about your background, we'll cover just the basics, but, uh, what, what would be a kind of speaker bio short version of Peter Attia, just to get people up to speed who have not heard previous episodes?

   6. PADr. Peter Attia6:50

      A part-time shepherd, part-time race car driver, part-time archer, part-time doctor.

   7. TFTim Ferriss6:58

      And that pie chart has most of the pie on doctor. Uh, [laughs] what else do we have here?

   8. PADr. Peter Attia7:05

      [laughs] Um-

   9. TFTim Ferriss7:08

      Not your-

   10. PADr. Peter Attia7:08

       Doctor interested in longevity.

   11. TFTim Ferriss7:09

       Not your-

   12. PADr. Peter Attia7:10

       And [laughs] I guess I have to do all the serious stuff now. Um, podcast host, courtesy of you. Um, podcast is called The Drive, and it focuses on things beyond driving. Mostly, I guess, things related to longevity. And, uh, and dad. I guess that's another thing on the bio.

   13. TFTim Ferriss7:29

       Another responsibility.

   14. PADr. Peter Attia7:30

       Yeah.

   15. TFTim Ferriss7:32

       And, uh, for those who have not heard our prior conversations, Peter is my go-to resource for anything related to extension of lifespan, or more accurately, healthspan. So threading the needle of combining both longevity and performance, and that's across many different dimensions. We're probably not gonna spend all of our time on that today, but Peter is one of the most methodical and, uh, oftentimes obsessive people I've ever met, and that's coming from me, keep in mind. So I think it was in episode one that we talked about, so we're not going to spend time on it now, but, uh, Peter's very, very, very particular etiquette for stapling, uh, which has measurements in the metric system and so on. So we're not gonna get into that. But Peter is my de facto expert when it, uh, when it comes to many different things, uh, including longevity. And one of our episodes, uh, which was a group episode with two other very, very accomplished scientists, was actually recorded on Easter Island, as a teaser for people who might want to explore, which is known as Rapa Nui, and is the, uh, the, the namesake from which rapamycin is named, which we may talk about. And, uh, there you have it for a preface to our conversation. But we're gonna try something today, which is a first, and, uh, I think we're gonna call it temporarily Five Things with Peter Attia. It might end up being more than five, but I know Peter pretty well, and Peter knows certainly me quite well. And I said, "What do you think of doing an episode where we talk about, say, five things that you're excited about currently, five things you've changed your mind on in the last whatever it is, a year, two years, three years, whatever, and then five absurd or stupid things that you do or still do?" And, uh, we're gonna give that a shot. And I think we'll maybe cycle through. Do you think we should do the five excited, five change, five stupid in that grouping, or should we do one, one, one and kind of cycle through?

   16. PADr. Peter Attia9:47

       Ooh, that's a, that's a good question. [laughs] I don't know. I, uh, I was all mentally prepared to go from one category to the next, so I would suggest do the opposite of what I was prepared for.

   17. TFTim Ferriss9:59

       Perfect. Let's cycle through. So what is, what is the first, the first thing you'd like to confess or describe that you're excited about?

3. 10:08 – 18:12

   “Centenarian Olympics”: training for physical ability in your 90s and beyond

   1. PADr. Peter Attia10:08

      So the first thing, and, and, and I guess for the listener, you were very kind enough to give me a heads-up that this is what you wanted to talk about, so I actually did have some time to think about this, which, um, fortunately allows me to not sound like an idiot, which is what I [laughs] would've sounded like if you had just asked me this cold. So the first thing I have on my list about excited stuff is the Centenarian Olympics, which is my favorite sport. It's the sport that I am exclusively training for, and, um, it has become one of the highest priorities within my medical practice in the past pro- probably two years. So the idea is the following. I had this, um, I, I think I can call it an epiphany, actually, uh, maybe 18 months ago to two years ago. I was at the funeral of a close friend. Uh, the, the parent of a close friend. And, you know, like all funerals, there are, there's, there's, there's a somber nature to them, but, but on some level, people are also generally rejoicing in the fact that a person hasn't suffered too much. And in the case of the, my friend's parent, um, who'd been diagnosed with Alzheimer's disease, uh, the time from diagnosis to death was, like, six months. And everyone was like, "Ah, that's great," you know? Th-this-- there wasn't much suffering there. Um, but I knew that parent for many years. Um, and what I realized in spending more time talking with everybody was that the last 10 years of their life, um, even though their brain was still intact, shy of the last six months of that 10 years, um, the body had broken down. And the two things that gave that person the pleasure, you know, beyond sp- spending time with their grandkids and things like that, which was golf and gardening, like landscaping, really some killer landscaping, were basically off the table. You know, courtesy of nip in- in, uh, like, um, hip injuries, shoulder injuries, back injuries, all these other things. And so I sort of reflected on this for a while and realized that's pretty much the standard path that people go on, which is before they actually die their physical death, you know, the sort of what I call death certificate death, they tend to die some combination of a cognitive and physical, as in exoskeleton death. And so we're sitting there at the funeral and I'm, I don't know, I'm just thinking there's got to be a way to stop this because nobody's really thinking about this. We do all this amazing training for athletes who are, you know, trying to go to the Olympics or even being weekend warriors or doing whatever they're gonna do. But why aren't we training to be kickass 90-year-olds? So my hypothesis was, well, it's just a lack of specificity. I mean, the, what separates, you know, a professional athlete from a weekend warrior is generally the specificity and the intensity with which they pursue this thing. So I said, "Well, what if we came up with an event that actually defined what one would want to be able to do when they're 100, using that just as a benchmark?" Again, you may never live to 100, but to train to achieve this thing when you're 100, you'll obviously be in great shape when you're 80. And so I sort of came up with this idea of the Centenarian Olympics. And the first thing you gotta know about the Centenarian Olympics is it's, it's very personal. It's individual. Everyone will have a different even- a, a set of events. So you and I might have a different looking Centenarian Olympics, though I think there are some common things to all. Um, so the first thing I did to figure this out was I, for myself, which is, y- you know, the person I'm solving for in the first iteration is sort of mapped out how old everyone in my life would be when I'm 100. So how old would my kids be? How old would their kids' kids be? And all, all, all the way down. And that gave me kind of a mental model of what the world looks like when I'm in my 10th decade. And what I realized is the things that are probably gonna give me the greatest joy at that stage will involve interacting with those littler people. Uh, and my kids won't be that little. They'll be in their 60s or whatever, but their kids will be, you know, in their 20s and 30s, and their kids' kids will be basically the age of my youngest kids now. And so I just started paying more attention to what I do with them. And it's stuff that, you know, Tim, you and I would take for granted that in fact, uh, I'm guessing anybody listening to this is gonna take it for granted. But kids, you've seen my kids a million times, they play on the floor. So step one, can you get up off the floor? Can you lay on the floor? Can you do something on the floor? And can you get up under your own support? Again, you could do that blindfolded today, but watch how many people, even in their 60s, let alone 70s and 80s, can't do that. And then you start to deconstruct why. What are the structural misgivings that prevent someone from doing that? Another thing I noticed is how often toddlers come running at you headfirst, and they don't actually stop when they get to you. So there's an implicit assumption that as they're running to you, you're going to be able to pick them up and stop that momentum. And if you can't, you're gonna get a headbutt to the groin. So that's, that's [chuckles] a very essential part of the equation here. So I started saying, "Well, how many times does my son, my youngest son, come running at me, and how often do, how often do I have to, you know, drop down into a goblet squat, grab him, and pick him up?" And so basically, I listed out 18 things that I can do today that I want to be able to do when I'm 90, for example, and those events constitute my Centenarian Olympics. And so I'll rattle off a couple of them, but, you know, a 30-pound goblet squat. Again, could you do that today, Tim? Yeah, you could do 100 of those today. But how many 90-year-olds can do that? Very few. Um, walking up three flights of stairs with 10 pounds of groceries in each hand and walking down under the same load. Um, again, biomechanically, that's not tr- that's not a trivial task. The walking down has its own challenges. The walking up has its own challenges. Um, being able to pull myself out of a pool where the gap between the water and the s- surface, the lip of the, you know, the sur- the, the ground is six inches away, so being able to actually, like, pull myself up. Um, as I said, getting up off the floor with a single point of support, being able to put a 30-pound suitcase over my head, all these sorts of things. And-

   2. TFTim Ferriss16:13

      Which would simulate putting your luggage into the overhead.

   3. PADr. Peter Attia16:16

      Exactly.

   4. TFTim Ferriss16:17

      Mm-hmm.

   5. PADr. Peter Attia16:17

      Like, again, I would not want to n- I don't want to get to the day when I can't put my luggage above myself in the airplane. And once I sort of mapped out all these things, I kind of broke down what the movement patterns that were necessary to do this. So this requires the ability to hip hinge. This requires a certain amount of aerobic efficiency. This requires a certain amount of anaerobic efficiency. This requires a certain amount of scapular stability, et cetera, et cetera. And they basically condense into four elements of health, which is stability, so the ability to, um, control, um, you know, using the muscles of the body, control the exoskeleton such that load is transferred safely through muscles as opposed to unsafely out joints. Strength, aerobic efficiency, and anaerobic performance. And then you back out of that and say, "Well, if you want to be able to do all of those things by the time you're 100 or, say, in your 10th decade, so between 90 and 100, what do you need to be doing when you're 70?" 'Cause there is going to be an inevitable decline from 70 to 100. And if you can do this metric at 70, what do you need to be able to do at 60? And what do you need to be able to do at 50? And, you know, since that's the decade I'm closest to, you know, I'll be 50 soon, that becomes my benchmark is, okay, so that's what I'm training for. And so this idea we've sort of translated to our patients, which is, you know, unless you really have a strong desire to do an Ironman or run a marathon, um, most people are exercising without a real sense of purpose. And so the question is: Could you create a true sense of purpose around this and then work backwards to build towards it? And obviously, we're not gonna know the answer to that question until people start getting there, but m- my, my strong belief is you can and you should. And if you, if you, if you don't do this, if you just assume by chance you're going to get there, I think the likelihood of that is low.

4. 18:12 – 27:27

   Reverse-engineering training: goblet squats, deadlifts, and trunk stability mechanics

   1. TFTim Ferriss18:12

      And- If we look at one of those exercises, and you can pick any one, but let's just take the goblet squat.

   2. PADr. Peter Attia18:18

      Yeah, goblet squat.

   3. TFTim Ferriss18:19

      To simulate picking up a toddler. How do you back out from doing that at 90 or 100 with 30 pounds? Do you assume a certain amount of sarcopenia, is that the right word?

   4. PADr. Peter Attia18:32

      Mm-hmm.

   5. TFTim Ferriss18:32

      Muscle loss per year from 70 to 100, and then somehow calibrate a much higher weight for a certain number of repetitions as a result? How do you, how do you think through that calculus?

   6. PADr. Peter Attia18:44

      It's exactly that. Um, so it's not rocket science to figure out a 30-pound goblet squat at 90 equals how many pounds at 50. The bigger question is to understand how you have to do it biomechanically at 50 to ensure you can still even do it safely at 90. So let's just say the number's 90 pounds at 50. Um, it's not that hard to goblet squat 90 pounds for a fit guy like you, but it's actually kind of hard at our age to, or anybody's age, frankly, to do it perfectly, especially with p- complete scapular protraction, which is another thing you wanna be able to do, 'cause remember, you're holding a toddler here. So you need to be completely stabilized through the upper and lower body, and at... The thing that's nice about a goblet squat, just as one example-

   7. TFTim Ferriss19:35

      Do you wanna d- just describe a goblet squat to people, for those who don't know? I mean, there's, y- you could use a kettlebell as an example-

   8. PADr. Peter Attia19:41

      Yep, yeah

   9. TFTim Ferriss19:41

      ... or something else.

   10. PADr. Peter Attia19:41

       Yeah, yeah. So if you're picturing holding a dumbbell or a kettlebell, and you have both hands on it, and it's in front of you, and you're going into a squat position that way. So as opposed to like a barbell squat, where the bar is on your back and you're holding it back, the nice thing about this goblet squat is it's a little bit more representative of real world movement because you now have your scapula that have to move forward. That's called protraction, and you have to be able to stabilize that position, which is, you know, gonna be holding the, the, you know, the, the, the, um, kettlebell or the dumbbell or the child. Um-

   11. TFTim Ferriss20:15

       Or if you're our friend Kevin Rose, you wanna be able to throw a raccoon at 90.

   12. PADr. Peter Attia20:18

       [laughs]

   13. TFTim Ferriss20:19

       Al- also helpful.

   14. PADr. Peter Attia20:20

       There's-

   15. TFTim Ferriss20:20

       For those who haven't seen, you don't have to get into it.

   16. PADr. Peter Attia20:22

       [laughs]

   17. TFTim Ferriss20:22

       There's a great video of Kevin Rose throwing a raccoon.

   18. PADr. Peter Attia20:24

       [laughs]

   19. TFTim Ferriss20:24

       You can look it up. Back to the children and the goblet squat.

   20. PADr. Peter Attia20:28

       Yeah. So, um, and then of course, you get into the real minutia of what does it really mean to, to be able to squat safely? And again, for most people, myself included, before I was really putting a lot of thought into this, uh, to, to do a, a heavy hip hinge activity like a squat or a deadlift, y- you will naturally tend to fall into a place of lumbar compression. You will compress the spine when you do these things. That's not that sustainable. What you really wanna be able to do is get to a point where you can do those things under spinal traction, which sounds very counterintuitive. Most people think of traction as something you can only achieve when you hang-

   21. TFTim Ferriss21:05

       Mm-hmm

   22. PADr. Peter Attia21:05

       ... which is elongating the spine. But it turns out if you generate concentric intra-abdominal pressure from diaphragm to pelvis, you can actually stretch out the spine while you're under load. And once you start doing it biomechanically correctly at the age of 40 or 50 or whatever, and you start to carry that forward, um, then you're sort of winning on two fronts, uh, with the more important of those being by the time you get to 90, you actually have the ability to even move in that direction and stabilize your trunk, which is the rate limiting step for a squat.

   23. TFTim Ferriss21:40

       So it seems, it seems like with many of these movements, and I suppose in many things in life, if you wanna play the long game, you kind of have to check your ego at the door, right? Because y- you would probably be making some trade-offs in terms of the amount of weight you can lift, et cetera, if you're going to be training technically to be able to perform these movements at 90, right? You might have... If, if you're not gonna be doing a, a wide powerlifter squat with a limited range of motion compared to, say, an Olympic-assed heel squat, very different in terms of-

   24. PADr. Peter Attia22:17

       Yeah

   25. TFTim Ferriss22:17

       ... biomechanics and what you can do.

   26. PADr. Peter Attia22:19

       I mean, I work with three people, um, a woman named Beth Lewis, a guy named Michael Strömsnes, and another guy named Michael Rintala. Um, and the, and all of them have a training in something called dynamic neuromuscular stabilization, or DNS, and then they all of course bring in their own expertise outside of that from powerlifting and other athletic disciplines. And Beth, who's sort of the one that kind of defaults into my deadlift program, um, so I deadlift twice a week, and we started from scratch. So we have basically pr- you know, imagined I've never deadlifted, even though I started deadlifting at the age of 15 and powerlifted all the way through high school. Uh, her view is, "No, we're starting from scratch. It's as though you've never done this before." And one day a week, I'm doing straight bar, you know, a very traditional closed leg straight bar deadlift, and I mean, she had me starting at 105 pounds, and I was not allowed to progress from that for a couple of months. And I was like, "Beth, at least let me just get to 135 so I can use the goddamn 45s-"

   27. TFTim Ferriss23:18

       [laughs]

   28. PADr. Peter Attia23:18

       "... on the side of this thing. I mean, it's getting ridiculous here."

   29. TFTim Ferriss23:21

       [laughs]

   30. PADr. Peter Attia23:21

       And she's like, "No, you're not ready yet." And y- you know, so, so-
5. 27:27 – 37:54

   Changed mind on metformin: longevity hopes vs. mitochondrial performance tradeoffs

   1. TFTim Ferriss27:27

      ... this is gonna be a long podcast. Uh, but let's put a bookmark in the Centenarian Olympics, which we might come back to. You never know. Something you've changed your mind on.

   2. PADr. Peter Attia27:39

      So the, in no particular order other than the order that I listed these things out, um, the use of metformin in very healthy individuals is something I've changed my mind on. So, um, I don't think we talked about this on any of our other podcasts.

   3. TFTim Ferriss27:52

      I don't think so. So yeah, what was the previous po- m- the previous position or conclusion and then-

   4. PADr. Peter Attia27:58

      So my-

   5. TFTim Ferriss27:58

      Right

   6. PADr. Peter Attia27:58

      ... 2010 view, which sharpened and became more and more, uh, bullish from say 2010 through 2015, '16, was that metformin was a very, very low risk cancer mitigating drug, um, in anybody. Um, now I believed that it was more so in patients who had diabetes or, um, conditions that approximated diabetes, like hyperinsulinemia. But the data were, I think, quite convincing to me, and my extrapolation was, well, even in people who don't have diabetes, this is still a great longevity agent.

   7. TFTim Ferriss28:44

      And for those, those who don't know, what does metformin do?

   8. PADr. Peter Attia28:47

      Well, [chuckles] you know, that's a, um-

   9. TFTim Ferriss28:49

      That is a big question, but-

   10. PADr. Peter Attia28:50

       I- i- yeah, and it's, and that's part of the rub is metformin does a lot of things. It's a mild mitochondrial toxin, and this becomes relevant to the story. So it sort of inhibits c- the first complex of the mitochondria, what's called complex one. And by doing so, and it seems to do so almost so, I mean, m- preferentially in the liver, it leads to a cascade of events that activates an enzyme called AMP kinase. And when you do that, the body basically starts acting like it's in a fasted state. So it's sort of like a junior fast in a pill. And for people with diabetes, what's beneficial about it is it lowers the amount of glucose that the liver puts into circulation. So there's plenty of benefit to that, and that's, there's, there's no disputing its efficacy there. Um, and in the last five years, frankly, it's become a very popular topic. There's, uh... and I've interviewed a guy named Nir Barzilai on my podcast, and we've talked exclusively about this. Nir is one of the world's experts on metformin. Um, and he's leading the charge to do a very large clinical trial to test the question of whether metformin is a longevity drug in non-diabetics. Anyway, the point is, my baseline view was that this is the case, and I had been taking metformin since 2010. What changed a year ago was I began doing a very focused type of exercise that was geared towards mitochondrial performance and efficiency, something called zone two training, where you basically push the boundaries of how much work you can do while keeping lactate below two millimolar. So lactate is a byproduct of metabolism under conditions in which You're asking the body to make ATP, which is the energy currency, at a rate faster than can be sustained aerobically using oxygen only. So by pushing the boundaries of how much work you can do, and I mean work in the very technical sense, so how fast you could run, how many watts you could push on a bike, and, and ratcheting up that level while still keeping lactate below two, you're training your mitochondria to become more and more efficient. And what I started noticing when I was mucking around with different drugs was whenever you have metformin in your system, that, that output goes down. So, and, and again, that-- I was-- when you thought about it for a minute, that shouldn't be surprising. It's a mitochondrial toxin.

   11. TFTim Ferriss31:22

       Could you, uh, just to-- don't lose your train of thought, but what are mitochondria?

   12. PADr. Peter Attia31:26

       So-

   13. TFTim Ferriss31:26

       Fucking fascinating, but mitochondria-

   14. PADr. Peter Attia31:28

       [laughs]

   15. TFTim Ferriss31:28

       ... I think really, really interesting. We, we-- I don't want to take us off the rails, but-

   16. PADr. Peter Attia31:31

       Yeah, they do a lot of things, but for the purpose of this discussion, what they do is they do the most efficient form of energy transfer, which is transferring energy that comes in the chemical form of energy, uh, like food energy, right? So when you eat something like glucose or fat, or your body breaks down and gives you glucose and fat, how do you turn the energy that is stored within those chemical bonds, the carbon-carbon bond, the carbon-hydrogen bond, et cetera, how do you turn that into ATP? And you do that by first s- breaking those things down and getting electrons into these electron donors. And people who might remember from a high school class something called the electron transport chain, that runs through the mitochondria, and those electron donors eventually donate back, make an energy gradient that makes ATP, and in the end, all they spit out is oxygen-- um, uh, carbon dioxide and water. So that's why we breathe out carbon dioxide and water vapor in exchange for taking food and making energy. So they play an essential role, obviously, in, in energy production. And if you lose the ability to make energy with the mitochondria, uh, that's effectively what happens to a cancer cell. So this idea of zone two efficiency is so important for metabolic health that I started questioning, well, why the hell would metformin be a good thing if it's impairing that? Um, and basically, after doing a lot of experimenting with and without metformin, metformin under different clearance pathways, et cetera, et cetera, it became unambiguous to me that metformin was impairing this, and there was no two ways about it. And then I began to question, well, you know, how would you reconcile that with the fact that metformin is helpful? And then you realize, well, metformin's only really ever been shown to be helpful in people who have diabetes. And when you look at the sort of mitochondrial performance of people with diabetes, it's abysmal. In fact, even though that's not a hallmark that the medical system would typically pay much attention to, but if you do that type of zone two testing in people with diabetes, it's such a contrast between them and someone without diabetes. So I realized, well, maybe when you are all-- when your mitochondria are that sick, a little bit more toxicity doesn't matter that much. But if you're playing a different game, it might. Now, since that time, a number of other studies have come out. I've written about one of them, um, maybe actually two of them, that look at the effect of mitochondria-- uh, pardon me, um, metformin and mitochondrial inhibition on the difficulty of growing muscle mass, which again, is not as interesting to me, but that appears to be a totally different issue, which is the blocking of, um, sort of the stress response. Um, I think the jury's still out on all this.

   17. TFTim Ferriss34:21

       Meaning that it appear-- that metformin appears to inhibit versus not administration of metformin-

   18. PADr. Peter Attia34:27

       Correct. Metformin-

   19. TFTim Ferriss34:28

       ... hypertrophy muscle growth.

   20. PADr. Peter Attia34:29

       That's, that's right. Metformin seems to impair the sort of, um, the, the, uh, inflammatory response that would be pro-growth to muscle, pro, um, uh, adaptation, for lack of a better word. Um, I think it's still too soon to say how this story shakes out, but I was-- basically in the past year, I've seen enough data to suggest that for me personally, the benefits of just focusing and doubling down on my exercise are probably going to yield better results than the use of metformin. And, and of course, then the question is, how do you translate that into patients, and where do you draw that line? Which patients are sufficiently on the healthy enough side? And I don't know the answer. I think my thinking on that is the more you exercise a- a- and the healthier you are, the less benefit and potentially the, the more detriment you could experience from metformin.

   21. TFTim Ferriss35:24

       Uh, I, I mean, I suppose this is, this is, uh, not Tim playing a doctor on the internet, but just thinking about that, that even if someone were, say, a pre-diabetic or presenting the symptoms of or biomarkers of someone who's pre-diabetic, it might s- it might make sense to try other interventions before metformin, right? Because you might slap on 10 pounds of muscle mass and lo and behold, they're much better at, at, uh, disposing of glucose or any number of things could change.

   22. PADr. Peter Attia35:56

       I think no matter what-- like if you take somebody who's got diabetes, I don't think people appreciate how potent a tool fasting, exercise, and sleep are. You know, when you rob someone of sleep, when their sleep sucks, when they're not exercising, and when they have full stores of glycogen in liver and muscles, which is basically the state you're in when you're constantly fed, the ability to reverse those three things is, is more powerful than all drugs combined. I mean, so, so I agree. If, if, if there's a way that you can treat patients without using, uh, medication, one should always do it. Um, sometimes metformin does offer a great step forward, and again, it, you know, comes down to every patient's ability to sort of, you know, adhere to exercise and all these other things.

   23. TFTim Ferriss36:47

       Would you ever consider using Metformin, uh, uh... Maybe this is more a job for acarbose. Is that- [laughs]

   24. PADr. Peter Attia36:55

       Mm-hmm. Yeah, you remember that.

   25. TFTim Ferriss36:57

       But, uh, using, say, Metformin selectively when you're going through a period of overfeeding for some period, for s- for some purpose?

   26. PADr. Peter Attia37:05

       I mean, I think those are exactly the kind of questions I'm still struggling with, which is does it make sense to cycle Metformin? Does it make sense to only use Metformin in the evening but not use it in the morning? So you, let's say in the morning, you know, you exercise, but in the evening when most people are fed... Like, for one of the things I did notice when I stopped taking Metformin is definitely my nighttime glucose levels are just a little bit higher. 'Cause nighttime glucose is controlled by the liver. It's not really a function of what you just ate. It's, um, you know, you're so far outside of that last meal that it's, it's generally the response of the liver putting glucose in circulation and titrating that. So yeah, I think there are probably different, like, you know, five different ways that you could sort of slice this thing up and decide on how to do it, and I don't know the answer, and I, I guess I reserve the right to change my mind again, but for now, that's been, that's been a pretty big change for me.

6. 37:54 – 42:29

   Absurd habit: egg boxing (and the legendary champion egg)

   1. TFTim Ferriss37:54

      Absurdity, stupidity. I know we have a, uh, a wealth- [laughs]

   2. PADr. Peter Attia38:00

      [laughs]

   3. TFTim Ferriss38:01

      ... of options because, uh, you and I are sort of connoisseurs of the absurd. [laughs]

   4. PADr. Peter Attia38:07

      So one of them, which is, is one that you already know about, and I know you're a big fan of, is egg boxing.

   5. TFTim Ferriss38:12

      [laughs]

   6. PADr. Peter Attia38:13

      I just cannot get enough of egg boxing.

   7. TFTim Ferriss38:15

      Okay, so [laughs] oh, God. Where do we even go with this? 'Cause this could be a podcast in and of itself. So, but I- I don't think we have time to tell the story. If people look it up or we can link to a video of the, the Ramanujan of egg boxing.

   8. PADr. Peter Attia38:32

      That's right.

   9. TFTim Ferriss38:33

      Uh, but can... [laughs] That, that is maybe a story for another time, which really does put into concrete terms just how ridiculously obsessive Peter can be. But what is egg boxing?

   10. PADr. Peter Attia38:45

       So it's a sport, um, slash game where whenever you're making something with eggs, you, you, you hold an egg, you hold another egg, you bang them off each other. The one that cracks, you obviously break, and the one that didn't crack, that consider, that's considered one win. So that, like, let's say these are two eggs you've never touched before. You smash them. That, that guy is now one and O. And then you pick up another egg. Let's say you want to make five eggs, and you smash, and let's say that guy wins again, so he's now two and O. And then you smash again, and let's say he loses. Well, then he retires with a record of two and one, and the other guy is now one and O. And you keep going, and at the end, like when you break your last egg that day, you write down how many wins the last guy has, 'cause by definition, the last one standing is always the winner. And then the next time you come to make eggs, you just play again. And so I don't know when I started playing this game, but it was somewhere in high school, and I've never stopped.

   11. TFTim Ferriss39:42

       [laughs]

   12. PADr. Peter Attia39:43

       And I take it very seriously, and I guard the champion very closely.

   13. TFTim Ferriss39:47

       [laughs]

   14. PADr. Peter Attia39:48

       And as you're alluding to, we did, we did... There was, there was one very, very special egg in my life-

   15. TFTim Ferriss39:54

       [laughs]

   16. PADr. Peter Attia39:55

       ... in 2007 and 2008 who I nicknamed Ramanujan after the great mathematician, not a great boxer, but he was such a prodigy-

   17. TFTim Ferriss40:03

       [laughs] Probably a terrible boxer.

   18. PADr. Peter Attia40:05

       Yeah.

   19. TFTim Ferriss40:05

       [laughs]

   20. PADr. Peter Attia40:06

       But, uh, he's the only egg I've ever had where his winning record was so great that we lo- I lost track of his actual record.

   21. TFTim Ferriss40:14

       Was it in the hundreds, thousands?

   22. PADr. Peter Attia40:17

       Oh, I, I mean, put it this way. He was the champion for more than a year.

   23. TFTim Ferriss40:21

       [laughs] Now, uh, all right, we're gonna, we're gonna, we're gonna continue on to future bullets, but I, I will say if my memory serves me correctly that at one point you were like, "I wanna know what type of strange, like, abscess or [laughs] like structural abnormality exists in this egg," but you couldn't get someone to agree to x-ray the egg for you, so you like snuck it into your pocket. [laughs]

   24. PADr. Peter Attia40:45

       Well, no, the plan was I was gonna go to the ER and pretend I had a groin injury-

   25. TFTim Ferriss40:49

       [laughs]

   26. PADr. Peter Attia40:50

       ... and have them do a CT scan of my pelvis with Ramanujan in my pocket-

   27. TFTim Ferriss40:55

       [laughs]

   28. PADr. Peter Attia40:56

       ... 'cause I wanted to see what was really going on inside of him.

   29. TFTim Ferriss41:00

       [laughs] And alas, we shall never know.

   30. PADr. Peter Attia41:04

       [laughs]
7. 42:29 – 54:10

   Excited about fasting—but frustrated by the lack of dosing science

   1. TFTim Ferriss42:29

      All right, we're back. I, I like this cycling through. I think we should go back to excited about.

   2. PADr. Peter Attia42:34

      Okay, the next thing I have on my excited list is, um, just overall the space of fasting and the potency of fasting. Um, but it's, it's sort of taking a page out of your playbook, right? So the work that you've done recently, um, with Johns Hopkins is basically, and I was talking about this with a bunch of people today at the race, and they were like, "What is Tim really excited about these days?" And I said, "Well, you know," and I kind of walked them through your thesis.

   3. TFTim Ferriss43:00

      In context, by race, we mean F1-

   4. PADr. Peter Attia43:02

      Yes

   5. TFTim Ferriss43:02

      ... here in Austin. And if you don't know anything about F1, just consider this. Top cars have, what is it, 500 million behind them, put into them, teams of hundreds? I mean, it's-

   6. PADr. Peter Attia43:14

      Oh, yeah, yeah, yeah. $500 million a year budget easily.

   7. TFTim Ferriss43:17

      It's just incredible.

   8. PADr. Peter Attia43:17

      And a team of, team of 1,000.

   9. TFTim Ferriss43:19

      So, [laughs] all right. So continue. Didn't mean to interrupt, but-

   10. PADr. Peter Attia43:23

       So, um, so what I've realized is, and I've, I've vented about this many a time, and in fact I have an entire Sunday email devoted just to my vent on this, which is it really bothers me that we don't... Like, if fasting is such a potent tool, and I don't think anybody who's studied nutrition or biochemistry would disagree with that, it's sort of odd we don't know how to dose the tool. And, um, so as, as you know, Tim, I fast for about seven days a quarter.

   11. TFTim Ferriss43:52

       Ah, and this is how it ties into the Hopkins, is the question of dosing?

   12. PADr. Peter Attia43:56

       Uh, is the question of studying something. Is basically taking-

   13. TFTim Ferriss43:59

       Ah, yes.

   14. PADr. Peter Attia43:59

       Yeah. So, so, so it's basically saying, okay, I fast seven days a quarter, and people ask me, rightfully so, "But Peter, how do you know to do that?" Like w- you know, I f- you know, someone will say, "Well, I fast three days a month." And that's a comparable number of days, total days fasted, but what's producing the ideal physiologic response that would lead to life extension at, or at a minimum reduction of, you know, disease risk? And again, it bothers me greatly that I don't know that. So it sort of occurred to me that what we need to do is form a little coalition, and a number of my patients have already said, "Oh, sign me up. I'm in." And we'll basically put a pot of money together and find the best people who understand and can help us pick the right animal model, because we're not gonna be able to study this in humans. Like, you have to accept that you, that we're in the option B territory. [laughs] There is no option A. There's no let's do this experiment in humans and study them for 20 years.

   15. TFTim Ferriss44:53

       Is that because it wouldn't get cleared by the IRB, or is it-

   16. PADr. Peter Attia44:56

       It would take too long.

   17. TFTim Ferriss44:56

       Just takes too long.

   18. PADr. Peter Attia44:57

       Yeah, yeah, yeah.

   19. TFTim Ferriss44:57

       Yeah.

   20. PADr. Peter Attia44:57

       If you want a hard outcome, which is actual mortality, you have to do this in an animal model.

   21. TFTim Ferriss45:02

       [laughs] Yeah. Yeah. Agreed. Okay. Missed that last part. Yeah.

   22. PADr. Peter Attia45:05

       Yeah, yeah. So, so should it be mice? Well, you know, mice have the advantage of being really easy to study, and you could probably know the answer in a year. Um, and that might be the answer, but it will require people really smart to understand what the equivalents are for mice in fasting, and it's not going to be a linear extrapolation from our humans. Like, for example, you know, a mouse that fasts for two days dies and loses 25% of its body weight directionally, so that's not gonna be that helpful. But-

   23. TFTim Ferriss45:32

       I'm thinking ostriches. [laughs] I mean... I'm kidding. Continue. Sorry. Just being an idiot.

   24. PADr. Peter Attia45:37

       [laughs] Yeah, yeah. And I mean, I have no idea what it is. Like, ferrets? I mean, I just, I don't know. But what I really wanna do is in the next couple of years come up with the next best answer. And, um, until that time, unfortunately, I'm gonna continue to flail, um, which means I'm gonna continue to fast, but do so without much real insight, um, about what the quote unquote best way to do it is, or if regimen A is better than regimen B. But I think this idea of just saying, you know what? Look, NIH is probably not gonna fund this, um, because I don't think this is a question they're that interested in. Industry is not gonna fund this, 'cause you can't sell a fast. Uh, you know, VCs aren't gonna fund thi-... Like, all... When you look at all of the traditional funding vehicles that would go into exploration of question, this one really has to come down to philanthropy. And I have no interest in, like, creating an organization to do this, so why not just, you know, k- bring a coalition of people together, find the right people, and just directly fund them?

   25. TFTim Ferriss46:38

       What would the study design look like?

   26. PADr. Peter Attia46:41

       So let's just say, and again, I don't know if you would do this, but let's just say it was agreed upon that mice would be an appropriate model, and let's just say that, you know, you agree that there would be three arms, right? One arm would be, um, mice that were on regular mouse chow. And it would be important that it would be proper chow, not nonsense chow. Like, a lot of these studies are done with pure sugar, high fat nonsense chow. The goal isn't to do that. The goal is to take, like, healthy mice, and then picking the right strain is in and itself a, a huge decision that would have to go into this. Um, so you have the ad lib feed. So these are the mice that are allowed to eat normally.

   27. TFTim Ferriss47:18

       Yeah. Ad libitum?

   28. PADr. Peter Attia47:19

       Yes.

   29. TFTim Ferriss47:20

       Mm-hmm.

   30. PADr. Peter Attia47:21

       Then you'd have probably-
8. 54:10 – 1:00:57

   Changed mind: personality isn’t fixed (Peter’s anger “half-life”)

   1. PADr. Peter Attia54:10

      Okay, this one's a little heavier. Um, I, I think that the fate of one's personality may not actually be set. I, I think I have historically believed that we are born with hardwired motherboards and our personalities are set in stone and there's no changing them. And in particular, I think for me, you know, you and I have talked about this a lot, I've never known a time of not being angry. I've just, I don't, I mean, I think I was probably just a pissed off fetus is sort of my-

   2. TFTim Ferriss54:40

      [laughs]

   3. PADr. Peter Attia54:40

      I don't think that's actually true, but that's been my belief template. And I don't know, I think just a few years ago, I just, maybe more than that, maybe 10 years ago, even 15 years ago, I remember kind of having this discussion with my dad once. It was really sort of a sad day 'cause my wife and I, who had been barely married, we might've been married for like a couple of years, and my parents were over, and it was just, I mean, I'm too even, I'm even too embarrassed to tell the story. But my wife and I had a fight, which was basically just me being a total piece of shit. It, in other words, it's not even like there was any symmetry in this. It was just, I was 100% wrong, and I dug my heels in, and I was such a jerk. And you could sort of tell my parents were just- So sad for us, um, and I think sad for me at my sort of miserable existence. And I sort of remember my dad not saying anything, but sort of his body language being like, "Dude," like, "What? I mean, what are you doing?" Like, "Why are you such an asshole?" Um, and so I preemptively struck at him, which was, "Look, I don't even wanna hear about it, man. Just, like, I'm not meant to be around other people." You know, I just, I just remember going... Like, launching into this tirade about how I am not really designed to be around other people. Like, there was just no two ways about it. Like, I'm way too volatile, I'm way too angry, I'm way too, you know, all of these other things. Um, and I think I've carried that belief system with me u- up until about a year ago. Up until probably... Yeah, up, up until about a year ago, maybe a year and a half ago, and I now realize that that entire narrative is simply incorrect. Um, it's no more correct than saying, you know, I have two copies of an APOE4 gene, which is, you know, which would be a genetic template that would make you much more likely to get Alzheimer's disease, but arguing that it's a given that you're going to get Alzheimer's disease. That's not the case. These are not deterministic genes. And similarly, I don't think that these flaws in our personality are deterministic. And while there may be people who are more or less predisposed to be one way or the other, and then of course events in life can reinforce that and push you more into that, and then the response to that can reinforce that. So all of those three factors can drive you in a given way. Um, I, I know this sounds like a very glib example, but I, I really think that with enough work you can start to overcome these deficits. And I think that for me, I think I'm only 50% you know, as angry as I was during my, you know, sort of anger heyday. And so, I don't know, to me that's amazing. Like, that, that... 'Cause I now r- I, I now have this confidence that I've never had before, which is two years from now I might only be 50% of what I am today, and that would be 25% of what I was at the outset. So-

   4. TFTim Ferriss57:33

      The tracking of the fury half-life. [laughs]

   5. PADr. Peter Attia57:34

      Yes, exactly. So, so I just, I just think that that's, that's my personal example, but for someone who says, you know, "I'm just not fill in the blank enough," or, "I'm too fill in the blank," uh, I, I do think a lot of us start to buy our narrative, and we just start to believe the story. And for me, that is, that is by far the most hardwired story I've ever believed about myself. There, and there are lots of stories I believe about myself, right? I mean, we all have our insecurities, and I'm too this or I'm too that, or I'm not this enough, or I'm not good enough, or blah, blah, blah. But this, this one was like, no, no, no, that one you don't get to change. Like, that's eye color. Um, and there's not even a contact lens you can put on it. Like, it just is what it is.

   6. TFTim Ferriss58:22

      I've seen certainly, and I mean, we talk about a lot of this in the first episode of your podcast, uh, where you and I had a long, long conversation about many of these things, The Drive. We'll link to it. But I don't, I don't know if I'm... If, uh, if we talked about this particular perspective on what we might view as deficits or weaknesses, and that is finding a way to inspect them as coping mechanisms and protective mechanisms that served an incredibly important function at some point, right?

   7. PADr. Peter Attia58:57

      That's exactly right.

   8. TFTim Ferriss58:57

      So instead of refusing and rejecting those pieces of you, maybe feeling anger towards them, certainly which I've done plenty of, instead looking at how you might thank them for mitigating or preventing, even if it ended up being now counterproductive when overused, but at some point these were responses that protected you, right? Like, if that, if that were the assumption, how would... How might you look at them differently? Could that possibly be true? And that's been incredibly important for me in reconciling all [laughs] all different types of facets of myself that I've long held kind of resentment and, uh, anger towards.

   9. PADr. Peter Attia59:47

      Yeah, I mean, and we could... If we were to really double-click on this topic, that, that's exactly the direction we'd, we'd go, which is it starts with a little bit of self-empathy and introspection and realization of, well, let's examine the why. This, this must have served some purpose at some point. This was an adaptation to something. Let's acknowledge that. And, um, you know, in the words of, of Terrence Real, who, um, I, I just recently interviewed for my podcast, um, you know, it's, it's, it's taking that adaptive child in you and, um, thanking them, but just moving them to the back seat. Like, making sure their hands aren't actually on the, on the steering wheel.

   10. TFTim Ferriss1:00:30

       Yeah.

   11. PADr. Peter Attia1:00:31

       Um, and saying, "Hey," like, "thank you. Thank you for, for the help you gave me during this period, but I, I need you to just sit back there now and just, just chill out, man. Just look out the window. We're just gonna go on a drive, but, but the adult has to drive now."

   12. TFTim Ferriss1:00:43

       Hmm. So this is a hard segue into stupid and absurd things, but- [laughs]

   13. PADr. Peter Attia1:00:48

       [laughs] Well-

   14. TFTim Ferriss1:00:48

       Let's, let's fucking force it. [laughs]

   15. PADr. Peter Attia1:00:50

       You know what's funny is looking at the stupid thing, you would, you would... I'll just tell you what it is, and you'll see why it's really fun.

   16. TFTim Ferriss1:00:56

       [laughs] Cheating. Yeah.

9. 1:00:57 – 1:07:51

   Absurd habit: tearing phone books (technique, obsession, and unintended consequences)

   1. PADr. Peter Attia1:00:57

      Yeah, yeah. So the, the next stupid thing on my list is tearing phone books.

   2. TFTim Ferriss1:01:01

      [laughs]

   3. PADr. Peter Attia1:01:01

      But I will say it's not out of rage.

   4. TFTim Ferriss1:01:03

      No, this is like a wine pairing. It works perfectly. All right.

   5. PADr. Peter Attia1:01:06

      Yeah, yeah, yeah. So when I was in college, a good friend of mine named Todd Remington, uh, one... I will never forget this. I was at... So, so it was his wife and my then girlfriend were, like, best friends. So we were all... All four of us were at their place, and he came home with a phone book, like a standard two, two and a half inch phone book. And he goes, "Do you think you can tear this?" And I- But in college I was, like, really strong, right? I was like, "Ah, probably not, but let me try." And I, like, you know, just wailed on this thing, and of course could not tear this phone book. And then he shredded it, like just, whoo, just ripped it in half. And I was like, "Oh my God, how did you do that?" And he's like, y- you know, he immediately just told me. He's like, "Look, it's a technique." And he explained the technique, and I was like, "All right. Well, do you have another phone book?" He's like, "No, that was our only one." And I was like, "All right, we gotta go get more." And this was back in the day when, like, you had phone books. So we... I remember this. We got into his f- ah, Land Rover or whatever. No, he had like a, it was like, I don't know, some Toyota, like-

   6. TFTim Ferriss1:02:05

      4Runner or something

   7. PADr. Peter Attia1:02:06

      ... 4Runner, that was it, yeah. And I still remember we, in his silver 4Runner, we drove to the mall, which was like 20 minutes away, and we went into the phone store, 'cause they had phone stores inside of malls. This is, like, pre-cellphone. And they had a wall of phone books, like hundreds of them, and I just... I don't know why, like it was just such an obnoxious thing of me to do. I just started grabbing all the phone books.

   8. TFTim Ferriss1:02:26

      [laughs]

   9. PADr. Peter Attia1:02:27

      And the woman comes up and she goes-

   10. TFTim Ferriss1:02:29

       Not a word? [laughs]

   11. PADr. Peter Attia1:02:30

       Yeah, nothing. Like, just totally in, you know. And the woman comes up and she goes, "What are you doing?"

   12. TFTim Ferriss1:02:35

       [laughs]

   13. PADr. Peter Attia1:02:35

       And I was like, "Oh, um, I work at a camp for kids, and we do a lot of papier-mâché-

   14. TFTim Ferriss1:02:42

       [laughs]

   15. PADr. Peter Attia1:02:43

       ... and the phone books are the best for papier-mâché." And she was, like, [laughs] almost apologetic. She's like, "Oh, oh, oh, okay. Um, uh, yeah." I think I mumbled, like, it was a camp for kids that had, like, less than a week to live or something.

   16. TFTim Ferriss1:02:55

       [laughs] Terrible.

   17. PADr. Peter Attia1:02:56

       Stupid thing.

   18. TFTim Ferriss1:02:56

       Terrible.

   19. PADr. Peter Attia1:02:56

       Yeah, it was awful. So, so we leave the store with as many phone books as two guys can carry.

   20. TFTim Ferriss1:03:03

       [laughs]

   21. PADr. Peter Attia1:03:03

       Go back to his house, and I practiced that night until my hands bled and I could tear phone books. And by the end of that night, I was very good at it, and then it became fully pathologic as an addiction. So I could not see a phone book and not tear it.

   22. TFTim Ferriss1:03:22

       [laughs]

   23. PADr. Peter Attia1:03:23

       And so-

   24. TFTim Ferriss1:03:23

       You're like the Cookie Monster of-

   25. PADr. Peter Attia1:03:25

       I think-

   26. TFTim Ferriss1:03:25

       ... of phone books?

   27. PADr. Peter Attia1:03:26

       That is exactly right.

   28. TFTim Ferriss1:03:27

       [laughs]

   29. PADr. Peter Attia1:03:27

       It is, it was like Cookie Monster. So I remember in college, I rode my bike everywhere, and there... This was back in the era of phone booths and phone books. And so anytime I rode past, even if I was late for class, if I saw a phone booth, I stopped, laid my bike down, went into the phone booth, grabbed the phone book, tore it, got back on my bike, rode to class.

   30. TFTim Ferriss1:03:43

       [laughs]
10. 1:07:51 – 1:21:13

    Excited about archery, hunting, and eating wild game (plus gear deep dive)

    1. TFTim Ferriss1:07:51

       Uh, excited about. What's next up on excited about?

    2. PADr. Peter Attia1:07:55

       So this is something that you deserve quite a bit of credit for, but just sort of archery, hunting, and the consumption of wild game. Um, and again, this, it started out totally benign as, oh, maybe I'll just get a bow, you know, Tim has told me about why he enjoys this, and I've got a bit of a sense of, you know... And, and just for the listeners, I guess the story is, uh, it would've been the summer of 2016. You were getting ready to go out on a hunting trip. The irony of it, of course, was it was with a guy named Jonathan Hart, who at the, I would get to know years later.

    3. TFTim Ferriss1:08:32

       Yeah, founder of a great brand called Sitka.

    4. PADr. Peter Attia1:08:35

       Yeah.

    5. TFTim Ferriss1:08:35

       Excellent, excellent gear.

    6. PADr. Peter Attia1:08:36

       Yep, unbelievable gear. Um, and after watching you go through that journey of training for and going on the hunt, I was like, "You know, I'm gonna get a bow. It just might be one of those things you, I wanna do every, you know, couple times a month." And-

    7. TFTim Ferriss1:08:54

       Just to pause for a second, so I also have come to, I think, better understand the perfect, or more perfect than I used to understand, cocktail of characteristics that make something more likely to be your crack cocaine of activities.

    8. PADr. Peter Attia1:09:13

       So what, tell me what you think.

    9. TFTim Ferriss1:09:14

       Can, can-

    10. PADr. Peter Attia1:09:14

        Or you want me to tell the story?

    11. TFTim Ferriss1:09:15

        Well, in the, in the preparation for that, it was, I mean, it was very methodical, very, uh, meticulous. You have gear to tinker with, right? And it takes, it brings in some degree of mathematics and physics, which you have background in. Uh, so there's more to it, but continue.

    12. PADr. Peter Attia1:09:38

        Yeah, so, so in early 2017, I call up the local bow shop, Performance Archery in San Diego, um, just get real lucky, and the guy that happens to answer the phone, JR, turns out to be a complete obsessive... I mean, it turns out everyone that works there is totally obsessive, but JR might even take it to another level just in terms of his technique obsession, and the rest is history, as they say. And it's, it's now at the point where in some ways my life revolves around this thing.

    13. TFTim Ferriss1:10:09

        [laughs]

    14. PADr. Peter Attia1:10:10

        Um, if you come to our house, I mean, you have, you haven't been in a while. You need to see what it looks like now.

    15. TFTim Ferriss1:10:15

        Yeah, I haven't seen the new ranch.

    16. PADr. Peter Attia1:10:16

        It is out of control.

    17. TFTim Ferriss1:10:18

        [laughs]

    18. PADr. Peter Attia1:10:18

        I mean, we, we, it's like, you know those life s- those huge block targets now?

    19. TFTim Ferriss1:10:22

        Yes.

    20. PADr. Peter Attia1:10:23

        You know, like the five feet by five feet block targets. I mean, I've got like eight of those. Every animal you can imagine throughout the range. And, um, yeah, I mean, every single day my morning routine i- in- it involves, um, at least one round of 300. Uh, so 300 is the scoring system you use on the paper target when you either, either shoot at the three spot or the five spot. Um, so I get, you know, I, I'll, I'd like to get 90 shots out of the way first part of the day at the target, and then do the longer range shooting, the 3D target shooting. Um, and, and I will say this, it, it, a big part of this is this has been an amazing tool tying it back to part of the training a new set of emotional skills, right? So there was a day when if I didn't shoot well, that was the end of the day. Everything went off the rails. Uh, and I've talked about this, I think, once even on a post, an Instagram post. I was, you know, kind of opening up about this, which was, like even as recently as a year ago, I remember there was a day when there was something wrong with my bow that I didn't realize at the time, but I ended up lodging three straight arrows into the fence. So I'm taking long range shots, but I missed something in my bow, and one, two, three arrows into the fence. And you can't recover an arrow once it's in the fence, so that's like three arrows I just flushed down the toilet. And I was so pissed that when I took each of them out of the fence, 'cause you have to snap them to pull them out of the fence, I then proceeded to snap each one over my thigh. Now, these are, you know, 450 to 500 grain carbon fiber arrows. I was welted for a week.

    21. TFTim Ferriss1:12:05

        [laughs]

    22. PADr. Peter Attia1:12:06

        Which, you know, if you like-

    23. TFTim Ferriss1:12:07

        You basically gave yourself like a Thai kickboxing leg kick with each one of those.

    24. PADr. Peter Attia1:12:11

        Yeah. And y- you know, so when you think about the complete and utter stupidity of that type of behavior, um, I've now realized archery is always going to be an amazing teacher because either you go up there and you just have this amazing day where you're in this flow state and everything goes well and it feels amazing, or it's some variation of not going that way, but you get to practice this skill of distancing yourself from the narrative that is, "Dude, you suck. You suck. How can you be so bad at this?" You know? And all of these awful, stupid thoughts that sort of spiral you out of control. So, so that's a part of it. And then, of course, the other thing is, you know, then once I finally took these skills into the field and began to hunt and began to experience this cycle of, you know, what is it like to go into a, an area where you have an animal that is a pest that needs some population control in the area that we hunt, it's so much the case that that's, that the government is basically killing these animals and just leaving them for dead or burying them, and you instead get to go and try to use your skill to do this and then harvest the animal and then feed your family and feed yourself. I mean, it, it, the whole thing is just, it's such an incredible experience that, um, has changed many things about the way I look at food. Like it's made it, it, it certainly reduced my appetite for, um, consuming food that I haven't had some- ... relationship with. And I think my aspiration is by next year, uh, meaning by 2021, um, to only eat food that I've, I've killed.

    25. TFTim Ferriss1:13:48

        Mm.

    26. PADr. Peter Attia1:13:49

        Which I, I think I'll be able to get there by next year.

    27. TFTim Ferriss1:13:54

        Yeah, there's a lot [sighs] that, there's a lot to discuss there. It's, uh, A, making me wanna get back into archery. I do have my gear, and, uh, only recently reconnected, or I should say connected with two guys who train here in Austin, which I'm excited about. Not for hunts here, but at higher elevation. And I don't hunt very often, uh, in part because it's been mostly larger game, so you've got a lot of meat afterwards to keep you busy. Uh, oh, and I remember you were on, uh, on Joe Rogan's show, and [laughs] the, the name of the bird that I shot, just for clarity, uh, was a grouse.

    28. PADr. Peter Attia1:14:31

        Yes. Yeah.

    29. TFTim Ferriss1:14:32

        A mountain chicken. It's like the, the chewiest, fastest running mountain chicken you can imagine. So that's what that was. Um-

    30. PADr. Peter Attia1:14:38

        It was an amazing shot.
11. 1:21:13 – 1:27:45

    Changed mind: childhood experiences can shape adults more than we admit

    1. TFTim Ferriss1:21:13

       ... animals of death, the animated Pet Sematary in the back of your house. Changed your mind on. What else have you changed your mind on?

    2. PADr. Peter Attia1:21:22

       Well, this c- you know, in some ways sorts a bu- sort of builds off the last one a little bit, but it's, and it's basically this idea that, that, that childhood experiences, um, can matter in ways that after the fact seem sort of irrelevant. So, um-

    3. TFTim Ferriss1:21:38

       So that's not the belief that you have reversed. That's the current-

    4. PADr. Peter Attia1:21:45

       Yes, that's correct

    5. TFTim Ferriss1:21:46

       ... that's the current belief.

    6. PADr. Peter Attia1:21:46

       The current belief is-- Yeah, so, so I'll rephrase it. I used to believe that, um, that, uh, you know, traumatic events in your childhood probably weren't that relevant or could be net positives if they, you know... And, and it's, it-- this is effectively like a parallel to the first thing, um, to, to the previous one we talked about, about personality stuff. I, I think what I've come to realize through, you know, extensive interaction with experts in this space, my own experience, the experience now of many people that I know is if a child perceives helplessness, even as an adult if you look back and think, "Eh, that wasn't so helpless," um, it, th- you have to be thoughtful about what the implications and ramifications of that are going forward, right? So, um, you know, for example, let's take an extreme example. If a child loses a parent when they're young, um, you might say, "Well, look, they have another parent. That other parent is a loving parent. Everything is gonna be fine." But there's an enormous amount of chaos that's inserted into that person's life, and, um, if a child perceives that as, as, like, helplessness, um, that can really shape the, uh, the subsequent years of their life. That can shape aspects of their personality that I don't think I ev- I just don't think I really understood and appreciated before, and I've seen this now with a number of my patients, for example, using that example, patients who lost parents when they were very young, seven years old, eight years old, 12 years old, um, suddenly and/or tragically, or not suddenly or tragically. I mean, you could have someone who's, you know, suffering for three years with cancer, and it's not sudden, but it's still, to a child, they perceive things differently. An extension of that, which comes back to this whole thing around anger, and this was part of my motivation to sort of begin to make sure I wasn't so angry, was I almost never got angry at my kids, right? But my kids saw me angry. So, you know, the last time I got really, really pissed in front of my kids was a year ago, and I remember this very well. We were actually driving to a funeral of the mother of one of my daughter's best friends. So this is a young woman, a woman who's, you know, in her 40s, who dies of cancer, and we're going to the funeral. It was exactly a year ago. So it's not a happy day. And so it's me, my wife, and my daughter going to the funeral, and I'm driving, and, you know, traffic is sort of moving along at a sort of slow pace, and there's a merging lane that's coming on, and there's this woman who's not paying even a modicum of attention to what's going on, like she's on her phone or something, and then at the last minute, she just goes, like accelerates, jumps in front of us. I almost hit her. And I mean, normally that would be annoying, but on that day, I went ballistic. Now, she didn't even hear me, right? She's in another car. But the torrent of just, you know, profanities and, like, what I wanted to do to her and say to her and blah, blah, blah, blah, blah was unbelievable. Heightened presumably by the fact that I was just in this awful mood about all this other stuff, whatever. I never for a moment would have realized, like, that could have an effect on my daughter. It's like I'm not yelling at her. I'm not yelling at my wife. I'm not like... You know, I'm yelling at some random stranger in front of us. But I realized that kids internalize that stuff different. Kids, and, you know, my daughter's not a baby, but she's still a child. They internalize that type of stuff as it's still like, it, it's still hitting them, right? So it's, I don't know, I don't know how to think of it. Like, there's still shrapnel that is hitting them in a way it wouldn't hit an adult. Um, and so you take an extreme that's very min- you take an example that's very minor like that one versus something that's very major like the funeral we were going to, which is for her friend's mom. I, I, I don't think we are paying enough attention to how these things that kids experience can shape their personality. And so, and, and to be clear, like, these are two-edged swords. There are some good things that can come from hard experiences. I'm not suggesting everything is negative. But you don't have to throw the baby out with the bathwater, right? You can accept some of the positives that come from these things without, um, ignoring the things that need to be mended or repaired. So, um, I think that, that broad topic is something that I have really been much more attentive to, uh, both in myself and in my patients and in understanding their, their lives and their emotional health as it pertains to, uh, the events of their, of their childhood.

    7. TFTim Ferriss1:26:47

       Speaking from my firsthand interactions with you, I mean, you are... And we, we talk quite a bit or just text stupid [laughs] jokes to each other, uh, at least that on, with fair frequency, and you, you, you are much less anger-ridden than you have been historically, which is really nice to see, and, uh, I mean, it's something that I've battled with a lot myself also, quite possibly for similar reasons [laughs] or some similar reasons. But what resources or tools, if any, I don't know if there are any books, uh, or anything else that you would recommend or simply mention as having been valuable for defusing the default anger response or helping you to revisit the story of that being an inalterable aspect of your personality?

12. 1:27:45 – 1:42:30

    Therapy and tools for anger: meditation, vocabulary, and accountability

    1. PADr. Peter Attia1:27:45

       Uh, I think, uh, there have been a lot of things. There's, there's no one thing, um, which isn't to say that for others one thing couldn't do the trick. Um, I think the good news is if somebody's listening to this and they're also thinking to themself, "Man, like I just wish I was a little less angry too," um, I, I think the good news is the probability [laughs] that you are walking around with as much anger as me is, is hopefully low. You're, you're probably starting from a better place and therefore maybe your anger is less recalcitrant to change. There were many things. So I'll start with one. Meditation has made a big difference, not by itself. Meditation simply gives a gap. That's, that's the only thing meditation does is it creates a pause between the stimulus and the response, and that gap used to never exist. That gap, I didn't even know it was a gap. So it was a, it was a s- it was a potential space that I didn't realize had the potential to be a space, which meant stimulus, you know, woman cuts you off while you're on the way to worst funeral you could be imagining going to, um, blowing up. That's happening in microseconds, not in milliseconds. Well, the difference is today, 'cause that still s- I mean, that still happens every day, like some stupid thing will happen that would have normally fired me off. The difference is now I have seconds to inspect that and look at the template of beliefs that are feeding into that and examine the why, which is what, like what is anger, right? I mean, so, so that's, that, so that, that's the f- the first thing is using a practice of vipassana meditation to create a tool in the mind to slow time down. Then the second one is-

    2. TFTim Ferriss1:29:29

       And is that, uh, sorry to, uh, to jump in, but just for specifics, I know that you and I have both used Sam's Waking Up app. Uh, do you, do you now meditate, uh, without that? What does the practice look like?

    3. PADr. Peter Attia1:29:42

       No, I, I, I use either Sam's or Dan Harris'. I go back and forth between them.

    4. TFTim Ferriss1:29:47

       The 10% Happy.

    5. PADr. Peter Attia1:29:47

       And, and yeah, so sometimes I'll do like a month on one and not see the other one and vice versa. I, I, I sort of go back and forth-

    6. TFTim Ferriss1:29:53

       Yeah

    7. PADr. Peter Attia1:29:53

       ... with no p- with no rhyme or reason.

    8. TFTim Ferriss1:29:55

       The Harris twins.

    9. PADr. Peter Attia1:29:55

       The, the-

    10. TFTim Ferriss1:29:56

        Unrelated. [laughs]

    11. PADr. Peter Attia1:29:57

        Yes, exactly. The, the-

    12. TFTim Ferriss1:29:58

        [laughs]

    13. PADr. Peter Attia1:29:58

        ... the brothers Harris, no relation. Um, so, so yes, just having just, just... A- again, I can think of a million analogies. It's like imagine, you know, being a race car driver and you get to see time travel half as fast as the other drivers. Well, you're gonna be a much better driver. Like, you see the road coming at you at half the speed. Um, the second thing is just work through, through really helpful therapy, has been actually examining what is, what, what anger stems from. So I think, you know, the first time I was ever f- you know, I wanna say forced to or [laughs] suggested to play the game of emotional check-in, I didn't have a vocabulary. So the question was, how do you feel right now? Pissed off. Okay, say more. How do you feel? Fucking pissed off. How do you feel? So fucking pissed off that if you fucking ask me again, I'm gonna fucking kill you. Like, that was the only response I had, right?

    14. TFTim Ferriss1:30:57

        [laughs]

    15. PADr. Peter Attia1:30:57

        What I didn't have at the time was I didn't even have a vocabulary to understand I'm hurt, I'm sad, I feel helpless, I don't feel in control. So, so I had to learn a new vocabulary and start to learn what those other things looked like so that I could in that gap of time start to say, "Oh, y- you're feeling X, but you're, you, you have such a, you have such a beautiful default wide lane highway that turns X into anger. And oh, by the way, yours turns Y into anger, and yours [laughs] turns Z into anger too." Like, that's Peter's thing. Um, other people might have, you know, depression or sadness or anxiety as these other well-worn paths that come out of these various converging stimuli. So, so learning how to recognize what was understanding that has made a big difference. A- another thing has just been, you know- ... traditional insight-related therapy. W- you know, I mean, so Esther Perel, who I actually met through you many years ago, uh, who is s- you know, uh, an in- an incredibly important part of my life today. Um, I'm trying to think. Oh, I know what it was.

    16. TFTim Ferriss1:32:13

        For every Jocko, you get one Esther Perel. [laughs]

    17. PADr. Peter Attia1:32:16

        [laughs] I'll take it.

    18. TFTim Ferriss1:32:17

        [laughs]

    19. PADr. Peter Attia1:32:17

        So, so I'll give you another... I'll, I'll tell you the last time I actually lost my shit. Um, I thought... I, it wasn't a year ago. It was a year ago was with that, that funeral. It was more recently than that. It was when, um, one of our chickens got killed, and so I'm up actually shooting, doing my archery, and, um, I hear my daughter, like, kind of scream like something's wrong, and I kind of run down and she's crying, and I see one of our chickens is mangled into, like, a million pieces, and it... of course, I immediately figure out what's going on, and, you know, we had just lost one like, I don't know, a month earlier. I thought I had reinforced the coop as much as possible, but clearly I hadn't done a good enough job, and I just went off on a tirade. I mean, a- and again, I'm embarrassed to even say all the things I said 'cause it's so stupid. I'm basically yelling at whatever animal that is no longer there that killed our chicken about what I'm gonna do to it.

    20. TFTim Ferriss1:33:13

        [laughs]

    21. PADr. Peter Attia1:33:15

        [laughs] I mean, again, we can laugh at it. It's so ridiculous though.

    22. TFTim Ferriss1:33:17

        Yeah.

    23. PADr. Peter Attia1:33:18

        Right? What Esther was able to point out was, um, was let's deconstruct that whole situation. So first of all, why are you angry? Well, if I'm gonna be brutally honest about it, I'm angry 'cause I feel inadequate. I failed. Like, I'm... my job is to protect my family, and, uh, my chickens are now a part of my family. Like, I failed at protecting these chickens. Like, it can't be that I'm actually angry at the bobcat for being a bobcat, right?

    24. TFTim Ferriss1:33:44

        [laughs] Right.

    25. PADr. Peter Attia1:33:45

        Like, you know, Marcus Aurelius once said something along the lines of, you know, to be... you know, it's like being angry at a fig for making fig juice or something like that.

    26. TFTim Ferriss1:33:54

        [laughs] Right.

    27. PADr. Peter Attia1:33:54

        You know? Or like a fig tree for growing figs or something I think he said. So, so no, there's no way I'm pissed at the actual bobcat who killed the chicken. That's called the cy- th- that's, that's like the carbon cycle. Like, that's the way it works. I'm pissed at myself. I have failed to protect my family. Um, I feel helpless, blah, blah, all these other things. But the point is, in that moment, I'm... I missed an opportunity to console my daughter. I was so consumed with my own rage and my own... Like, and rage, as you can probably relate to, and many people who get angry can relate to, is a very su- it's a very numbing, transiently numbing thing. Lots of dopamine gets secreted in that outburst that actually makes you feel a bit better. Now, that doesn't last long. It's a very hollow... Uh, I think there's a saying about the... it's like a honey with a poison tip or something like that, you know. It's, it's a very short-lived, transient, um, benefit that comes with a long tail of misery. But I lost an opportunity, which was my daughter's actually very upset about this. I mean, like, you know, not only do our chickens give us eggs, but, like, the kids love them. They play with them every day. They all have names. They all have... Like, we know everything about every one of those chickens and their personalities, so it's no, it's no different than her losing her cat or her dog. Um, and instead of consoling her, like, I'm wrapped up in my own nonsense. So sometimes you just actually have to be confronted with that type of brutal truth. And again, if you go back to the first thing, which is you now have a gap, the next time a couple months later something came up, it wasn't related to the chicken, but it was something where I think the Peter of old would have gone right down the default pathway of just raging. I had a little b- I had that breathing room to notice the feelings of another person and realize, wait a minute, the much more important thing to do here is make sure that person is okay, and not, you know, go down your own stupid rabbit hole. Um, another tool that I think has been very important here, you know, Ryan Holiday, um, recently put out, and I'm sure it's still available, a whole work, like a, a whole sort of 10-day or 11-day course on anger. Um, Ryan writes about anger a lot, um, and I've talked with him about this actually on, um, on, on i- in my interview of him very recently, which probably by the time this is out will not even be out yet. But, um, those types of exercises are helpful. Again, it comes down to this idea that once you accept that this is not something you are hardwired to, like your height or your shoe size, and you can start to change it, you just have to start working at it. Um, so there, there are a number of other tools as well. I think a lot of the sort of David Foster Wallace relational, um, reframing stuff also has been just incredibly helpful.

    28. TFTim Ferriss1:36:43

        So there is an audio recording of his commencement speech, This Is Water, that you listen to on a regular basis.

    29. PADr. Peter Attia1:36:51

        Yeah. To this day, I still listen to it at least once a month.

    30. TFTim Ferriss1:36:54

        Yeah.
13. 1:42:30 – 1:51:03

    Absurd habit: “Forks and Knives” (plus a detour into xenon and drug rules)

    1. PADr. Peter Attia1:42:30

       So I think we're now onto stupid things again.

    2. TFTim Ferriss1:42:32

       All right. Let's do it. Stupid things.

    3. PADr. Peter Attia1:42:35

       So to this day, I still play a game called Forks and Knives. Uh-

    4. TFTim Ferriss1:42:40

       Forks and Knives.

    5. PADr. Peter Attia1:42:41

       Forks and Knives is the name of the game. So I like-

    6. TFTim Ferriss1:42:43

       [laughs]

    7. PADr. Peter Attia1:42:43

       So, so I have an awesome system with my wife, which is she likes to put stuff in the dishwasher and hates to take it out. I hate putting stuff in the dishwasher, and I love taking it out.

    8. TFTim Ferriss1:42:55

       [laughs]

    9. PADr. Peter Attia1:42:56

       I just, I don't like touching dirty stuff.

    10. TFTim Ferriss1:42:58

        [laughs]

    11. PADr. Peter Attia1:42:58

        I really like clean stuff. And I don't know why she doesn't like taking it out, 'cause that seems more enjoyable. But anyway-

    12. TFTim Ferriss1:43:03

        [laughs]

    13. PADr. Peter Attia1:43:03

        Um, and as a kid... This game started when I was a kid. Um, my mom says, like, I was the best at chores. Like, my brother and sister apparently didn't like doing chores as much as I did, but I loved chores. I was like her little helper. So whatever she said to do, I couldn't wait to do. And one of my chores was doing the dishwasher, and I loved it. So this started when I was probably, like, about eight, and I remember she used to always say, "Peter, can you put away the forks and the knives?" And it really kinda got to me, 'cause I was like, "Why don't you also include the spoons in that discussion? It's not just forks and knives. It's forks and knives and spoons."

    14. TFTim Ferriss1:43:40

        [laughs]

    15. PADr. Peter Attia1:43:41

        And she would be like, acknowledge that I said that, but, you know, the next day she'd forget, and she'd be like, "Can you please put away the forks and the knives?" So I was like, "I'm gonna just start keeping track." And so I played this game where I would count the forks and the knives and the spoons, and the game is, the spoons would win anytime there were more spoons than forks and knives. Now, anyone who's played this game, and I'm guessing the answer is nobody, but-

    16. TFTim Ferriss1:44:04

        Wait a second. The number in the dishwasher-

    17. PADr. Peter Attia1:44:07

        Yes

    18. TFTim Ferriss1:44:07

        ... that you're removing?

    19. PADr. Peter Attia1:44:08

        Yes.

    20. TFTim Ferriss1:44:09

        Okay. I see.

    21. PADr. Peter Attia1:44:09

        So basically every time I got to do this, it turned into a game of who's gonna win, the forks and the knives or the spoons.

    22. TFTim Ferriss1:44:14

        Which was a counting-

    23. PADr. Peter Attia1:44:15

        It's just a counting game

    24. TFTim Ferriss1:44:16

        ... counting game.

    25. PADr. Peter Attia1:44:16

        But I was always rooting for the spoons, 'cause they're the underdog. 'Cause the probability of the spoons winning is very low. You generally have way more forks and knives combined than spoons. So over the years, the game evolved, and I started to allow other things to be proxies for spoons. So if there was, like, a spatula or a carrot peeler, that would get to go in the spoon category, just to, to, to sort of level the playing field a little bit.

    26. TFTim Ferriss1:44:39

        To handicap, yeah.

    27. PADr. Peter Attia1:44:40

        Yeah, you had to handicap this thing somewhat. But the game started, you know, almost 40 years ago, and to this day, I mean, just two days ago, I played Forks and Knives versus Spoons.

    28. TFTim Ferriss1:44:50

        [laughs]

    29. PADr. Peter Attia1:44:50

        And I love it. I love the game. And it's at the point now where I don't want anybody else to put that stuff away. So let's say, like, Jill is putting stuff away. I'm like, "No, no, no, l- I, I want to get the forks and knives."

    30. TFTim Ferriss1:44:59

        [laughs]
14. 1:51:03 – 1:55:56

    Excited about race car driving as an “audit” (and what it teaches)

    1. PADr. Peter Attia1:51:03

       I think we're back to excited, yeah.

    2. TFTim Ferriss1:51:04

       All right. Yeah, we'll do one or, we'll do one or two more. Let's, let's, let's go with excited.

    3. PADr. Peter Attia1:51:08

       Uh, next thing I'm pretty excited about is just driving. You know, just sort of getting deeper and deeper into the craft of learning how to drive a race car and, um, and sort of just, you know, training both in the simulator and actually on a racetrack with a, with a race car. Um, and again, I think part of it is I just, I love, you know, I, I, I love mechanical things. I love cars. I love driving them fast, and there's no better place to do that than on a racetrack. But also, part of it is it's another one of these audits. You know, like archery, it is not a sport that gets better the more pissed you are. It is not a sport that gets better the harder you squeeze. So, and it's also a sport where, let's say you miss an apex on a turn. If you think about that or dwell on it anymore, it only increases the likelihood you're gonna miss the apex on the next turn or miss your break point or miss your turning point or do something wrong. So it, it's one of these things that teaches you a skill that I just think is good for life, which is you don't want to not know that you made a mistake because then you run the risk of making that mistake again. But you can't beat yourself up for making the mistake, so you have to have a relatively short half-life for torturing yourself. Otherwise, you will spiral out of control, and it's really amazing. I just happen to be very lucky to have a great coach, a guy by the name of Thomas Merrill, in driving. And I don't know, he's just, he's so good at spotting when my mistakes start.

    4. TFTim Ferriss1:52:36

       Mm.

    5. PADr. Peter Attia1:52:36

       And it's never really the case that when I screw something up at, you know, turn seven where I went off track-

    6. TFTim Ferriss1:52:42

       That that was the first screw-up.

    7. PADr. Peter Attia1:52:43

       Yeah, not even close. He's like, "Actually, look at what you did at turn five."

    8. TFTim Ferriss1:52:47

       Mm.

    9. PADr. Peter Attia1:52:47

       "And then look at how that fed into turn six, and by the time you got to seven, it was..." Uh, he, he said, "Look, the only way you were not gonna crash at seven is if you had slowed down enough n- to a speed much slower than you would normally go there because of the mistake you made in five and six."

    10. TFTim Ferriss1:53:04

        Yeah.

    11. PADr. Peter Attia1:53:04

        So I, I think for a lot of people, again, y- it's easy to look at what people are doing in a race car and not think there's much to it. But of course, like many things, the further you are from the shore, the deeper the ocean, as Bob Kaplan says. And so the more I do it, the more I appreciate the gap between me and Sebastian Vettel.

    12. TFTim Ferriss1:53:26

        And you're wearing an Ayrton Senna shirt as we speak, and for those people who don't know who that is, you should absolutely watch a documentary called Senna-

    13. PADr. Peter Attia1:53:39

        Mm-hmm

    14. TFTim Ferriss1:53:39

        ... which was just incredible, uh, which, which I think helped me at least as someone who's completely naive to race car driving to develop a high level of appreciation for just how hard it is to perform at a high level in those circumstances. I mean, [chuckles] it's, uh... And, and how incredibly dangerous it was at that point in time. Things have changed quite a bit, but when he was racing, certainly, uh, far more dangerous.

    15. PADr. Peter Attia1:54:09

        Yeah, it, in the, in the '60s, I, you know, I'd say sort of mid, early to mid-'60s into mid-'90s, it was a staggeringly dangerous sport, u- unacceptably so.

    16. TFTim Ferriss1:54:24

        Uh, dude, something occurred to me that, uh, I don't think I've ever asked you before. Uh, and that is have you considered, maybe you already have something that fits this bill, but picking a hobby or something to obsess about that is a group activity or a partner activity? Because it seems like most of the things I find you, uh, gravitate towards and become very obsessed about are, uh, even though there might be other humans around, they're mostly solitary experiences.

    17. PADr. Peter Attia1:55:03

        Yeah. I, I-- you're not the first person to ask me this, and I, I think it's a great point. Um, I, I suspect the problem is I love these things I do so much, I barely feel like I have as much time as I want to do them. But it might be the case that as my kids get older and I can do more of these things with them or, or d- different things with them, that that would sort of scratch that itch. But there's definitely something to be said for it. I mean, I think ever since I was 13, I've been so... That was sort of a turning point, I think, in my personality or something where I just remember really gravitating towards individual things, um, for a whole bunch of reasons I could probably unpack. [laughs]

    18. TFTim Ferriss1:55:46

        [laughs] That might, that, uh, I think that could be an entirely separate podcast. Uh, so racing. Changing your mind.

15. 1:55:56 – 2:10:36

    Changed mind: exercise benefits are bigger than he realized + sleep protocols and alcohol tradeoffs

    1. PADr. Peter Attia1:55:56

       Um, I would say the next one here on this list would be... And this is gonna sound almost silly, but- On the, I- I've changed my mind on the benefits of exercise being much greater than I ever envisioned. So, you know, I would probably classify as a borderline exercise addict. So for me to say I now actually think exercise is incredible and has all these benefits is sort of a- a funny statement. Um, which is not to say that I didn't think it had benefits before, but I n- I don't think I understood or appreciated metabolically. So if you just take one example, um, probably like four years ago, three years ago, um, I had one of our analysts do this exercise that took him about a year, which was with some direction around where to start, comb through all the literature on Alzheimer's disease and get a sense of what tools in the toolkit would be most beneficial to prevent it or reduce the risk of it and/or delay it. And, you know, I mean, it was anything was on, anything was on the table. What drug, what supplement, what this, what that. And he came back and said... And we had a, a framework that was a, a very mechanistic framework. He came back and said, um, "It's definitely exercise." And I was like, "Dude, that, I mean, that sounds like such a politically correct thing to say. Come back with like a real answer [chuckles] , please. Like, that just sounds dumb. Exercise. Like, how can it be exercise?" And of course, it, you know, he came back and made the case, and in the end I believed that case, which is when you look at what exercise does from a vascular standpoint, from a growth factor standpoint, you know, the creation of BDNF, brain-derived neurotrophic factor, um, I really believe that... And again, you shouldn't take the view that you should only do one thing, but i- if you're, if you're really committed to brain health, um, you, you wanna be exercising every day.

    2. TFTim Ferriss1:57:55

       What parameters are there on that exercise? When, when you say exercise, for instance, there are people that view running as cardio, but then you, in the case of resistance training, are obviously utilizing [chuckles] the vascular system-

    3. PADr. Peter Attia1:58:09

       Yeah

    4. TFTim Ferriss1:58:09

       ... and your heart. But how, how do you think about, uh, type and dose?

    5. PADr. Peter Attia1:58:14

       So the literature is not crystal clear on that, but if you loosely take three types of exercise, which is modest or low intensity, quote unquote, cardio, uh, high intensity cardio, and strength training, if you took those as the three legs of the exercise stool, um, the good news is they all appear to increase BDNF. They all appear to have benefits, though to different degrees, on vascular tone, circulation, et cetera. What I basically decided a couple of years ago, or maybe a year ago, was in the absence of better information, just having a portfolio approach to those in the context of the training for the Centenarian Olympics was the best of both worlds. So in other words, my training is programmed through the Centenarian Olympics, which requires that you have training, a very specific type of training in all three of those legs, coupled with the tabletop, which is stability. So you have these four pieces of training: stability, strength, aerobic, and anaerobic. And by doing these every day or some combination of them every day, you also know that to at least to a first-order approximation, you are getting the benefits of brain health. And then, of course, I mean, while we're just on that topic, I think sleep and, you know, periods of nutrient cycling and obviously the appropriate steps on nutrition.

    6. TFTim Ferriss1:59:35

       Nutrient cycling meaning fast and famine?

    7. PADr. Peter Attia1:59:38

       Yeah. I think some period of-

    8. TFTim Ferriss1:59:39

       Or I guess those [chuckles] are probably the same.

    9. PADr. Peter Attia1:59:41

       Yeah, I know. Feast and famine. Yeah, yeah, yeah.

    10. TFTim Ferriss1:59:43

        [laughs] That'd be a great name for a podcast about fasting.

    11. PADr. Peter Attia1:59:45

        [laughs]

    12. TFTim Ferriss1:59:47

        [laughs] Fast or Famine. Uh, right, Feast, Feast or Famine.

    13. PADr. Peter Attia1:59:51

        But it's funny, like, you know, if you think about Silicon Valley right now, right? Like everybody's so obsessed with this nootropic and that nootropic, but, what I don't think people understand is correct nutrition, exercise, and sleep are far better nootropics than modafinil. I mean, modafinil, modafinil might be one of the most potent nootropics out there, but it's actually not that strong a nootropic. It's actually kind of a weak nootropic actually, by the literature.

    14. TFTim Ferriss2:00:13

        It, it is pretty amazing how many narcoleptics are, uh, Olympic level sprinters though. [laughs]

    15. PADr. Peter Attia2:00:20

        [laughs]

    16. TFTim Ferriss2:00:20

        They could prescribe modafinil.

    17. PADr. Peter Attia2:00:21

        [laughs]

    18. TFTim Ferriss2:00:21

        Anyway, Provigil, anti-narcolepsy drug, true story. [laughs]

    19. PADr. Peter Attia2:00:25

        [laughs]

    20. TFTim Ferriss2:00:25

        Wow, eight of the 10 top 10, eight of the top 10 are narcoleptics. Who would've thought? [laughs]

    21. PADr. Peter Attia2:00:31

        [laughs] That's just 'cause they... That, that's how they get so much time to train.

    22. TFTim Ferriss2:00:33

        Back in the good old days. Uh, what are things, and I know you're a fan, uh, correct me if I'm wrong, but, uh, of Matt Walker and a lot of his thinking on sleep, and I shouldn't say thinking, I mean his, his research related to sleep. How have you changed, or better yet, improved sleep protocol, things that y- uh, you prescribe, not necessarily chemicals, to patients to improve sleep quality?

    23. PADr. Peter Attia2:01:02

        I mean, this, sleep is a hard thing because it's sort of like exercise in the sense that you can't just give somebody a pill that makes sleep better. Um, it really comes down to changing... It, it's, you have to sort of accept you're gonna make behavior change. You have to prioritize this thing, and it's not just the eight hours you wanna spend in bed. It's the buildup to it. So my sort of simplest toolkit, which is what I basically employ... I mean, most nights I don't require a supplement to sleep. It's not like I'm taking, you know, melatonin or even using Kirk Parsley supplement. I mean, those things I'm basically reserving for jet lag situations and things like that. But if I'm, if I'm doing everything correctly, or fasting, you know, that's another time when you need a little bit of a boost. But if I'm doing everything correctly, you know, using the right amount of blue light blocking glasses, and I've recently switched to a new brand that, that I am fricking super jazzed about. It's... I, I mean, I find... First of all, they actually have published research that, you know, documents, uh... Actually, I shouldn't, uh- I don't know if it's been published yet, but anyway, they, they have data that I've actually seen that demonstrate, you know, how much they're able to block blue light, and at least according to my, my, um, sort of sleep tracking metrics, they're, they're definitely contributing to much more deep sleep than I've seen historically.

    24. TFTim Ferriss2:02:24

        Can you name?

    25. PADr. Peter Attia2:02:25

        Yes, yes. It's called Felix Gray.

    26. TFTim Ferriss2:02:27

        F-E-L-I-X?

    27. PADr. Peter Attia2:02:28

        Yes. Uh, Felix and then Gray. Uh, actually you can see the box, right, sitting over there. So those glasses sitting right over there are my Felix Grays, and they're, they're just redonkulous.

    28. TFTim Ferriss2:02:40

        G-R... Well, people can find it.

    29. PADr. Peter Attia2:02:42

        Yeah.

    30. TFTim Ferriss2:02:42

        A-Y or A-Y. One of the two.
16. 2:10:36 – 2:38:35

    Absurd habit: the “What if?” game + excited about podcasting and interviewing craft

    1. TFTim Ferriss2:10:36

       Hmm. So many questions that I'm gonna table for now. On, on this list, on these three lists I should say, i- is there anything that you think I would find particularly thought-provoking or hilarious that you'd like to share?

    2. PADr. Peter Attia2:10:54

       Um, my next thing on this stupid list is the what if game. Um, have we talked about the what if game?

    3. TFTim Ferriss2:11:00

       [laughs] I don't think so.

    4. PADr. Peter Attia2:11:03

       So I don't know when this started. Um, it, it was definitely before I got married. I... But I, I just, I thought it was really funny to play this game of would you still like me if...?

    5. TFTim Ferriss2:11:17

       [laughs]

    6. PADr. Peter Attia2:11:17

       And then I would make up something really stupid, and uh, even the game itself bugs my wife.

    7. TFTim Ferriss2:11:24

       [laughs]

    8. PADr. Peter Attia2:11:25

       But I make her do it. I make her go through the explanation of why it's yes or no. So I still remember the very first one I did.

    9. TFTim Ferriss2:11:32

       Would you, would you still like me if?

    10. PADr. Peter Attia2:11:33

        If, yes. And so the very first one I ever did, this is probably, we'd been dating for like a few months, and she came over to my place and I made my f- one of my favorite meals is like a curry stir-fry, which is a very labor intensive meal. You're carving up a million different vegetables and all this other thing. And so we're sitting there, we're eating this thing. She's like, "Oh, this is great." And I was like, "Would you still like me if I was the exact same guy?" It always gets prefaced by that. "Would you still like me if I was the exact same guy, but instead of using a knife to cut these, I was like this really flexible guy with long toenails and I used my toenails to cut them?" So I sat cross-legged on the floor and I sliced and diced all the vegetables using my toenails. [laughs]

    11. TFTim Ferriss2:12:19

        [laughs]

    12. PADr. Peter Attia2:12:20

        But I was... Everything else about me is the same. And she's like, "Ugh." [laughs] Like, what? And I was like, "I want you to like literally picture this. I'm the same guy. Everything about me is the same except for this one little thing, which is I just like to use my toenails to cut the vegetables instead of a knife and a, you know, chopping block." Then, you know, she sort of humored me with that, and I just went over and over and over again. And to this day, I still play this game constantly. And I actually asked her before I came over, I was like, "Do you remember some of the ones that really like annoyed you when I would ask these?" And so she reminded me of a few. So one of them.

    13. TFTim Ferriss2:12:54

        [laughs]

    14. PADr. Peter Attia2:12:55

        We were in Italy this summer and we, uh, we walk into a department store, and they have this big, bright red Speedo with a gold belt.

    15. TFTim Ferriss2:13:03

        Nice.

    16. PADr. Peter Attia2:13:03

        And I was like, "Would you like me if I was the exact same guy, but I only wore this as my shorts?" So like, I would still wear shoes and a shirt, but instead of wearing like the shorts that I'm wearing now, like I would only wear this bright red Speedo with the big gold belt.

    17. TFTim Ferriss2:13:19

        The European, this, this American hero.

    18. PADr. Peter Attia2:13:21

        Yes.

    19. TFTim Ferriss2:13:21

        Yeah.

    20. PADr. Peter Attia2:13:22

        And she's like, "Eh, probably not."

    21. TFTim Ferriss2:13:24

        [laughs]

    22. PADr. Peter Attia2:13:25

        And I'm like... And then of course, whenever she says that, I'm always like, "How can you be so superficial?" Like, how can that one thing be such a deal breaker?

    23. TFTim Ferriss2:13:31

        [laughs]

    24. PADr. Peter Attia2:13:31

        Um, another one that she remembered was car dancing. I was like, "What if I was the exact same guy, but I was, I would dance like crazy while I was driving?" And then I would mock...

    25. TFTim Ferriss2:13:41

        [laughs]

    26. PADr. Peter Attia2:13:41

        Do you remember in Sixteen Candles when Anthony Michael Hall is dancing around Molly Ringwald at the dance?

    27. TFTim Ferriss2:13:46

        Yes

    28. PADr. Peter Attia2:13:47

        I would do that dance, but I always did that while driving. And I was like, what if I was the exact same guy, but I did that? [laughs] What if I wanted to watch The Smurfs for two hours every single day? I loved The Smurfs. Like-

    29. TFTim Ferriss2:14:02

        The Smurfs-

    30. PADr. Peter Attia2:14:02

        The TV show

Episode duration: 2:47:10