Why Dr. Peter Attia Changed his Mind on Fasting (and 4 other Longevity topics)
Summary
TLDRIn this video, Dr. Peter Attia reflects on changes in his views regarding health and wellness over the past five years. He discusses his altered stance on regular fasting, his growing concerns about GMOs and glyphosate, the underestimated power of exercise, and the complex effects of Metformin as a disease-preventative drug. Additionally, Dr. Attia addresses the significance of emotional health and therapy in overall well-being. He emphasizes the importance of regenerative agriculture, the critical role of exercise, and a nuanced approach to nutrition and medication, illustrating his journey towards a more balanced and informed perspective on health.
Takeaways
- 💦 Dr. Peter Attia changed his view on regular fasting, finding the loss of muscle mass not worth the benefits, leading to discontinuing prolonged fasting since 2020.
- 📚 He shifted his stance on GMOs and organic food, growing more concerned about pesticide effects and the lack of long-term data on glyphosate, and is now more interested in regenerative agriculture.
- 💪 Dr. Attia now views exercise not just as beneficial but as critical for brain, nervous system, cardiovascular health, and overall lifespan, reflecting a deeper appreciation for its impact.
- 🏠 He has evolved his thoughts on agriculture, expressing more nuanced views on GMOs and organic farming, and stressing the importance of soil health for the ecosystem.
- 💰 Endorses the benefits of macadamia nuts and supports sustainable farming practices through House of Macadamia, highlighting the freshness and quality of their products.
- 🚴 Changed his exercise routines due to time constraints, focusing on a balanced approach across stability, strength, and aerobic efficiency.
- 📈 He revisited his stance on Metformin as a prophylactic drug, noting concerns about its effects on lactate levels and mitochondrial function, and awaits the results of the TAME trial for conclusive evidence.
- 😷 Emphasizes the importance of emotional health as part of the longevity equation, advocating for therapy and dialectical behavioral therapy as tools for maintenance and improvement.
- 🌮 Discusses the critical role of nutrition in health but acknowledges past overemphasis at the expense of recognizing the power of exercise.
- 💻 Shares a personal journey of adapting lifestyle practices over time, reflecting changes in professional focus, personal health beliefs, and the integration of new scientific evidence.
Q & A
What change in perspective did Dr. Peter Attia have regarding regular fasting?
-Dr. Peter Attia changed his perspective on the importance of regular fasting, noting that the loss of muscle mass outweighed the benefits for him, leading him to discontinue prolonged multi-day fasts since the end of 2020.
How did Dr. Attia's view on genetically modified organisms (GMOs) and organic agriculture evolve?
-Initially skeptical about the criticisms of GMOs and organic agriculture, Dr. Attia now has more concerns about GMOs due to the use of pesticides like glyphosate and is more interested in regenerative agriculture and its focus on nutrient density over yield.
Why did Dr. Attia reconsider his use of Metformin as a prophylactic drug?
-Dr. Attia reconsidered Metformin due to observations of higher lactate levels and potential mitochondrial toxicity, as well as recent studies challenging the benefits of Metformin in non-diabetics, leading him to stop using it prophylactically.
What has been Dr. Attia's revised approach to exercise?
-Dr. Attia now values exercise more for its comprehensive benefits on health, including its effects on the brain, nervous system, and cardiovascular health, and has become more disciplined in how he allocates his limited time for exercise.
How does Dr. Attia now perceive the role of emotional health in longevity?
-Dr. Attia has come to see emotional health as a crucial component of longevity, recognizing its importance through personal experience and now incorporates practices like therapy and dialectical behavioral therapy into his routine.
What was Dr. Attia's dietary approach prior to his change in perspective on fasting?
-Prior to changing his perspective, Dr. Attia engaged in regular fasting, including seven to ten day water-only fasts quarterly and three-day water-only fasts monthly, which he later deemed not worth the muscle mass loss.
What concerns led Dr. Attia to reevaluate his stance on GMOs?
-Dr. Attia's concerns about GMOs shifted due to potential long-term effects of pesticides like glyphosate on health, moving him towards an interest in regenerative agriculture for its emphasis on soil health and nutrient-rich crops.
How has Dr. Attia's exercise routine changed due to time constraints?
-With time constraints, Dr. Attia now spreads his limited exercise time across stability, strength, low-end aerobic efficiency, and high-end peak aerobic output, aiming for a balanced approach within 10 to 12 hours a week.
What led Dr. Attia to question the long-term use of Metformin for non-diabetics?
-Dr. Attia questioned long-term Metformin use for non-diabetics due to its mild mitochondrial toxicity, higher lactate levels in his observations, and recent studies challenging its benefits, leading him to halt its prophylactic use.
In what ways has Dr. Attia incorporated emotional health into his well-being practices?
-Dr. Attia incorporates emotional health through regular therapy sessions, practicing dialectical behavioral therapy, and applying its principles in daily life, recognizing its importance for overall health and longevity.
Outlines
🔄 Changing Views on Nutrition and Fasting
Dr. Peter Attia discusses significant shifts in his perspectives on nutrition and health practices over the past five years, emphasizing his changed stance on regular fasting. Initially, Attia engaged in extensive fasting, including 7 to 10-day water-only fasts quarterly and 3-day fasts monthly, believing in their health benefits despite the loss of muscle mass. Over time, recognizing the detriment of substantial muscle loss, he reassessed the value of such extreme fasting, concluding the trade-offs were not worth it. Additionally, he touches on his sponsorship with House of Macadamia, highlighting the benefits of macadamia nuts and related products for health-conscious individuals.
🌱 Shifting Perspectives on Agriculture and Exercise
Attia reflects on his evolving views regarding GMOs, organic agriculture, and the importance of regenerative farming practices for long-term soil health and nutrient-dense food production. He critiques the narrow focus on yield over quality in conventional farming and expresses concern over the long-term effects of synthetic fertilizers on soil biomes. In another shift, Attia reevaluates the role of exercise in overall health, recognizing its profound benefits beyond physical fitness, including its impact on brain health, the nervous system, and longevity. He advocates for a balanced approach to exercise, considering his time constraints and the need to address different physical capacities.
⏳ Time Management in Exercise and Learning from Past Training
Attia talks about how his current time limitations shape his exercise regimen, limiting him to 10 to 12 hours per week, which he considers low compared to his past routines. He emphasizes the importance of a disciplined approach to exercise, incorporating stability, strength, aerobic efficiency, and peak output within his constrained schedule. Reflecting on his past, particularly during his intensive swimming and cycling phases, he wishes he had incorporated more balance in his training to prevent imbalances and preserve muscle health.
💊 Reevaluating the Use of Metformin and the Importance of Emotional Health
Attia discusses his skepticism towards the use of Metformin as a prophylactic drug, noting a shift from his previous endorsement based on its potential cancer-fighting benefits. Observing its effects on his lactate levels and considering recent studies, he questions its efficacy and safety. Moreover, Attia underscores a significant realization about the critical role of emotional health in overall well-being, a factor he previously overlooked. Through therapy and dialectical behavioral therapy, he highlights the importance of emotional wellness in longevity and quality of life, advocating for greater awareness and de-stigmatization of mental health care.
📚 Conclusion and Acknowledgements
In closing, Attia thanks the host, Tom, for the discussion and emphasizes the value of the insights shared during the interview. He mentions linking to additional resources, including his book and relevant podcast episodes, to provide viewers with further information on the topics covered. This segment serves as a wrap-up, reinforcing the importance of continuous learning and openness to changing perspectives on health and wellness.
Mindmap
Keywords
💡Fasting
💡GMO
💡Regenerative agriculture
💡Exercise
💡Metformin
💡Emotional health
💡Dialectical behavioral therapy (DBT)
💡Nutrient density
💡Chronic effects
💡Precautionary principle
Highlights
Dr. Peter Attia discusses changing his stance on the importance of regular fasting, highlighting the trade-offs between benefits and muscle mass loss.
Attia now questions the value of prolonged multi-day fasting, having stopped such practices since the end of 2020.
He shares a shift in perspective on GMOs and organic agriculture, moving towards a concern over long-term effects of pesticides and the importance of regenerative agriculture.
Attia emphasizes the significance of soil health in producing nutritious food and supports regenerative farming practices.
A newfound appreciation for exercise's impact on brain health, nervous system, cardiovascular health, and overall longevity is discussed.
Attia reflects on how his limited time has influenced a more disciplined approach to exercise, focusing on stability, strength, and aerobic efficiency.
He expresses skepticism towards the use of Metformin as a protective agent against diseases, citing concerns over its mechanism and recent studies.
Attia notes the importance of emotional health as a critical component of overall well-being and longevity.
The discussion covers Attia's journey through therapy and the adoption of dialectical behavioral therapy as part of his routine.
Attia addresses the stigma surrounding therapy, advocating for its importance in maintaining mental and emotional health.
He acknowledges the need for a balance in nutrition, avoiding extremes in dietary practices.
The conversation includes insights into the potential downsides of excessive fasting, such as muscle mass reduction and nutrient deficiencies.
Attia's evolving views on agriculture emphasize a nuanced understanding of GMOs and the ecosystem's health.
He reevaluates his exercise routine, incorporating varied forms of physical activity to address time constraints and health goals.
The interview concludes with a discussion on the role of scientific analysis and clinical trials in validating the use of drugs like Metformin for non-diabetic purposes.
Transcripts
Dr Peter attiev we all change our mind
on things uh I want to go into some
detail with some things you've changed
your mind over the last five years Let's
Just Jump Right In
um
let's start with a couple in
um nutrition so I think the the the
first one that I would say I've changed
my mind on is the importance of regular
fasting so I used to really do a lot of
regular fasting
um probably considered excessive by by
some
um so probably did a seven day seven to
ten day water only fast once a quarter
in a three day water only fast once a
month and
um I think while there were clearly some
benefits of doing that
um
I think you know it's very difficult to
measure what's happening cellularly but
my belief at least was that the benefits
of that outweighed the downside the
downside of doing that by the way is
you're going to lose a lot of muscle
mass
um
you know as much as you might exercise
during those periods of fasting which I
tried to uh you know you're just not
going to be able to maintain lean mass
so you you basically I was always sort
of accumulating a little bit of a debt
of lost muscle mass and over a period of
about three years I probably lost about
10 pounds of lean mass
um and so today I just don't feel that
that trade-off is worthwhile at least at
that extreme level uh that I was doing
and so I don't I haven't done a
prolonged multi-day fast since the end
of 2020 actually I popped the link down
below for House of macadamia if you want
to try them out too they are where I get
my macadamia nuts these days they're all
grown in South Africa when you buy from
them you're directly supporting the
farmers as well so the farmers really do
take a hit in South Africa so by going
through House of macadamia a lot of it
goes back to working through the farmers
and helps support those Farmers but
everything is harvested and packaged
less than an hour from each other they
harvest them and then they drive them
less than an hour away package them
everything's Super Fresh not going
rancid which macadamia nuts don't really
go that rancid anyway but the point is
they have macadamia nut oil macadamia
nut bars straight up macadamia nuts with
all kinds of different flavors so really
easy to add to your diet I just I
recommend them if you're going to get it
you're going to spend a fortune at the
grocery store macadamia nuts are not the
cheapest nut but using that discount you
can save a few bucks I'm getting some
good macadamia nuts from House of
macadamia plus with any purchase using
that link a free 20 ounce bottle of cold
pressed macadamia nut oil literally the
only cold pressed macadamia nut oil that
I know of that's on the market and
you're getting one completely free if
you just use that link down below
there's no catches it's just to get the
word out there where do you stand
nowadays on the occasional 24 hour or
the occasional 20 hour yeah I think
that's totally fine yeah yeah okay what
else
another one in nutrition is
um I've really had a change of heart
around
agriculture right so I used to sort of
subscribe
to the view that there was nothing wrong
with GMO like just from a scientific
basis I always felt it was misunderstood
right like GMO is really just a crop
trait strategy right so GMO is modifying
organisms to make them resistant to
pesticides and you know I thought that
people's opposition to that was a little
conspiracy theory-ish and you know
there's nothing wrong with a plant that
was genetically modified
um I also felt that sort of the entire
organic industry was kind of a scam sort
of masquerading as you know kind of a
you know a tribe of you know like
a food tribe basically just another sort
of dietary phony altruism yeah yeah yeah
I have a much more nuanced of that today
and I would say that
I do have actually more concern of GMO
today again not because of the actual
Gene modification of the plant but
because of the herbicide because of the
pesticide I don't think we have
sufficient long-term data on the effects
of glyphosate and I think that we have
been probably overly concerned with
acute toxicity which is I would be
fairly comfortable to say the acute
toxicity of glyphosate and herbicides
and fertilizers is very low if not
non-existent but I don't think we have
sufficient data on The Chronic side and
therefore I think that the
um the precautionary principle would
actually suggest we're doing this
incorrectly and so on a personal level
today I am far more interested in what
I'm learning about regenerative
agriculture and the principles of
optimizing around nutrient density as
opposed to yield
um furthermore the more I learn about
this and I would still consider myself
quite early in that Journey having only
read you know three books on the subject
matter so far but it's been very
influential and it's really shifted my
thinking about this to the point where
I'm now basically asking the question
yes I think organic is still a bit of a
bad term because it doesn't mean
anything
um and organic food can still be
horribly grown but there's something in
this about the importance of how we grow
food and to the best of my understanding
right now I think if I could wave a
magic wand I would never eat anything
that was not produced regeneratively
meaning crops that are grown not as mono
crops not without cover crops without
using any nitrogen spiking but rather
done through this longer life cycle of
regenerative production what does
nitrogen spiking actually do I'm curious
well what it's basically doing is
altering the soil
environment so just as we are pretty
familiar with how we have our gut biome
the soil is the biome of the plant and
when we nitrogen Infuse that which was
really a process that was started uh
kind of roughly around World War II uh
which is really when we saw crop yields
explode right we you know we had
historically been producing about 20
bushels per acre per year of corn uh
globally let's just say in the United
States even
for you know most of the modern history
and and then post World War II that
number has just gone up and almost
increased in some places tenfold so you
know in the United States today you're
probably seeing 140 to 200 bushels per
acre per year of corn production
um and that came through a lot of things
that
um you know involved just pumping more
and more nitrogen in because of course
plants have to fix nitrogen externally
and carbon from the air
but what that's done is completely
changed the health of the soil and so
at the risk of being a bit sort of cute
about it
you if you don't have healthy soil you
won't have healthy plants if you don't
have healthy plants you won't have
healthy animals if you don't have
healthy animals you don't have healthy
humans I think we're kind of in a little
bit of that life cycle
um and while I don't think that
this is something that you know can't be
managed
um I definitely have worry about
long-term soil health and as a result of
that I I I've become much more
interested in something that I had been
quite dismissive of in the past yeah
well it's it's a good way to look at it
as far as GMO inherently isn't the
problem it's the fact that that's sort
of a canary in the coal mine for okay
well what are we protecting this plant
from does that indicate that there's
more crap on this plant yeah you know
and that's a really interesting way to
look at it all right what's next
say overall on just exercise in general
I think despite the fact that I've been
a lifelong exerciser I love exercise
it's always been kind of enjoyable to me
it's never been something that's
required like discipline I've got to
make sure I got an exercise I don't
think I fully appreciated how powerful
exercise was as
um as a drug frankly for lack of a
better word uh until really the last
five years I think I had you know sort
of
thought it was beneficial in a sort of
holistic way but I don't think I
understood what its effects were
specifically on the brain what its
effects were specifically on the nervous
system what its effects were on the
cardiovascular system at a really deep
level and and and overall what its
effects are in terms of lifespan and
health Span in other words how much it
reduces all-cause mortality and how
important it is at preserving quality of
life which again it seems pretty obvious
but I think I had been overly fixated on
nutrition and that that just came at the
expense of me thinking really long and
hard about exercise and how we need to
be more thoughtful in our application of
that tool has that changed
how you personally exercise and
I'll couple that with I know you have a
different
life circumstances now you're focusing
on different things and that's changed
how you look at exercise but has your
view of exercise
itself changed how you exercise it
certainly has because if
because this is the first time in my
life where I'm truly time Limited
so up until I was you know in my early
40s
I don't know even though I was always
busy I I've somehow always had seemingly
as much time as I wanted to exercise
and therefore I could always kind of
just pursue my Bliss in that whatever
way I was doing
now I'm truly limited by time I really I
mean if I had more time I if I had more
time to exercise I would today but I
can't I'm really stuck at
you know what still sounds like a lot
for people but for me is historically
low you know 10 to 12 hours a week is
the most I can really make time for with
the other commitments I have that are
more that I deem you know for any
marginal time I would deem those other
commitments more important so yes in
that sense my view is much more
disciplined about how that time is spent
you know if it were
10 years ago I might use that time today
to just focus on one thing whereas now I
have to spread that time out across
stability strength uh low end aerobic
efficiency high-end Peak aerobic output
I have to spread it across those four
pillars so if you could go back to say
prime time maybe early 30s uh or you
know whenever you were putting a lot of
time into your endurance work if there
was something that you could do
differently than what would it be
well I would still allow myself to kind
of pursue my Bliss right so in my early
30s or yeah in my early 30s I guess
mid-30s it was swimming ultra distance
swimming I think I would have just been
a little more thoughtful about what I
was doing in dry land so instead of
spending you know 25 to 30 hours a week
swimming I should have been in the
weight room at least you know three
hours a week on top of that uh same
thing when I was at you know when I was
just cycling non-stop I think I could
have been more thoughtful about other
types of activities uh to balance out
some of the obvious imbalances that come
with being crunched over on a bike all
day yeah I think I can speak for myself
with uh yeah I mean resistance training
I probably went too full bore into that
for a while where you know I had to
unravel walking like a robot for quite a
while you know and so okay what's uh
what's next on the list here uh probably
my
skepticism for the use of Metformin as a
zero protective molecule so metformin is
a drug that has been widely used for the
early intervention of patients with type
2 diabetes and even patients with you
know severe insulin resistance who are
not yet type 2 diabetics uh and in that
regard it's been a productive drug uh so
it it seems to work by reducing
hepatic glucose output and so in other
words it works by putting less glucose
into the system
uh but of course it became a drug of
interest about a decade ago because of
some epidemiology that suggested that
people who took metformin uh with type 2
diabetes had better odds at surviving
cancer than people who didn't have
diabetes and didn't take metformin and
that was an enormous suggestion because
we understand very clearly that people
with type 2 diabetes are at a much
greater increase for cancer so how is it
that people with this disease who have a
much higher incidence of cancer if they
take this drug seem to not get cancer at
the same rate as non-diabetics who don't
take the drug
and there's clearly some interesting
mechanisms of action for why that might
be the case it could be that
um you know activation of ampk
itself is protective it could be that
just lower in glucose and lowering a
growth factor like insulin and igf is
protective there are lots of
explanations for this
and as a result of that
gosh I mean I was taking metformin
prophylactically I.E is zero protective
agent starting in about 2011 is when I
began taking it and
by about 2018 2019 so about five years
ago
you know I noticed a couple of things
that I didn't like one was as I track my
lactate levels I noticed my lactate
levels were always higher than I thought
they should have been this was most
notable even at rest and also doing kind
of zone two activity
um
that might not be surprising when you
understand how metformin Works which is
it's at least in part a weak
mitochondrial toxin so if you're
poisoning the mitochondria just slightly
which is what you're doing to get that
ampk activation you're also impairing
somewhat oxidative phosphorylation and
that's why you're going to see a higher
lactate
that struck me as not a great idea uh at
least in a person who's capable of
exercising greatly as I am and many of
my patients are
furthermore there was a a study that
came out quite recently that only had me
kind of double down on that thinking
which was it was a repeat of the
epidemiologic analysis that suggested
that metformin was beneficial relative
to non-use in non-diabetics but just
done on a different cohort of patients
and frankly done a little with a little
bit more statistical rigor and it came
to the opposite conclusion it came to
the conclusion you would expect which is
that patients with diabetes who take
Metformin still actually fare worse than
the other than non-diabetics not taking
metformin when adjusted for all of their
variables and uh you know for reasons
that I cover in a newsletter that I
wrote which you know we can maybe link
to I find the latter study more
compelling not simply because it agrees
with my newfound thinking but because I
simply think it's a more reasonable uh
scientific analysis ultimately we will
find this out one way or the other
because there is a clinical trial that
is going on that's asking this question
and so my hope is that in five years
we'll just have the answer and we won't
have to rely on this
indirect Insight or indirect information
that's always going to be prone to
biases and therefore is ultimately not
dispositive in helping us understand
this and if we're sitting here in five
years in the tame trial which is the
name of the trial found that metformin
is indeed zero protective I'll be the
first one to be taking it again so a
question that I've always had that might
sound like a total Noob question but if
if metformin is a mild mitochondrial
stressor and activates ampk
is it potentially going to inhibit
hypertrophy like I mean are you are you
potentially limiting the rate of muscle
preservation or potentially growth
it's possible I don't know yeah yeah
it's an interesting interesting thought
that it's always crossed my mind but
well all right so we've got one more put
you on the spot
uh potentially the the most important
just in terms of quality of life has
been you know something I write about a
lot in the book or not a lot but it's
something I write about at the end of
the book which is the importance of
emotional health
um and I think that
I just had never really considered that
an important part of the equation of
this you know longevity equation right
um it didn't fit neatly into a box of
you know delaying death from
cardiovascular disease cancer
neurodegenerative disease it was a
little amorphous and I I think you know
I just had my own blind spot to it which
was ironic given that it was a part of
my life that wasn't especially healthy
so I think now having been through all
I've been through and you know sort of
reflecting on what I've learned I
realize not that not only for me was
this a very important thing but I
suspect it is for many people as well
um if they will you know take the
opportunity to to kind of probe that
yeah it's I mean it's a it's a huge
umbrella that people definitely miss and
it's just It ultimately is the
umbrella literally of just how I guess
not literally figuratively but how we
look at life and how it changes how we
look at exercise and how we perform and
how we eat and how we and not to mention
the actual physical effect that we have
of being in a good mood and what are
some things that you're doing today to
improve that
well luckily I'm kind of more in a
maintenance mode now I mean I think I
had to go through sort of the heavy the
heavy lifting
um you know
six seven you know or you know
three four five six years ago
um so so what I do today I think is is
much easier than what I did in the past
but I still work with a therapist once a
week
um and I still practice uh something
called dialectical behavioral therapy so
that's one form of therapy that I do and
um and that is just what it is right
it's like a practice so it's sort of
like saying like we'll you know
you know is it enough to know that a
workout is important no you actually
have to do the workout so similarly it's
not just enough I think to kind of show
up for an hour a week to do the therapy
you have to be able to kind of take what
you learn in that therapy and then put
it into daily practice and if you
succeed you note it if you fail you note
it but you're just constantly trying to
to sort of get better and DBT or
dialectical behavioral therapy is a
system that I really like and it really
works for me and it works for many
people
um I've done a podcast on it actually
which maybe we could link to I think
it's a it's something I think a lot more
people should know about yeah I mean my
life changed for the better when therapy
became a regular part of my life and I
think there's a stigma that's attached
to it and that needs to get broken down
significantly because people don't go to
therapy until there's a cause for it or
a reason for it and especially this day
and age not to you know go off on a
tangent but it's very it's difficult to
have that connection and sometimes
therapy is the only place you actually
get that connection especially if you're
not married you don't have a spouse you
don't not going home to someone you know
and you're just on your device all day
so I think that's really really good
advice and it's something that I would
Echo I think over the last five six
years I would have I don't think I would
have casted judgment upon someone that
was going to therapy but I certainly
wouldn't have looked at it with the same
lens that I look at it now so I think
that's a great one yeah well we'll link
out to those episodes down below we'll
also link out to your book so as always
keep it locked in here and Dr Tia thank
you very much yeah thanks Tom
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