Peter Attia, M.D. — Fasting, Metformin, Athletic Performance, and More (#398)

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“If you’re really committed to brain health, you want to be exercising every day.” — Peter Attia

Dr. Peter Attia (, TW: @PeterAttiaMD, IG: @peterattiamd, FB: @peterattiamd) is a former ultra-endurance athlete (e.g., swimming races of 25 miles), a compulsive self-experimenter, and one of the most fascinating human beings I know. He is one of my go-to doctors for anything performance- or longevity-related. He is also easily the best quarterback and sherpa for the US medical system I’ve ever met.

But here is his official bio to do him justice:

Peter is the founder of Attia Medical, PC, a medical practice with offices in San Diego and New York City, focusing on the applied science of longevity. The practice applies nutritional biochemistry, exercise physiology, sleep physiology, techniques to increase distress tolerance, lipidology, pharmacology, and four-system endocrinology to increase lifespan (delaying the onset of chronic disease), while simultaneously improving healthspan (quality of life).

Peter trained for five years at the Johns Hopkins Hospital in general surgery, where he was the recipient of several prestigious awards, including resident of the year, and the author of a comprehensive review of general surgery. He also spent two years at NIH as a surgical oncology fellow at the National Cancer Institute where his research focused on immune-based therapies for melanoma. He has since been mentored by some of the most experienced and innovative lipidologists, endocrinologists, gynecologists, sleep physiologists, and longevity scientists in the United States and Canada.

Peter earned his M.D. from Stanford University and holds a B.Sc. in mechanical engineering and applied mathematics.

Peter also hosts The Drive, a weekly, ultra-deep-dive podcast focusing on maximizing health, longevity, critical thinking, and a few other things. Topics include fasting, ketosis, Alzheimer’s disease, cancer, mental health, and much more. Subscribe on Apple Podcasts, Spotify, Overcast, or wherever you listen to podcasts.

Please enjoy!

Listen to the episode on Apple Podcasts, Spotify, Overcast, StitcherCastbox, Google Podcasts, or on your favorite podcast platform.

You can find the transcript of this episode here. Transcripts of all episodes can be found here.

#398: Peter Attia, M.D. — Fasting, Metformin, Athletic Performance, and More

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Want to hear the first time Peter was on the podcast? — Listen to our conversation here. In that interview, we discuss optimizing blood testing, drinking “jet fuel,” training for ultra-endurance sports, consuming synthetic ketones, using metabolic chambers, extending longevity by avoiding certain types of exercise, and much more. (Stream below or right-click here to download.)

#50: Dr. Peter Attia on Life-Extension, Drinking Jet Fuel, Ultra-Endurance, Human Foie Gras, and More

QUESTION(S) OF THE DAY: What was your favorite quote or lesson from this episode? Please let me know in the comments.



  • Connect with Peter Attia:

Website | Podcast | Twitter | Facebook | Instagram


  • Something Peter’s been excited about lately: The concept of Centenarian Olympics. [09:00]
  • Peter describes one of his favorite exercises for all ages: The goblet squat. [18:12]
  • How Peter is training with dynamic neuromuscular stabilization (DNS) to correct some of the weightlifting quirks he’s picked up over the years. [21:40]
  • Why is the ability to control our intra-abdominal pressure — especially as we age — so important? [25:25]
  • Something Peter has changed his mind about lately: The use of anti-diabetic drug metformin in healthy individuals for enhancing longevity. [27:30]
  • What are mitochondria, what role do they play in our metabolism, and how could taking metformin — a mitochondrial toxin — possibly be good for us? [31:22]
  • While certain drugs for certain people under certain conditions can improve and even save lives, never underestimate the power of fasting, exercise, and sleep. [34:51]
  • What is egg boxing? [37:54]
  • Something else Peter’s been excited about lately: The space and potency of fasting. We know it’s effective, but how can we scientifically quantify it for greater efficiency and secure the funding to do it? [42:28]
  • Peter’s current fasting regimen, diet, and supplement intake. [49:42]
  • Something else Peter has changed his mind about recently: The fate of one’s personality may not actually be set. [54:06]
  • A stupid and absurd thing Peter likes: Tearing phone books in half. [1:00:44]
  • Another thing Peter’s been excited about lately: Archery hunting, the consumption of wild game, and a 2021 goal to only eat food that he’s killed. [1:07:35]
  • What type of gear does Peter use currently? [1:16:31]
  • In archery, what is the significance of back tension? [1:17:43]
  • Something else Peter has changed his mind about recently: Childhood experiences that seem minor in the moment can linger long after the fact in unexpected ways — and we, as adults, need to make sure we’re not inadvertently creating negative experiences by behaving badly around the children in our lives (e.g., road raging). [1:21:18]
  • Tying in with Peter’s acknowledgment of the possibility that personality isn’t fixed in place, how has he managed his own relationship with anger? [1:26:47]
  • As someone who’s been historically skeptical of therapists, what are the characteristics of a therapist Peter would trust to help him reduce his own suffering? [1:37:00]
  • Another stupid and absurd thing: Since he was eight years old, Peter has played a game called Forks and Knives. [1:42:26]
  • Peter’s thoughts on The World Anti-Doping Agency’s efforts to stay ahead of performance-enhancing drugs not yet labeled as such or with restrictions that would be difficult to enforce — like xenon gas and growth hormone. [1:46:04]
  • Something else Peter’s been excited about lately: Racing cars. [1:51:02]
  • Something else Peter has changed his mind about recently: The benefits of exercise being much greater than he ever envisioned. But how does he think about type and dose for getting the most out of the effort involved? [1:55:53]
  • Since taking sleep expert Matt Walker’s advice to heart, how has Peter helped his patients improve their sleep quality, and how has his own sleep protocol changed? [2:00:35]
  • Another stupid and absurd thing: The What If? game. [2:10:37]
  • We discuss another game that comes with its own Kevin Rose story: “The How Much Would I Have to Pay You To…” game. How many times in human history has this game been played by women? What’s the worst thing Peter ever agreed to do when he played it in high school? [2:14:39]
  • Peter and I discuss what we’ve struggled with, enjoyed, and learned in the process of hosting our own podcasts, and what we’ve observed from the interviewing styles of others in the sphere. [2:19:51]
  • The sometimes intense prep work that goes into an interview, plus pointers for aspiring podcasters eager to get their feet wet before diving in headfirst. [2:31:15]
  • Parting thoughts. [2:36:53]


The Tim Ferriss Show is one of the most popular podcasts in the world with more than 900 million downloads. It has been selected for "Best of Apple Podcasts" three times, it is often the #1 interview podcast across all of Apple Podcasts, and it's been ranked #1 out of 400,000+ podcasts on many occasions. To listen to any of the past episodes for free, check out this page.

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24 Replies to “Peter Attia, M.D. — Fasting, Metformin, Athletic Performance, and More (#398)”

  1. I love the idea of the Centenarian Olympics. As I age, Im working more on my flexibility while also building strength by using kettlebells, functional training, and yoga. You know, the “muscles that you really don’t get to see”.

    I have friends who are going for all out body-building mode, but I have to remind myself what my goals are just stick to that. I want to be able to MOVE…..especially well into my 70’s and 80’s.

    1. Totally! I’ve had a shift away from working towards aesthetic goals and more towards functional goals, so this mentality was a great way to reinforce that mindset.

  2. Hi Tim, You, Peter Attia and Joe Rogan have had a huge impact on my life. If you take a cross section of the three and personified it, it would be me. I would love the opportunity to learn more from all of you. How would you recommend going about it?


    Peder Nelson

  3. Peter Attia’s honesty is disarming! A surgeon who admits he’s been playing a game of “forks and knives” since he was 8 years old…. that takes balls.

  4. Thank you, Tim! I’m the Typewriter Poet who wrote the “darkness” poem and I’m honored you shared it on Instagram/5 Bullet Friday. I love your podcast and books, and am inspired by your work. Cheers!

  5. Querido Tim,

    Hasta ahora, usted ha publicado 5 Libros de 5 Estrellas, encaminó al mundo a restaurar una Especie de Lobos en Peligro de Extinción, y ahora es un hombre dedicado a avanzar la Ciencia de la Medicina Psicodélica para ayudar a personas que sufren de enfermedades mentales.

    Este año llegó a 1 Millón de Seguidores en Instagram y está a punto de publicar el Episodio Número 400 de su Podcast de Clase Mundial.

    Como se SIENTE?

    Esperando su pronta respuesta,

    Maria Palais

    Revista Hola México

  6. I loved this episode and the format. I learned or re-learned something every 15 mins of the show. Of course, making eggs will never be the same 🙂

  7. Hi Tim – I’m first year investment banker strait out of undergrad working in Silicon Valley. I have been doing TM over the past few months, but it brings to surface many things (current and past) that are too difficult to bear emotionally which have been leaving me more stressed. I think I need additional help. Do you have any therapists in the area you would recommend? Would be happy to travel anywhere between SF and San Jose. I’m looking for assistance for both work (stress) and personal/mental issues. Any direction here would be greatly appreciated.


  8. Love the format. If you and Peter did this once a month/once a quarter, I think everyone would be thrilled. I know I would! Gracias muchachos!

  9. Hey Tim,

    Thanks for addressing the unintentional AMSR noises (lip smacking mainly) you used to make quite frequently on the podcast.

    I really like your content and have been a fan since wayyyy back but stopped listening because I couldn’t deal with the mouth noises.

    Not sure how many people this affects as it’s an awkward subject but anyone with misophonia like myself probably has had to tune out.

    Anyway, glad you got that under wraps.

  10. I was reliably told that LSD, and I’m sure Magic Mushrooms too, were taken by Rally Car navigators, to stop motion sickness.
    Keeping in mind that where I am from was a hotspot for both LSD, Mushrooms and Rallying, back in the 70s and 80s, (Operation Julie, anyone?) which is when the navigator who told me would have been rallying.
    This was hobby, local rallying, not top flight international rallying, and I’d be sure it was micro dosing, but I can well imagine it is why sports governing bodies have banned it as a PED.

  11. Amazing Podcast. I will definately exercise even more now and drink less alcohol. But this probably only is so clear because of the “stupid” thing.
    I love the fork and knive game. Awesome to hear what a playful child Peter is. Please go on with these types of interviews.
    In addition this episode gave me a huge motivation to get more specific coaching when approaching new tasks.

  12. Tim, learning that you moved to Austin and hearing you and Dr. Attia discuss what you think is important in a therapist, brought to mind a friend of mine that lives in Austin and has for many many years. I met Harry in the early 90’s while attending workshops for NLP in Austin. Harry and I became good friends and he would invite me to his ranch outside Boerne and we would talk for hours. Well, I would mostly listen. I remember thinking way back then that other people would love listening to Harry. I know you would enjoy knowing Harry. He’s a rancher, former law enforcement, former pastor, psychotherapist (expert in NLP), former olympic lifter and many other titles. Most importantly, he’s just a good human being. If you would like to meet Harry please shoot me an email and I’ll send you his contact info. Regards. Chris
    Houston TX

  13. Lots of good stuff in the podcast, but I could do without the stupid stuff. I found myself blindly fast forwarding to skip them. I do enough stupid shit..don’t need to know about anymore.

  14. I really enjoyed the format of this podcast. And, while I’m at it, let me just say that I’m a huge fan of the Tim Ferris podcast. I learn so much AND feel strengthened and encouraged to “be all that I can be” in all of the areas of my life. Thank you, Tim, and all who work to produce this podcast.

  15. I am interested in becoming one of Peter’s patients, but cannot find any information on how to do so. What would be the best way to go about doing this?

  16. I love this format of the most absurd, most excited, and mistakes.. This podcat with Peter Attia is like humanizing an idol…just like when you Tim Ferriss talk about your own experiences. Way to go!

  17. One of the funniest, well done. I also found the tone and tempo exactly right, both soothing and insightful.
    Keep up the good work!

  18. Absolutely loved this podcast – so informative and hilarious! In regards to fasting – I know coffee breaks the fast if the intention is gut rest, however is decaf coffee okay? And how about herbal teas?

    Cheers Peter and Tim!

  19. Tim, both you and Peter talk about sleep tracking during the episode. What tools are you guys using to measure the duration/quality of your sleep on a regular basis?

  20. Really enjoyed this one and especially hearing about the stupid things that smart guys do – just because. Can’t figure out why in my house we use so many spoons..? Expect the kids are spooning random bits of peanut butter out of the jar. Love the concept of the Centenarian olypics and would like to explore with my dad who will be turning 80 and is still in great health. He has always had a note stuck on the fridge “we don’t stop playing because we grow old, we grow old because we stop playing”