The Peter Attia Drive - #63 - AMA #7: Exercise framework, deadlifting, lower back pain, blood pressure, nootropics, CGM, and more

Episode Date: July 22, 2019

In this “Ask Me Anything” (AMA) episode, Peter answers a wide range of questions from subscribers. Bob Kaplan, Peter’s head of research, asks 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. You can also watch (or listen) to this full episode on our website at the AMA #7 show notes page. Questions continue to be pulled from the AMA section on the website, and any subscriber is welcome to submit questions for future AMAs.   We discuss: What can I do to prevent/reduce interruptions in sleep due to needing to get up to urinate at night? [3:00]; Peter’s note card system for organizing his to-do lists [7:15]; How do I get smarter at reading/understanding the studies (or the media's interpretation of them) that get the headlines on health and/or disease? [11:15]; How can I obtain a continuous glucose monitor (CGM) as a non-diabetic individual? [11:55]; What is the most effective way to bring blood pressure down? [15:00]; Does Peter use any nootropics? [28:10]; Peter’s thoughts pertaining to concussions and head trauma [33:00]; Does Peter structure his exercise plan for lifespan or healthspan? [36:45]; How did Peter rebuild his lower back strength after his devastating injury during med school? [38:15]; Peter’s approach to deadlifting with a bad lower back [43:25]; Did Peter cave and buy a dog? [51:50]; and More. Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

Hey everyone, welcome to the Peter Atia Drive. I'm your host, Peter Atia. The drive is a result of my hunger for optimizing performance, health, longevity, critical thinking, along with a few other obsessions along the way. I've spent the last several years working with some of the most successful top performing individuals in the world, and this podcast is my attempt to synthesize what I've learned along the way to help you live a higher quality, more fulfilling life. If you enjoy this podcast, you can find more information on today's episode and other topics at peteratia-md.com.

Welcome to AMA number seven. I'm again joined by my right right hand man, Bob Kaplan. This episode is dubbed the Two Minute Drill, even though none of the questions were answered within two minutes. I sort of tried. In this episode, we'll discuss how not to wake up in the middle of the night to use the bathroom. I go over my note card system to keep organized, including a list of dumb things I like to do, which was initially codified by Tim Ferris. How to understand scientific studies that come out. How to obtain a CGM without a prescription. Conversations around blood pressure, no tropics, concussions, and CTE. My current exercise routine and how it can focus on health span and lifespan.

My history with back issues and my current deadlifting routine, and lastly, we end with an update on if the atias got a dog. As a reminder, AMAs are for subscribers only. If you're not a subscriber, you'll only be able to hear a preview of the AMA here. If you are a subscriber and hearing this, it means you have yet to download our members only podcast feed. With this members only feed, you'll be able to subscribe to the drive in your podcast player to get every episode of the drive without the subscriber call out, plus full episodes of the AMA podcast directly, along with other exclusive content. You can learn more about it at pteratia-md.com

forward slash members. To become a subscriber to have access to the members only podcast feed, as well as other benefits such as detailed show notes and member-only discount codes in the products I believe in, you can visit pteratia-md.com forward slash subscribe. We'll continue to pull these questions from the AMA forum and we encourage all subscribers

to participate, ask questions as we hope to get to all of your questions in time through future AMAs. So without further delay, here is AMA number seven. Hi and hello podcasters or subscribers actually. I think most of the subscriber demand is that the fact that I'm behind a paywall, so everybody's just clamoring to get more of the Boba Tron. Bob Kaplan here, Peter Etio over there. I think this is AMA number seven. So time flies. Yes? Maybe more. December Matt Walker did one too. Oh, that's right. Yeah. It could be the eighth in order. So I thought we might flip things around a little bit.

We'll put the system on trial. We'll do the two-minute drill first, and then we'll do a couple deep dives. And then maybe you can chuck the ball out of bounds at first on first down, and then we can do a deeper dive later in this episode. So here's the first question. What can I do to prevent myself from getting up to pee at night? At the risk of sounding like Captain Obvious, the first, second, and third step would be

to not drink in the proximity of bedtime, but the second step would be not to drink alcohol because alcohol inhibits a hormone called ADH, the anti-diuretic hormone, also known as vasopressin. And as the name suggests, if you inhibit the anti-diuretic hormone, it has the effect of acting as a diuretic. So alcohol disproportionately will drive you to 1a p, which anybody who's ever been at a bar and had too many drinks knows, somehow by the end of that evening, you're like going

to the bathroom every 30 minutes or something like that. So just taking more hygiene around how much water or any liquid you drink, but in particular, being mindful of alcohol are probably the most important steps. Just to cut you off for a second, it sounds right, but you actually might be able to kill two birds with the Captain Obvious Stone. A lot of people ask me how to avoid a hangover when I tell them them is don't drink the night before. So it's another tip right there. I love the free tips being infused. So now for people who are, so let's say someone's gone through all the usual, they've done the common sense, like I'm not drinking, you know,

I'm doing all these things. We have a journal that people can fill out that allows them to keep track of what they drink and how much they're voiding and when they're voiding, etc. When you've gone through all the usual housekeeping on that stuff, in men in particular, you then want to sort of investigate prostate size. So I mean, you do the same thing with women that don't have a prostate, but you can still do the same sort of exercise, which is called you measure a post-void residual. Now, everything I'm now talking about sort of falls in the lens of what you would need to do with your doctor, but just to help the listener sort of think about this, the test is you basically,

they fill a person's bladder with water, so they put a catheter in, they fill it with water, they take the catheter out, and then you go and you void it all, or you they can sometimes just have you go and void, and then they do an ultrasound of the bladder to see how much is remaining. Because if everything's working correctly, after you void, you should have very little less than 30 cc of urine remaining in the bladder. So another reason for people to be peeing a lot, although this doesn't necessarily just manifest at night, at night it can also manifest during the day, is you're not completely emptying the bladder. So that thing has to be ruled out.

Now one thing I've done, and I don't know that I recommend this actually as sort of middle of the road play, but you can actually take vasopressin the hormone. So back when I used to drink more than now, which is to say, now I very rarely drink alcohol at all, but when I was drinking maybe two drinks, two to three drinks, one or two nights a week, the impact of that on my need to get up to pee was so annoying that I would actually take vasopressin the hormone before bed and then override that ability. Like basically I didn't have to go to bed. It was like a hack to the system. So you would take like 0.2 milligrams of DDAVP or vasopressin before bed. You have to be a little bit careful with that. That's something you really couldn't do without your doctor prescribing it because

you do run the risk of getting something called hypo-natremia with excessive use of vasopressin. 0.2 milligrams in a normal person isn't going to remotely cause it. So it does become kind of a neat little trick if you absolutely positively don't want to get up to pee. But not withstanding all of the other things I said,

those are the things you start with. This hypo-natremia that think people have to worry about with excessive water drinking. Yep, when sodium concentrations get low enough that you create an osmotic mismatch, which is most troubling in the brain. And so that's, you hear about this, unfortunately, every year, at least someone running a marathon

is over-hydrating and they're deluding their sodium concentration too much. There's also a contest. It was called Hold Your Wee for a Wee. And I think somebody died during that contest. It's another little factoid as well. All right. Yeah.

I probably went over two minutes there. Yeah. I had a bunch of questions I think in there. So also best form of birth control is don't have sex. So second question is, what is your note card system? I think I've heard of that. This is the one question you told me I'd be asked. So I even prepared by bringing the note card system over here.

So I have this little leather pouch. By the way, those of you listening to this on the podcast, this may be reason enough to just go and look at the video. I've been a note card taker carrier for as long as I can remember. Though this leather one which I got from the company, I think they're called Levenger, they make bags and stuff, I've had this one for about 10 years. So I use 3x5 Q cards and they all have different colors to do different things. Now, my daily list is the first card. So these are the things that I want

to do today. And truthfully, I don't always get everything done on my today card. Probably two thirds of the time I do go to bed with everything on the daily card done. But if not, you will flip it over and then the next day take something there if it's still relevant and put it on that card along with the next things that need to be done. I then have, and by the way, I sometimes use a white card or a green, it's either white or green is always my daily card.

My pink card is my number two card and you can see that this was last week so I'm cheap with these things. So it's like I just love the fact that I'm saving money by using both sides of it. So for this week's pink card, I have all with these things. So it's like I I just love the fact that I'm saving money by using both sides of it So for this week's pink card I Have all of the things that have to be done by Sunday. So every week I redo the pink card and as you can see for all of my Things there's like a little square box and it says next to the thing. So a lot of the times it'll be

a box with a half check through it, which is when I'm partially done with that task. So the task is fully done when you have the two checks through the box. So I have boxes here that have nothing. I haven't done them yet. I have others that have a single pass through, which means it's in progress. And I have others that are fully hashed through, which means they're all the way done. I then have my orange card, which is, it's a notice this one, to get this color of orange, it has to come on this awful,

shartruse, stripey color on the back, which I don't reuse. This is very patient-specific, so I have a very patient-specific group of things that go on here. The white card, which is different from the white card that I lead with because it sits far enough back in the pack, it never gets confused, has all of my long-term, sort of, just random personal things that I don't want to cloud on my weekly list, although intermittently things from here will go on the weekly list. So again, I don't want to read these things because they won't make any sense to you, but it's it's just a bunch of stuff like, oh, you got to fix the auto responder in your email and oh, I got to return my rangefinder because

it's not working very well. And oh, I need to sync the way this thing works with that thing. It might take me two months to get through this list. And that's fine because intermittently things from this list will make it on to the weekly pink list and obviously things from the weekly pink list intermittently make it on to the green list. Unrelated my last card is just a place where I keep track of stupid things that I like to do. I don't even know why I carry this. I think Tim Ferris once asked me to make a list of all the dumb things I do.

And I started carrying this list around, which has like egg boxing, tearing phone books, counting forks and knives, doing my TSA voice, playing the What If game, and pretending to be in a little bit of a rush. And every time I think of another dumb thing I like to do, it goes on that list. So that is the card carrying system.

Obviously highly modifiable, it goes on that list. So that is the card carrying system, obviously highly modifiable, anything you want. That's the beauty of the card system. I think I've used it before too, as well. I have a purple card. It's called my people to kill list. I hope I'm not on that list. Now fans of Billy Madison are on there. Sometimes people are on there and then they get removed for good behavior. Next question, an often repeated question, how do I get smarter in reading, slash, understanding the studies or the media's interpretation of them

that get the headlines on health and or disease? You can find all of this information and more at peteratia-md.com forward slash podcast. There you'll find the show notes, readings, and links related to this episode. You can also find my blog this episode on the PC. You can find the link to this episode on the PC. You can find the link to this episode on the PC. You can find the link to this episode on the PC. You can find the link to this episode on the PC. You can find the link to this episode on the PC. You can find the link to this episode on the PC.

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You can find the link to this episode on the PC. You can find the link to this episode on the PC. You can find the link to this episode on the PC. You can find the link to this episode on the PC. You can find me on Twitter, Instagram, and Facebook, all with the ID, Peter, ATF, MD. But usually Twitter is the best way to reach me to share your questions and comments. Now for the obligatory disclaim. This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. A note, no doctor-patient relationship is formed. The use of this information and the materials linked to the podcast is at the user's own risk. The content of this podcast is not intended

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