The Peter Attia Drive - #73 - AMA #9: NAD & metformin, fat-burning zone, creatine, estrogenization of men, emergency kit for cold & flu, and more

Episode Date: September 30, 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 #9 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: The story of how Peter almost worked for Theranos [2:00]; The trend of lower testosterone and higher estrogen in men: Why is it happening and what to do about it? [10:00]; Takeaways from Peter’s recent hunting trip in Hawaii [14:45]; What books are you currently reading/listening to? [21:30]; What advice would you give to the 25 year-old Peter? [24:00]; What is your emergency protocol if you start getting sick? [27:45]; How have your thoughts changed on NAD precursors, and also on metformin, in the past year or so? [30:30]; What are your thoughts on “fat burning” zones for cardio workouts? — A lesson in relative vs. absolute fat combustion [34:15]; What mental models do you use and how do you go about solving problems and approaching difficult questions? [49:00]; Creatine supplementation—Yay or nay? Why? [49:30]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama09/ 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 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.

Hey everyone, I'd like to take a couple of minutes to talk about why we don't run ads on this podcast and why instead we've chosen to rely entirely on listener support. If you're listening to this, you probably already know, but the two things I care most about, professionally, are how to live longer and how to live better. I have a complete fascination and obsession with this topic. I practice it professionally and I've seen firsthand how access to information is basically all people need to make better decisions and improve the quality of their lives. Curating and sharing this knowledge is not easy and even before starting the podcast that became

clear to me. The sheer volume of material published in this space is overwhelming. I'm fortunate to have a great team that helps me continue learning and sharing this information with you. To take one example, our show notes are in a league of their own. In fact, we now have a full-time person that is dedicated to producing those, and their feedback has mirrored this. So all of this raises a natural question. How will we continue to fund the work necessary to support this? As you probably know, the tried and true way to do this is to sell ads, but after a lot of contemplation, that model just doesn't feel right to me for a few reasons. Now the first and most important of these is trust. I'm not sure how you could trust me if I'm

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by signing up from monthly subscription. Another month, another AMA, welcome to AMA number nine. I am again joined by the incredibly handsome Bob Kaplan. In this episode, we talk about my history with Theranos. This is kind of a funny sort of sad story. The estrogenation of men, a conversation around plastics and glass containers, takeaways from my recent hunting trips, what books I'm reading and listening to at the moment, what advice I would give my 25 year old self relating to mental health. My emergency protocol for when I get sick as a dog, things that I used

to be bearish about, that I'm now bullish about, or vice versa. Bob and I talk about exercise in the quote unquote fat burning zone. Hint, that's a term I can't stand. And we end with a little creatine supplementation conversation. 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 pteratiamd.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 pteratiaambi.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, welcome to AMA number nine. Hi, and hello again, podcasters, subscribers. Bob Kaplan here. Peter, here. Oh, I didn't see you there. I know. I know it's hard. It's hard to see me in this get up. I can see the other drink, soil and green. All right, let's jump right into it.

Two-minute drill. Should I even say two-minute drill? It's a two-minute drill that might take longer. Not exactly Tom Brady on these drives, but who's counting? Will you talk about your history with Theranos? I think you alluded to this in that tweet. Yeah, so in 2006, I was working in Palo Alto at a consulting firm. And a good friend of mine, he had a connection to Theranos. And at the time, both he and I were considering jobs there in the

role of chief financial officer and me in the role of chief medical officer. This was very early days. I don't recall what year Theranos was found that I want to say oh three, but it was still very small and I remember their office was next to ours. I think we were actually both on California Avenue in Palo Alto. So the first time I went over there to meet with Elizabeth Holmes, I remember it was just a tiny place, I think there were maybe 20 or 30 employees, and we sat down and looked at this black box that they had

and talked about a bunch of things that had to do with the business and the technology, and we met again, and ultimately that had to do with the business and the technology. And we met again. And ultimately I decided not to take the job for several reasons. One of the reasons was when I did my due diligence on their investors, something came up on one of the investors that someone I knew and trusted a lot, didn't have a lot of great things to say about one of their investors. And when you're thinking about joining a startup company,

that kind of stuff matters. The other thing is I really loved what I was actually doing. So the hurdle rate for me to kind of leave what I was doing had to be very high, because I was super happy at McKinsey and really, really loving the work I was doing. And then the third thing was I wasn't convinced that what you could test in a box that size was interesting. So although Elizabeth was incredibly secretive about what

they were doing, and I was not allowed to look in the box, which of course I, and I'm sure every other person that showed up would ask that question, okay, let's actually see what's in the box. That was a no go, even under an NDA. If people want a primer on Theranos, there's a documentary right on HBO, if they don't know the story behind it. That's right. Nothing I'm saying now will be even remotely interesting if you don't understand why in the end this is an interesting story. I knew enough about diagnostics and I knew enough about the chemistry of it that I knew that there was pretty much not going to be anything you could do on a drop of blood in a box that size that was clinically interesting. And so in the end, the reason I did not go forward was I just didn't think it was medically

interesting enough. I thought, look, yeah, you'll figure out a way to do a chem 20 and a CBC and a few other things, but I don't care. Like, you're not moving the needle in terms of clinical medicine. So that was the end of that. So that was 2006. Now fast forward to 2014, those eight years later, Elizabeth is on the cover of Forbes. The most recent valuation of Theranos is $9 billion.

And I remember coming home and saying to my wife, remember that company I almost joined eight years ago and she didn't remember and I told her the whole story and she's like, oh yeah, yeah, yeah. And I said, this is how much money we'd be worth today if I had taken that job based on my estimation of how much delusion would have occurred in the cap table, et cetera, et cetera.

And it was a big number, like a life-changing number. And she was just like, oh, wow. He went somewhere loose, huh? I was like, yeah. So I kind of never really thought about it again. And then fast forward to the beginning of October, 2015, there was an event in San Francisco called the Vanity Fair, something. It's like a Vanity Fair event.

And this was back in the day when I was a lot of my life revolved around fundraising and having to be at events like this. So I was at this event and Elizabeth was the main attraction of the event, actually. So much so that Mark Zuckerberg also spoke, but he was at one of the smaller breakouts. So Elizabeth was really the main attraction.

And the night either of or before her big, big talk, there was a cocktail party. And I actually wasn't invited to the cocktail party because it was really only for the important people, but I was there with Tim Ferris and he was invited to it. So I got to be Tim's date. So Tim and I went to the cocktail party together and we're just sort of playing patty cakes and in walks Elizabeth. And of course, she's just swarmed by people. But somehow over the course of the next 20 or 30 minutes,

she ends up standing kind of right next to me. And I'm thinking to myself, there's no way she's gonna remember me. Because of course by this point, it's been nine years. But anyway, I said to her, I said, hey Elizabeth, you're probably not gonna remember me. But we met and she goes, oh no, I remember you. Your name's Peter. She didn't remember my last name. I barely remember my last name. She's like, Yeah, your

name's Peter. And we met in 2006. And you're a friend of so and so who was the person and she knew everything. I was really, really surprised. And I said, Oh, but that's unfriickened believable. How could you possibly remember that? And she's like, Oh, no, no, I totally remember him. Well, I was like, Hey, well, congratulations on all of that's unfriicken believable. How could you possibly remember that? And she's like, oh no, no, I totally remember him, blah, blah. And I was like, hey, well, congratulations on all of your success. It's just amazing. And she gave me her card.

And she's like, look, let's stay in touch. I'd love to talk with you again, blah, blah, blah. So this was the first week of October, 2015. And I want to say that was like a Thursday night. I think it was like a couple days later, early in the next week, when the John Kerrio story in the Wall Street Journal hit. And in retrospect, now, of course, you realize that all of that stuff had been brewing long before, and obviously Elizabeth knew this was coming. And, you know, I got to say, like, I think you don't

come away from that documentary with a lot of empathy for Elizabeth. I think that's the purpose of the documentary at all. But in retrospect, if you're going to try to just, if do nothing else, but practice the art of having empathy for people who you don't think deserve any, it's hard for me to imagine the cognitive dissonance she would have been experiencing when on the one hand she is at this event, which is a huge event, by the way, the sort of people who were there, I mean, it was the who's who of everything. I remember walking out of one of the sessions and literally almost bumping into Bradley Cooper, who by the way is incredibly good looking.

It's worth pointing this out by the way in real life how good looking Bradley Cooper is. I just wanna state that for the record. It's almost upsetting how good looking he is. Because you sort of think person's not supposed to be that good looking, but anyway. And here she was as the headliner of this event and yet in her mind she has to know,

her world is about to get really messy. Now the flip side of that, from a psychology standpoint, is I don't believe that Elizabeth ever thought she was doing anything wrong, which is not for a moment to say she shouldn't be held accountable for what happened. I think you can be so delusional that I mean, I don't think Hitler believed he was doing anything wrong either. So the fact that you don't believe you're doing something wrong doesn't in any way absolve you over the responsibility of what you've done. But it's a very important distinction, I think, which is you are so delusional that you really believe that the lies you're

telling are for the better good. And therefore, I think Elizabeth felt that this was just a temporary speed bump along the way. But anyway, it's sort of interesting. We stayed in touch over email a couple of times in the ensuing months and then obviously in Lost Track. But anyway, it's sort of interesting. We stayed in touch over email a couple of times in the ensuing months and then obviously lost track. But that's my little history of almost having gone to work at Theranos. I think another thing that I've thought about with that, but watching the documentary is the people

that were on board, how could these people be so foolish and be duped and everything? I think hindsight bias really plays a role there that after the fact when everybody's looking at where all the chips have fallen People think and to be clear I want to make sure that nobody ever assumes I'm trying to take credit for knowing the whole thing was a fraud that I never Suspected not for a second did that ever cross my mind either at the time or in the years that followed I just thought it was the world's most uninteresting business in the history of civilization

like point of care testing in a drug store for Chem 7 and CBC, I mean, I would have more interest in a business that's specialized in removing hang nails and nose hairs. That to me is more interesting than just being able to get a CBC and Chem 7 at right age. My opposition to it was, I never suspected there was fraud going on.

And opportunity costs, it sounded like it had a good gig going to. Yeah, I mean in the end our paths are our paths. You have referenced to the estrogenation of man as one of the most important, yet largely uncovered trends. What is this? What causes it? And what can be done to fix it? You can find all of this information and more at pterotiamd.com forward slash podcast.

There you'll find the show notes, readings, and links related to this episode. You can also find my blog at pterotiamd.com. Maybe the simplest thing to do is to sign up for my subjectively non-lame once a week email where I'll update you on what I've been up to, the most interesting papers I've read, and all things related to longevity, science, performance, sleep, etc. On social 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 health care services, including the giving of medical advice.

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