The Peter Attia Drive - #108 - AMA #13: 3-day fasting, exogenous ketones, autophagy, and exercise for longevity

Episode Date: April 21, 2020

In this “Ask Me Anything” (AMA) episode, Peter explains some observations he’s noticed since switching to a 3-day fasting cycle from the longer fasts, the various things he’s measuring, and some helpful tips for getting through a prolonged fast. He also discusses the role of exogenous ketones in fasting and ketogenic diets as well as their impact on autophagy, specifically. Finally, Peter provides some practical advice for those looking to fit exercise for longevity into their busy life. Once again, Bob Kaplan, Peter's head of research, will be asking the questions. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #13 show notes page. If you are not a subscriber, you'll be able to listen to a sneak peak of this episode. We discuss: Peter’s observations since switching from a 7-day to a 3-day fasting regimen [1:25]; Ketone measuring devices—blood and breath [7:40]; Can zero-calorie sweeteners affect ketone production? [10:40]; Will there be a continuous insulin monitor anytime soon? [11:55]; Exogenous ketones—Role in fasting and ketogenic diets and their effect on insulin, blood glucose, and autophagy [14:10]; 5 tips to help you get through a multi-day fast [25:55]; Relationship between BHB levels, glucose levels, and autophagy—Are high levels of ketones enough to produce autophagy? [34:10]; Why is measuring blood insulin so much harder than blood glucose? [36:55]; Advice and resources for people wanting to stay up to date on developments related to health and longevity (and how to quickly sift through all the bad science) [40:10]; Advice for those looking to fit exercise for longevity into their busy life [51:10]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama13 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Hey everyone, welcome to a sneak peek, ask me anything, or AMA episode of the Drive Podcast. I'm your host, Peter Atia. 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 PeterittiaMD.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 days 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, etc. 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 AMA13.

Hey everyone, welcome to another Ask Me Anything, or AMA with Peter Atilla. Peter, how 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 one's stick. Okay. Rapid fire meeting, you're going to be on the stopwatch or... Yeah, we could do it two minutes drill if you want. And then we'll just go over if we need to.

It defeats the purpose. Okay, go for it. All right. 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 notice 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 it March 2nd today. So this is the March fast and When it 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 use 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 fasts, 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 the 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 workout I did today, which was two hours and super intense, lots of sled work, lots of dead lifts, 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 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 this 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. Triglycerides, 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. Yurick 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. So you started last night Sunday night, do you get glucose and BHB 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 1. 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 Dagostino, who many listeners will recall, having been on the podcast, and I might add, we're gonna 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. I've got a breathalyzer here at home. I think it's called a ketonix. 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 P-strips of 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 gonna 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 gonna 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. So, 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 a 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, coax, and trident sugarless gum and stuff like that. So I wasn't adding any calories

to the fast. And it could be true to an 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 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 new phirishmo 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. You do throw an insulin too? Meaning it continues insulin?

Yeah, monitor. Well, that's an interesting topic. Thank you for listening to today's Sneak Peak AMA episode of the Drive. If you're interested in hearing the complete version of this AMA, you'll want to become a member. We created a membership program to bring you more in-depth, exclusive content without relying on paid ads. Membership

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