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


Photo by Tyler Ruiz

“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.

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

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Peloton is offering listeners to this show a special offer: Enter the code you heard during the Peloton ad of this episode at checkout to receive $100 off accessories with your Peloton bike purchase. This is a great way to get in your workouts, or an incredible gift. That’s and enter the code you heard during the Peloton ad of this episode to receive $100 off accessories with your Peloton bike purchase.

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]


Posted on: November 27, 2019.

Please check out Tribe of Mentors, my newest book, which shares short, tactical life advice from 100+ world-class performers. Many of the world's most famous entrepreneurs, athletes, investors, poker players, and artists are part of the book. The tips and strategies in Tribe of Mentors have already changed my life, and I hope the same for you. Click here for a sample chapter and full details. Roughly 90% of the guests have never appeared on my podcast.

Who was interviewed? Here's a very partial list: tech icons (founders of Facebook, Twitter, LinkedIn, Craigslist, Pinterest, Spotify, Salesforce, Dropbox, and more), Jimmy Fallon, Arianna Huffington, Brandon Stanton (Humans of New York), Lord Rabbi Jonathan Sacks, Ayaan Hirsi Ali, Ben Stiller, Maurice Ashley (first African-American Grandmaster of chess), Brené Brown (researcher and bestselling author), Rick Rubin (legendary music producer), Temple Grandin (animal behavior expert and autism activist), Franklin Leonard (The Black List), Dara Torres (12-time Olympic medalist in swimming), David Lynch (director), Kelly Slater (surfing legend), Bozoma Saint John (Beats/Apple/Uber), Lewis Cantley (famed cancer researcher), Maria Sharapova, Chris Anderson (curator of TED), Terry Crews, Greg Norman (golf icon), Vitalik Buterin (creator of Ethereum), and nearly 100 more. Check it all out by clicking here.

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22 comments on “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.


  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. Hey,
    long time listener, first time comment!

    This episode is one of my top episodes and the format, cycling through the three topics is brilliant!
    Keep it up with other guests.


  11. What a great podcast – so much good information! Really enjoyed the format. Would love to hear a follow-up relating to Peter’s (reduced) alcohol intake. Hearing the brief discussion on avoiding mixed drinks if you care about your liver was eye-opening.

    Also, love the idea of the Centenarian Olympics.


  12. Tim – a little off topic – but have you tried Sam Harris’ Group Mediation feature within his Waking Up app? I’ve been using his app for almost a year now, but would love to try it within a virtual group setting. Just a thought


  13. Peter Attia’s new favourite blue-blocking sleep glasses are Felix Gray brand, linked in the notes above. Maybe someone else is tracking them down too. Thank you for a fine show, Tim and Peter.


  14. Tim, Peter – thanks for the brilliant conversation!! I have a 5-0 egg right off the bat – my wife saw me doing this and cracked up. Pun not intended.

    I have a sleep decision crisis. Tom recommends eight sleep, and I heard Peter swear by Ooler. Both look amazing. Have you tested Eightsleep? Any insight is much appreciated!!


  15. Thank you…Simply put…best podcast I ever listened to!!! Both Peter and Tim laughing are infectious. Knives over forks and egg boxing are instant classics. This podcast was like drinking from a firehose.


  16. I was just listening to this and the section about egg boxing came on. It reminds me so much of an easter tradition my family has where we play this game called “pick an egg.” You bring a dozen hardboiled and decorated eggs and everyone goes around essentially doing this exact same thing… tapping the eggs together (similar ends together first and then the opposite ends if one of each survives) and whoever’s egg remains in tact wins the other person’s egg… it gets surprisingly (but good-naturedly) combative sometimes.

    I looked it up on wikipedia and apparently it’s not just an old Baltimore tradition like I had previously thought. I thought you all might get a kick out of it: