¶ Podcast Introduction And AMA Overview
Hey everyone, welcome to a sneak peek, Ask Me Anything, or AMA episode of The Drive Podcast. I'm your host, Peter Attia. At the end of this short episode, I'll explain how you can access the AMA episodes in full, along with a ton of other membership benefits we've created. Or you can learn more now by going to peteratiamd.com forward slash subscribe. So without further delay, here's today's sneak peek of the Ask Me Anything episode.
Welcome to another edition of Ask Me Anything, AMA episode 13. I'm joined again today by my head of research, Bob Kaplan. In this episode, we talk about a bunch of things. It was supposed to be rapid fire. But we, on the first question, got so far off the rails and I think it literally took up half the time. But it was basically a question about seven-day versus three-day water fasts. And then that evolved or devolved, depending on how you think of it, into...
all things related to fasting, how you cope with them, all the things that you would measure, what's happening physiologically, the use of exogenous ketones, et cetera. We then pivoted off to some other topics such as favorite resources that I have. for staying up to date on information as it relates to medicine, health, longevity. We talked a little bit about exercise and specifically how one might craft an exercise program around longevity.
I hope you enjoy this episode of AMA 13. Hey everyone, welcome to another Ask Me Anything or AMA with... Peter Atiyah. Peter, how are you doing? Doing well, Bob. How are you? Living the dream. Ready to ask you some questions. I'm nervous, man. You got that look in your eye that says you've got questions to make a fool of me or something. Well, we're just going to do a rapid fire.
and see which ones stick. Okay. Rapid fire, meaning you're going to be on the stopwatch or? Yeah, we could do a two minute drill if you want. And then we'll just go over if we need to. Defeats the purpose. Okay, go for it. All right.
¶ Insights On 3-Day Fasting Regimen
First question, any early observations from your new three-day-per-month fasting regimen? So I guess for folks who maybe aren't familiar, I'll give a bit of background for... A great deal of time, I would do a seven-day fast once a quarter. And around Thanksgiving last year, I decided to try something different, which was more frequent fasts.
that were shorter. And so being completely arbitrary, I was like, well, if I was fasting seven days every quarter, three days a month is almost the same in terms of total aggregate fast time. By the way, Bob, this is not going to be a two minute answer, just FYI. So I decided, well, what if I could do three days a month? And I think part of the rationale was twofold. One, the seven day fasts are.
quite intrusive just in life in general. I've done enough of them that I can pretty much sail through them, but it's seven days of not eating, not drinking. And I just thought, Well, every time I do one of those, I noticed that by about the second day of the fast, my glucose levels really start to normalize as in low levels of glucose. My ketone levels really start to rise.
I started to suspect that maybe around day two and day three is when some really interesting metabolic stuff is going on and basically figured, well, what if we just did a slightly less extreme version where we got... some of the benefit that we got from the seven day fast, but maybe not all of it, but revisited that more quickly. So anyway, that was the rationale for it. So actually by total coincidence, I'm on day one of this month's fast.
We're recording this on, what is it? March 2nd today. So this is the March fast. And when was your last meal? My last meal was Sunday evening. So I will. break the fast Wednesday evening. So now having done one, two, three, maybe four or five of these shorter fasts, they're definitely easier. And that's saying even though the longer fasts.
you get more and more used to them. You have periods during those longer fasts where you're, at least for me, I'm just sort of dragging. I'm kind of wearing it. I'm just not my normal self. For the three-day fast, I seem to... skate through them a little bit easier. That's one thing. I think the other thing is my exercise tolerance seems higher because obviously I'm not subjected to the same degree of glycogen depletion. So Today, for example, not that today's workout counts because it was.
basically the first day after having a dinner. So this doesn't really a fasted workout, but I suspect I could do the type of work that I did today, which was two hours and super intense, lots of sled work, lots of deadlifts, lots of compound movements.
I could do that easily through a three day. Whereas in the longer fasts, I still try to do those activities each day, but I really have to reduce the volume. And I just find that during the three day fast, nothing really seems to happen. I will say this, Bob, I... have not done a lab test on myself at the end of a three day. So that's kind of an important thing I still need to do is do a blood test. I have.
done a blood test on myself after a four day fast. And I was very surprised to see it looked almost identical to the stuff you and I discussed at the end of a seven or eight day fast. And again, to reiterate for folks what that was, insulin, of course, is basically unmeasurable. Glucose is very low. Triglyceride's not that low. Again, because you're probably, you've got so much flux of triglyceride.
to free fatty acid going through that. That's basically your substrate for making all those ketones. So it's not like my triglycerides were high, but they were about the same as they are when I'm fed. Uric acid, very high. free T3, very low, reverse T3, very high, testosterone, very low. Those are sort of the signature findings I see after a long fast. Oh, IGF also very low.
And again, after a four day fast, they looked almost the same. So I really do need to get around to doing a three day post lab. Maybe I'll do it this time. I'll look at my schedule and see if it makes sense, but that would be kind of an interesting thing. So kind of a long answer to a.
Simple question. And I hope that suffices. The seven day fast that you were doing before you were doing the nothing burger or the KFK. So you're doing a week of a ketogenic diet going into the fast and then a week. coming out. Are you doing anything different or similar with the three-day fast? Since January, so for the last two months, I have...
Not been on a full ketogenic diet, but I've been much more low carb than I normally have been, at least for the previous four or five years. So I'm not doing a very strict keto, but... I'm really not eating any sugar. I'm not eating hardly any starch. The only carbs I'm eating are sort of vegetables and My one little vice is fiber one cereal with 27 pounds of fiber in it, which is, it's amazing how it does not spike my blood sugar. And I mix it in with like some cashew milk and some yogurt.
but that's probably sufficient to exclude me from making too many ketones. But just sort of a slightly more strict dietary restriction probably makes it also easier for me to slip in and out of this fast.
¶ Ketone Monitoring And Sweetener Effects
So you started last night, Sunday night. Do you get glucose and BHP on Monday morning? And what does that look like? And maybe relative to what you're doing when you're full keto, not half keto. Right, right. I didn't today. I'll probably do my first check tonight. I would expect ketones tonight to be in the neighborhood of 0.5 to one. And you may recall, I use these two devices. One of them seems.
I think a little bit more accurate at lower levels, which is the precision extra. The keto mojo seems to run very high at low levels. I'm also going to be testing out a new breath device for measuring. acetone. I don't think it's commercially available yet, but Dom D'Agostino, who many listeners will recall having been on the podcast, and I might add, we're going to have Dom back on.
to do a follow-up because there's been so many great questions for Dom, who is one of the most knowledgeable people on this topic. But anyway, I'll be testing a breath acetone device that I think is still sort of in the research phase. and looking to see if there's any correlation between that and BHB. Historically, the answer is no. Historically, breath acetone testing is not very well correlated with blood BHB testing. So for that...
test. I've got a breathalyzer here at home. I think it's called a ketonics. And it basically, it's acetone. And I think it gives you red, yellow, and green. And green means you're in... Let's say it's probably like the pee strips or the urine strips. It's not giving me an output of a number. It's just basically saying you're in deep ketosis. You're in moderate or probably undetectable. Does this new device have anything that's a little more accurate than...
The stoplight or the traffic light? It's sitting in the box. And one of the people who works with me in the practice has done all the vetting on it, including talking with the company. So I have to talk with her today. to actually get the tutorial on it. So I don't know how quantitative versus qualitative it is, but based on an email she sent me last week. after she did a pretty deep dive into it, I'm going to guess that it's actually somewhat quantitative.
and hopefully pretty impressive. Look, for me personally, I just like checking my blood. I don't really see some great advantage in checking breath ketones, but I can understand that there are advantages to it. One, it's going to be a heck of a lot cheaper. Because when you're checking in the blood, those strips really do get expensive. And two, there are people who don't like to poke their fingers. So it's probably more accessible.
And we shouldn't lose sight of what the purpose of this type of testing is, which I think is easy to do. It's basically there as a guidepost. And I think, frankly, it's more helpful during... phase when someone is trying to go through nutritional ketosis than it is during fasting. During fasting, it's just kind of a way to gamify it a little bit. And look, I'm as guilty as the next person because I'm always...
checking my ketones three times a day when I'm fasting. But I truthfully don't know that that's that relevant. There's nothing I can do about it per se. I will say this. One interesting observation that I learned. in a fast maybe two years ago was I decided to experiment and consume diet stuff, diet Cokes and...
Trident sugarless gum and stuff like that. So I wasn't adding any calories to the fast and it could be true, true and unrelated, but I'll tell you, I never forgot the lesson, which was I've never had lower ketones and I've never felt more miserable during a fast and that. by the way, can be sort of the power of suggestion. I think sometimes when your ketones are low, you think you feel crappy. Maybe you don't, but the numbers clearly were low that.
is not subject to a placebo effect, whether I felt good or bad might be. But that was a sort of an interesting lesson that came from checking those ketone levels during the fast was I realized, hey, there's something about these non-nutritive sweeteners that might be impairing ketosis, or at least impairing some aspect of the fast that is increasing ketone production. So for people who are trying to get into nutritional ketosis, I think...
these devices are probably helpful. And who knows? I mean, I think we're probably within the next few years, we'll see continuous ketone meters just as we have continuous glucose meters. Did you throw in insulin too? Meaning continuous insulin? Yeah, monitor. Well, that's an interesting topic. Thank you for listening to today's sneak peek AMA episode of The Drive. If you're interested in hearing the complete version of this AMA, you'll want to become a member.
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